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2008/03/06, 12:47 PM
Lets start from scratch. Tell me everything you know and everything you can think of... You know the deal.
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/06, 01:17 PM
Haha, thanks Steve.
Well let's see. As you know, my knees have been bothering my since I was about 12 or 13 and I've had PT twice, and found out last year that one of my kneecaps is misaligned.
Also, when I was maybe 15 I found out that I could crack my hips. It sounds like when you crack any other joint, and also feels similar. My dad took me to my pediatrician who said it was the tendon in my hip sliding over the bone or something like that, and it was common. About 6-8 months ago I had some pain when I cracked them, so my dad took me to get an MRI which showed that I had torn labarums in both hips which can only be corrected by surgery, which I don't want/need.
So basically, from what you've told me, my knee problem is probably originated in my hips. I just would like to know what it could be caused from. I have also had minor ankle pain before which my PT said was caused by my knee problem.
If there's still information you need, let me know, I just kind of put the basics down here.
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2008/03/06, 05:38 PM
Hip popping is nothing new. You're pediatrician is probably right.
My first recommendation would be to find another PT. Most are more than competent, but if your PT didn't tell you more than a misaligned kneecap (only one?) then it might be worth another opinion. The thing that make me suspect more are that it is only one kneecap, and that your knees were bothering you before the labrum tears. Unfortunately, it is difficult to work around this kind of injury, and it isn't likely to heal on it's own. I'm finally having some luck with it after almost 2 years, but I wouldn't recommend that most people attempt what I am doing.
I'm actually going to need a lot more information. Doing this over the internet takes a lot longer than it would if I could just look at you and have you move.
Most likely it is an ankle problem. However, I'm in disagreement with a lot of old school PT's that feel there is no regular cause for a labrum tear. I've noticed too many similarities between people with anterior labrum tears to think they are coincidental, and think that while it probably won't fix your labrum, it would be worth fixing whatever caused it to tear in the first place.
For the record, I'm not alone in my feelings, as a lot of Dr's are swinging this way as we learn more and more about the labrum.
I would normally assume an anterior labrum tear, but just to clarify, it's a pain at the FRONT of the hip joint?
This is difficult to quantify without having the personal experience, but I'm going to try to have you do a visual diagnostic. I want you to stand in front of a mirror and completely relax.
Look for the iliac crest (hip bone right below your obliques). Does one of them sit higher than the other?
Now look down towards your feet. Is there any misalignment as far as how your knees, hips, and stomach align?
Look at your self in the mirror from each side. Does your pelvis tilt one way or the other (most likely forward, or anterior tilt)? Is your spine more curved at the lower back, does your stomach stick out and seem stretched? These may be confusing, but they aren't the same question...
Now to look below the knees...
Do this: http://video.google.com/videoplay?docid=-459254121796662817 How far can you get your foot from the wall while still touching your knee to the wall with your heel planted firmly?
Sit flat footed. Try to bring the front of your foot up while keeping the heel planted on the ground. Can you do it without curling your toes up?
Perform a toe touch, but keep your back as straight as possible. Bend at the knee slightly keeping the joint just unlocked. Do you feel a stretch in the calf? How bout if you put the front of your foot on a 1" block or 10lb plate?
Inversion/eversion... Perform the exercises that start at 3:20-4:30 in this video http://www.youtube.com/watch?v=QdTmh5yKdR8 even if you don't have a band. Which ones give you difficulty?
If you are uncomfortable with any of this or would rather not post something publicly, just drop me a PM. A lot of people would rather do that when it comes to certain things.
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/06, 07:04 PM
Well both my kneecaps were misaligned, but one was worse than the other. (the right I think) She taped them both and had me do a few exercises. When I was done with PT she told me that the one that wasn't so bad was just about straight again. She also recommended that I get arch supports for my feet because she said I had fallen arches, but I haven't done that yet.
The pain in my hips isn't usual. I can generally crack them whenever I want without problems, but when there is pain it is in the front.
My iliac crest seems pretty well aligned. If anything my right might be a tiny bit higher, but it's kind of hard for me to tell. I don't know if this is related or not, but I have always thought that the right side of my waist curves in differently than my left side does. To me, I look crooked. The right side seems to curve in more drastically than the left. Again, it's not a huge difference though, it's just something I've noticed.
My kneecaps seem to be sitting more towards the inside of my legs than the center, but other than that, everything seems straight.
My pelvis tilts forwards I think, and my back is curved at the lower spine. It's always been like that though, for as long as I can remember, and so is my dad's. My stomach does tend to stick out, but that could just be from lack of a clean diet haha.
I can get both of my feet four inches away from the wall comfortably, four and a half if I really stretch, but then it kind of hurts.
I can bring both feet up without my toes curling easily.
I feel a small stretch in my calf without the block underneath, and a larger one with it.
Neither of those ankle exercises really gave me difficulty. I can get my left ankle to go farther to the outside than I can my right though.
I hope this helps you more, and thank you for taking the time out of your life to help me, I really do appreciate it.
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2008/03/06, 07:26 PM
Also, I forgot to add that for training around it, I've just been working through the pain. I know it's not good, and it's probably why I have the problems I do, but it's just what I've done.
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2008/03/08, 04:25 PM
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Quoting from yessicarathsak:
My stomach does tend to stick out, but that could just be from lack of a clean diet haha.
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Ive got that same problem, tummy stickeroutus... :big_smile:
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How do you feel? That is the question
But I forget.. you dont expect an easy answer
When something like a soul becomes
Initialized and folded up like paper dolls and little notes
You cant expect a bit of hope
So while youre outside looking in
Describing what you see
Remember what youre staring at is me.
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Get busy living or get busy dying.
Bill
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2008/03/08, 04:36 PM
Thank you Bill, I'm glad that there's a scientific name for it!
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2008/03/08, 05:29 PM
eh, nothing good. And by good, I mean easy to diagnose.
Calf mobility is good but flexibility isn't doing great... How many degrees (take a guess) inside and outside can you bring each of your feet?
Has the spinal curve been diagnosed as scoliosis?
My guess right now is that your calves are pretty beat up. Do you know what soft tissue work is? Foam rolling, etc? I think it would do wonders for you to work on the ankles, and even underside of the foot.
If your gym has adductor and abductor machines, do a difficult set of 6 on each and tell me which one is tougher.
I'm also guessing that you have a tight IT band and probably spend a good amount of time sitting which has resulted in a tight hip flexor. Unfortunately, with a torn labrum it would be counterintuitive to work on flexibility for the psoas.
Start foam rolling the IT band regularly. Until it stops being painful.
Stand on one foot, bring your knee up so it is above the crease of your hip, hold for time. Report both legs.
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/08, 06:12 PM
I can get my left ankle to about 30ish degrees inside and maybe 20 outside, and my right 35ish in and like 15 out. Those are probably really off though, sorry. I was basing it off of where 90 was. I'm not good at angles.
No, I don't have scoliosis. I had my Dr. check my spine at one of my physicals a few years back, and it's normal.
Yup, I know what foam rolling is, and I'll try that for my ankles, hips, and feet. I'll also try to stretch more, I honestly hardly ever do right now.
My gym has both the machines, and I'm pretty sure the one where your legs go apart is the harder one for me, but I can do the same weight on both. I'll double check that the next time I go to the gym though.
I do have tight IT bands, sorry I forgot to mention that. My PT told me that when I was going for therapy. I really don't sit a lot though, probably only an average amount. I'm even standing as I'm typing this haha. I also have really tight hamstrings though, could that cause tight IT bands as well? Would you recommend not stretching my hip flexors because of the torn labarum?
On the standing exercise, my left hip was fine, but my right one hurts at the front of my hip once I go past 90 degrees.
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2008/03/08, 08:11 PM
Try a piece of PVC pipe or a large glass bottle instead of foam for the ankles. A tennis ball works well for the bottom of the foot.
The tight IT bands were the easy thing to figure out. The abductor weakness presenting with the tight IT band was something I was unsure of.
The average american sits too much. So if you sit an "average amount" then you are sitting too much. If you ever get a desk job, I'd recommend an ergonomic kneeling chair to someone in your position.
I'd recommend not being too aggressive with the hip flexor stretching. If you stretch your quads enough you may be able to compensate to some degree. I'd recommend stretches like this: http://www.thepilatesacademy.com.au/assets/images/pilates_exercises/quad_stretch.jpg that focus on the quad while also stretching the hip flexors. Try to focus on tilting the pelvis posteriorly, or at least keeping it neutral while doing this. I'd also recommend glute activation work prior to any lower body training, since this will help to prevent anterior glide syndrome that is sometimes present with tight hip flexors. I'd recommend x-band walks and glute bridging.
How long could you hold each standing exercise?
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/08, 08:47 PM
Well I'll definitely try to stand more then, even though I already move around enough to drive my parents crazy haha. Hopefully I'll never get a desk job, but if I do, I'll keep the kneeling chair in mind.
I could hold the left leg for at least 10 seconds, maybe more if I tried without it bothering me, but the right one hurts immediately after I raised it past 90 degrees. On my left leg, it depends on what I was doing beforehand too. If I was sitting down and tried it right after I stood up, I can only hold it for about 5 seconds before I feel anything, but if I was standing I can go longer. So I guess that means you really do know what you're talking about when it comes to sitting and tight hip flexors haha. :big_smile:
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2008/03/08, 10:37 PM
I also noticed that the more I do the standing exercise, the faster it hurts. Idk if that's normal or not? The first time I tried it my left leg didn't hurt at all, and it felt like I could hold it for at least 30 seconds without discomfort. I'm not sure how long I held it for though, but it was at least 15 seconds. Then, the second time I did it to answer your last post, I counted to about 10 and I started to feel it, and now when I do it I can almost feel discomfort immediately, just like in my right hip.
Also, I was kidding in my last post about guessing that you knew what you were talking about, just in case you took me seriously. I know you know your stuff, and I would most likely trust your opinion over anyone else's.
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2008/03/08, 10:53 PM
So we've got a tight hip flexors with a weak psoas. Unfortunately, it's difficult to strengthen the psoas when the individual has a torn labrum. I'll need to think about some of this.
I might also send an email to gray cook if you don't mind. Dr. Cook is considered one of the most innovative PT's of the current day.
And it would be a bad idea to trust me over a PT that has seen you. Observation is a huge thing. I'm just here to give you ideas and make recommendations. Besides that, I'm still not very good at this, and will never have the same kind of experience most PTs get (though I have helped at least 3 members of this board after their PT's failed them, mostly because of my knowledge of strength training though).
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/08, 11:02 PM
oh, and i was kidding when i called you an airhead.
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2008/03/09, 10:04 AM
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Quoting from wrestler125:
oh, and i was kidding when i called you an airhead.
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Haha, okay, that was fair enough. I just know that humor's harder to detect over the internet than it is in person, and I didn't want you to think I wasn't taking you seriously.
It's fine by me if you want to send an e-mail to Dr. Cook. Trust me, I can use all the help I can get.
Well, you've said quite a few things that my PT said without having seen me, so that makes you pretty smart in my book. Also, aren't you only like 20-21? Too bad I don't even think you're in the same state as me, otherwise this would be a lot easier haha.
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2008/03/09, 04:45 PM
Steve, misaligned knee caps is not always treatable. My wife knees are aligned correctly Her ligaments and tendonds are not in the right groove, and no amount of exercise of PT will fix them. Talk on the net this way is just not safe i think.
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FOR MY WIFE:
Her little ring was a little thing
but it was all that i could afford
now shes mine all mine
till the day i die
and i never wanted nothing more
7707mutt@freetrainers.com
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2008/03/09, 05:26 PM
Mine are treatable though. When I was at PT I had my kneecaps taped, and by doing that my left knee got much better, and my right improved too. My right was more crooked than my left though. It's nothing to do with my ligaments and tendons that I know of. My PT explained to me that since I had a weak inner thigh muscle, and a strong outer thigh, the imbalance was pulling my kneecaps out, and to fix it I had to do inner thigh work.
Mostly I'm just here for my hips though, to try to learn what could have caused my torn labarum and how to loosen my hip flexors and stuff.
Thanks for your input though, and I know that being treated over the internet is not the most reliable thing in the world.
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2008/03/09, 06:08 PM
I understand that in many cases misaligned kneecaps is a congenital deformity. However, there are ways to determine this.
And I'm always the first person to say that it is better to see a trained PT in person. Like I said before, I'm throwing out general suggestions here.
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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2008/03/11, 09:24 AM
Okay.. thanks for all your help!!
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2008/03/11, 12:52 AM
Here's my review.
You have tight IT bands, most likely tight/inflexible abductors, weak adductors, and beat up quads. The most helpful thing for you would probably be foam rolling for the IT band and quad. This will probably be very painful, because I'd imagine your IT band is probably pretty beat up.
Also, I think you have tight fascia on your foot. Use a tennis or lacrosse ball. Don't forget to stretch the front of the foot as well. This might seem weird, but...
Also, your psoas is weak. As soon as I figure out a way to strengthen that without risk of further wear to the labrum, I'll let you know.
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SQUAT MORE ~Jesse Marunde
Blood Guts Sweat Chalk
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