i wrongly assumed it had to be an MCL strain due to it's location, clicking, half-buckling descending stairs, but because the pain is randomly intermittent level 0-9, with no knee joint tenderness, the ortho's formal diagnosis was a simple knee misalignment.
the soonest appointment with a physio is 4 weeks out, but after 15+ years of on/off knee pain, now full tilt limp-grade with randomly excruciating pain in bed, i had to do something about it asap.
after 2-3 hours of online research incl youtube physios, one guy/channel gave me the big clue to the fascinating deeper root cause and i was able to test the theory and make this old knee pain go away with easy leg presses and easy 15min bicycle at the gym. pain and clicks immediately subsided, lasting 3+ days so far. details below on instant miracle cure...
my parkinson's yoga teacher Petra replied to add:
This makes sense. People with PD are known to have weak hips/glutes. Actually most people who don't workout consistently and sit at the office or in a car all day have what they call 'glute amnesia' aka 'sleepy butt'. PD makes it worse due to the neurological issues. [she suggested exercises i include below.]
thursday
searched: patellofemoral pain syndrome runner's knee
found two factors re patella sliding to outside of knee incl weak VMO
searched 'VMO' on a physio youtube channel: jackpot!
friday
I think I found the smart out-of-the-box physio video that helped me figure out what the root problem with my years of knee pain knee alignment is, which muscles are likely the root contributors and it isn't frontside muscles ex quads or around the knee, but most likely weak and atrophied muscles up high on the back side of my leg the glutes and hips, that even now on meds have been failing me more than other muscles to where getting in and out of the car/bed continues to be super difficult which all lines up and makes sense. after a short walk in the exam room, the ortho PA said my always-tight calf was atrophying which made sense and fits the left leg's 15+ year history.
I'm tempted to setup a followup visit with the orthopedic MD and strip down as needed to see if she can ID atrophy in my L glute which is what i'm sure is at play and has been for 7+ years and was one reason i had to always wear a knee sleeve to play soccer late 40s, couldn't jump forward or sideways in basic warmups and had to quit soccer. but it's fairly safe to assume glute atrophy for a few reasons incl how back in 2006 when I met Tanya, a muscle/posture pro, she immediately spotted it and i had been walking miles every day on hills with a book/laptop pack for months.
obvious to me in retrospect are two things: daily walks are not enough to adequately strengthen glutes and glute atrophy was actually an early neurological neuro-muscular clue as was wobbly one-leg balance in yoga class.
based on the video and a history and a hypothesis that fits, i gotta go the gym to test the theory; exercise my glutes as the simplest way to stimulate/activate the glute and see if i notice an alignment fix so I can walk again.
if that proves to work, i may want a real bike, so will need to fix the garage door spring so it's easy to open/close and make room for a bike by giving the neighbor back his wheelbarrow and move the generator to the yard where it might best permanently live with a tarp over it.
punchline
- re patella knee tracking, in reality, it's the position/rotation of the thigh bone influenced by the glute, so it looks like the knee is rolling outward when really weak glutes/hip are rotating/rolling the thigh bone inward.
Does Strengthening The VMO Really Help Knee Pain? (10min)
El Paso Manual Physical Therapy
VMO (Vastus Medialis Oblique) muscle weakness is always blamed for knee pain, yet it's only at fault in very specific situations. For people with knee pain, who haven't had any trauma, the VMO is rarely ever the problem. In fact, getting the VMO stronger can make knee pain worse!
i'm 56, a desk jockey researcher, havent yet seen your 5 glute muscle exercises, but this glute idea instantly made so much sense on many angles incl a 15-year (pre-parkinsons) history of knee pain and atrophy in the same leg's glute and now calf too and how weak glute/hips are also characteristic of parkinsons (makes it difficult, a near impossible hurdle, for the L hip/glute to lift your leg out of the car and then to stand up).
it clicked on all cylinders, and unable to see a physio for next 4 weeks, i had to do something asap, so i had to go to the gym (first time in many months) to do the simplest test i could think of. believe it or not, i fixed the issue with one easy workout which in my view is a major validator worth sharing to motivate others...
saturday, i did a token easy 70% effort 'no sweat test' incl 15min of bicycle, 3x 24 (100-115 lb) reps on leg press, 1x 12 reps donkey kick glute machine (20lb on L, 30lb on R). sunday gait was 85% normal, monday 95% normal, tuesday and wednesday ditto. i'm so glad to identify the root cause and find instant relief.
after 15-years of on/off pain, a knee sleeve required to play soccer, last 4-5 years of walks getting ever shorter due to knee pain sneaking in, finally culminating in the last 15 days of hinged knee braces, baby stride limping to avoid bending the leg and random excruciating pain in bed and on wonky turns, wrongly thinking it was MCL, this token exercise provided immediate 'miracle-grade' relief (not placebo).
video notes:
1:47 but medical research shows VMO is not the main reason of misalignment if no trauma to knee involved incl surgery or accident. 4:22 VMO litmus test to ID weak VMO...
6:18 if VMO is OK, you need to look for a muscle imbalance and it's almost always a glute weakness on the back of the hip. i have a great video to get you started working on your glutes. 7:13 a stronger VMO can add to pressure in the knee, can grind on the joint.
7:37 re patella knee tracking, in reality, it's the position/rotation of the thigh bone influenced by the glute, so it looks like the knee is rolling outward when really weak glutes/hip are rotating/rolling the thigh bone inward.
my parkinson's yoga teacher Petra added:
ACE exercises that create the most contraction in the glutes was quadruped hip extensions (we do this on all fours, lift leg up) but they also mention squats, single leg squats, lunges, and step-ups. You can add weight ex goblet squats with a kettlebell or holding dumbbells while doing lunges etc. For most contraction in the hamstrings it was kettlebell swings, singe arm/single leg Romanian deadlift, prone leg curls.
Feb 26, 2021
4:19 straight leg plea fire hydrant (quadruped hip extensions toes turned outward) 6:32 donkey kicks 8:24 wide knee low bridges 11:34 clamshells (isolates gluteus medius on side of hip) 14:11 isometric plea squat toes turned outward, wider knees, push hips forward.
Learn more about the 28 Day Knee Health & Wellness Boost Program:
https://www.epmanualphysicaltherapy.c...
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Glute exercises are CRITICAL for fixing knee problems for the long term! NOT quadricep or hamstring muscles.
In fact, strengthening quads and hams might feel good in the short-term, but more strength tends to make knee problems worse over time.
Getting stronger in the quadricep and hamstring muscles will create more arthritis, meniscus problems, cartilage damage, tendonitis, IT band syndrome or ligament problems.
The reason quadricep and hamstring strengthening makes knee problems worse is because it creates more knee pressure, rather than reducing pressure. Over time, this creates more inflammation and knee injuries worse.
This is sooo backwards thinking from what is usually recommended: Knee problems = Knee muscle strengthening.
But the research is growing more and more. And the patient success stories are growing too!
Really the only time we recommend patients directly strengthening their quads or hamstrings is after a traumatic knee injury (like a car or sports accident) or surgery (ACL, meniscus or knee replacement) because these muscles will be much less active after these events.
But if you haven't had a traumatic knee injury or knee surgery, and your knee problem just crept up over time with normal everyday activities and exercise then you MUST pursue glute muscle strengthening!!! And DO NOT pursue quad or hamstring strengthening!!!
Now I'm saying it's bad to ever feel your quadricep or hamstring muscles working. No, they will work normally, but they should be secondary to your glutes with nearly every leg motion.
If you don't feel your butt muscles getting tired regularly with leg exercises, then there's a big chance you've got a muscle imbalance and you're using quads, hamstrings or even lower back muscles too much.
It's only a matter of time before a knee problem progresses to a chronic knee problem.
So get going on these glute exercises. Make your glutes work harder and more often. You need more strength back there and you need to use them more!
Glute exercises are CRITICAL for fixing knee problems for the long term! NOT quadricep or hamstring muscles.
In fact, strengthening quads and hams might feel good in the short-term, but more strength tends to make knee problems worse over time.
Getting stronger in the quadricep and hamstring muscles will create more arthritis, meniscus problems, cartilage damage, tendonitis, IT band syndrome or ligament problems.
The reason quadricep and hamstring strengthening makes knee problems worse is because it creates more knee pressure, rather than reducing pressure. Over time, this creates more inflammation and knee injuries worse.
This is sooo backwards thinking from what is usually recommended: Knee problems = Knee muscle strengthening.
But the research is growing more and more. And the patient success stories are growing too!
Really the only time we recommend patients directly strengthening their quads or hamstrings is after a traumatic knee injury (like a car or sports accident) or surgery (ACL, meniscus or knee replacement) because these muscles will be much less active after these events.
But if you haven't had a traumatic knee injury or knee surgery, and your knee problem just crept up over time with normal everyday activities and exercise then you MUST pursue glute muscle strengthening!!! And DO NOT pursue quad or hamstring strengthening!!!
Now I'm saying it's bad to ever feel your quadricep or hamstring muscles working. No, they will work normally, but they should be secondary to your glutes with nearly every leg motion.
If you don't feel your butt muscles getting tired regularly with leg exercises, then there's a big chance you've got a muscle imbalance and you're using quads, hamstrings or even lower back muscles too much.
It's only a matter of time before a knee problem progresses to a chronic knee problem.
So get going on these glute exercises. Make your glutes work harder and more often. You need more strength back there and you need to use them more!
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