AD: Lateral Tear and OA in a Distance Runner: Home Program (2-23-20)

3-15-20
- I am glad things are feeling better.
- I am going to give you 2 lists below
  - One will be the initial movements with a couple new options that can be done daily
  - The other will start a list of strength pairings that I like or super sets
    - These should only be done every other day at most
    - Each circuit will have 2 movements, do the first then the second movement then repeat a second or third set if you are really feeling excited. Each set try to work towards fatigue so it is normal that each set the reps or time should be gradually less if you are truely working towards fatigue
    - Some of these may be variations of some of the movements you are already doing
    - A big key for me with the strength stuff is that you feel muscle fatigue without significant knee pain
      - To do this you may have to adjust the range of motion you are moving through
- Daily movements
  - 113.1) Ball Hamstring Curl to Knee Extension VIDEO
  - 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
  - 14.1) Mulligan Knee Flexion Tibial IR VIDEO
  - New options
    - 28.8) Step/Chair Raise in and out of Dorsiflexion VIDEO
      - Ankle dorsiflexion is very important to offload the knee
    - 41) Cross Leg Contract Relax Posterior Hip VIDEO
      - Always a good idea to maintain good hip mobility just make sure it doesn’t increase pressure on the knee
  - Myofascial Release can be useful to help loosen things up if a movement above feels limited
    - I am listing a couple options below
    - Now a couple things about myofascial release
      - I only do it if a movement feels painful or restricted…then I do the myofascial release…and then following that movement that felt limited feels better
        
        Once the movement whether that is a stretch or a squat feels fine…I stop doing the myofascial release….the goal of it is to open a window for you to move into a position that was limited and then move better. The more you move in that direction and work on strength, the less you should need to do the myofascial release
    - Try to compare side to side and if you find something that is more sensitive on the problem leg or if doing it improves some of the stretches above then focus on that…you do not need to do all of these and don’t feel the need to spend 20 minutes rolling on a tennisball unless you really enjoy it….which would be a little weird
    - Self MFR
- Strength Circuits
  - Circuit #1
    - Movement: Elevated Bridge Progression (Choose one of the movements below
      - Bridge Progression Physio Ball: Goal 8-20 reps
        
        114.1) Straight Leg Bridge Gradual Integration of Bent Knee VIDEO
        
        115) Double Leg Bridge Phase 3 VIDEO
        
        117) Double Leg Bridge With Hamstring Curl Phase 4 VIDEO
        
        118) Single Leg Bridge Phase 5 VIDEO
        
        119) Single Leg Bridge With Hamstring Curl Phase 6 VIDEO
    - Movement: Squat pulses short range as deep as not painful
      - 30-90sec
      - 149.1) Squat Pulses In Short Range VIDEO
  - Circuit #2
    - 55.2) Band Dead Bug Variations VIDEO
      - 30-90sec
    - Lunge Slide options(ChooseOne)
I have a summary of the information you gave me below
This first week I am going to give you some movements to try that focus on muscle activation and range of motion
They are not meant to be hard so keep them easy this first week
Most important part of this process is recognizing what is helping you and what is actually harming you.
- I always ask the question during and after doing an exercise do you feel better, worse, or the same
- We are doing things to an area of your body that already hurts you so there may be some pain associated with any movement but you have to recognize if what you are doing is helping or harming you
- Ideally you will feel stretching, tightness, muscle fatigue or atleast muscle activation with very little to no pain
  - If there is pain you have to gauge how much of a negative is there…a little soreness that goes away within 1-2 days, is reduced with post activity ice, and is not incredibly severe is ok
  - Pain that last more then 2 days, is not muscle workout pain, causes increased swelling, causes you to limp, is not helpful and is typically a sign that what you just did was more harmful then helpful. Continuing to push into those types of symptoms will make you weaker instead of stronger
  - As an athlete who is used to pushing yourself, be careful that you are not pushing too hard and respect that you are injured and need to have adequate rest between episodes of pushing yourself.
Week one above is more of a test. You will add a new movement every 2 days to whatever your current regimen is. You will assess if there is any positive or negative associated with each movement that you add.
- If the first movement is fine for 2 days then you will keep that movement and add the next. If the first movement causes pain, get rid of it or adjust is when you move to movement #2
Send me an email at the end of the week with a recap of what movements were helpful, what was harmful, what felt beneficial, what felt like a waste of time. That will help me prepare for week 2
The first time you do anything I give you…make it easy..error on the side of caution
Movement #1: Knee range of motion in non weight bearing
- 113.1) Ball Hamstring Curl to Knee Extension VIDEO
- Good warm up movement for knee motion without weight bearing
- 10-20 reps gentle…if not painful can be done 2-3x per day especially as a warm up/cool down to keep knee motion
- Stay short of pain and don not push down into heels if painful
- Do this for 2 days, as long as no significant increase in pain, keep it and add next movement
Movement #2: Quad Mobilization, Isometric, active knee motion
- 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
- Start by just pulling in and out of knee bend
- When you add the quad isometric, try to keep your knee in a position with the least amount of pain, if quad iso hurts do not do it
- 10x-15x each movement if not irritating
- This can also fit in the same warm up cool down regimen
  - If the movement above hurts try the alternative below
    - 33.11) Supine Edge of Couch Heelraise VIDEO
    - With this one I like to know if you feel your knee, your quad stretch, or a combination of the two
    - Same 10-15x, if its in the quad you can hold each 5 sec, if it is in the knee no hold just movement in and out
      - Does it get better worse or the same as you do it?
Movement #3: Self knee mobilization at the stairs
- 14.1) Mulligan Knee Flexion Tibial IR VIDEO
  - Foot up on step, higher the better because the higher the foot less pressure on the knee
  - This is semi weight bearing so be careful
  - no hold 10-15 reps
  - same multiple tomes a day if not painful
Background
- Last race Ultra 40 miles in 11-19
- Martial Arts
- Weight Training
- HIIT
- Running 30-50 miles per week pre race
- May 2019 Sharp knee Pain
- Relief with cortisone shot
- Complex lateral meniscus tear and OA
Symptoms
- Decreased range of motion
- Squats/Lunge/Stairs/Running/Biking/sit to stand
- Intermittent locking
Current activity
- bike, weights, machines
- Orange Theory, Martial Arts
- Walking
- Using unloader brace as needed