Author Topic: Tips for figuring out how much is too much PT/delayed pain  (Read 334 times)

Offline gotchaknee

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Tips for figuring out how much is too much PT/delayed pain
« on: June 05, 2017, 03:36:35 PM »
About 2 months ago, I started having PFS in my right knee. Took me four weeks of waxing and waning pain to see a specialist. MRI shows "retropatellar damage", but essentially, I have fairly mild non-localised pain around my patella, usually a dull burning sensation that can be very diffuse, or change location. Doc's recommendation is for PT, but I've done quite a bit of reading/googling as well, incl. Dr. Dye's work.
I'm trying to find the right balance between resting and PT, but I'm struggling to recognise how much is too much, since most of the pain I experience is delayed, often by a few hours, and is very vague/diffuse. Luckily, I seem to have a mild case!
I've been trying to pay attention to what/how much I've been doing on a day, and how it affects knee pain, but it's really hard to isolate any particular thing since the pain tends to appear towards the afternoon/evening, and by then I'll have done all sorts of things (driven to work, sat at desk (with legs up as much as possible), navigated the odd stairs, done some PT). Any good tips on how to "rate" activities to try and get a better grip on things?

Last week, I'd made it through 4 days of squats twice a day (as advised by physio, had been pain free for two weeks prior while on holiday, doing only straight leg clenches as PT) before the pain returned. Clearly, I've gone over the limit (squats probably weren't a great idea in retrospect, but I had no pain while doing them, and it felt great to use my muscles), but I'm still not sure if it was the squats alone (four-day delay in pain?), the squats on top of horse riding (over the same four-day period, long weekend) or whether it was actually returning to work on the day the pain returned (desk job, sitting isn't great despite trying to keep legs elevated) that was the nail in the coffin, rather than the exercise over the pain-free long weekend.
Any useful tips? Also, any good tips on how to find a comfortable position at the desk in the office? Putting the legs up is definitely good for the knee, but it's killing my back since the elevated legs put me in a rounded-back position. I try to alternate with working in a standing position, but so far I really struggle to be completely comfortable at work.
Thanks!

Offline tinydinosaur

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Re: Tips for figuring out how much is too much PT/delayed pain
« Reply #1 on: June 05, 2017, 10:16:33 PM »
i find the more load bearing exercises involving bending and straightening the knee tend to stress it more, things like stairs, squats, lunges, leg extensions - i believe the technical term is 'sheering force'. the more you get to know your knee and your exercises the more you will be able to parse this out for your particular case.

eg. quad contractions from a seated position with a towel under the knee, applies some force to the knee (especially if you have maltracking issues), but in most people that should be relatively minor, now think of that same exercise except instead of pushing into a towel you are pushing against resistance (leg extension w/ theraband for example), similar exercise in that you are required to recruit those muscles but now must do that through resistance, more stress to the knee. again similar exercise but now you are bearing load forcing the leg not only to hold the contraction but push against weight (your body weight or static weight from say a leg press) this is an even larger stress on the knee.

if you can pre-think of the things you need to get done in a day and find a way to work in exercises to the days that are less busy in terms of knee/leg action, that is one step that can be helpful. or if you have a range of exercises (or better yet a trusted sports physio or athletic therapist to help you fine tune and tweak your exercises) you can then start fiddling around with what is going to make you sore or contribute to your delayed pain reaction. most pt programs say do squats, do lunges, do one leg balancing but these are very stressful even to a healthy knee, they are the most effective at building muscle which is why they are often recommended except with PFS there is irritation under the kneecap, and some grade of cartilage degeneration which makes those types of exercises tough (often painful).

if you feel the need to get your muscles working i would suggest trying to find a low impact activity to add to your PT routine (cycling or swimming is often recommended, though again swimming has a kicking motion that could stress the knee and cycling, depending on the bike's resistance you would be pushing through extension a bit).

have you ever tried sitting with one leg up and one leg down, and switching if need be? this allows your bent leg to be a counterbalance, it's easier to sit up with one leg down though you still end up in a lopsided position. you may need to add stretching your back, glutes, possibly hip flexors (this is where a good physio or athletic therapist comes in handy!).

i also recommend adding core / transverse abdominus exercises to your routine, it helps take some stress off your back and your legs. there are some very gentle ones such as bent knee fall out that over time with strengthen the core with minimal stress to the rest of your body.

Offline gotchaknee

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Re: Tips for figuring out how much is too much PT/delayed pain
« Reply #2 on: June 07, 2017, 01:34:30 PM »
Thanks, that's very helpful.

 

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