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  • Knee injuries

    Heya Doc, how you keeping...

    Couple of questions. After some of my workouts recently, my hamstrings (I think it's my hamstrings - the top of my legs anyway) get pretty sore for a couple of days; that recurs about a couple of times a week. I always thought that it was just sore from the workouts; but now that seems a little strange since I train several hours a day six days a week. So I've come to the conclusion that it's from my stretching; I've increased my stretching a little bit over the past month or two. Now, I always warm up properly beforehand and I don't even stretch that much; it's not as if I'm a stretch freak. What gets me is why I'm sore for a good couple of days after a moderate stretch. Do you have any idea how to minimise the soreness that stretching causes aside from a correct warmup?

    Number two. I don't know if you remember but I once asked you about my knees; they hurt when they shouldn't have been. I kept on putting off an appointment with the doctor because the pain kept on going and coming. Anyway, I finally went a couple of days ago, and he said it wasn't from the impact (which I thought it would be; Yanzi said it might be an infection); they where just inflamed. So he's given me theses anti-inflammatory tablets. My question is, do you know if it will cure the problem itself once I'm off them? What causes this swelling, and how do I keep it at bay in the future? Aside from those knee supports; he told me to get them.

    Thanks alot and stay healthy...


    Two issues. Let's talk about the "hamstrings" first.

    Muscle injury and treatment

    For the life of me, it's late, and I can't remember what the hell the hamstrings are now, lol. I think they refer to the muscles in the back of the thighs, and not the front, but, don't hold me to that. The muscles that you refer to are the quadriceps. They are on the front of the thigh, they stretch medially from the lateral side of the thigh, across the front, over to the medial aspect of the lower leg. They are responsible for extending the leg; that is, straightening it out. (The hamstrings, on the rear of the thigh, are responsible for flexing the leg, that is, bending it at the knee). These muscles are not only responsible for locomotion (the repetitive flexion and extension of the knees that cause walking and running), but they also play a major role in keeping the knee joint stable. More on that later.

    Muscle pain after a work out can be caused from a few things. First, lactic acid, which is a by product of anaerobic metabolism. When the muscle operates with an inadequacy of oxygen supply (that is, not enough blood flow to bring oxygen and take away lactic acid), you can get a temporary build up of lactate locally in the muscle, which can cause localized pain and soreness. This usually goes away once adequate perfusion is restored. Athletes with better cardiac output and improved muscle training tend to get less of this soreness, all depending of course on the intensity of the workout.

    Prolonged muscle soreness can be due to overactivity, or to muscle trauma, such as that found in overstretching and partial tearing (from improper stretching), or just from over use of the affected muscle groups. Partial tears and over stretching heal naturally over a few days, depending upon the severity of the tear(s), and the frequency of use of the torn/overstretched muscles. Continued use of damaged muscles will just delay healing, and possibly cause further injury, which further delays muscle healing and strengthening.

    Remember the adage "No pain, no gain"? It refers to muscle training, that is, you can't build up muscles unless you work them, and work them hard enough to stress them. Stressing them, and tearing them, are two different things. If you overwork a muscle without damaging it, it eventually builds itself up, and gets larger and more stronger. Overworking a muscle to the point of damaging it, just gives you pain for a while (and an inability to really train that muscle significantly for a while, until it heals). The key is, to overwork a muscle, giving you that initial pain sensation (the lactate buildup), but not to the point where you have localized muscle pain for a few days afterwards (a possible indication of muscle tearing or overstretching).

    Stretching can cause the same type of damage. Overstretching or muscle tears can result from stretching an improperly prepared muscle. Muscles should be exercised first, so that increased blood flow occurs to the tissues, so that the tissues get "warmed up", moving, and put through their full range of flexion and extension, in preparation for "stretching activities". Remember, stretching a joint not only "stretches" the associated muscles; there is also tension applied to the tendons (which attach muscles to bones) and to the ligaments of the joint (which attach bones to bones). One should properly exercise the soon to be "stretched" muscle groups, so that they have been moved through their full range of flexion and extension, and warmed up properly, so that damage to the tissues during the "stretch" is minimalized. In Shaolin gong fu, stretching occurs after some running, which not only increases cardiac output and blood flow to the affected muscles, but gets the muscles moving through their full range of extension and flexion, and also causes the tendons to lubricate themselves. Quite frankly, you actually would be better off doing your serious stretches, after your workout, after the muscles have been used and abused. A good warm up, some initial stretching to loosen everything up, a good work out, and then, once you've really warmed up and gotten everything moving well, then, some serious stretching. I tend to believe that it's more effective that way.

    The best way to treat muscles that have been injured either during overuse or stretching, is to rest them. Continued activity will only delay healing, and could cause further damage. You'll notice that a lot of trainers use ice for muscle damage. Granted, it does minimize swelling, but it does so by diminishing capillary blood flow to the area (the cold causes a localized vasoconstriction). Injured muscle needs increased blood flow for repair, but, remember, increased blood flow to an area that is acute damaged, can lead to localized swelling initially. Swelling is good in one sense; it diminishes further damage to an area by causing that area to become edematous (at least, that's one idea). But swelling is bad for many other reasons, for one, swelling causes pain, and, swelling can diminish blood flow to the injured area by virtue of increasing intra-tissue pressure. A good rule of thumb is, ice for the first 24 hours, warmth afterwards, rest it until it feels better, start training again slowly. Some physical therapists like to use ice for prolonged periods of time after a muscle injury because they feel that it diminishes painful spasm (prolonged muscle contraction). I went to a physical therapist for my neck injury a while back; she preferred these damn ice compresses to relief muscle spasm. Painful therapy. Nasty bitch. My Jewish neurologist referred to her as "Helga from barracks 11 in Auschwitz". I understand why. Well, my neck did get better, and I avoided surgery, but, to this day, I still think that getting into a hot tub with some buxom bimbos would have made me feel a hell of a lot better.

    The knee

    You have to think of the knee as two bones, the femur (thigh bone) and the tibia (leg or calf bone, hereby referred to as the "leg"), one standing on top of the other. That is, end to end, one on top of the other, constantly rubbing and grinding together. Think of holding your two closed fists together in front of you, knuckles to knuckles. Now, just bend your arms so that your fingers roll on each other, as the palms come together. That's bending your knee, in simplistic terms. But the important thing to get from this analogy, is the fact that the bones do not really provide any sort of structural integrity to the joint. The joint is basically made up of one bone resting on top of another. A few things hold it all together.

    The cruciate ligaments are inside, between the two bones, crossing from one side to the other, front to back, and back to front. The purpose of these ligaments, is to prevent the one bone from sliding either forward or backward upon the other. The collateral ligaments (medial and lateral) traverse alongside the medial or lateral sides of the bones, preventing the one bone to slide side to side on top of the other, and to help prevent the leg from flexing medially or laterally with respect to the femur. (remember, the leg should only flex backward, not sideways, or frontward). These ligaments, basically bands of tough tissue, keep the knee together.

    The muscles, and their corresponding tendons which traverse the knee joint, not only cause the joint to flex and extend, but also provide some stability for it. Having strong muscles that control the tendons across the joint, keep the joint "tight", and keep it from moving in positions that it shouldn't, such as medially or laterally. The quadriceps form a tough tendon which envelops the patella (the knee cap) as it traverses the anterior part of the joint before it attaches to the upper tibia (the patella not only forms a protective "cap" on the front of the joint, it provides a surface for the tendon to move over the front of the joint, and acts as a pivot point). That tendon extends the knee joint. The hamstrings attach across the rear of the joint, and are responsible for flexing the joint. Having strong quads and hamstrings give enhanced stability and strength to the knee joint.

    Obviously, moving the knee joint in a direction that it isn't designed to go, can cause injury to either the ligaments that hold it together, or the tendons which traverse it. Flexing the leg medially or laterally can cause tearing of the medial or lateral collateral ligaments; flexing the leg too much, or putting tension on the leg during flexion can cause damage to the quad's tendon; providing resistance to extension of the leg can result in damage to the hamstrings. Twising the leg upon the femur can result in damage to the cruciate ligaments.

    But there's more....

    We haven't talked about the cushioning surfaces of the knee joint yet. (It's coming...)

    Check out this excellent shockwave animation on knee anatomy: http://www.sportsknee.com/kneeanatomy.htm

    Some basic anatomy:
    Attached Files
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  • #2
    My knees, particularly my left knee, makes crackling noises (sort of like the sound of someone stepping on bubble wrap, but muffled) occasionally during training. What does this indicate and is it normal or does it signify a problem?
    Show me a man who has forgotten words, so that I can have a word with him.

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    • #3
      Good post doc....

      A few things. People need to remember things like jumping can irritate their knees. Sometimes this will result in a fluid build up around the knee, which (to me) make my knees sore. Usually an anti-infalmatory like ibuprofine will help, but it should be noted that the knee is "harder" to move when this fluid is there, and will work the muscles around the knee more. Or, at least that is my understanding. Knee injuries are very tricky. I've heard sometimes it is better to "not fix them." Meaning, let yourself heal as much as possible and attack the root cause of the injury... which usually boils down to lack of conditioning to the muscles surrounding the knee or a nasty movement of the leg... aka, twisting of the knee, or anything that would make it buckle to a side (like a side kick to the side or front of the knee). It is important to remember to not land while your knees are locked etc.
      practice wu de

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      • #4
        There's alot of factors to consider as doc has eluded to earlier, PROPER stretching, over stretching, and others ...... I have attached a file explaining the proper way of warming up, stretching, working out, stretching againg, and cooling down. As in a class I was in we would run to raise our body temperature, stretch, then do a light cardio or workout not as much as your regular workout, then follow up with the actual workout, then another light run followed by a stretch.
        natual crackling of the knees is fine when stretching to lubricate the knees, but if the knee makes noises with out the proper stretches you should consult a physician about the problem your having.

        So as you can see stretching plays a big role in the workout for the proper development of the muscles.
        Attached Files

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        • #5
          Good post, good link... thanks.
          practice wu de

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          • #6
            Not a problem my pleasure.

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            • #7
              Just to continue on what someone else said,( sorry can't remember the name) many of my joints crack, especially after extended peiods of being stationary, actually a lot less or not at all when i'm training...
              what the hell is wrong with me???

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              • #8
                The "cracking of joints" generally is something that is normal and is the result of tendons passing over bony parts of the knee joint. Also, some noise can be generated via fluid movement within the knee joint itself, via a fluid dynamics mechanism that I just don't understand. Generally, if there is no pain or swelling involved (in a non-diabetic patient), the cracking sounds that joints make should not be a concern.
                Experienced Community organizer. Yeah, let's choose him to run the free world. It will be historic. What could possibly go wrong...

                "You're just a jaded cynical mother****er...." Jeffpeg

                (more comments in my User Profile)
                russbo.com


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                • #9
                  Hey guys.
                  I injured my right hip and knee a while ago, and have been out of action for a while. It still hurts just above and behind the patella, when I squat or bend the leg, and my hip still pops out of joint every now and then. (Very painful that is). I just wanted to point out, no wait, re-iterate what everyone is saying... Stretch properly, and warm up as well as down and also make sure that before going into a full contact tournement that you are properly conditioned otherwise you'll be hopping around on one leg for a while like me.

                  Has anyone heard of a thing called Sieverts Disease?

                  I know I was wrongly conditioned with it as a kid, but I would like to know more about it. All I know is that it has to do with the Achilles Tendons...

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                  • #10
                    What about too much liquids in the knee? I heard about someone having it sucked out with a syringe... is there any medicine for external use that will do the same trick?

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                    • #11
                      A Sievert is a way of measuring ionizing radiation, with respect to short and long term damage, to various parts of the human body. Never heard of Sievert's disease. Are you spelling it correctly?

                      And as for too much liquid in the knee, it's usually the result of trauma. Injured tissue results in blood vessels leaking fluid out into the interstitial space, and, other "empty" spaces of the body; the knee being one of them. There is no medicine that will cause the fluid to leave the joint space, anti-inflammatory medicines, which I recently found out I'm severely allergic to, can diminish the leakage and inflammation, but will not generally decrease sub-patellar fluid. It's best to just remove the fluid physically.
                      Experienced Community organizer. Yeah, let's choose him to run the free world. It will be historic. What could possibly go wrong...

                      "You're just a jaded cynical mother****er...." Jeffpeg

                      (more comments in my User Profile)
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                      • #12
                        Doc, you've mentioned many times before the stresses that can be put on the knee ligaments when placed past certain angles.

                        Can you elaborate?

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                        Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.


                        What's wrong with these? Is the knee not made for this ROM? What's wrong with training full ROM, it's counter intuitive to restrict the knee to large and obtuse angles.
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                        • #13
                          You can't compare these guys to the general population. They're professional full time athletes who train, well, "appropriately". For the general population, the rest of us, my comments hold true. You have to be careful with your joints.
                          Experienced Community organizer. Yeah, let's choose him to run the free world. It will be historic. What could possibly go wrong...

                          "You're just a jaded cynical mother****er...." Jeffpeg

                          (more comments in my User Profile)
                          russbo.com


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                          • #14
                            What about too much liquids in the knee? I heard about someone having it sucked out with a syringe... is there any medicine for external use that will do the same trick?
                            __________________
                            I've had both my knees and Elbows have to be drained via a syringe. I also have had "Swellbow" that i just never did anything to and eventually it went away. I spent half of last year with "water" on my left knee, just cause it's a pain in the ass to get an RX appt through my Doctors office and it went away. I don't know of any medicine you can take to get rid of it just time and probably Ice might help if there is swelling that's keeping the fluid from draining.

                            It usually isn't painful anymore after the original injury has healed but sometimes putting weight on it can hurt. Everytime I have gotten "water" on the knee or "Swellbow" it has been from slamming hard on cement without wearing protective gear, I havn't seen anyone get it from just overuse of the joint but i suppose it could happen. My doctor told me there is a sac that the fluid is in behind the patella and somewhere in the elbow too, it might be called the bursa i think...so if you have "water" on a joint you have burst the sac which is consistent with an impact injury like falling or elbow striking something that just wouldn't give.

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                            • #15
                              Originally posted by doc
                              You can't compare these guys to the general population. They're professional full time athletes who train, well, "appropriately". For the general population, the rest of us, my comments hold true. You have to be careful with your joints.
                              Dimas is a professional athlete. The second video is some guy I know on a forum.

                              As far as I know, professional athletes do just that -- lift. And heavy. My question was, what is wrong with training full ROM? With good, consistant form, one should be able to work up to heavy loads.

                              Dimas just clean and pressed more than 400 lbs at a low bodyweight. He had to start somewhere.
                              Becoming what I've dreamed about.

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