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Thought I should probably write an update on the knee issue that I mentioned last week.
Its fine.
There we go.
The rest for a couple of days that I enforced on myself, along with the ice, compression and elevation for the first couple of days during acute and subacute phases appears to have done the trick. I abstained from deep squats for the next few days after that, though from an analysis of my squats, double legged squats do not appear to be the issue. Its the single legged ones that are the problem.
As I squat down, the knee starts tracking medially (inwards - toward the midline) which then strains the patella tendon- and at the point that I squat back up, THAT's when the tendon becomes overloaded. As it is at a biomechanical disadvantage while the pressure is being put through it, it is placed in a weakened position - the collagen fibres are not taking the strain as they do on a day to day basis, and the tendon becomes inflammed and tender to touch.
IF it was in the correct position, and I was squatting in a biomechanically efficient way, then the force generated would go through the tendon in the way it is meant to, in its strongest position, it would not become inflamed, and I would continue to build up muscular endurance.
Now, the issue with this is that when running, especially up and down hill, as fell running tends to demand, you rarely land on both legs at the same time. When you hit the floor, you do a mini squat - on one leg, on unstable ground. The chances are, you aren't giving the knee any chance to land in a biomechanically advantageous way... so therefore, more chance of being injured, and having a very tender spot below the knee cap, and maybe having to rely upon pain killers in longer races. (not a good idea, it masks the pain but the issue is still there).
How to sort this issue out?
I may have mentioned this in a previous post, but it boils down to a weak gluteus medius and deep lateral rotators. The best way to describe this muscle to imagine your shoulder- there is a large muscle covering the the shoulder- you can easily see how it influences movement in the shoulder. The gluteus medius does pretty much the same thing over the hip joint, being involved in almost every movement of the hip.
The lateral rotators - of which there are 6, rotate the hip outwards, and help prevent the upper leg diving in toward the midline as you single leg squat. So it's these muscles that need to be recruited and built up to prevent the knee diving, which, in turn, will stop the pain the knee.
The fact my glute med hurts after Mount Famine yesterday means that it has been overworking, needs a bit of rest, a bit of massage to get the waste products out of it, and blood back in, some foam rollering, and then a bit of strength work.
Slow single leg squats, in front of a mirror, ensuring the knee is tracking where it should be, accompanied by balance drills on a wobble board.
Simple.
The main take away from this is, if you have a knee issue, and there has been no specific trauma to the knee, chances are, your knee is NOT the problem, only the symptom.
If you see a massage therapist about your knee, and they start looking at issues in the hips or feet - that is a good thing. They are looking for the fire - not the smoke.
