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Old 07-19-2010, 04:27 AM   #2
Jon Cowie
Member Jon Cowie is offline
 
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Join Date: Apr 2010
Location: Portsmouth  Hampshire UK
Posts: 99
Re: Knee problem,Doc says no more CrossFit or working out!?!

Quote:
Originally Posted by Jason Homesley View Post
I have a client who has the following wrong with her 'knee' and has been told to stop exercising indefinitely:
Here is what the MRI said.

Lateral Patella complete/near complete full-thickness fissure extending in transverse dimension over 3mm where T2 signal abuts the subchondral plate and subtle adjacent patella edema is present.

Mild patellar tilt, lateral patellar subluxation and widened sulcus angle, configuration may predispose to patellar tracking abnormality.

Small joint effusion and mild synovitis.

Mild hyperintensity lateral gastrocnemius may represent mild muscle strain.

She had surgery on the same knee 25 years ago and has not had any real issues since. She began CrossFit 6 months ago and now this happens.

Any ideas or help someone out there can give us would be appreciated?
Hi, i am by no means an expert in the field (i am one year in to a 2 year sports injuries course, which will be followed with a 3 year degree befor i will be at the bottom of the sports therapists' ladder) but what i have learned so far equates as roughly:

Lateral Patella complete/near complete full-thickness fissure extending in transverse dimension over 3mm where T2 signal abuts the subchondral plate and subtle adjacent patella edema is present.
= damage to the outer side of the kneecap with some slight swelling

Mild patellar tilt, lateral patellar subluxation and widened sulcus angle, configuration may predispose to patellar tracking abnormality.
= kneecap is not properly located and is loose, this means it does not move correctly during knee flexion/extension


Small joint effusion and mild synovitis.
Mild hyperintensity lateral gastrocnemius may represent mild muscle strain
= carry over/knock on effects of the above

It is my understanding (although i hasten to add that i am less than 1/5th competent in the field and my knowledge is probably bettered by a google search) that the vastus lateralis & medialis pull the kneecap slightly off centre during knee extensions, but the counter each other when healthy to provide a solid & stable central tracking path. However, the vastus medialis offers full force contraction during the final 20 degrees of extension; during non-maximal extensions (jogging, squats etc.) the momentum generated prior to this means the vastus medialis will not contract properly (or you will fly off somewhere, as shown by jump squats). this over time leads to a trained vastus lateralis (which is always involved during knee extensions) with a non trained vastus medialis (which is not required except to 'top off' the force generation); if you compare the legs of sprinters and jumpers vs. joggers and casual distance runners this can be seen. This causes unequal pull on the kneecap to the outside which forces it to contact poorly with the groove in the femur and over time leads to damage to both. To further the problem, once pain is continually felt in/around/under the kneecap (patellofemoral pain syndrome) the vastus medialis action will be delayed in comparison with lateralis, and it may interfere with proprioceptive feedback and lead to motor control function problems.

the way to avoid this is to include training methods for the vastus medialis (which i think i was told was the fastest-recovering muscle in the body due to it's muscle fibre composition, blood supply, location and function; but i am probably wrong!) by ensuring full force contractions are used near the final 20 degrees: jump squats, jump lunges, ball kicks, knees to chests, heavy squats/deads/cleans etc. The problem here being that these exercises are all dificult for the beginner yet without them they will not learn proper motor programming and potentially injure themselves quite seriously if they stay at the beginner level indefinately.

As far as rehab goes the only help i can offer is that bone will heal itself stronger than pre injury levels given optimum recovery; patellofemoral pain syndrome is (at least to my limited knowledge) a very hazy subject with multiple causes and treatments (activity, age, Q angle, sex, ;previous injuires etc all influence it) and there is no one answer. But then again what do i know! I would reccomend consultation with a physiotherapist or similar with experience of athletic populations ie. an expert

I fully expect (and hope for) proper replies off of proper smart people (or at least those who didn't leave school at 16 to join the army!) But i am happy to share my knowledge (or lack thereof) until that point

Good Luck
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