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Common injuries (The knees)

January 20, 2010

Note:
It is important to understand that all bodies are different and all injuries are different. My reason for these posts is to possibly open you eyes to alternative ideas for therapy. It is NOT to diagnose YOUR injuries. If you have similar pains, you should talk to a professional to verify that there is not further damage and you will not be causing permanent injury by treating it in some way.
Crossfit has a huge potential for injury, as it does for amazing results. Be smart with your training and you will last longer as an athlete and a human.

Ok, so almost 5 years deep into crossfit i have had my fair share of injuries caused by training. Some have been obviously my fault, and by that i mean being careless in training, forgoing a warm up, not taking care of myself post workout, or being just flat out lazy. Others have been flukish. Think about falling off the pullup bar or missing a box jump, or even receiving a jerk a little off and tweaking your neck. These are expected in training and have to be handled when they come up. I have recently been exposed to a couple injuries that seem to be recurring in our population so i will do my best to tell you how i have fixed them or seen them handled.
This may be a two part post to spare you from reading an extended essay. Oh, and don’t worry i’ll stay as low tech as possible. I’m not a fan of all the sciency talk.

Injury #1: Tendonitis below the knee cap.
This one got me for the longest time till i, by a fluke, cured it in a week. I’ll get into that in a bit. I can’t really pinpoint the exact time the injury popped up, which is common with tendonitis (basically a localized inflammation (swelling) that causes pain usually during movement). It tends to just get worse and worse till one day you really notice it and then its all over.
First, some treatments i tried and recommendations i got. I had been told by physical therapists, ART practitioners and top level coaches that i just needed to stretch and roll out my quads and hip flexors. Like i said i talked to anyone that would listed, phone, email, in person… When i am in pain everyone needs to know and be working to fix it for me. Thats just the way i am.
A couple months go by and i’m stretching and rolling about a week on and a week off just out of laziness. I would feel immediate relief but the pain would creep back as soon as i quite treating it. At the time i was traveling quite a bit so i had some free time at random gyms so i could stretch and roll regularly. The one place its ok to look like you are taking a shit around other people is while you are rolling on a lacrosse ball at a crossfit gym. I will save the stretches i did for another post or possibly a video.
Basically everyone was in consensus that it was my damn tight quads and hip flexors. I had a couple ART sessions and let me tell you… That was not fun! It gave a bit of relief but like everything else, it would come back within 24 hours.
At the time i was healed i was spending some time at John welborns house on Balboa Island and training with Max Mormont.
The first day i felt total relief was the day after spending a couple days with Brian McKenzie learning how to run. Any of you that have been to his cert realize how “woken up” your hamstrings become after just a couple hours or minutes in my case. We spent an hour working drills and such and then he decided i should do a tabata run on the treadmill with everyone watching… Not fun.
I wake up the next day and my hammies (hamstrings, the things just below your ass) are feeling it. That day Max had me do Stiff Legged Deadlifts with 225 for something like 21-15-9 but it could have been a bit different. He had me do those because that whole week i was bitching and moaning about my knees. Stairs hurt and i’m not kidding. I wake up the next day and besides the sharp soreness coming from my hammies, my knees are 100% cured.
Moral of the story:
Make sure you are sharing the load with your posterior chain. I’m not sure where i went wrong but i shifted to being anteriorly (front) dominate which is not a bad thing so long as your posterior (back) doesn’t go to sleep.
Fix:
Continue to roll, stretch and work mobility before and after workouts. Add in some posterior chain strength post workout. Keep it simple. Good mornings, SLDL’s, Glute Ham Raises. Keep reps a bit higher and weights lower till you feel confident with the movements then slowly increase weight or range of motion. I have to add that my knees felt fine if i took advil but i did not want to be dependent on drugs so i rarely took them. With the exception of being in excruciating pain.
Additional issues:
I have seen additional tendonitis in the knees above the knee cap and am still working on solutions for that. If anyone has experience here please post how you fixed it or how you are fixing it.

Wow! I got a bit carried away. I will continue this series with more common injuries and fixes. The hips are next.

From the Doctor:

Good stuff Dutch! Tendonitis below the knee cap is commonly known as patellar tendonitis and usually caused from repetitive trauma, acute injury or biomechanical deficiency otherwise known as movement in-balance. The primary thing to look at first is how old is the condition. This significantly affects how it might respond to care or treatment. Chronic conditions give us cause to look at lack of cellular primary healing and why the condition has not resolved through primary healing. Acute conditions can be gotten on top of immediately and hopefully we can promote healing through the primary system. Chronically inflamed tissue has different morphology than acutely inflamed tissue and has to be view differently. So, treatment of this condition has to consider where we are in the healing or lack of healing process. From clinical experience and what I have seen in CF, I would agree with Dutch that posterior chain insufficiency, poor sequence firing of the anterior chain (quad, rectus femoris, VMO) and flexibility deficiency of the post/ant chain need to be addressed. But, some athletes can get this condition from just “too much of a good thing, ie/ over training and repetitive trauma and lack of rest.” Which, as we all know is not uncommon for athletes in all arenas. The key with this treating this condition is early detection, movement analysis, and then correction of any problems. This condition when not acutely inflamed, responds well to stretching, foam rolling, muscle re-education, posterior chain development and lighter load anterior chain, pain free tendon rehabilitation. I also like to use cold laser immediately @ 830nm direct to site coupled with ice, DTFM. Not all conditions are the same, and thus need to be treated differently. But, I stress that early detection, determination of history and length of time with condition is crucial to outcomes.

9 Comments

  1. Donna
    January 20, 2010 at 7:19 pm #

    Great stuff Dutch. I am familiar with this as well. Sounds like you’re traveling around a bit. Barber is back home so it is safe to come to New Zealand now.

  2. Edward Stedman
    January 20, 2010 at 7:48 pm #

    Regarding your pain above the knee cap…I experienced this for a time when I was not doing my squats below parallel, however, as I’ve seen you squat, I highly doubt that is your problem. I’ve had temperamental knees ever since jr. high. Low-bar back squats (to full depth of course) have always provided me with the best relief. Obviously, what works for one person may not work for another…

  3. Josh
    January 20, 2010 at 11:40 pm #

    Good post Dutch! Really quality information! Thanks for the info and looking forward to the next one!

  4. Björn Uddenfeldt
    January 21, 2010 at 1:37 am #

    Great post, looking forward to the videos! I´ve also realized the things below my ass are pretty stiff when doing stifflegged DLs when following OPTs post-wod.

  5. Ddeaton
    January 22, 2010 at 9:49 am #

    Good stuff Dutch! Tendonitis below the knee cap is commonly known as patellar tendonitis and usually caused from repetitive trauma, acute injury or biomechanical deficiency otherwise known as movement in-balance. The primary thing to look at first is how old is the condition. This significantly affects how it might respond to care or treatment. Chronic conditions give us cause to look at lack of cellular primary healing and why the condition has not resolved through primary healing. Acute conditions can be gotten on top of immediately and hopefully we can promote healing through the primary system. Chronically inflamed tissue has different morphology than acutely inflamed tissue and has to be view differently. So, treatment of this condition has to consider where we are in the healing or lack of healing process. From clinical experience and what I have seen in CF, I would agree with Dutch that posterior chain insufficiency, poor sequence firing of the anterior chain (quad, rectus femoris, VMO) and flexibility deficiency of the post/ant chain need to be addressed. But, some athletes can get this condition from just “too much of a good thing, ie/ over training and repetitive trauma and lack of rest.” Which, as we all know is not uncommon for athletes in all arenas. The key with this treating this condition is early detection, movement analysis, and then correction of any problems. This condition when not acutely inflamed, responds well to stretching, foam rolling, muscle re-education, posterior chain development and lighter load anterior chain, pain free tendon rehabilitation. I also like to use cold laser immediately @ 830nm direct to site coupled with ice, DTFM. Not all conditions are the same, and thus need to be treated differently. But, I stress that early detection, determination of history and length of time with condition is crucial to outcomes.

  6. Steven Low
    January 26, 2010 at 9:45 pm #

    Tendonitis/osis from the physical therapy standpoint:

    http://www.eatmoveimprove.com/2009/08/on-tendonitis/

    The thing is there’s multiple ways it forms. Overuse is one, poor biomechanics is another, chronic inflammation of course.

    For something like patellar the post above me is correct with anterior chain dominance being the likely culprit. Overuse of the quad leading to chronic tightness, poor mobility, and strong activation patterns at the expense of the posterior chain is very bad.

    Since the hamstrings are very weak compared to the quads, most people in the gym and during movements will inadvertently start their squatting, running, etc. all with knee bending instead of proper hip action.

    Since they begin with knee bending, the hamstrings don’t receive proper tension and it becomes all quads putting extreme stress on the knee and will likely interefer with proper roll and slide of the joint. This leads to increased clicking/popping/etc. and often tendonitis.

    Easily correctable if you know what you are doing. Most knee problems can be solely improved a fair margin with JUST strengthening of the glutes and hamstrings.

    Add in soft tissue massage, high dose fish oil for anti-inflammatory, heat to the muscles, ice to the tendon (if it’s -itis) otherwise heat (if it’s osis), and some light eccentric work + other stuff I mentioned in the above linka nd you’re golden.

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