bad knee!
Ok so Ive had a dodgy knee for about 5 years now, and it is such a pain (no pun intended) in the arse! I think it has always affected my riding style as I tend to favour my strong leg/knee.
I recently saw a specialist who (with the help of an MRI scan) diagnosed it as patella tendinitis. I have done research on the net but I was hoping Becky or anyone else might be able to give me some advice or particular exercises or anything that might help.
A bit of background - it originally started getting sore when i got into skateboarding, but playnig soccer all my life probably didnt help either. It soon became quite painful and only then did I stop pushing myself during sport (i havent played soccer in a few years and skate like once a year). I have seen a physio several times and he originally thought it was chondromalacea patella with maltracking (knee cap wasnt gliding properly and damaging the cartellage). He gave me exercises to strengthen the muscles around the knee and stretches for felxibility. The muscle near the knee cap on the inner part of my quads (sorry not sure what its called) is very weak and I have trouble engaging and building that muscle. I have been doing exercises for a few years now with some results but its still a problem. I can genrally play most sports without compromissing my performance too much, but its particualrly prone to pain when Im not fully warmed up. I will be seeing the physio again next week ( for the first time since finding out its patella tendinitis) so hopefully he has some specific exercsies.
to add frustration I recently started going to the gym more and working on generally pretty light exercises to build the leg muscles before I head to NZ (in a week). I had a real positive attitude and was going to do everything I could to get rid of the problem. Unfortuantely I have re-aggrevated (and damaged I assume) the tendon and it is even is a bit sore jsut walking. Absolute worst timing!! Obviously now I can only rest it up and hope it will be ok for boarding in a week + time…
It is beyond frustration - as I said Ive had it for about 5 years so any advice would be much apprecited. Any questions, please ask.
Cheers
Hey Dan, just a quick question which might explain a couple of the problems - do you wear orthotics at all? or if not do your feet “roll in” when you are walking/playing sport/snowboarding? the only reason I ask is from personal experience - I wear orthotics but if I am running barefoot or playing football for long periods of time I get knee (patella tendon) pain because my Vastus Lateralis (the outside quad) is much stronger than my Vastus Medialis (inside quad - the one that you have been told is weaker) and due to all of the quads muscles coming together in a single point of insertion (the patella tendon) it pulls my patella outwards as you were describing because of two maing reasons - firstly it gets in a better line of pull due to the knee angle created by my foot rolling in, and secondly because the Lateralis is a stronger muscle, and the body has a habit of letting stronger muscles take the slack, and switching off weaker muscles, even if it means that injury will be caused because of it…
One of the best ways I have found to purely strengthen your Vastus Medialis is to do leg presses (I gathered by your post you have access to the gym?) with your feet angled out at about 25-35*, by doing this you are isolating your Medialis, and training your patella to be pulled by this muscle and not simply allowing the stronger Vastus Lateralis to pull your patella outwards all the time…
BUT because strong muscles generally means tight muscles, stretching your Lateralis muscle would be the first thing I would advise you to do…it is a prick of a muscle to stretch (just to cut the crap out 
), so mobilising massage or self-massage using a foam roller can be a great way of releasing tension in this area.
I will come back with more exercises, but if you get back to me about the orthotics thing that might eliminate or explain some of the problems…
Hope this helps a bit…
I also have a pretty dodgy knee myself from a Football injury two years go.
Its not too bad, but I always stretch it and wear knee support whenever I ride or even do sports in general. Good knee support can make a pretty big difference.
After reading Bangabains post I’m going to start hitting up the gym.
Good luck with everything.
Hey Dan,
Just wanted to let you know that Becky is currently competing overseas in soccer and won’t be back for a couple of weeks. I will email her to see if she can come on here to give you advice. If not, she will definately be back soon. I’m sure she will give you very good advice as she has currently come back from knee surgery.
Thanks fellas. Bangabain, some great advice there.
Banga, yes I do have orthodics, they are foam (made of hard foam) ones that the physio made for me. When being assessed by him he found i have flat feet and suffered from the “roll in” you describe. I always wear them in my work shoes and my joggers and cricket shoes. However, I will probably go to a podiatrist to get “hard” orthodics (i think they are plastic with a foam covering) for my work shoes and some new “soft” (foam) orthodics for sports shoes. I was thinking of putting my old foam orthodics permanately in my snow board shoes, any one tried that? On another post I heard orthodics are no good for snowboarding cause they are too hard, but I assume the foam (softer) ones would be ok? Oh and I have had the orthodics for about 3 years.
At the gym I use the 90 degree leg press and yeah open my foot stance a bit (like duck stance) to work the inner quads. I have done the stretch you mention but I have to admit its not part of my regualr routine (probably only done it a handful of times). I will start implementing that stretch more…
A quick run down on stretches and exercises (terminology may be a bit off) I do:
- regularly (4-5 times a week) stretch thighs, hammys, and calf.
- regular (average 3 times a week) exercises are leg press, wall squats, and wall sit (legs at 90 degrees, back against the wall and remain stationary, works wonders this one!!) while lying on back individually raise legs keeping the straight to about 45 degrees from ground (works inner quads with no impact or stress), calf raises, machine hammstring exercise (cant remember what its called, its where you lie down face first and lift weights with your legs)
- occasional exercises (once a week) are balance work on half ball, step exercises (aimed to work inner thighs).
I think thats about it…
Over the last 2 weeks I did most of those exercises 4 times a week, which was clearly too much for my knee…
Another stretching exercise can be while standing up and try to touch your toes with your ankles crossed.
There are other ways to copy what the image above is displaying, but more standing up. I try to hold on to a wall, or car bumper, squat with say my left leg and bring my right leg behind it and out to the side, stretched out.
think about making the outside of the leg as long as possible and stretch it slowly.
Looking at the picture above the guy is doing this with his right leg, and even twists his upper body some to stretch a little more.
- just another option.
Hi Dan, sorry I haven’t replied for a while, I have been in the middle of going back to uni and have been on here a couple of times, but never for long enough to be able to reply with a response that I felt would get what I want to out…so here goes…
Banga, yes I do have orthodics, they are foam (made of hard foam) ones that the physio made for me. When being assessed by him he found i have flat feet and suffered from the “roll in” you describe. I always wear them in my work shoes and my joggers and cricket shoes. However, I will probably go to a podiatrist to get “hard” orthodics (i think they are plastic with a foam covering) for my work shoes and some new “soft” (foam) orthodics for sports shoes. I was thinking of putting my old foam orthodics permanately in my snow board shoes, any one tried that? On another post I heard orthodics are no good for snowboarding cause they are too hard, but I assume the foam (softer) ones would be ok? Oh and I have had the orthodics for about 3 years.
Firstly, good to hear that you have had something done about your roll in, it is a huge cause of knee problems that quite often is overlooked, and it is good that you have had something done (with the soft orthotics) to hopefully start to alleviate some of the problem.
I would definitely recommend going to a podiatrist though to get some prescription orthotics, I have had them since I was 4, and have had various types throughout having them. I have had both the hard type (hard plastic “base” that is moulded to the foot with a slightly softer heel wedge, and a plasticky/fabric (don’t really know how to describe it properly) covering) which were always half-foot (due to them being hard) and used with the footbed of the shoe still in; but the last 3 pairs I have had have been the ‘softer’ full length type, basically 3 layers of foam with a harder part under the heel, with the latest pair having a neoprene fabric coating because I wore through the last 2 pairs…
The only problem I have had with the foam ones, is that they have worn through a lot quicker than the hard ones, however they are so much more comfortable (in my opinion - you or anyone may find differently), and provide much better shock absorption than the hard type, so to me for the sports you play (jogging, cricket and snowboarding) they would seem the obvious choice, however I am no podiatrist, and they may have a different opinion on the matter…
(I am at uni at the moment, but when I get home I will upload some pictures of the different orthotic types)
As far as snowboarding goes, this would be the place where I would wear the pair of orthotics you have that provide the most relief in normal shoes - because it puts such a strain on your ankles and knees (even if you aren’t hitting huge booters or riding park all day (don’t know your riding style so can’t comment )) it would therefore make sense to protect your knees by at least correcting what you can correct, by wearing your orthotics in your boots. The only way I can see that it would be a problem in snowboard boots is with the hard-moulded ones as far as cushioning goes, but apart from that I have never had a bad experience with them. On top of that, if you are wearing them with your other shoes, it would seem silly to me to add the extra strain on your knees of being in an angle that they are not used to or made for, to the large strain snowboarding places on your knees anyway…
At the gym I use the 90 degree leg press and yeah open my foot stance a bit (like duck stance) to work the inner quads. I have done the stretch you mention but I have to admit its not part of my regualr routine (probably only done it a handful of times). I will start implementing that stretch more…
A quick run down on stretches and exercises (terminology may be a bit off) I do:
- regularly (4-5 times a week) stretch thighs, hammys, and calf.
- regular (average 3 times a week) exercises are leg press, wall squats, and wall sit (legs at 90 degrees, back against the wall and remain stationary, works wonders this one!!) while lying on back individually raise legs keeping the straight to about 45 degrees from ground (works inner quads with no impact or stress), calf raises, machine hammstring exercise (cant remember what its called, its where you lie down face first and lift weights with your legs)
- occasional exercises (once a week) are balance work on half ball, step exercises (aimed to work inner thighs).
I think thats about it…Over the last 2 weeks I did most of those exercises 4 times a week, which was clearly too much for my knee…
Sounds like a good set of exercises for increasing strength where you need it (inner quad), however I think you might be right when you say you might have overcooked it a little initially 
To begin with, lighter weights are good (even though you may not feel like you are getting anywhere) for ensuring you have the right technique, and also training the muscles to turn on when they need to be on, rather than the bigger, more powerful muscles switching on and taking over when the weight gets too heavy for the smaller muscles (that need to be trained). Once the muscles you need to be training have been programmed to switch on when you want them to (through good technique early), you can then progress the weights which will hopefully further increase the strength of that area.
Most of the adaptations (at least initially) in muscles and increased muscle strength are neural, ie “training” the muscles to work in a more coordinated and efficient way - kind of like a train interchange - the neural adaptations are like the timetable telling each of the trains where they need to be and when - without the timetable the trains are going everywhere without control or efficiency - with the timetable they are all working together for the same goal…
probably a terrible analogy…but hope some of this helps
THAT’S what else I was going to say - a fantastic way of doing squats to reduce pressure on the knees is to do them with a fitball on the wall behind you - making sure that your knees do not go out past the end of your toes. This is a huge problem in teaching people how to do squats, as most people tend to go straight in to “skiier” stance, with their knees way out in front of their toes, because this is what feels natural, and it is much easier to balance in this stance than in a “proper” squat position. This is why the fit-ball squat is extremely useful…
This could probably take the place of both the normal squat and the wall squat (unless this is what you meant by the wall squat initially - if it is great 
)
You can also do squats with a duckfooted stance with the same goal as the spread-foot leg press, to again isolate your Medialis…
Once again hope some of this is helping a bit…and I hope your knee gets better soon…:)
Update #3 in a row…sorry again…
Here is a couple of pictures of the softer full-length orthotics I use at the moment in all my shoes.
Not really all that in focus but you get the idea of the layers of foam with the harder heel “shell” and the neoprene top…
Thanks for the great posts bangabain. I really appreciate you giving your time and knowledge…
Yeah I am definitely seeing a podiatrist soon to get a couple sets of orthodics (hard and a soft) to complement the ones I already have.
Re the squats, I occassionally do the ball exercise against the wall, but if you recommend that exercise I will try it more regularly (and yeah I dont do ‘normal’ squats). The other squat exercise I like (and mentioned above) is where you remain stationary sitting against the wall, legs 90 degrees, it burns your quads real well.
I realised that I do have some pain on the underside of my knee cap (chondromalacea patella) after all. However, this problem is lesser than it has been (i think from all the exercises). As mentioned Ive also the main problem at the moment is the patella tendonitis. Basically my knee is just damn weak…
Anyway, I saw the physio yesterday. He didnt have too much more to add, it seems like I’m doing all the right things I just need to be persistant. A critical thing he mentioned was to find a balance with the exercises, so as not to over do it.
I’m going to NZ tomorrow lets hope the knee holds up
Cheers
The custom made orthotics I have seen made have a lot of cork in them, is that a standard product to be used?
Back from NZ and no dramas with the knee
Wow, the snow there was epic! Ive never ridden powder or snow generally anywhere near as good as that in Aus. Coronet Peak and Cardrona were awesome!
The best pow i ever rode was last year at Falls Creek after a few dumps.
The last time i went to Mt Hutt for a week, it was closed for most of that week cos of shitty weather :*(
yeah, our best day in NZ was also the worst. Awesome pow at Cardrona sunshine in the morning then at lunch it was pretty much a blizzard. We waited around but the weather never came good so had to call it a day.
yeah, our best day in NZ was also the worst. Awesome pow at Cardrona sunshine in the morning then at lunch it was pretty much a blizzard. We waited around but the weather never came good so had to call it a day.
Must have been a shame to have such great snow all morning then have it cut so short. Better to get half a great day than one average day imo.
yeah definitely