# Knee rehab



## Kevin Landon (Feb 11, 2019)

I injured my knee running on a hiking trail last year. The knee joint compressed, had to be reset and operated on. I was cleared by my doctor several months ago to resume full activity. I am doing squats, leg extensions machine at high resistance, climbing stairs, walking uphill. 

I'm still unable to get back to running because of the high impact. Any opinions on if Muay Thai beginners classes would be possible/advisable? I've always wanted to practice Muay Thai and am a signifcant fan of the sport. Any input would be appreciated.


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## Danny T (Feb 11, 2019)

I've had 4 knee surgeries and now have two total replacements, took about 9 months each time to get back to being able to train at full intensity.
Oh and I train Muay Thai, Submission Wrestling, BJJ, Kali, Wing Chun, and Boxing. You just need to get in there and do it, start slowly and build up.


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## Kevin Landon (Feb 11, 2019)

Great advice. Muay Thai seems like a great way to strengthen the legs and I'm goin crazy with the boring weightlifting and sh*t at the gym. Thanks for reply.


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## jobo (Feb 19, 2019)

Kevin Landon said:


> I injured my knee running on a hiking trail last year. The knee joint compressed, had to be reset and operated on. I was cleared by my doctor several months ago to resume full activity. I am doing squats, leg extensions machine at high resistance, climbing stairs, walking uphill.
> 
> I'm still unable to get back to running because of the high impact. Any opinions on if Muay Thai beginners classes would be possible/advisable? I've always wanted to practice Muay Thai and am a signifcant fan of the sport. Any input would be appreciated.


cycling ??


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## Deleted member 39746 (Feb 19, 2019)

i would consult a doctor as they should know the parameters of your injury etc if it wont further damage and all that.    Or when you should be ready to put more pressure on it.    (the go to suggestion is usually thai chi or yoga or something similar due to its lack of stress on the joints at least until recovered enough for it)

If you can do it, dont forget to mention it to the teacher as they might want to evade some exercises for you.


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## Gerry Seymour (Feb 19, 2019)

jobo said:


> cycling ??


I think it depends on the specific knee problem. My doc recently suggested avoiding cycling and elliptical trainers - something about the motion is apparently possibly bad for the current problem with my right knee (as opposed to the chronic issues). He liked rowing (both weighted and just rowing machines), though that probably depends on the specific knee issue, as well.


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## JR 137 (Feb 19, 2019)

gpseymour said:


> I think it depends on the specific knee problem. My doc recently suggested avoiding cycling and elliptical trainers - something about the motion is apparently possibly bad for the current problem with my right knee (as opposed to the chronic issues). He liked rowing (both weighted and just rowing machines), though that probably depends on the specific knee issue, as well.


Depending on the knee issue, elliptical and regular bike can be bad, but recumbent bike can be good. Different angles of stress on the knee joint and all. 

Some people love the stationary recumbent bike because it’s a lazy kinda seat, so they feel like they’re getting the exercise while lounging. The actual intent of it is a different angle for people with knee issues, not a lazy-boy recliner with pedals.


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## JR 137 (Feb 19, 2019)

Kevin Landon said:


> I injured my knee running on a hiking trail last year. The knee joint compressed, had to be reset and operated on. I was cleared by my doctor several months ago to resume full activity. I am doing squats, leg extensions machine at high resistance, climbing stairs, walking uphill.
> 
> I'm still unable to get back to running because of the high impact. Any opinions on if Muay Thai beginners classes would be possible/advisable? I've always wanted to practice Muay Thai and am a signifcant fan of the sport. Any input would be appreciated.


If you’ve been fully cleared to do everything and have finished up your rehab, then try it out and see how it goes.

One thing in all of this that raises a red flag - the knee extension machine. Don’t overdo it with weight, and don’t lock your knees out. It puts a lot of bad stress on the knees. If you’re looking to go heavy with weights, do it with squats and lunge variations, not the knee extension machine. It may very well be the single worst exercise machine in gyms.


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## dvcochran (Feb 19, 2019)

Danny T said:


> I've had 4 knee surgeries and now have two total replacements, took about 9 months each time to get back to being able to train at full intensity.
> Oh and I train Muay Thai, Submission Wrestling, BJJ, Kali, Wing Chun, and Boxing. You just need to get in there and do it, start slowly and build up.


@Danny T, if I may ask, how old were you when you had your replacement surgeries? Did you have them done at the same time? Would you do it again? My Ortho has said I have needed replacements for about five years. I am determined to make it to 2020 but the pain just sucks sometimes. I have to get through the summer somehow. My left leg is pretty messed up and doc said it would be a complicated surgery because there are some plates that will have to be removed first, replacements "installed", then the plates may go back on if stability is an issue. So there will be some downtime, and if it makes sense to get them over with at the same time I would rather go that route. What has you Ortho said about MA type exercise? I am primarily TKD so worst case scenarios for knees replacements I am concerned.


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## Gerry Seymour (Feb 20, 2019)

JR 137 said:


> If you’ve been fully cleared to do everything and have finished up your rehab, then try it out and see how it goes.
> 
> One thing in all of this that raises a red flag - the knee extension machine. Don’t overdo it with weight, and don’t lock your knees out. It puts a lot of bad stress on the knees. If you’re looking to go heavy with weights, do it with squats and lunge variations, not the knee extension machine. It may very well be the single worst exercise machine in gyms.


I've heard you and other say this several times in the last couple of years. I wish I'd known it years ago, as that was always one of my favorite leg exercises, and I really piled the weight on.


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## _Simon_ (Feb 20, 2019)

gpseymour said:


> I've heard you and other say this several times in the last couple of years. I wish I'd known it years ago, as that was always one of my favorite leg exercises, and I really piled the weight on.


Yeah not the best for heavier weights, and especially the way many people do them, just hurling and jerking it up, uncontrolled and almost hyper extending their knee with the momentum...

But a few serious weightlifters I know (whom are very knowledgeable and actually do alot of very heavy, low rep stuff) have used leg extension for light rehab work, just for getting good blood flow and use lighter weight and higher reps. Curious as to your thoughts on that @JR 137?


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## Gerry Seymour (Feb 20, 2019)

_Simon_ said:


> Yeah not the best for heavier weights, and especially the way many people do them, just hurling and jerking it up, uncontrolled and almost hyper extending their knee with the momentum...
> 
> But a few serious weightlifters I know (whom are very knowledgeable and actually do alot of very heavy, low rep stuff) have used leg extension for light rehab work, just for getting good blood flow and use lighter weight and higher reps. Curious as to your thoughts on that @JR 137?


I never did light work with it. At most gyms, I could max out the stack on leg extension machines. And I enjoyed doing so (and actually had good form doing it) - the exercise always felt good, but that practice probably contributes to my Crappy Knee Syndrome.


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## JR 137 (Feb 20, 2019)

_Simon_ said:


> Yeah not the best for heavier weights, and especially the way many people do them, just hurling and jerking it up, uncontrolled and almost hyper extending their knee with the momentum...
> 
> But a few serious weightlifters I know (whom are very knowledgeable and actually do alot of very heavy, low rep stuff) have used leg extension for light rehab work, just for getting good blood flow and use lighter weight and higher reps. Curious as to your thoughts on that @JR 137?


I’ve used it as a rehab exercise, both light and heavy-ish. The problem with it is a physics thing, due to the the angle the knee is at and just as importantly where the resistance is. With the knee bent that way, the knee cap is pushed hard into the knee joint, causing a lot of grinding on the bottom surface of the kneecap. Then when you get to the top, same thing. At the same time at the start and finish, the meniscuses (menisci?) are also compressed. Use too much weight and/or throw the weight around too much, and you’ve got some problems waiting to happen. Besides the potential for an acute injury like that, doing the exercise over time will wear down the structures.

It can be quite good for rehab. It’ll isolate specific muscles depending on how far you go with it. One of the most common problems following ACL reconstruction is atrophy of the VMO (vastus medialius, or the teardrop shaped muscle of the thigh at the kneecap towards the inside). Going to that full extension targets it; the reason why that muscle atrophies is because ACL people have a hard time locking out their knee. If I didn’t use an isometric machine for it (using hydraulic resistance where it’s even resistance all the way through) and had to use a traditional one, I’d make sure they weren’t throwing the weight around, were starting at a better angle than the fully bent one, and they weren’t slamming their knee into full extension. I didn’t use the traditional machine with everyone, but did it when I really needed to. I used a rowing machine far more often, as the motion and range of motion are the same, but you don’t have all that stress at that angle. 

Sorry to bore you guys


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## Danny T (Feb 20, 2019)

dvcochran said:


> @Danny T, if I may ask, how old were you when you had your replacement surgeries? Did you have them done at the same time? Would you do it again? My Ortho has said I have needed replacements for about five years. I am determined to make it to 2020 but the pain just sucks sometimes. I have to get through the summer somehow. My left leg is pretty messed up and doc said it would be a complicated surgery because there are some plates that will have to be removed first, replacements "installed", then the plates may go back on if stability is an issue. So there will be some downtime, and if it makes sense to get them over with at the same time I would rather go that route. What has you Ortho said about MA type exercise? I am primarily TKD so worst case scenarios for knees replacements I am concerned.


I had my left knee replace first had so much wear and bone damage that I couldn't straighten it completely was bent approx 22 degrees. I was still running every day then and was on a run when it gave out. Wife came and got me, saw my othro a couple days later and surgery was done the next day. Painful, yes but a week in the pain was less than I had been in for years and at 2 weeks I was in the gym and having fun. 6 months later my right knee gave out and got that one replaced a week later. April will be 3 years and I'm still doing muay thai (kicking and kneeing) and wrestling. Don't have as much flexibility as I'd like but I do everything I was doing prior to the surgery except running. I can but the experts say running will wear out the knees in half the time. Oh and I was 61 at the time


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## JR 137 (Feb 20, 2019)

Danny T said:


> I had my left knee replace first had so much wear and bone damage that I couldn't straighten it completely was bent approx 22 degrees. I was still running every day then and was on a run when it gave out. Wife came and got me, saw my othro a couple days later and surgery was done the next day. Painful, yes but a week in the pain was less than I had been in for years and at 2 weeks I was in the gym and having fun. 6 months later my right knee gave out and got that one replaced a week later. April will be 3 years and I'm still doing muay thai (kicking and kneeing) and wrestling. Don't have as much flexibility as I'd like but I do everything I was doing prior to the surgery except running. I can but the experts say running will wear out the knees in half the time.


Yup. Replaced joints only have a certain lifespan. Unlike living tissue, artificial joints don’t heal from daily wear and tear.


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## _Simon_ (Feb 20, 2019)

JR 137 said:


> I’ve used it as a rehab exercise, both light and heavy-ish. The problem with it is a physics thing, due to the the angle the knee is at and just as importantly where the resistance is. With the knee bent that way, the knee cap is pushed hard into the knee joint, causing a lot of grinding on the bottom surface of the kneecap. Then when you get to the top, same thing. At the same time at the start and finish, the meniscuses (menisci?) are also compressed. Use too much weight and/or throw the weight around too much, and you’ve got some problems waiting to happen. Besides the potential for an acute injury like that, doing the exercise over time will wear down the structures.
> 
> It can be quite good for rehab. It’ll isolate specific muscles depending on how far you go with it. One of the most common problems following ACL reconstruction is atrophy of the VMO (vastus medialius, or the teardrop shaped muscle of the thigh at the kneecap towards the inside). Going to that full extension targets it; the reason why that muscle atrophies is because ACL people have a hard time locking out their knee. If I didn’t use an isometric machine for it (using hydraulic resistance where it’s even resistance all the way through) and had to use a traditional one, I’d make sure they weren’t throwing the weight around, were starting at a better angle than the fully bent one, and they weren’t slamming their knee into full extension. I didn’t use the traditional machine with everyone, but did it when I really needed to. I used a rowing machine far more often, as the motion and range of motion are the same, but you don’t have all that stress at that angle.
> 
> Sorry to bore you guys


No bore at all I love this stuff haha. Thanks heaps for that.

Awesome, yeah makes sense, I'd been incorporating it more just because I've had a bit of knee pain, just to try and strengthen the muscles surrounding the knee joint and get some good blood flow.

But I've switched to an isometrics program (without weights) to see how that goes. And also in my weight training days working more on strengthening the glutes/hams so that the quads/knees aren't taking all the work.

That and stretching, as it's possible the hammies are too tight at the knee joint, not sure the cause of my niggling knee pain but just covering all bases haha. If it gets really bad I'll obviously see someone, but it's just every now and then it'll play up, tendonitis maybe...


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## JR 137 (Feb 20, 2019)

_Simon_ said:


> No bore at all I love this stuff haha. Thanks heaps for that.
> 
> Awesome, yeah makes sense, I'd been incorporating it more just because I've had a bit of knee pain, just to try and strengthen the muscles surrounding the knee joint and get some good blood flow.
> 
> ...


Where’s your knee pain? Doing the knee extension machine may actually be making it worse without you knowing.


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## _Simon_ (Feb 20, 2019)

JR 137 said:


> Where’s your knee pain? Doing the knee extension machine may actually be making it worse without you knowing.


Yeah am very wary of that haha, I always did light weights (like 25-30RM) and very controlled, not overextending, but figured I'd try isometrics, as they seemed to be very effective in strengthening around the knee cap. I definitely won't be doing heavy weights with leg extension.

Was always hard to pinpoint but the pain was usually at the top of the knee I think and sort of inside the knee cap, and usually was painful when squatting and approaching a 90 degree angle. That's the thing am not sure what its origin is, I know my hamstring tension was on the higher side when I had my bowen therapy sessions, and could have been related to my pelvic tension stuff. And it sort of alternated between knees, they alternated as to which hurt haha which made it trickier to pinpoint!


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## JR 137 (Feb 21, 2019)

_Simon_ said:


> Yeah am very wary of that haha, I always did light weights (like 25-30RM) and very controlled, not overextending, but figured I'd try isometrics, as they seemed to be very effective in strengthening around the knee cap. I definitely won't be doing heavy weights with leg extension.
> 
> Was always hard to pinpoint but the pain was usually at the top of the knee I think and sort of inside the knee cap, and usually was painful when squatting and approaching a 90 degree angle. That's the thing am not sure what its origin is, I know my hamstring tension was on the higher side when I had my bowen therapy sessions, and could have been related to my pelvic tension stuff. And it sort of alternated between knees, they alternated as to which hurt haha which made it trickier to pinpoint!


Where you’re describing your pain is often enough cause by chondromalacia. It’s the cartilage on the back of the kneecap wearing down. Sounds far worse than it actually is; people usually think it’s like the articular cartilage in the knee that leads to arthritis, but it’s not. 

A good test for that is this one. If you feel grinding, that’s what it is. And the knee extension machine is definitely making it worse. 
Patellar Grind Test


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## _Simon_ (Feb 21, 2019)

JR 137 said:


> Where you’re describing your pain is often enough cause by chondromalacia. It’s the cartilage on the back of the kneecap wearing down. Sounds far worse than it actually is; people usually think it’s like the articular cartilage in the knee that leads to arthritis, but it’s not.
> 
> A good test for that is this one. If you feel grinding, that’s what it is. And the knee extension machine is definitely making it worse.
> Patellar Grind Test


Ah cool thanks, I just tried the test a heap of times but felt no pain (which is good news I guess haha), maybe a little discomfort on one of the top outside tendons above the kneecap, but may have been because of the pressure I exerted. My kneecap moved pretty nicely with the contractions. Will see how I go, it's just an every now and then thing that 'flares up'. And sometimes I will feel pain there without any movement at all too.


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## JR 137 (Feb 21, 2019)

_Simon_ said:


> Ah cool thanks, I just tried the test a heap of times but felt no pain (which is good news I guess haha), maybe a little discomfort on one of the top outside tendons above the kneecap, but may have been because of the pressure I exerted. My kneecap moved pretty nicely with the contractions. Will see how I go, it's just an every now and then thing that 'flares up'. And sometimes I will feel pain there without any movement at all too.


Interesting. Just making sure you did it right... web of the hand (I guess; space between the thumb and index finger) right on the top edge of the kneecap, not pushing down too much into the quad muscles, and not letting the kneecap come up too much; quads relaxed and knee straight; then tighten up your quads. If you feel grinding, it’s a positive test. And the grinding is unmistakable.

There’s plenty of other possibilities. No way to tell without putting my hands on you and moving you around. Your one or two sentence description lead me to believe chondromalacia because those are textbook symptoms and chondromalacia is very common.


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## _Simon_ (Feb 21, 2019)

JR 137 said:


> Interesting. Just making sure you did it right... web of the hand (I guess; space between the thumb and index finger) right on the top edge of the kneecap, not pushing down too much into the quad muscles, and not letting the kneecap come up too much; quads relaxed and knee straight; then tighten up your quads. If you feel grinding, it’s a positive test. And the grinding is unmistakable.
> 
> There’s plenty of other possibilities. No way to tell without putting my hands on you and moving you around. Your one or two sentence description lead me to believe chondromalacia because those are textbook symptoms and chondromalacia is very common.


Ahh ok, I tried it again, this time I put more pressure and pushed much harder into the kneecap (pushed it forward, ie down the leg) and contracted and yep it did hurt, mainly at the top of my kneecap. Definitely alot moreso in the left knee. Not sure about the grinding though.. I did feel some clicking occurring but not sure what it feels to be grindy. Interesting! I don't know if it was because I was pushing my kneecap too hard though and the kneecap was just trying to elevate..


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