Kneemageddon- the story so far.
I’m starting this one off with a big old disclaimer that I am not specifically qualified to offer advice on joint health/injury, and the conclusions made here are my own opinions based on my own experience, and cannot necessarily be applied to anyone else. Ok cool.
It’s important for me to write about my knees. Not because I have a particular need to share details of this body part, but because of how impactful the whole saga has been on me as both a coach and athlete.
My knees started to bother me during the OG 2020 lockdown. I had access to pretty much a full set up and took the opportunity to train more than I ever have. My perspective around how I could best progress as an athlete at that time can be summed up as more = better. So I was living the dream (lol at how much this really did backfire on me). By the end of May I was undoubtedly the strongest I’ve ever been. But my knees were starting to hurt. Initially it was really just stiffness that disappeared as I got going. Then it was more than that, but some targeted stretching and warm up movements could sort it, and I was still training normally.
Then I started to get sharp pain in my right knee as I moved through full flexion; now it was interfering with my training. I can’t exactly recall when the joints started to obviously swell, but it was around this time.
Loss of function actually peaked after going surfing again for the first time post-lockdown. Jumping around in the shallows and walking across the beach and over sand dunes… afterwards I couldn’t walk comfortably and had lost full extension in my right knee. Those particular symptoms were short lived, but it was at this time I realised it wasn’t something I was going to be able to ignore and would go away.
While it started in my right knee, over the 2.5 years since I’ve actually had more issues with the left, and neither has returned to baseline. I’ve worked with five different physios, an osteo, a chiro, and two sports doctors. I’ve tried an extensive range of passive and active treatment options alongside various methods of managing pain and inflammation. I have achieved brief periods of pain free training (assuming adequate warm up), but something has always been ‘wrong’. There are movements I used to do without conscious thought, like getting on and off the ground, that I no longer perform the same way or without hesitation. I hate the nervousness I now have around movement; always bracing for pain, even when there isn’t any. As far as I can recall I have only managed to complete one block of training since without a flareup, and I’ve not got back to the same level of strength since. As a result of pain and inflammation affecting my positions under load, I’ve also had a slew of other issues crop up as a byproduct, mostly in my shoulders and upper back. I used to be incredibly proud of my physical self and the trust I held in it’s ability to handle any stress I placed it. Now I’m wary of anything involving knee flexion or impact. It’s a difficult thing to wrestle with.
How exactly did we get here? I’ve had a few minutes (months) to think about it and a few other brains to consult, and here is where I’ve landed; misalignment through movement. Both my patella tracking, and my femur in relation to my tibia as the joint flexes and extends. I know this to be true because of the pattern of wear shown through imaging. I now essentially have early stage osteoarthritis in both joints, but it took time to get this way so the issues are definitely historical.
Where did the alignment issues stem from? At this point, who knows. Little bit of this, little bit of that, unfortunate combos and timing. Here’s some stuff that at the very least didn’t help, and maybe probably contributed;
I competed in trampoline gymnastics in my teens and incredibly, never died. I did however experience some fairly major ankle sprains that I definitely never rehabbed under professional supervision, and the only accompanying strength work I was doing was midline focused. Reasonable to assume I had compromised ankle stability which invariably affects things up the line
Once I got into actual strength training, my body let me get away with some pretty horrendous squat patterns, and early on I wasn’t working with coaches who had the skills to support me. Like there’s valgus and then there’s valgus (knees caving in). I was also a big fan of the ‘good morning hybrid’…why squat with your legs when your back can do it…. In everyone’s defense I was also pretty stubborn and didn’t really care how I moved, just that I stood it up.
I may have FIA (Femoroacetabular Impingement), or some sort of anatomical hip restriction. I haven’t had a diagnosing scan, but practical assessments indicate something along those lines. Note I have never had any real issues with my hips. The theory only holds up under the premise that the restriction (in my case hips that don’t particularly enjoy rotating externally/out) has been managed through compensations through other joints…such as the knees.
I have absolutely no neural control of my feet. I cannot move my toes in isolation. I have no idea why, but whatever adjustments of balance the toes are usually responsible for in movement, mine don’t do that with any sort of nuance. I don’t know what this means for the rest of the leg, but I can’t imagine it’s an ideal scenario when trying to produce then absorb force and maintain balance.
Besides the hips and feet, my mobility is actually really good; to the point where in weightlifting it has allowed me to dive into receiving positions and use my joint end range as the brakes. Bar feel and moving with it has always been something I have struggled with, so you pair that with the diving and not shockingly the bar has crashed on me in the snatch and clean who knows how many times. Lack of control under load, sure joints love that…
So yeah all things considered the old knees have possibly been taking one for the team for quite some time. Circling back to around May 2020, I think with the extra training (and absolute intensity as the loads were heavier #stronk and (lol) so was I #covidkilos) I just finally surpassed the point at which my knees could handle it.
Recovery.
As with the likely complexity in the cause of the issue, what solutions, if any, are just as complex. We’re not there yet.
After Nationals in November I stopped lifting- i.e. I had continued to lift in some capacity at all times since June 2020. That often meant powers, reduced range and reduced impact. But always lifting. And always trying to be back for the next comp. It wasn’t until North Island Champs in June 2022 that I pulled back and didn’t compete. I can acknowledge the approach of keeping on keeping on didn’t serve me- while also recognising that it is complicated, and at the time the thought of not lifting was less tolerable than trying to continue to lift.
I received cortisone in both knees a few weeks before Nationals. Once this wears off in the next couple of months, I will book in for PRP (Platelet-Rich Plasma) treatment. No guarantees for any long-term effect, but worth a shot.
In the meantime, the Olympic lifts are not a priority. I’m doing associated movements to keep feeling like I’m doing something related (pressing, muscle movements, pull variants), and keep a bit of load going through my skeleton. Otherwise, I’m extremely rehab focused alongside some upper body bodybuilding.
Knee rehab is addressing all of the work-ons I have identified throughout this journey. Lots of mobility things (feet and hips in particular), lots of neural pathway stuff (how I’m completing movements), lots of low-impact slow eccentric strength, a few holds for good measure, and hopefully eventually some body weight reduction… So not one particular thing.
As much as I’d rather not be in this position, there is a huge amount I’ve gained from this journey so far- not only in coming to understand my own approaches and perspectives, but in knowledge gained around movement execution and control. It’s definitely helped me to develop a more discerning eye when it comes to coaching and correcting movement, and effective cues. I have a much better understanding of what it means to train with an injury, and an appreciation that chronic injuries can be rather…complex.
The circumstances that led to my issues likely started in my teens. As a coach now armed with that knowledge, I feel a huge amount of responsibility to do what I can to prevent anything similar in athletes I work with, particularly youth.
I do believe that I an capable of getting to long-term pain free function, and I hope I can avoid the need for future knee replacements. I do accept that pain free might not allow for involvement in weightlifting the way I would like to, as the associated force is just too much. At the same time, I bought an Eleiko barbell last year and I mean it’d be rude not to put it good use… so let’s see how the next 6 months go, see you out the back.
