What do rugby guys and powerlifters do for anterior knee pain?

[onspeed]

Hi guys

do get much AKP in your athletes with unknow etiology? Someone suggested to me that lineout jumpers commonly had this problem (or do they actually have jumpers knee? patellar tendinitis?)

Apart from ruling out obvious ITB issues etc what exercises do you find beneficial? and conversly flare it up?

We find that tall sprinters with narrow hips and long femurs are quite prone to AKP wthout any obvious tightness or stretching issues – these athletes also typically have problems developing VMO but no problems developing V Lateralis

We have found that adding in terminal knee extensions using getstrength type bands with an isometric hold really helps as does kneel squats. Likewise ham-glute work seems to help (possible tightening up knee joint). Obviously ice on the knees post workout helps the pain.

I would appreciate hearing firstly if this is even a problem in rugby / powerlifting (outside of obvious knee damage or ITB problems) and if so what solutions you guys have found!

Thanks guys

[ashley]

Sorry mate showing my ignorance but what does AKP stand for, we have issues with patella tendonitis at times, I like 1 & 1/3 leg extensions for medialis, also some heavy 1/4 squats and also explosive quarter squats if there core can take the loading, cheers, ash

[onspeed]

thanks Ash! and I dont believe ignorance is part of your vocab mate – you are a seeker mate !!!

that reflected my poor typing skills (and my laziness) – akp = anterior knee pain

on the explosive part squats mate – I am guessing you would totally avoid them in any history of lumbar injury/ pain?

Sprinters mate – everyone looks at them and thinks what great athletes! They are basically a bag of compromise – small bones and joints big muscle and contractile ability – many of them are hypermobile around lumbar 5 and end up with spondylolithesis – its like nursing a loose sack of bones – yet tey squat twice bodyweight below parallel likes its a baby

thanks mate – we are damn fortunate to have your contributions on this forum!

[ashley]

Cheers mate as always way too complimentary, I saw Christie do some of these 1/4 exposinves a long time ago and it really impressed me, yes if any contraindications they are cut out and we work around it, we have a power sprinter, prone position, alternate leg action, driving backwards whislt shoulders are locked in to a pad, thanks, ash

[fergus]

Anterior knee pain can be from a number of factors but one of the most often seen issues is Chrondomalacia Patella (CMP) or poor tracking of the patella.
With weak VMO also look for glute misfiring also as often the two go hand in hand causing that medial bow in the upper leg.
Terminal knee extensions and Petersen stepups are very good for VMO firing, but also 1&1/4 squats (at the bottom of the squat) as the VMO fires coming out of full flexion as far as I can remember also.
I do remember one case of what I thought was CMP and I treated it as such, but this only resulted in more pain so I treated it as hypertonic quadriceps in general rather than misfiring VMO and this relieved the pain immediately – just pointing out that the misfiring can also be simply a case of hypertonicity rather than weakness of VMO.

[onspeed]

hypertonicity!

good lateral thinking

cheers ferg

[onspeed]

Ash

mate! – and I think you are too humble – but that a damm fine trait my friend!!!!

nice I like the idea of prone position power training – great activation of posterior chain – less pressure on vulnerbale knees!!

thanks my friend – always appreciated!!!

[onspeed]

ash / ferg

we need to steal guys like you away from that silly oval ball game and into olympics … we are so short of quality minds in condiitoning!!

No – I jest – rugby is a damn fine game too!

thanks Gents

one thing I like about this forum is the eclectic mix of minds

[fergus]

Prone work is interesting – possibly sled work too?

The problem I guess is – are you reinforcing an error or fixing it? So a combination of rehab exercises and general strengthening is best.

Certainly the diverse areas of interest is what makes it interesting here!! Great challenging topics to think about.

As for Olympic sports vs rugby – any sport will do for me!!
(once the athlete is keen!)

[fergus]

Oh and reverse sled pulls with emphasis on the full extension can hit the VMO nicely too

[onspeed]

yes – we do the reverse sled work – part of a superset on speed days
speed squats – heavy sled pulls

its great! and they really enjoy the contrast

with sprinters ferg we use the 10 second rule …. that as long as you can expect to get their attention!!! :>>>

[fergus]

Well that brings us back to personality with many of the sprinter personality types doesn’t it? 🙂

[onspeed]

and that interesting interaction between physiology and psychology !

which drives what and when and why!!

cheers my friend

[ashley]

@onspeed 433 wrote:

ash / ferg

we need to steal guys like you away from that silly oval ball game and into olympics … we are so short of quality minds in condiitoning!!

No – I jest – rugby is a damn fine game too!

thanks Gents

one thing I like about this forum is the eclectic mix of minds

I always agree with Clint Eastwood in Dirty Harry that “a man has got to know his limitations” rugby is just fine for me, cheers, ash

[drlukemccabe]

Hi guys just thought Id add a little to what everyone has said… again, in my humbled experience of these sort of things, you tend to find that the debate for CMP still rages, and tends to only exist in young teenagers, as it is softening of the bone.. the evidence out there still does not say yes or no for this type of diagnosis and so in my thought prosesses I never use when looking at some of my athletes..

you are 100% correct in terms of the quads being the problematic area.. whether of not its a weak or dysfunctional VMO (which may I also say research on cadavers suggests only 35% of people have one..) or another part of the quads.. patella tracking is also part of it, but again is influenced by the quads.. The process that tends to happen for AKP is this. the quads all form the pre-patellar and the patellar tendon. the patella itself is actually enveloped by the tendon and the tendon then inserts into the tibial tuberosity, where alot of the CMP arguement comes from, well just superior to it. now my understanding is that as the quads become hypertonic/dysfunctional/weak, they start to tighten up like most muscles do, this then pulls on that tendon, causing the tendonitis like Ashley mentioned, but more importantly it drives the knee cap posteriorly into the structures below, mostly condyles of the femur and tibia, this casues irritation and an inflammatory process around that area and is why most people complain of pain in and around there..

as apposed to addressing the problem, I also like to look at why this has come about.. I tend to look for answers in the pelvis (which can cause strain on all the musculature) and also the lumbar vertebrae. Reason why is that if you think of the spine simply as a power supply or mains box to the muscles. now if you go to mains in a house and turn it off, it doesnt matter how many times you turn light switch on/off, lights wont work and same thing happens in body.. if the quads are only getting 60% of overall out, yet the athlete continues to put the same demands on the quads as he normally does when 100%, then over time they will tire out… tired muscles become time/weak and then you start to get problems… so I tend to ensure that poewr supply to these areas are fully functionally while rehabbing them, cus if not, no point rehabbing a muscle if can only get to 60% power output…

just thought I’d throw a little of my knowledge in there and see what people think.. sorry if came out all confusing, have just been talking to myself and typing haha…

keep up good work guys, loving the debate!

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