Hey guys,
I do not really post her much at all but I have a lot of respect for the staff here.
My wife is 5’2", 110-115 and 26 years old.
She started experiencing pain in her left knee, then locking. After ultrasounds, joint fluid pull, and MRI the following was determined.
Chondromalacia of the Patella-especially on the inner area of her knee. She likes to run and her knees do cave a bit.
Possibility of reactive arthritis. She is going to a sports doctor and they only see 2-3 cases a year so it is doubtful.
Excess wear of the meniscus
She had a bakers cyst that popped right after the excess fluid was pulled off her knee. That seems to be going down.
Fluid was cloudy and bloody so they did quite a few labs and so far nothing like lupus, etc has come back. White blood cell count was high so they are still looking into that.
They told her she needs to strengthen all the muscles around her knees in order to put less wear on the joint. Specifically quads and hamstrings. Doctor’s orders were 6 weeks of bodyweight squats, leg extensions, leg presses at 60 degrees, leg raises, etc.
No running. Rowing is their choice of cardio.
We are going to LP her squats very light for 3 sets of 5 two to three days a week, while working in upper body work. Also have her doing RDLs to help with hamstring/lower back strength. Am I missing anything in terms of rehab? These guys seem to know their stuff except for the typical lack of promoting loadable barbell squats to depth.
Thanks for your time,
Mike
Mike,
So there are a lot of ways to approach the rehab on this and many of the decisions will be predicated on what your wife can tolerate. There isn’t a best exercise in this scenario and sometimes we have to start with something a little more basic than a squat. That being said, if she can tolerate squatting early on, by all means, go with that plan. When the diagnosis is retropatellar chondromalacia it does tend to start me working with a few caveats in place. 1) emphasize the eccentric portion of lifts i.e. I will often start with something as simple as a heel tap where you start on a step, standing on the affected side, go down slowly and tap your heel to the ground, then come back up. You can also run this on a leg press where she presses up with two legs, then comes down with 1. 2) try and block anterior tibial translation initially. This does not mean that knees should not go forward at all. That being said, in the initial phases, athletes tend to tolerate exercise more with a more vertical shin. For either the heel taps or the leg press, I will often put something in front of their knees or cue to not let knees go very far forward. 3) Work within tolerable ranges. You do not need to emphasize a full range of motion early on and can almost approach this as though you have two variables to track, the range of motion through which the exercise is performed, and the weight with which she is performing the exercise. Progress in either area is still progress. I do think the RDLs are a good idea and even working. towards a deadlift will be beneficial.
Awesome, thank you!
I think I understand what you are saying and will apply it to her PT.
I personally do not think her knees have degenerated that badly. But we will definitely work on some things.
Currently while we do have access to a gym with barbells, I cannot go with her as we have 2 young kids. We do have dumbbells at the house up to a 105 single or a pair of 75s. How would you suggest a dumbbell deadlift? At the sides or in front like a typical barpath?
Thanks again!
I think some of that answer is going to be contingent on what your wife can handle for weight. Either holding two and going down more a dumbbell RDL or sitting one on the ground in front and treating it more as a traditional deadlift are both fine.
Derek,
. Thank you for all your help last year. We worked on getting her stronger as we could at the house. Over time she had fluid drained twice, one or two cortisone shots, and then within a few weeks she was good.
She now is back to running and doing some strength work when she feels like it, without pain.