Latest / The Driven Athlete / Your Knee Is Talking, Stop Ignoring It | Ep 129

Transcript

Your Knee Is Talking, Stop Ignoring It | Ep 129 · The Driven Athlete

• 0:00
  SPEAKER_00: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what?
• 0:06
  SPEAKER_00: This podcast is for you.
• 0:08
  SPEAKER_00: This is the Driven Athlete Podcast.
• 0:12
  SPEAKER_00: What's up, y'all?
• 0:12
  SPEAKER_00: It's your man, Dr.
• 0:13
  SPEAKER_00: Kyle, the Driven Athlete Podcast.
• 0:16
  SPEAKER_00: I'm excited that you're here to chat with us.
• 0:20
  SPEAKER_00: So a common question that I've gotten recently, somebody recently was asking me, like, um, you know, I've been running more and my knee is clicking.
• 0:27
  SPEAKER_00: What's that?
• 0:28
  SPEAKER_00: Right.
• 0:29
  SPEAKER_00: So knee clicking.
• 0:30
  SPEAKER_00: Uh well, it can come for a lot of different things.
• 0:32
  SPEAKER_00: And a lot of different uh behind the scenes or previous stuff that has happened changes the answer as well.
• 0:39
  SPEAKER_00: So and this particular person, they had an ACL reconstruction surgery five years ago.
• 0:44
  SPEAKER_00: All right.
• 0:45
  SPEAKER_00: And then they recently had been trying to dive more into running.
• 0:49
  SPEAKER_00: All right.
• 0:49
  SPEAKER_00: So without knowing all the other full um uh history, right?
• 0:55
  SPEAKER_00: This person's younger, like they're in their mid-30s, and they want to start running for five Ks.
• 0:59
  SPEAKER_00: They want to train.
• 0:59
  SPEAKER_00: I'm like, awesome, let's get after it.
• 1:01
  SPEAKER_00: Let's do the right things and support and set the stage for your success and that.
• 1:06
  SPEAKER_00: Because running five K's is fun, you know?
• 1:08
  SPEAKER_00: Um, and it's a goal of yours, let's get after I'm here to support you.
• 1:11
  SPEAKER_00: You can do this, right?
• 1:13
  SPEAKER_00: It can be done.
• 1:14
  SPEAKER_00: Um, but anyway, so uh he had this person had a uh re ACL reconstruction five years ago.
• 1:20
  SPEAKER_00: They're in their mid-30s and they just recently started running.
• 1:23
  SPEAKER_00: So my question would be in the last five years after your um surgery, number one, what was the rehab like?
• 1:30
  SPEAKER_00: Do you feel like after when you kind of finished your really purposeful rehab and efforts on getting your knee back after surgery, do you feel like you got back to like 100% symmetry strength, side leg to leg, like pre-surgery, pre-injury strength, did you achieve at least 90% of the strength that you did prior to the injury?
• 1:51
  SPEAKER_00: If the answer is like not really, then like the rehab was insufficient and you were set for failure for stuff later, as in like exercise, squats, lunges, step ups, Bulgarian split squats, reverse lunges, lateral lunges, cock squats, like whatever, um, Zercher squats, all the exercise, like lower body exercise that people would do for health and wellness and fun, it would they're they were set up for compensation patterns.
• 2:16
  SPEAKER_00: Because if it's not as strong and it's 80% the strength that it was, what do you think the other leg's gonna do?
• 2:21
  SPEAKER_00: It's gonna overcompensate, right?
• 2:23
  SPEAKER_00: Especially for double leg exercises.
• 2:25
  SPEAKER_00: So then, all right, it's like a so it was insufficient.
• 2:29
  SPEAKER_00: I didn't get 90 to 95% of my limb symmetry strength as my other leg or pre-surgery strength.
• 2:36
  SPEAKER_00: So it was set up for not the best success to begin with.
• 2:40
  SPEAKER_00: Um, and then between then, which is like a year of a rehab, right?
• 2:43
  SPEAKER_00: That's what I would usually eight for adults, it's usually like six to eight months because they they're not athletes and they don't, the insurance runs out.
• 2:49
  SPEAKER_00: It's what happens.
• 2:50
  SPEAKER_00: Or they get to a functional level of like I can work and I can play with my kids and I can climb stairs and I really haven't noticed an issue.
• 2:58
  SPEAKER_00: And then the commitment level of like full dive for six more months, it just it just fizzles out because they're good now at this point for like an active life.
• 3:06
  SPEAKER_00: And then they say a year later, you know what?
• 3:09
  SPEAKER_00: I want to get back to strength and I want to get, I want to improve my physique, improve my health and wellness.
• 3:13
  SPEAKER_00: Perfect, let's go.
• 3:14
  SPEAKER_00: And then they get back to exercising, like lower body workouts, like I was just describing, lunges, squats, deadlifts, kettlebell swings, Bulgarian split squat, like whatever, all the lower body exercise on top of a leg that was only 80 to 85%.
• 3:27
  SPEAKER_00: Usually it's like 80%, 80% of the strength that it was prior.
• 3:31
  SPEAKER_00: So a lot of compensations and avoidance, fear avoidance, lack of confidence avoidance through that leg with leg exercises, which increases the disparity of strength.
• 3:42
  SPEAKER_00: The other leg is getting stronger, and the the surgery leg isn't getting as strong as rapidly as that one.
• 3:48
  SPEAKER_00: So they're both getting stronger, but it's like that.
• 3:51
  SPEAKER_00: One leg is getting way stronger faster, and the other one is getting stronger, but not at the same rate.
• 3:56
  SPEAKER_00: Um, and it doesn't reach the same level of symmetry.
• 4:00
  SPEAKER_00: So it just increases the disparity of strength and the compensation issues that will come after.
• 4:06
  SPEAKER_00: So then they're like, and I want to run five K's.
• 4:09
  SPEAKER_00: Well, running is way more challenging to not compensate than more controlled lower body exercise like lunges or squats or something like that.
• 4:20
  SPEAKER_00: It's way easier to compensate with running.
• 4:22
  SPEAKER_00: All right.
• 4:23
  SPEAKER_00: It's a series of single-leg falls and more impact.
• 4:26
  SPEAKER_00: All right.
• 4:26
  SPEAKER_00: So it's higher impact than a smooth controlled motion of like a lower body workout exercise.
• 4:31
  SPEAKER_00: So the compensation patterns, uh, unknowingly, subconscious, and then very subtle, that just adds up.
• 4:39
  SPEAKER_00: I mean, you run five, a five cats, 3.1 miles, right?
• 4:42
  SPEAKER_00: So like you run three miles uh and you do that, let's say you run a mile and a half and you've been running 10 miles a week, let's say 12 miles a week.
• 4:51
  SPEAKER_00: I mean, how many steps?
• 4:52
  SPEAKER_00: That's 5,280 feet per mile.
• 4:55
  SPEAKER_00: Um, and then let's say you run like, you know, you're a jog, you're you're uh uh completing like two feet a distance per step.
• 5:03
  SPEAKER_00: Oh my gosh.
• 5:04
  SPEAKER_00: I mean, that's you know, if you run 10 miles a week, that's 52,000 feet divided by it's 25,000 step running steps per week of um just training, not even just like walking around your house and work and playing with your kids and stuff like that.
• 5:21
  SPEAKER_00: There's a lot of mild and subtle little compensation episodes every single step that adds up, right?
• 5:29
  SPEAKER_00: And that's only one week times it's you know, I've been renting for six months now.
• 5:33
  SPEAKER_00: I mean, that's 20, well, I mean, what is that, 20 weeks, right?
• 5:37
  SPEAKER_00: Um, sorry, 26 weeks.
• 5:38
  SPEAKER_00: That's 26 weeks of six months, right?
• 5:41
  SPEAKER_00: I mean, times 25,000.
• 5:43
  SPEAKER_00: That's a lot of steps and microcompensations that occur every time that that just accumulates.
• 5:49
  SPEAKER_00: All right.
• 5:50
  SPEAKER_00: And then uh over time, after over that length of time, it's like it's been clicking more.
• 5:53
  SPEAKER_00: So that's part of my conversation, as in like, oh, you had ACL reconstruction five years ago.
• 5:59
  SPEAKER_00: Oh, the rehab seemed to be insufficient, where you didn't uh you weren't able to gain, it's not your fault.
• 6:05
  SPEAKER_00: It's more of like the it was the you weren't able to make it happen because of a lot of factors.
• 6:10
  SPEAKER_00: Uh, but because life happens, but um, you weren't able to gain um up to at least 90, 95% of your limb symmetry strength, which is our goal um for like return to sport, return to play is 95, 90 percent at least, right?
• 6:24
  SPEAKER_00: For a high-level athlete, you need to get 95%, right?
• 6:27
  SPEAKER_00: That's our metric.
• 6:28
  SPEAKER_00: Be like, you're good, let's get after it.
• 6:30
  SPEAKER_00: Um and then the confidence that comes with it and subconscious avoidance patterns just because of a confidence avoidance or even fear avoidance because you're just not confident on it.
• 6:39
  SPEAKER_00: Imagine planting on your leg every time.
• 6:41
  SPEAKER_00: But anyway, so he had surgery five years ago.
• 6:43
  SPEAKER_00: Um, the the rehab was kind of insufficient.
• 6:46
  SPEAKER_00: You didn't you only gained 80% of your leg strength.
• 6:49
  SPEAKER_00: I'm I'm assuming the range of motion got back to 100%.
• 6:52
  SPEAKER_00: So let's just assume that that's usually it's easier for younger adults to make that happen.
• 6:57
  SPEAKER_00: Um, and then didn't really work out much, then went back to exercising at uh a leg that's not at the capacity the other leg is at, all right, of strength and confidence, and then started running on top of that.
• 7:11
  SPEAKER_00: So all those things play a role until they and then they say, My knee's been clicking.
• 7:16
  SPEAKER_00: So it's like those kind of things all factor in as in like, why has my knee been clicking?
• 7:20
  SPEAKER_00: But general rule of thumb, it's usually underlying lack of stability, a lack of tolerance to the impact, as in like it just wasn't ready for that volume and level and intensity of impact yet.
• 7:33
  SPEAKER_00: Um, we we had to ramp things up in incrementally and appropriately while also strengthening the leg back to back to 90 to 95% to avoid just the natural compensation patterns that come with.
• 7:45
  SPEAKER_00: Um, so the knees clicking because there's usually an underlying instability, a lack of strength, um, not the best running mechanics, right?
• 7:54
  SPEAKER_00: Because of underlying compensation patterns and a lack of tolerance to the impact and the volume, and that leads to joint irritation, all right, mild, subtle irritations where the soft tissue gets more irritable, it gets irritated and inflamed and some swelling, mild swelling gets in the joint, and that leads to more popping and clicking.
• 8:16
  SPEAKER_00: So the presence of popping and clicking usually represents more fluid and swelling in the joint and irritable tissues.
• 8:22
  SPEAKER_00: The tissues are irritated, irritated, right?
• 8:24
  SPEAKER_00: That's usually why joints pop and click more.
• 8:26
  SPEAKER_00: If it's a chronic thing where there's no pain, it's usually because of hypermobility.
• 8:30
  SPEAKER_00: So a joint pops and clicks more if it's more hypermobile.
• 8:33
  SPEAKER_00: And that sets the stage for it to be more irritable, irritated easier because of an instability issue.
• 8:38
  SPEAKER_00: All right.
• 8:39
  SPEAKER_00: It's instant more, it's not as stable as it could be.
• 8:42
  SPEAKER_00: Sets the stage for it to get more irritable and irritated easier, and that creates more swelling and fluid in the joint.
• 8:48
  SPEAKER_00: So that presence of swelling and fluid and irritation, that in that increases and exacerbates popping and clicking in someone's joint.
• 8:55
  SPEAKER_00: So that's that's usually the answer.
• 8:56
  SPEAKER_00: All right.
• 8:57
  SPEAKER_00: Um, same thing with shoulder, you know, like shoulder pops and clicks, my neck pops and clicks, my ankles pop and click.
• 9:03
  SPEAKER_00: The joints that pop and click um without some kind of pathology, like without some kind of issue, that represents that those joints are more hypermobile than maybe the joints above or below them, their neighbors.
• 9:14
  SPEAKER_00: All right.
• 9:14
  SPEAKER_00: And the disparity of joint mobility of being hypermobile, that just takes on a lot more brunt of the movement of just daily life, where like like water, like water takes the path of least resistance.
• 9:26
  SPEAKER_00: Our body joints move the the more hypermobile joints that have more available motion will be the first ones to take on more of the movement of like whatever activity you're doing.
• 9:36
  SPEAKER_00: Um, so if turning your head, right, segmentally, some segments in the neck will take on more brunt or more of the motion to make that rotation in your neck happen.
• 9:45
  SPEAKER_00: And it's usually mid-cervical.
• 9:46
  SPEAKER_00: It's pretty classic.
• 9:47
  SPEAKER_00: Mid-cervical hypermobility.
• 9:49
  SPEAKER_00: The shoulder joint, same thing.
• 9:50
  SPEAKER_00: The glenohumeral joint is the ball and socket joint.
• 9:53
  SPEAKER_00: That joint's usually more hypermobile than the scapula.
• 9:55
  SPEAKER_00: The scapula, the scapulothoracic joint or the scapuloumeral, the scapulothoracic joint, and it has to rotate and move and uh protract, retract, and upwardly rotate or A-B duct, which is like retraction, and has to do that in addition to your shoulder joint contributing to overhead motions or reaching and stuff like that.
• 10:13
  SPEAKER_00: So if the glenal humoral joint is naturally more hypermobile and it continues to facilitate that, like the path of least resistance, like water, um, it's gonna just be more hypermobile.
• 10:23
  SPEAKER_00: And that makes that joint pop and click more, just with daily movement stuff.
• 10:27
  SPEAKER_00: So, and then same with the knee.
• 10:28
  SPEAKER_00: You know, usually the knee is gonna be more unstable and hypermobile compared to it's it's instability that sets the stage for it to be more hypermobile and micro shearing, micro compensations and micro movements in the knee excessively compared to uh what it was previously, and what it's ready to tolerate for impact, which is like running, that's gonna set the stage for things to get a little bit more um uh irritable, you're more irritation, more stress than the tolerance that it can take.
• 10:58
  SPEAKER_00: And that over time creates more irritation and swelling in the joint and the soft tissue structures, and then more presence of swelling and fluid, more clicking and popping.
• 11:07
  SPEAKER_00: So that's where that kind of comes from.
• 11:08
  SPEAKER_00: And that's my lens on that.
• 11:09
  SPEAKER_00: So with him, like this patient, I'd be like, we need to investigate the strength, clear the range of motion, make sure the range of motion is full, because if it's not, then we have to make efforts towards that.
• 11:20
  SPEAKER_00: Um, full knee extension, full flexion, knee extension is the more difficult priority.
• 11:26
  SPEAKER_00: It's the more priority to get, is just getting the knee fully straight or a little bit a couple degrees hyper compared to what the other leg is like.
• 11:31
  SPEAKER_00: The goal is to get symmetrical to the other leg.
• 11:33
  SPEAKER_00: And if that leg is two degrees hyper hyperextended, then the the injury need is to also the surgery need is to get to that point too.
• 11:40
  SPEAKER_00: That's the goal.
• 11:41
  SPEAKER_00: All right, but most we're gonna check that out.
• 11:43
  SPEAKER_00: We're gonna investigate his strength.
• 11:44
  SPEAKER_00: Usually the quad strength is the first one we have to look at.
• 11:47
  SPEAKER_00: Um, and if it's not as strong as it could be, then we got to start working on strengthening, eccentric strengthening, dynamic heat, knee, hip stability, um, balance, and proprioception.
• 11:57
  SPEAKER_00: Um, and that dynamic stability translates to doing more challenging things, and then we can wean into running and then also look at the running mechanics.
• 12:04
  SPEAKER_00: And then we dial in like what volume and and intensity level right now is appropriate for the stage of your knee and the strength of it right now.
• 12:11
  SPEAKER_00: It's just not ready to run off marathon tomorrow.
• 12:14
  SPEAKER_00: Like, well, so then what is appropriate?
• 12:16
  SPEAKER_00: Well, I mean, right now, maybe like, you know, let's let's start doing interval runs.
• 12:19
  SPEAKER_00: I'm a fan of interval runs, especially at the beginning stages of reintroducing a new exercise like running like this.
• 12:24
  SPEAKER_00: Um, interval runs.
• 12:26
  SPEAKER_00: All right.
• 12:26
  SPEAKER_00: So we're doing like run a half of a mile and then walk a quarter mile.
• 12:30
  SPEAKER_00: Run half a mile and then walk a quarter mile and do multiple rounds of that.
• 12:33
  SPEAKER_00: So they kind of track.
• 12:34
  SPEAKER_00: We would say be like, run the long leg and then run the short curve.
• 12:39
  SPEAKER_00: Run the long leg and then run the short curve and do four laps, and that would be a mile, all right?
• 12:43
  SPEAKER_00: So it's like run, if you get what I'm saying, like run the straightaway, but then walk the curve.
• 12:47
  SPEAKER_00: Run the straightaway, then walk the curve.
• 12:49
  SPEAKER_00: Um, and then for four laps, that's a mile.
• 12:51
  SPEAKER_00: You just traversed a mile in the interval pattern, all right?
• 12:55
  SPEAKER_00: And then um maybe take a break and then 30 for you know 10 minutes and then do it again.
• 13:00
  SPEAKER_00: And that'd be two rounds.
• 13:01
  SPEAKER_00: That's two miles that you traversed.
• 13:03
  SPEAKER_00: Um, but just I'm a huge advocate for interval training for stuff like this, so that we make sure a person can feel what they're trying to feel.
• 13:11
  SPEAKER_00: And also, and so they need to take a break or stop.
• 13:13
  SPEAKER_00: Like you know, the bottom line is it's overwhelmed.
• 13:16
  SPEAKER_00: We have to break, it's a stop.
• 13:17
  SPEAKER_00: Like if you continue, it's just gonna make things more irritable.
• 13:19
  SPEAKER_00: Where we're not looking at tomorrow, as in like my checklist today was to run five miles.
• 13:25
  SPEAKER_00: My checklist would be finish it with no pain, right?
• 13:29
  SPEAKER_00: That's the goal, and no more swelling, because that means you didn't overwhelm the joint and the tissues.
• 13:34
  SPEAKER_00: And I'm looking at like, what's six months look from now or three months?
• 13:37
  SPEAKER_00: What's 12 weeks from now look like?
• 13:40
  SPEAKER_00: If continuing this path of like when I finish, I didn't have pain or swelling.
• 13:45
  SPEAKER_00: I'm good, let's stop, let's live to fight another day, do it again the next day and be mindful in the meantime of like what am I feeling?
• 13:51
  SPEAKER_00: Do I dial it back?
• 13:52
  SPEAKER_00: Then we can dial it up.
• 13:54
  SPEAKER_00: Dialing it up is easy.
• 13:55
  SPEAKER_00: Dialing it back is hard for high high-level motivated individuals that are trying to like train for stuff.
• 14:00
  SPEAKER_00: But I'm looking at like if we continue that path of like it doesn't hurt, it's not swollen after this intervention that we did of Dave, what day my exercise, do it again the next day or day to after that, that incrementally stacks way better.
• 14:11
  SPEAKER_00: What's that look like in three months?
• 14:13
  SPEAKER_00: Way better.
• 14:14
  SPEAKER_00: Rather than, you know, it kind of hurts and it feels a little swollen, but I got through it.
• 14:18
  SPEAKER_00: I mean, that is just gonna continue to linger, swelling in pain over time, and it's just gonna not allow things to heal and facilitate the healing process as well as it could.
• 14:27
  SPEAKER_00: Um, so that's kind of the conversation we have.
• 14:29
  SPEAKER_00: And to answer the question of like, why do my why does my knee clicking?
• 14:33
  SPEAKER_00: Right.
• 14:33
  SPEAKER_00: Um, and it could be other to dive into that one last thing would be um is it's it's the patella femoral joint or is it the tibial femoral, the femoral tibial joint, right?
• 14:42
  SPEAKER_00: So like the sh the the femur on the sh on the tibia, the thigh bone on the shin bone, um, doing microcompensations and micro shifting, which are like micro shearing, which is a stacking stability problem, or is it the patella femoral joint, which is the patella gliding in the trochley of the femur, where that's also unstable if it's making micro movements, micro shearing, um, or if it's not gliding inferiorly efficiently enough, if it's the glide is is is stiff and not gliding as as smooth as it could glide or easily pliable as it could be, then we need to intervene there.
• 15:17
  SPEAKER_00: Um, and then that also, if that is occurring, it's usually some kind of pelvic hip instability that we need to look at, or ankle uh mobility, um dorsiflexion mobility, and also foot arch stability.
• 15:29
  SPEAKER_00: Those kind of things all factor in of like what's the course of action and what are we going to work on and what's the problem and why, right?
• 15:35
  SPEAKER_00: So if you have any questions, don't hesitate to reach out.
• 15:37
  SPEAKER_00: We're always open to kind of a conversation of what we can what we can uh fix you.
• 15:40
  SPEAKER_00: If you have an issue, what we can fix it like for you, what the course of action for you would be.
• 15:44
  SPEAKER_00: And uh we'll catch y'all next time.