Latest / The Driven Athlete / Kneecap Pain Explained & Strategies to Fix It | Ep 35

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Kneecap Pain Explained & Strategies to Fix It | Ep 35 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:13
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:15
  Speaker 1: This topic I am a little more passionate about and I like to nerd out on this because this is something that I've battled throughout my athletic career, mainly in college and post-college, just trying to be active, athletic and really maintain my level of health and wellness as best as I can.
• 0:33
  Speaker 1: So knee pain, patellofemoral pain, patellofemoral syndrome that's the topic that this is about and, like I said, I like to nerd out on this and really figure out as much as I can and work with patients on this and live vicariously through making their improvements, because I battled this and nobody had an answer.
• 0:48
  Speaker 1: It's a bummer.
• 0:49
  Speaker 1: So patella femoral pain is pain right under the kneecap, where it feels like there's grinding or pressure right under the kneecap, where the patella is your kneecap and it grinds against the top layer of your femur surface and it grinds against the top layer of your femur surface.
• 1:04
  Speaker 1: So the surface of your femur, which is your thigh bone, and your kneecap glide and grind against each other like this, which is appropriate and totally fine.
• 1:12
  Speaker 1: But if there's unnecessarily pinpoint pressure and grinding on one surface versus another surface, it's not distributed well enough or evenly, then it can cause knee pain.
• 1:23
  Speaker 1: It can cause intra-articular knee pain and specifically pain that feels like it's under the kneecap or just around the kneecap, just the perimeter of the kneecap, and it usually hurts.
• 1:34
  Speaker 1: With stairs, squats, lunges, jumping, plyometrics, agility drills, acceleration and deceleration moments, those are all pretty classic, provocative movements that is going to elicit this kind of knee pain.
• 1:48
  Speaker 1: So this is for people that are athletes and active people where they're like I don't know what I did, but my knee just started hurting.
• 1:55
  Speaker 1: It just hurts when I do this now and it's been going on for a couple of months.
• 1:58
  Speaker 1: It's gotten here and there for a couple of weeks, a couple of months and now it's more pronounced and it's definitely a little more irritated and it's easily provoked.
• 2:06
  Speaker 1: So like what the heck's going on, right?
• 2:07
  Speaker 1: So if that's the case patella femoral pain syndrome patella femoral and that's the kneecap, on the femur, on the thigh bone, and, like I said, the grinding of your kneecap, the retro patellar compression is necessary and normal.
• 2:21
  Speaker 1: The retro underneath the kneecap, retro patellar compression and grinding against your thigh bone, your femur, is appropriate and necessary.
• 2:29
  Speaker 1: That is how your joints actually get its nutrients is a little bit of compression and pressure on purpose.
• 2:35
  Speaker 1: That imbibes is the term that's used.
• 2:38
  Speaker 1: It absorbs and soaks in the fluid, the nutrients from your synovial fluid.
• 2:42
  Speaker 1: That helps to lubricate the joint and then also deliver nutrients.
• 2:47
  Speaker 1: Okay.
• 2:47
  Speaker 1: So it's important and necessary.
• 2:49
  Speaker 1: Over time, with an appropriate amount of that, it actually fortifies and improves and solidifies your articular cartilage over a long period of time through subchondral bone growth.
• 2:59
  Speaker 1: So that's what the research suggests and some evidence is purported, which is very interesting.
• 3:05
  Speaker 1: But how do people develop this and how do we fix it right?
• 3:08
  Speaker 1: That's what people usually ask.
• 3:09
  Speaker 1: Why is the problem happening, what's the painful tissue and how do we fix it?
• 3:15
  Speaker 1: Those are usually questions we get.
• 3:16
  Speaker 1: So there's two reasons why this type of pain usually develops, from my opinion, okay, from things that I've seen.
• 3:24
  Speaker 1: Reasons why this type of pain usually develops, from my opinion, okay, from things that I've seen.
• 3:30
  Speaker 1: It's usually an instability issue of the knee that can alter the angle of trajectory and pull of the kneecap.
• 3:33
  Speaker 1: That can put pinpoint pressure on the undersurface of the kneecap when it bends and flex and extends with a lot of pressure, and then also not the best inferior glide of your kneecap, of your patella.
• 3:43
  Speaker 1: All right, inferior, meaning low, so going down.
• 3:44
  Speaker 1: So if your kneecap of your patella Inferior, meaning low, going down.
• 3:45
  Speaker 1: So if the kneecap needs to glide downwards as you bend your knee, if it's inefficient and not well enough, then that can cause more pressure on the undersurface of your kneecap and cause pain, right?
• 3:57
  Speaker 1: So imagine when somebody uses their quad muscle and they do squats and their leg muscles, all those things and everything tightens and compresses the joint.
• 4:07
  Speaker 1: Imagine squatting 225 or 315 or 400 pounds.
• 4:10
  Speaker 1: There's a lot of pressure against the kneecap, backwards, against your thigh bone.
• 4:14
  Speaker 1: Like I said, it's normal and appropriate.
• 4:16
  Speaker 1: If it's not seated in the right position or the angle of pull isn't accurate and appropriate, as it could be, it's going to put pinpoint pressure and rub one surface more than other surfaces and not distribute it evenly and that's going to cause pain.
• 4:27
  Speaker 1: So there's a ton of pressure against the back part of your kneecap.
• 4:29
  Speaker 1: With squats and lunges, like I said, loading it a ton, it's going to increase that pressure even more.
• 4:35
  Speaker 1: So that is what exposes the grinding feeling, the clicking, the popping, the crepitus is what that's called, and also pain, of course, all right.
• 4:42
  Speaker 1: So why does that pain come?
• 4:44
  Speaker 1: Either instability of the knee or not, the best inferior glide of the patella going down when you squat.
• 4:52
  Speaker 1: So either way that causes retro patellar compression of the patella on the femur underneath.
• 4:57
  Speaker 1: So I mentioned crepitus.
• 5:00
  Speaker 1: Crepitus is just.
• 5:01
  Speaker 1: It represents roughening of the articular surfaces against each other okay, and increased fluid and edema, swelling in the joint, inflammation, all right.
• 5:11
  Speaker 1: So it just suggests more fluid in the joint, more popping and clicking and then roughening of the articular surfaces as things continue to progress and get worse and worse over time with patella, femoral pain, knee pain like this, and it gets worse with squats and lunges and jumping and stuff.
• 5:27
  Speaker 1: Chondromalacia can then be developed and in turn will happen.
• 5:31
  Speaker 1: But that's not necessarily the end game or like oh then you're screwed right that there's plenty of people with chondromalacial type of changes in their joints, especially the knee.
• 5:41
  Speaker 1: It's very common and they have, they're pain-free.
• 5:43
  Speaker 1: It just is crunchy right their knees just crunchy from the crepitus.
• 5:46
  Speaker 1: That doesn't indicate success or failure, because the body's really resilient and, like I said, things can get better and improve, even with chondromalacia.
• 5:54
  Speaker 1: I know it's controversial, I'm just saying what the empirical evidence suggests, okay, that with non-painful movement and exercise to purposely compress your joint, not at a painful level but sub pain threshold, over a long, long period of time I'm talking about like eight to nine, eight to 18 months worth of time of not effing it up over and over again and doing too much compression.
• 6:15
  Speaker 1: Um, that actually helps to fortify and solidify articular services, meaning your retro patellar cartilage and also your the trochlea of your femur cartilage where they grind against each other.
• 6:26
  Speaker 1: So it's interesting, right?
• 6:27
  Speaker 1: So what we look at is why did this particular person develop this kind of patella femoral knee pain in the first place?
• 6:35
  Speaker 1: Right, like what are they doing differently?
• 6:38
  Speaker 1: We have to address the compensation patterns, the compensatory movements, the mobility disparities, the range of motion and joint mobility disparities of the hip and the ankle and the knee, and then also the stability issues, which is usually recruitment what muscles are being recruited more than others?
• 6:54
  Speaker 1: Dominant muscle tissue or muscle groups, and then less dominant muscle groups.
• 6:59
  Speaker 1: The more dominant ones are going to overpower and they can affect and alter the joint mechanics and the biomechanics of your knee.
• 7:05
  Speaker 1: So we have to even out that disparity in what muscles are being recruited over and over again and make it easier for the less dominant and the less recruited muscles to be activated and used better and they can contribute to the movement.
• 7:18
  Speaker 1: That then decreases that disparity of movement and compensation patterns.
• 7:22
  Speaker 1: Same thought with joint mobility If some joints are very stiff and just inherently don't move as well as they could move, and other ones maybe are taking the brunt of the movement, we have to even out that hyper mobility and hypo mobility and create less disparity between them, and that evens out the playing field for less compensations.
• 7:40
  Speaker 1: All right, so for, as a manual therapist, that's what we have to do.
• 7:44
  Speaker 1: We have to, number one, diagnose the issue, like where these compensation patterns lie um for this particular athlete or active person, because it's different.
• 7:52
  Speaker 1: And then where can we intervene?
• 7:54
  Speaker 1: Right, we find ourselves intervening at the ankle.
• 7:57
  Speaker 1: We have to get the ankle to dorsiflex and bend backwards.
• 8:00
  Speaker 1: Better Dorsiflexion is when you bring your ankle up or your toes up towards the ceiling.
• 8:04
  Speaker 1: Your ankle needs to bend enough into dorsiflexion to bend that direction in order for your knee to not have as much pressure through the retro patellar surface on your kneecap.
• 8:16
  Speaker 1: The second thing we find ourselves mobilizing then is the soft tissue that connects to your ankle, which is your calf.
• 8:23
  Speaker 1: The tricep serratum is what that's also called your soleus, your medial and lateral heads of your gastrocnemius.
• 8:28
  Speaker 1: All right, your gastrocnemius is your calf.
• 8:29
  Speaker 1: Your soleus muscle is a muscle underneath the calf that is very high dense and type one fibers for long distance runners random, but those connect into your Achilles tendon, to your calcaneus, your heel bone, and that can limit and check dorsiflexion range of motion.
• 8:45
  Speaker 1: So there can be soft tissue restrictions and also joint mobility restrictions.
• 8:50
  Speaker 1: All right.
• 8:50
  Speaker 1: So we get to fix both right.
• 8:51
  Speaker 1: Cool.
• 8:51
  Speaker 1: So we'll mobilize the ankle.
• 8:54
  Speaker 1: Manual therapy, we'll manipulate the ankle joint, the talocrural joint, the TC joint, if it's appropriate.
• 8:58
  Speaker 1: We can look at the subtalar eversion, we can look at arch collapse, medial, longitudinal arch collapse if it's pronating and collapsing too much, and we can try to normalize the mechanics as best as possible.
• 9:10
  Speaker 1: And then we have to intervene at the soft tissue behind it, which is usually the calf right, the Achilles, the soleus and the calf.
• 9:16
  Speaker 1: So that's all collectively called your tricep surray.
• 9:19
  Speaker 1: So we'll strip that, we'll scrape it like Graston as an example cup, and then dry needling seems to be a great game changer for that too, which we've talked about.
• 9:28
  Speaker 1: So once we get the ankle moving better and the calf moving better.
• 9:30
  Speaker 1: Then we can look at the hip and usually for this posterior hip capsule mobility is limited.
• 9:36
  Speaker 1: So it's like how well can your hip bend backwards, um, bringing your knee to your chest, without any compensation patterns happening through the hip joint?
• 9:44
  Speaker 1: If it's lacking, then it's going to make your body shift forward more, you're going to have more lumbar spine shearing and it's going to put more brunt force through your knee.
• 9:53
  Speaker 1: So it makes sense.
• 9:54
  Speaker 1: So where the two most common places with squats or lunges or step-ups or Bulgarians rear foot split squats, rear foot elevated split squats People usually have pain where, right in the front of their kneecap or in their back.
• 10:07
  Speaker 1: Where are the two most common places?
• 10:08
  Speaker 1: That's going to overcompensate and make up for that what I just said biomechanically the knee and the low back.
• 10:13
  Speaker 1: It makes sense, right, so we can intervene to stop that from happening, like there is a solution, right, we can work on this stuff, not just like, well, just rest, just ice and take some Advil.
• 10:23
  Speaker 1: It's like that's not going to solve any problems.
• 10:25
  Speaker 1: It'll make things temporarily not hurt when you just like live your life.
• 10:28
  Speaker 1: But if somebody has aspirations or desires or goals to like squat and exercise again or do lunges and step-ups and plyometrics and have fun with our kids in the yard or whatever, run on the beach, run a marathon, stuff like that.
• 10:40
  Speaker 1: Then they have to address these compensation patterns.
• 10:43
  Speaker 1: Otherwise, if they rest, things will feel better.
• 10:46
  Speaker 1: But as soon as they get back in their activity, if they didn't fix the compensations they're going to, the symptoms are going to come back again.
• 10:51
  Speaker 1: We didn't fix the actual underlying reason why the pain started in the first place, which is usually this system of dysfunctional biomechanics.
• 11:00
  Speaker 1: We call that a movement system impairment or a movement system dysfunction.
• 11:04
  Speaker 1: There's a lack of hip mobility in opposed to your capsule.
• 11:06
  Speaker 1: There's a lack of ankle dorsiflexion range of motion and the kneecap isn't gliding inferiorly efficiently enough and all that combined collectively makes more retro patellar compression against the femur as it grinds up and down.
• 11:18
  Speaker 1: When someone bends their knee joint like this, okay, and that just creates symptoms and pain.
• 11:22
  Speaker 1: Over a long period of time we get a lot of articular irritation and inflammation and swelling and fluid and roughening of the surfaces and that causes clicking, popping, grinding, crunchiness in your knee joint and pain, of course, right.
• 11:34
  Speaker 1: So with that being said, hey, cool, we can fix that.
• 11:38
  Speaker 1: And, like I said, the reason why I'm even passionate about this, why I like to nerd out on this stuff, is because this is what I battled all through college, playing volleyball and football.
• 11:46
  Speaker 1: As a two sport athlete in college, my freaking knees always hurt and then we could figure it out Like it just hurt right under my kneecap and I'm like man, do I need surgery?
• 11:54
  Speaker 1: You know, is there something like?
• 11:55
  Speaker 1: Is there like bone particles that chipped off and I'm just rubbing against my knees when I squat or jump and land and stuff, and I'm like man.
• 12:03
  Speaker 1: I wish I would have had this kind of approach when I was an athlete playing sports and I wasn't able to get any kind of help or solutions with this, like actual, active, concrete solutions and action steps towards fixing the problem.
• 12:17
  Speaker 1: Where it's like if you'd intervene with this stuff, imagine over a couple of weeks, if we normalize these things, get things to settle down.
• 12:24
  Speaker 1: First, of course, the number one thing is you can't F it up over and over again.
• 12:27
  Speaker 1: You have to let things settle down, intervene and implement some of these solution strategies work on the soft tissue, work on the joint mobility, definitely work on mechanics Like you have to fix your jumping mechanics, running mechanics, squat mechanics, squat form, lunge form, all those things.
• 12:42
  Speaker 1: We can fix that stuff and improve the mobility, the functional range of motion, mobility requirements.
• 12:48
  Speaker 1: So improve the form and mechanics and coordination, all that stuff combined over a couple of weeks.
• 12:53
  Speaker 1: It would be unreasonable to think that an active, athletic, athletic, healthy, otherwise person wouldn't get better.
• 12:58
  Speaker 1: And we're living truth, like we do this all the time with our patients.
• 13:03
  Speaker 1: So, like man, I'm just excited about it and passionate about it because we live vicariously through our patients.
• 13:07
  Speaker 1: Like dang it.
• 13:07
  Speaker 1: Wish I had this when I was in college.
• 13:09
  Speaker 1: So I was like, hey, I'm gonna share this with you so you can avoid all the frustration, pain and limitations that we've battled right, me particular for this topic, but anyway.
• 13:20
  Speaker 1: So the patella femoral pain is a really common thing.
• 13:24
  Speaker 1: Here's what doesn't work.
• 13:25
  Speaker 1: Talking about what's going to solve the problem, right, why did the problem come in the first place and how can we solve it and prevent it from coming back in the future and implement now so you can get back into your sport and your activity and not be frustrated.
• 13:37
  Speaker 1: What doesn't work, unfortunately rest, okay, isn't going to solve the problem.
• 13:43
  Speaker 1: It's going to make.
• 13:44
  Speaker 1: It's going to stop effing it up, cool, but rest leads to rust and it's also not going to fix the underlying compensation patterns.
• 13:51
  Speaker 1: We're all about modifying your activity but we're not going to tell you to rest.
• 13:56
  Speaker 1: Rest isn't going to solve anything.
• 13:58
  Speaker 1: It's going to help decrease a lot of the inflammatory and irritating heightened irritating factors.
• 14:02
  Speaker 1: For sure, in the moment, for like a week, right, maybe two weeks.
• 14:05
  Speaker 1: But at the same time it's like for an active person that speaks the same language.
• 14:10
  Speaker 1: Usually what we hear is I'm driving myself crazy, I'm not doing anything.
• 14:13
  Speaker 1: This sucks, I don't know, I can't do anything right now.
• 14:16
  Speaker 1: I've been resting and I'm ready to just do whatever I want to do.
• 14:18
  Speaker 1: So after that deprivation it usually leads to binging right.
• 14:24
  Speaker 1: So two weeks later, 10 days later, no-transcript showing these structural changes.
• 14:45
  Speaker 1: You know you have a meniscus involvement too.
• 14:47
  Speaker 1: Your meniscus is torn.
• 14:48
  Speaker 1: It's like dude that's been torn for a long time.
• 14:51
  Speaker 1: That's not the reason why your knee hurts.
• 14:52
  Speaker 1: That's also controversial.
• 14:54
  Speaker 1: But there's plenty of people that have frayed or torn meniscus evidence on imaging and MRI.
• 15:00
  Speaker 1: But they have no symptoms.
• 15:02
  Speaker 1: They have full range of motion and no pain and full functionality.
• 15:05
  Speaker 1: So, with that being said, do we need to intervene with that structure?
• 15:08
  Speaker 1: That's not really the issue.
• 15:10
  Speaker 1: Temporarily, things are lit up right now when we know that.
• 15:13
  Speaker 1: But why right?
• 15:14
  Speaker 1: Is it an instability issue, patella femoral pain related?
• 15:18
  Speaker 1: And we can diagnose and work through all these factors that might've led to the pain in the first place.
• 15:24
  Speaker 1: Anyway, I digress.
• 15:25
  Speaker 1: So two weeks go by, people, these active people that are super motivated and amped, want to do stuff and exercise and workout.
• 15:31
  Speaker 1: They can't, they don't do it, they're getting crazy, they're stir crazy, they're getting cabin fever, they're frustrated and they're like F it, I'm just going to go out and do what I want anyway, and their knee gets all lit up.
• 15:40
  Speaker 1: Then they get really frustrated and they don't know what to do.
• 15:43
  Speaker 1: And then it comes back.
• 15:44
  Speaker 1: I'm like, well, we need to rest again and just ice, I'm tired of doing that, that's right.
• 15:49
  Speaker 1: So they rest again.
• 15:51
  Speaker 1: So this is the same cycle that we've noticed with people, a lot for weeks and months, right, even years.
• 15:57
  Speaker 1: The people years, like I've been on and off knee pain for two years, three, nine years, right, it's like is it?
• 16:04
  Speaker 1: It's clearly not working, something's not working.
• 16:07
  Speaker 1: If nothing changes, nothing changes.
• 16:10
  Speaker 1: Let's put some mental effort and dive into the matter.
• 16:13
  Speaker 1: Let's dive into this and rectify this problem.
• 16:16
  Speaker 1: Like I said, we'll be the first ones to refer out.
• 16:20
  Speaker 1: But there is a solution For active athletic people that have non-traumatic knee pain that just came out of nowhere.
• 16:26
  Speaker 1: My knee just started hurting three weeks ago or three months ago, whatever.
• 16:29
  Speaker 1: There's a reason why it started to hurt.
• 16:29
  Speaker 1: It knee just started hurting three weeks ago or three months ago, whatever.
• 16:31
  Speaker 1: There's a reason why it started to hurt.
• 16:32
  Speaker 1: It's just getting overloaded and overwhelmed because of these compensation issues and we can address that Cool Problem solved.
• 16:38
  Speaker 1: Just have to understand that, be aware of it and also buy in, be like I'm in.
• 16:43
  Speaker 1: Let's do this, let's fix this problem and not take the short route, which is the other thing that doesn't work.
• 16:49
  Speaker 1: Advil and just NSAIDs, anti-inflammatories over the counter, non-steroidal anti-inflammatory drugs, which is like Tylenol, aleve, advil.
• 16:59
  Speaker 1: Of course it's going to make you feel better, it's going to take the edge off the pain, but is it solving the underlying problem?
• 17:04
  Speaker 1: That's what I'm asking.
• 17:05
  Speaker 1: Is it actually solving the compensation patterns that led to the pain in the first place?
• 17:09
  Speaker 1: No, so we're icing also, and that's the other thing that really doesn't work, which is interesting in the research Ice.
• 17:18
  Speaker 1: I don't hate it, I don't, it's either way.
• 17:21
  Speaker 1: The main question I ask patients is do you like it?
• 17:25
  Speaker 1: Do you when you ice?
• 17:26
  Speaker 1: Do you like it?
• 17:27
  Speaker 1: Do you feel better?
• 17:28
  Speaker 1: Do you think it helps you like it?
• 17:32
  Speaker 1: Do you feel better?
• 17:33
  Speaker 1: Do you think it helps?
• 17:33
  Speaker 1: Yes or no?
• 17:35
  Speaker 1: That's the determining factor.
• 17:39
  Speaker 1: Unfortunately, in the research, the validity behind ice is pretty weak, as in like, the validity being does it do what it's purported to do?
• 17:43
  Speaker 1: Ice is purported to decrease inflammation or prevent inflammation.
• 17:46
  Speaker 1: Does it actually do that?
• 17:48
  Speaker 1: According to the research, there's mild to weak evidence to support that actually does it.
• 17:51
  Speaker 1: So that, according to the research, there's mild weak evidence to support that actually does it.
• 17:53
  Speaker 1: So, with that being said, are we going to spend a lot of time and effort prioritizing and emphasizing ice to solve your problem?
• 18:00
  Speaker 1: Probably not.
• 18:02
  Speaker 1: If you enjoy and you like it and you feel like it helps, go get after it, have fun, like do it I.
• 18:07
  Speaker 1: I enjoy ice baths personally.
• 18:09
  Speaker 1: I think it helps me.
• 18:10
  Speaker 1: We can't ignore that.
• 18:12
  Speaker 1: Athletes and active people.
• 18:14
  Speaker 1: We can't separate the mind from the body and there's a psychological component with being athletic and active, of course.
• 18:20
  Speaker 1: So if it's part of your routine and routine-based and you always feel better with ice, dude, do it.
• 18:26
  Speaker 1: It's not going to hurt you.
• 18:27
  Speaker 1: But at the same time, at like three o'clock in the afternoon, randomly you've been watching TV, you're hanging out resting, and then it's been like you know what?
• 18:35
  Speaker 1: I have an ice today.
• 18:35
  Speaker 1: I'm going to ice right now for no reason.
• 18:37
  Speaker 1: That's not really going to help anything in my opinion.
• 18:40
  Speaker 1: Like I said, I'm only going off what the empirical evidence and research suggests.
• 18:52
  Speaker 1: The other thing to consider with that is we know it's a constrictor, right Ice.
• 18:54
  Speaker 1: It helps to constrict capillaries and blood flow.
• 18:55
  Speaker 1: It also helps constrict all the other fluid vessels and blood vessels, like your veins and your lymphatic system, right?
• 18:59
  Speaker 1: So the thought is, if you sprain your ankle, slap some ice on there right away and it helps prevent a huge influx of edema and inflammatory fluids response into the joint so it doesn't blow up as much.
• 19:14
  Speaker 1: Right, an inflammatory response is necessary.
• 19:17
  Speaker 1: It helps with immune response and repairing tissue, of course, but ice might help prevent an overreaction of that and an over-inflammatory reaction by preventing a lot of fluid from diving into the joint and beelining for the joint.
• 19:30
  Speaker 1: So it's always like within like 24 hours if you put some ice on for 20 minutes.
• 19:34
  Speaker 1: It helps prevent that overreaction of inflammatory responses because it constricts the blood vessels and the fluid vessels.
• 19:40
  Speaker 1: So, with that being said, if somebody emphasizes ice and they ice all the time randomly during the day where they haven't really exercised or moved or sprained or like overly strained something to prevent an inflammatory response being overly reacted, and they just ice randomly, you are constricting the blood vessels.
• 19:57
  Speaker 1: But you're also restricting the lymphatic return, lymphatic vessels being like the lymphatic fluid return that helps get fluid out of your joints and out of your body to excrete it out.
• 20:08
  Speaker 1: So you're constricting that and you're also constricting the venous return, your veins.
• 20:12
  Speaker 1: Veins also return blood flow out of areas away from your body into your heart so you can excrete out the waste products again too.
• 20:20
  Speaker 1: So you're restricting lymphatic vessels and venous return vessels, which actually might help keep fluid in the joint.
• 20:26
  Speaker 1: Just food for thought.
• 20:28
  Speaker 1: So, that being said, I'm like I'm not going to overly emphasize and prioritize ice randomly through the day.
• 20:34
  Speaker 1: So ice baths are also controversial.
• 20:35
  Speaker 1: With this stuff too, I'm a fan of ice baths.
• 20:38
  Speaker 1: I think it's super invigorating and it's it's.
• 20:40
  Speaker 1: I like it, it's.
• 20:41
  Speaker 1: It's challenging, it's a mental challenge.
• 20:43
  Speaker 1: That's that's one of the biggest benefits I think it comes from is just being able to overcome your mental resilience and toughness because it's uncomfortable.
• 20:51
  Speaker 1: But there is some evidence to support.
• 20:58
  Speaker 1: There's a neurological response and an endocrine hormone response that helps with body inflammation and just reacting, better resiliency for the body in an inflammatory response.
• 21:04
  Speaker 1: So there is evidence to support that, which is cool.
• 21:06
  Speaker 1: So I like ice baths.
• 21:07
  Speaker 1: I'm cool with that.
• 21:08
  Speaker 1: If someone's going to ice, I'll be like do an ice bath instead, if you're cool with that.
• 21:10
  Speaker 1: If someone's going to ice, I'll be like do an ice bath instead, if you're cool with that, if that's what you like, right, but anyway.
• 21:13
  Speaker 1: So, with all that being said, here's what doesn't work.
• 21:15
  Speaker 1: To sum this up Advil, or sorry, anti-inflammatories, ice rest and the other ones are bracing and KT tape.
• 21:27
  Speaker 1: Bracing doesn't really help with avoiding these compensation patterns from developing.
• 21:34
  Speaker 1: It doesn't solve the compensation patterns in the first place, the thought being that the brace helps keep your kneecap in a better line of trajectory and pull to prevent it from like going in and out and being unstable.
• 21:44
  Speaker 1: There's weak evidence to support that.
• 21:47
  Speaker 1: Actually, that's what it actually does that because there's so much pressure and tension between your muscles and tendons, like people, like you're strong, it's a strong joint.
• 21:54
  Speaker 1: An external brace doesn't, doesn't prevent that from happening, unfortunately.
• 21:58
  Speaker 1: Okay.
• 21:59
  Speaker 1: And then kt tape is an elastic tape, kinesio tape thought that if you tape around the perimeter of your kneecap it helps improve the angle of pull of your kneecap.
• 22:09
  Speaker 1: Same thing.
• 22:10
  Speaker 1: It doesn't.
• 22:10
  Speaker 1: It doesn't it's.
• 22:11
  Speaker 1: The evidence is very weak to support that from the empirical evidence.
• 22:15
  Speaker 1: So I'm not going to I'm not as a practitioner when somebody comes with a knee pain, prioritize that.
• 22:20
  Speaker 1: But, like you know what you need, we got a KT tape, we got a brace.
• 22:23
  Speaker 1: I sit every day right and rest Real quick, oh, and take anti-inflammatory pills Real quick.
• 22:38
  Speaker 1: If you do see, what kind of practitioner do you think would do?
• 22:40
  Speaker 1: You hear that very often there are practitioners that we hear recommend, like solution for your knee pain, those things brace tape, anti-inflammatory meds, like over the counter, the counter, ice it and then just rest.
• 22:52
  Speaker 1: I'm just saying, I'm just saying so.
• 22:57
  Speaker 1: With that being said, what can we do to solve the problem right?
• 22:59
  Speaker 1: What?
• 23:00
  Speaker 1: What solutions, um, can we need to do?
• 23:02
  Speaker 1: We need to do, we need to take a deep dive into what actually caused the problem in the first place, okay, and the compensation patterns and everything we mentioned before the joint mobility mechanics and the biomechanics.
• 23:13
  Speaker 1: The other thing we need to work on if it's, if it's, an instability issue is we definitely need to work on the knee dynamic stability.
• 23:21
  Speaker 1: Okay, if the stability is compromised and it's not as stable as it could be and handle the load of like landing, jumping, deceleration, acceleration, box, step ups, plyometrics, all that stuff.
• 23:36
  Speaker 1: If the knee is set up for failure to be stable through that intense ballistic loading, then it's for sure going to get affected, right, and the angle of pull of your kneecap can be affected and it can be unstable.
• 23:48
  Speaker 1: So if it's unstable, then some of the tissues, the tendons, ligaments and joint capsule that surround the knee joint are going to get overwhelmed chronically, rep after rep after rep after rep.
• 24:01
  Speaker 1: So think about, like a marathon runner, endurance athlete, how many steps do they take in their marathon?
• 24:05
  Speaker 1: Like the word they're running, training, a ton, right, thousands.
• 24:08
  Speaker 1: So, every rep, every single time there's compensation patterns that happen and the tissues that are trying to overstabilize, that can't, or taking the brunt of that load and tension, are getting irritated over and over again every single time, right?
• 24:21
  Speaker 1: So?
• 24:22
  Speaker 1: And with athletes that are runners and exercise a ton um, over and over again, if there's an instability issue, the surrounding tissues are getting overwhelmed and that's where sometimes the pain comes into.
• 24:32
  Speaker 1: All, right, so we would still call that patella femoral pain and the solution for that is a little bit different than somebody with lacking inferior glider the patella okay, for mobility.
• 24:40
  Speaker 1: So it's an instability issue and we're going to definitely change that.
• 24:43
  Speaker 1: So we have to work on coordination of movement, recruitment, dynamic stability, especially through ballistic movements.
• 24:49
  Speaker 1: All right, we have to break that stuff down, like we have to get to work with the roller sleeves up and get in there and fix these biomechanical issues.
• 24:55
  Speaker 1: Okay, manual therapy is a great way to work on that too.
• 24:58
  Speaker 1: To set things up for success Okay, we can set the joint up for success to move better.
• 25:03
  Speaker 1: And then, while it's, since it's moving better and the soft tissue restrictions are relieved a little bit, now it's time to exercise and work on the compensation movement patterns and recruitment patterns of muscle tissue to keep everything as stable and even the playing field of these compensation, recruitment patterns and movement patterns, as best as we can, and over several, over a couple of weeks when working on that stuff.
• 25:25
  Speaker 1: Then we can wean back into more challenging and aggressive, um, ballistic movement, powerful movements where the knee can handle it now and it's not going to dive right back into those compensation patterns again, because athletes are the best compensators.
• 25:39
  Speaker 1: We can't neglect that.
• 25:40
  Speaker 1: Okay, athletes are the best compensators and just get the job done, they'll get it done.
• 25:44
  Speaker 1: They're really good at learning moving patterns to get the job done.
• 25:48
  Speaker 1: So we have to unlearn some of the moving patterns that cause the issue and then learn new ones, and that's part of the corrective exercise component.
• 25:57
  Speaker 1: All right, corrective interventions and manual therapy really sets it up for success, for the joints to move as best as they can.
• 26:04
  Speaker 1: Okay, so the corrective exercises is what really solidifies the change that we're looking for and really solidifies the movement impairment issues that led to the problem in the first place.
• 26:15
  Speaker 1: Does that make sense?
• 26:17
  Speaker 1: So if you have any questions, we can definitely chat, especially in the knee pain topic.
• 26:23
  Speaker 1: Like I said, I nerd out on this stuff and I'm super passionate, especially for young athletes or just active people, of course and athletes.
• 26:29
  Speaker 1: It's just something that I battled with and I'm like man.
• 26:32
  Speaker 1: I wish I would've had this understanding of, or at least somebody that would have understood this and gotten the treatment and implement implementation of these things to help fix it so I could keep competing at a high level.
• 26:43
  Speaker 1: But I just did anyway.
• 26:44
  Speaker 1: I just took Advil and just powered through, but, um, at at some point, the chickens are going to come with a roost you know what I mean and it's going to be a an issue that, um, it's going to be more of a more of a challenge.
• 26:56
  Speaker 1: So for, like, a longevity standpoint for our aging athletes that are, um, you know, wanting to stay, uh, a high vitality, mobility, longevity and for health and wellness activities that they enjoy, but also it's going to be good for their life and their body and their physique and their confidence all those things and their health and wellness.
• 27:15
  Speaker 1: These are the kind of things that we really have to dive into.
• 27:17
  Speaker 1: So, if you've been battling knee pain or knee issues we're on the kneecap definitely reach out.
• 27:22
  Speaker 1: We love to chat Okay, we help people with this all the time.
• 27:24
  Speaker 1: If you have any conflicting opinions, other suggestions within this topic, definitely reach out.
• 27:32
  Speaker 1: We're always open to have a discussion.
• 27:34
  Speaker 1: We're open-minded.
• 27:43
  Speaker 1: I've always thought that people who are aware and educated in certain subjects that are open-minded two open-minded, educated individuals have great conversations.
• 27:47
  Speaker 1: Close-minded, educated people usually a higher ego, not as much humility.
• 27:53
  Speaker 1: That leads to a power struggle and not really a great conversation at least a one-upping If you've ever been with around.
• 27:59
  Speaker 1: This is my own little thought on that.
• 28:01
  Speaker 1: So, um, usually a power struggle, one-upping type of conversation versus an open-minded, great conversation.
• 28:08
  Speaker 1: But anyway, I try to be as open-minded as I can be man because I want to be aware and learn as much as I can and help people.
• 28:13
  Speaker 1: I'm not saying I'm awesome or the best at any of this stuff.
• 28:16
  Speaker 1: I'm just saying I'm just sharing things that I've learned, that I like and I'm a nerd out on, but anyway, so definitely reach out, give me any questions.
• 28:22
  Speaker 1: If you want to call us directly, our best number is 561-899 725, or you can email us at team at athlete rccom.
• 28:30
  Speaker 1: T E a M at athlete rccom and we'll catch y'all next time.