Pain Exploration: Medial Knee

Pain Exploration: Medial Knee

For about two months, I’ve had some chronic discomfort in my left knee.  On a scale of 1-10, with ’10’ being agony and ‘1’ being noticeable/annoying, it oscillates between 1 and 4.  Though this might be thought of as acceptable to many, I want zeroes.  I spent a decade in pain playing rugby.  I’m over that sh*t.

Experimenting with painful movement follows the same principles as experimenting with non-painful movement.  Yes, pain is an x-factor that people tend to avoid, but it doesn’t make it any more dangerous.  People inherently want to protect themselves, and they can immediately feel what works and what doesn’t.  Without given prescriptions, we can learn to trust ourselves by stopping whenever we choose.

I am familiar with left knee issues.  I had reconstructive ACL surgery in 2003 and have been readjusting ever since.  I’ve written a few articles about my findings (going beyond typical protocols, and the hamstring connection), but I wanted to put together a piece on the process of figuring things out.  I call this ‘following the feels’ — problem solving through finding and putting the pieces together.

I begin everything with an exploratory movement.

Knowing the low sit was tough, I was looking for why it was so tough.  As I shifted around, I compared my right leg to the left:

The left heel had trouble shifting inward, the sticking point seemed to be the big toe.

 

I banked this discovery and went after the hamstring which I knew has issues:

 

I looked at standing angles in the short hamstring position, then took it to the ground for a bit of a variability.  I wondered if the heel could follow the hips dynamically, in multiple positions:

 

No further red flags or weak spots popped up, so I went back to the big toe, integrating the ankles, feet, and hips.  There are three sequences presented here, one at :25, 1:55, and 3:23:

The points I start to pressing on are exact locations of pain.  Not coincidentally, they line up with my surgery scars.

Movement variability creates a comprehensive road map of what loads, at what angles, and at what speed evoke pain.

It also allows me to clarify how to get out of it.

I use these insights to help drive movements at the hip and ankle, the two joints that bookmark the knee:

Keeping the knee down provided the right torque to re-distribute tension from the knee to the hip through the adductor.

 

Similarly, changing the vector of force from vertical to horizontal drastically changed where the dorsiflexion stress was allocated:

Variability, again, showed a particularly dysfunctional line down the anterior compartment of the lower leg.  It led from the point of knee pain right down toward the big toe.

 

It brings the exploration full circle, except for one major adjustment — putting the toe through flexion instead of extension:

The slightest variation can make all the difference.

The absence of pain validates that everything is working as it should, and that you are keeping your movement demands within your capacity to move.  The appearance of pain demonstrates that something has gone wrong.  If we can get away from judging feeling as good or bad and merely accept it as information, we’ll be better equipped to use this awareness to help correct things.  A fine line separates worked from wrecked, and becoming your own expert keeps you moving — on the right side of the continuum.

Movement, not the inhibition of, can lead to a pain solution. Though answers and blueprints are not on size fit all, the ability to use pain as a guide is.  Safe controls nurture safe exploration. Speed, force, load, direction, problematic joint angle, neighboring joint angles… all have to be analyzed and accounted for.  When not numbed or ignored, pain can be used to extinguish itself.  It offers those willing to engage with it the most sophisticated diagnostic tool available.

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