Knee Injuries
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WARNING NOTE – I AM NOT A DOCTOR. I AM NOT A PHYSICAL THERAPIST. IF YOU ARE INJURED, GO SEE A PROFESSIONAL.
Kneeling on the mats for hours, slamming someone’s face into your knee from the Thai Clinch, heelhooks and knee-bars – fight sports can be tough on the knees. Many fight cards have been changed due to knee injuries, so much so, that it’s almost common.
I injured my knee a while back and have since done some research to help me understand the subject. Boy, there is a lot to know. Here’s what I found out.
To See A Doctor Or Not To See A Doctor, That Is The Question
“I’m I really hurt bad enough to go see a doc? Can I afford it?”
If you had an unlimited pile of money, sure, if it hurts – why not go see a doctor and check it out? Or maybe you’re on a team of some kind and lucky to have a a sports medicine specialist on staff- then the check up is free. Of course, there’s the chance that there’s nothing the doc can do to make you heal faster and all you need weeks of rest and relaxation.
To me, there are two major distinctions in terms of knee pain.
1. You just had a sudden pain hit while you training – caused by a distinct injury.
2. A nagging pain that develops as you train, over time.
For the second type of pain, go see a professional, because it may not get any better if you don’t do something different.
For the first type, I think Medline Plus gives some good advice:
Call your doctor if:
- You cannot bear weight on your knee
- You have severe pain, even when not bearing weight
- Your knee buckles, clicks, or locks
- Your knee is deformed or misshapen
- You have a fever, redness or warmth around the knee, or significant swelling
- You have pain, swelling, numbness, tingling, or bluish discoloration in the calf below the sore knee
- You still have pain after 3 days of home treatment
(From the National Library of Medicine’s MedlinePlus Encyclopedia: Knee Pain, www.nlm.nih.gov )
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Get A Correct Assessment
Maybe you’ve decided to go see doc, maybe you’re going it alone. Either way, before you know how to fix the problem, you have to know what the real problem is.
If you want a professional, get a doctor, orthopedic specialist or sports medicine doc to check out your knee. If you’re not sure who to go to in your area, see if you can find who your local college football, basketball, or wrestling team uses.
I understand, there are considerations. I’m not rich and I don’t have great insurance. Plus, I’m a “do-it-yourself” kind of guy. If you are going to wait it out and try self-diagnosis and home care, you might try checking out this knee problem page at www.webmd.com or this knee symptom page at www.jointhealing.com to see if you’re on the right track of identifying the problem. It’s important.
For instance, if you tear the the ligaments on the sides of your knee (the extracapsular ligaments, the MCL/ LCL), there is a good chance of the injury healing on its own. However, the other ligaments (intracapsular ligaments) have “have limited potential for spontaneous healing and frequently require surgical reconstruction” (source).
Common Problems and Solutions
In terms of injuries, some of the most common are (in no particular order):
- Hamstring tendon strain
- ALC/PCL/MCL tears
- Knee-cap (patella) dislocation
- Patella tendinitis (jumpers knee)
- Cartilage injury
- Bruises
- Iliotibial band syndrome (runners knee)
- (For a full list, see here)
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However, in the textbook Introduction to Sports Medicine and Athletic Training, it states that the most common sports knee injuries are MCL tears (I happen to have one right now). In the fight-sports, it seems that ACL injuries are almost equally common.
There is a great ACL Injury FAQ posted on grapplearts.com with some awesome specific info, and if you have one, check it out.
One good thing about knee injuries it one simple formula solves a lot of problems.
R.I.C.E.
R. Rest. You know, not working out.
I. Ice – Cryotherapy. From the above textbook, the general procedure is to ice your knee 4 times a day, for 20 minutes a session, each session 2 hours apart.
I’ve heard some guys say 10 minutes on, 10 off is good, but I’ve had good success with the textbook version.
Another tip from the text – when you make an ice bag, make sure you squish out all the air in the bag before you seal it. You’ll get better cold coverage on your knee.
Also, make sure you ice the top part of your knee, not popliteal fossa – the soft underside. It’s got a network of capillaries, veins and nerves. Icing can damage the stuff back there.
C. Compression. Apply gentle pressure to the knee – a knee brace or knee sleeve will do the trick. Make sure there is a “snug” feeling without being too tight. Maybe something like this:
E. Elevation – get that knee lifted up and try to stay off it.
Drugs
Here’s what I’ve been told by a nurse. Taking some medicine will serve two main purposes: pain-relief and swelling reduction.
You want to take a full dose of an anti-inflammatory – Ibuprofen, Naproxin, Aspirin. It seems logical, if you have minor pain just take a minor dose, right? In terms of controlling swelling, you really need the full (as directed) dose to get the anti-inflammatory effect you’re looking for.
The thing is that some inflammation can help, bringing in some good body chemicals, but too much inflammation is bad. Many injuries are serious enough that the body overcompensates with it’s swelling so taking some Ibuprofen for the first day or so after the injury is a good thing. As the swelling goes down and you don’t need pain management, you don’t need them. However, your mileage may vary. People react differently to drugs, even over the counter ones. You know the drill – use common sense and seek medical advice when needed.
Supplements
I’ve never been a big user past my weekly multivitamin, but some people swear by the them. Glucosamine, shark cartilage, omega 3 fatty acids/DHA/EPA complex (like highly the ever popular supplement Flameout ), calcium, vitamin C – there is a wacky, wild world out there pimping supplements to helps your joints. You can read about some of them here.
I think there is some value to a few, and if you’re training hard I’d make sure you’re taking enough of the most important sports supplement: food. There are many guys who are over-training or have symptoms of over-training because they aren’t getting proper nutrition from well balanced meals.
Rehab
If you have to lay off the knee for a while, you’ll need to be extra careful when getting back into training. When it comes to specific knee rehab exercises for you, I’ll leave it to your physical therapist. In general, here is a decent list of knee rehab exercises. The list includes stuff like step-ups, calf raises, squats (you can do just the first 1/4 if you need). Another list with some different options can be found here. It talks a bit about stretches, coordination, and usage of the stretch-bands.
In this article, there is a more structured, “back to full function” approach, as well as an outlined workout program.
Of course, these are just examples and may not suit your injury. However, whatever the game plan is to heal your knee, you have to see it to the end.
When you’re sick and the doctor gives you a set of anti-biotics, you need to continue taking them as the prescription dictates until they run out, even if you’re feeling better – if you don’t you risk re-infection with a now resistant bacteria. In this context, we get that. But when it comes to training, we just like to jump the gun. If the doc says, 6 weeks, no training – take six weeks off. If the doc out lines 12 weeks of recovery exercises, do them.
If you’re passionate about your sport, take extra care not to push too hard. When you have a weak link, you’re more likely to injure yourself again. You’re still at risk of re-injuring the knee, or even injuring another body part. While protecting the bum knee, you can put other parts in danger -that’s what happened to me, I was nursing a hamstring tear on one leg, then I hurt the knee on the other leg.
In the majority of texts I read, when things aren’t too serious, you can exercise with weights as long as your knee tolerates. Just take it slow and easy.
If you’re looking for a simple book to supplement your knee knowledge, you might want to pick up “Treat your knees” by physical therapist, Jim Johnson. It’s short, to the point, and solid scientifically.
Surgery
There are times when things are serious enough that no amount of rest and exercise will fix the problem. It’s time to consider surgery. Can you put it off? Sometimes. From the stories I’ve heard, most people said that they wished they had gotten it done sooner. Many people can continue walking around, living and training, but remember, there are injuries that absolutely cannot be undone with ice and TLC. If one of your cruciate ligaments are ripped to shreds, it’s only a matter of time before re-injury.
If it’s come to surgery, a book you may want to consider is “Heal your knees” by orthopedic surgeon Robert Klapper and water therapy expert Lynda Huey. They show a bunch of exercises like pool walking, underwater bicycle kicks and quad extensions. This book talks about x-rays, MRI’s, surgery, post-hospital advice, etc. To me, it would be more useful if you think you’re going to have to go under the knife than the above “Treat your knees” – which is more pragmatic and abbreviated.
Prevention
In an interview with MMA trainer, Greg Jackson, he says:
If you’re training smart and the people around you are trying to help – not hurt you – that’s important. I think most people get injured when their teammates are trying to take their head off. You can be competitive without trying to blow each other out of the water. So you need a cooperative competitive dichotomy and you’ve got to skirt that line. Most injuries I know come through people getting a little overzealous, rather than just the freak injuries.
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I think this is spot on for knee injuries. Good training partners both push protect you. The first line of defense for your knees is a safe, quality training environment.
Know when to tap, when to stop. One of the defining attributes of adulthood is knowing when to stop. There is a difference between discomfort pain and injury pain. Don’t let machismo mess up the next few months of your training.
If you’re knees are sore, give them time and protect them.
You can also do specific exercises to prevent knee problems. Here’s a page about specific ACL injury prevention – their program includes warm ups, stretches, agility drills, etc. If that’s too much, make sure you read the article “What squatters Knee’d to know“, by Frederick C. Hatfield, aka Dr. Squat. Hatfield goes over proper lifting shoes, knee wraps, and proper squatting technique.
Talking with a friend of mine who does some flexibility and strength coaching at the U of U, he gave me the tip to make sure you’re adjust the angles of your feet when stretching. He also mentioned that you don’t want to hit the same exercise the same way every time. For example, you will want to pick different variations of the squat, such as the sumo squat where your feet and knees pointing slightly out, squatting with a wider stance. Making sure you’re getting strength and life with those different joint angles is important to keep the knee stable and strong.
Resources/Refrences
http://www.gundluth.org/upload/docs/Services/SportsMedicine/knee-MCL%20gradeII-1+instability.pdf
http://www.jaaos.org/cgi/content/full/8/6/364
http://www.jaaos.org/cgi/content/abstract/3/1/9
http://www.fpnotebook.com/Ortho/Knee/CltrlLgmntTrOfKn.htm
http://www.fpnotebook.com/Sports/Pharm/RcThrpy.htm
http://www.fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm
http://www.fpnotebook.com/Sports/Pharm/LclCldThrpy.htm
http://www.grapplearts.com/ACL-Injury-FAQ.htm
http://sfuk.tripod.com/articles_03/sports_injuries1.html
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