The Injury Files #1: Your niggly Knee

If you've had knee pain for more than six months and physio hasn't solved it - there's a reason. And it's probably not your knee.

More on that in a moment. First, an important note.

There are times when knees can be damaged to the point of needing MRIs and surgery - mine are at that point. If you're genuinely concerned about the structure of your knee, go and see a specialist. That's not what this is for.

What this is for is the niggling knee. The one that flares after a run. The one that stops you training legs properly. The one that physio has settled three times and keeps coming back.

This is how I've solved a lot of those. And significantly improved knees that are even at the point of needing surgery.

Part 1 - What actually happens when there's knee pain

When you have knee pain or swelling, the muscles around the knee get 'turned down'.

What I mean by that is your body subconsciously reduces the amount of force those muscles can produce because it doesn't want to cause further damage. It's a protective mechanism.

The problem is it creates a catch 22. The muscles around the knee need to support the knee - but the body won't let them work properly. So the knee stays unsupported. The pain continues. The muscles get weaker. And the cycle continues.

How to break it

The first step is getting those muscles activated again. But there's a problem with that too - doing it is often painful.

So the answer is to find a position where it isn't painful, and hold it there. The muscle works. The joint doesn't move. No pain at all - but the muscles are working. This is called an isometric.

That's where I start with almost every knee client.

For the quads: Sit in a leg extension machine with the leg straight, add a small amount of weight, and hold at the top of the lift for 30 seconds. Three sets - must be pain free.

For the hamstrings: A glute bridge variation - holding for 30 seconds. Three sets. https://www.youtube.com/watch?si=AKM585eHpM0AQlrk&v=os7V6CoxXnQ&feature=youtu.be

For a more specific calf isometric: This variation, which can be loaded with a Smith machine if bodyweight becomes too easy. https://www.youtube.com/watch?v=CGcAJRuXIwU

The nice thing about isometrics is that you can be very specific. If the pain has been on the inside of the knee, focus more heavily on the muscles there. Same for the outside or the back. Small adjustments make these hyper specific to your exact knee pain.

From there you progress. Move the exercises to a standing position. More challenging isometrics and added load. Then eventually, when the joint is no longer painful, movement. At that point the world opens back up and you can add any leg exercise you'd normally do in a controlled, progressive way.

The final part of this progression is hopping and plyometrics. In order to run, I believe you should be able to hop and jump - but for now this is beyond the scope of this newsletter. There are certain tests you need to pass before I'd recommend getting to this stage, and it would be irresponsible of me to suggest otherwise. Maybe there's scope for another newsletter there.

Part 2 - The part nobody tells you

Here's a view that changes how most of my clients see their knee pain.

Most of the time, the injury site is not the problem. It's the solution to a different problem.

Here's the easiest way to explain it.

Let's say someone had a bad ankle injury a few years ago. After that injury, the muscles around the ankle get turned down. They stop functioning at full capacity.

If the ankle muscles aren't doing their job, something higher up the chain has to pick up the slack. In this case, the knee. The knee joint starts taking on load it was never meant to handle. Over time, it gets overloaded and things go wrong.

So you come to me with a knee problem. But the source of the problem is an ankle injury from three years ago that was never properly rehabbed.

This is why I go back through every client's full injury history before I write a single session. The knee is often not the problem. It's the solution to a different problem.

Part 3 - What not to do

Don't stop doing any leg work altogether.

This is the biggest mistake I see. It's completely understandable - it hurts and you don't know where to start. But if you stop loading the leg entirely, you just get weaker and weaker. The muscles take longer and longer to rebuild. The knee stays unsupported.

If you're in this situation right now, here's the simplest thing you can do.

Add the three isometric exercises above to every gym session for the next month. Three sets of 30 seconds each. That's it. See if it reduces your pain.

Most of the men I've worked with who came to me with a niggling knee are now training consistently and HARD. Some are back running. All are back competing. The knee that was limiting everything became a strength, not a weakness, and everything around it is now functioning well enough for it not to be a problem.

Next week: why your lower back keeps going - and why rest is making it worse.

Part 4 - A secret

For the final part of this newsletter I want to introduce you to something which will revolutionise how you are able to train around a knee injury.

Blood flow restriction training - BFR is something I've been interested in for a long time. I've presented for smart cuffs for their level one course and I've presented to universities, professional rugby teams, and clinics about its benefits. if it's something that you are interested in, he was in an article with a lovely picture of me coaching it at Complete Physio

https://complete-physio.co.uk/blood-flow-restriction-training/

For my clients this can be an absolute game changer and it's been a game changer for me with my struggles with my knees.

If this is something you want to know more about or you are intrigued, please just send me a message and we can discuss it.

If you want to understand what's actually driving your knee pain - and whether there's something further up or down the chain causing it - and how to solve it - book a free 30-minute audit. That's exactly what we'd look at together.

calendly.com/razorperformance/30min