As I mentioned in a previous post, I finally made the decision last week to go to physical therapy for my knee pain (self-diagnosed as patellofemoral pain syndrome, or PFPS).
Knee Pain Background
My left knee started hurting after a great hill run in NY in November last year, and it was in real pain after an 8K race in early December. I continued to run on and off for a few weeks, but as the pain increased, I stopped running altogether. When marathon training began in January, I did all the runs in the pool. I went to see my orthopedist in early January, who thought the cause of the pain might be IT band irritation, based on the fact that the pain was mostly towards the outside of my knee at the time. He prescribed lots of stretching and foam rolling, and said I could get back to running since my injury was pretty minor.
After I started foam rolling/ stretching my IT band more rigorously, the pain on the outside of the knee went away, but I realized that the pain had now moved to the front and bottom of my knee, which sounded like PFPS from my internet research, AKA runner’s knee.
While I was able to continue running since the pain went away within 5 minutes of starting a run, I decided that I should try to strengthen my knee and hopefully get rid of the pain completely with physical therapy. So last week, I had my first appointment at Solutions Physical Therapy in Alexandria. Since I’ve never done PT before, I thought I’d give a short summary of my experience so far for those of you considering it for similar issues!
PT Session #1: Diagnostics and Exercises
I had my first appointment with my physical therapist Shera on Friday morning, and my first impression of the place was that it looked like a mini-gym with weight racks, a treadmill, an indoor bike and stretching tables in an open room. Shera took me into the one office, and after I explained my knee problems and my goal to strengthen my knees to run without pain, she had me walk around with my pants rolled up so she could observe my leg structure. She also tested the strength of my muscles by placing her arm against my leg at various angles and having me press against it. After about 20 minutes of examining me, she made a couple of observations:
– I have flat feet and am slightly bow-legged…
– My kneecaps move out to the side when I straighten my knees
– I have “substantial calves” (I’ve always known this)
– My upper leg and hip muscles are very weak
Shera confirmed that my pain was being caused by my kneecap grating against the femur (PFPS). She thought this was being caused by both my build (flat feet and bow legs), which tends to put more pressure on my knee joints, and also muscular weaknesses in my upper legs, which I’ve compensated for by over-using my calves when I run. So the plan was to strengthen my upper legs to improve my knee tracking and overall running form. She also suggested orthotics to help with the flat feet (I might dig out the orthotics the podiatrist made me last year, which I never used…)
She assigned me to do the following during the week, and watched me perform each exercise in the office to correct my form:
1. Dynamic warm-up – slow straight leg marches, quad stretches, and knee hugs for a few minutes before each run to warm-up
2. Cool-down stretches – calf, hip flexor and quad stretches after running
3. Daily exercises – regimen of exercises to be done daily, like hip adductors and abductors lifts, clamshells, squats etc. There’s about 8 exercises in all (takes me about 20 min a day). She gave me a Thera-band to use for the squats and clamshells and told me to use ankle weights for many of the other exercises to strengthen my muscles further.
PT Session #2: More Exercises and KT Tape!
My second session on Monday involved more of the same exercises, with Shera watching and correcting my form – this part reminded me of piano/ violin lessons as a kid! She also had me change into exercise clothes and sneakers so that she could observe me running on the treadmill. After a few minutes, she noted that I ran on the balls of my feet (my heels don’t touch the ground) and would probably be a good candidate for minimalist shoes. I might take this route in the future, but given my plantar/ tendonitis issues, I don’t think my feet are strong enough to run with so little support this year.
The other thing we tried was kinesiology (KT) tape over my knee to hold my kneecap in place. Apparently this stuff is waterproof and stays in place for a few days, so she told me to see if it reduced the pain during the beginning of my runs and buy a roll if it helped.
The plan is to continue doing the exercises, dynamic warm-up and stretching for the next couple of weeks, and I’ll see Shera once more this week and twice next week. If the pain isn’t gone by then, I have to go back to the orthopedist to get a formal prescription for PT before I continue. My knee pain does seem to be decreasing, so we’re hopeful that a few more sessions will give me all the tools I need to cure this injury for good!
Have you ever been to physical therapy? Did it fix your problem?