Im going to start this blog with a bit more of a personal touch than usual, since for many years, I was the gymnast. I was the gymnast versing knee pain. It started when I was around 12 or 13. I had some pain below my kneecap. First it was right, then it was left, then it was right again. I went to multiple orthopedic doctors and got diagnoses of everything from patellofemoral pain syndrome and jumpers knee to chondromalacia, patellar tendonitis, and my personal favorite "growing pains." I was prescribed physical therapy and I went to multiple facilities who had me doing everything from straight leg raises and step ups to tens units, ice massages ultrasounds etc. Occasionally I would find something that would make some improvements, but overall I continued to deal with the pain. I wore braces and straps and tape and took Advil and alive. At one point I was prescribed a higher dose of what was essentially Aleve and it did give me some relief, but due to kidney risks it was not a long term solution and so back to the pain I went.
So here I was, 14 or 15 years old by this point and cycling through different pills that would control the pain. Now, while these weren't opioids or what we traditionally think of as "pain killers" they didn't come without side effects and were a lot more like a band aid than a solution. I was training in the gym as much as I could, but at times the pain was pretty serious and made me want to quit gymnastics, but I never made it more than a week or two without asking my parents to take me back to the gym. My state meet came around and despite not being able to train much that year, I felt ready and was hoping to make the regional team, and perhaps go on to Easterns (I was a level 9 at the time). I was always a twister on floor so I finished my routine with a double full. I landed and felt a searing pain in my knee I had not felt before. I did my last pose and hobbled off the floor. I had vault as a last event, but when my coach saw I could barely walk, he pulled me from the lineup. I had several college visits and meetings with coaches planned for the following week, and spent the next few days figuring out how to hide my limp so they wouldn't see. I didn't know what I would do about my knees, but I knew I would figure it out and was excited about the prospect of competing in college.
Upon return from my college visits, I had a visit with the doctor I had been seeing, a well renowned non-surgical sports ortho. He scheduled me for an MRI, and upon getting the results called my parents and had them schedule my follow up with his associate (who was a surgeon) rather than him. I found out I had a 7/8 tear in my patellar tendon, and would need surgery. I would also undergo a meniscus repair, and a procedure called a micro fracture where they would drill into my femur bone to create some material to replace cartilage that had worn away, likely not from that injury but from previous "wear and tear".
I had the surgery and despite some setbacks managed to get back in the gym. Due to the surgery, the full recovery process was about 18 months. The timing of the injury was unfortunate, and took away hopes of a scholarship, but I ended up finding a D3 school that would support my recovery and allow me to continue to train and compete when I was ready. The beginning of my freshman year was great, I got all my skills back and more and developed a new found love for competing gymnastics in a team atmosphere. I still had some knee pain here and there, but now had a team of athletic trainers to help me and it was nothing like I had dealt with before, so I was able to push through.
January came and with that competition season, and I was slated to compete floor exercise and bars in our first meet. The night before, coach let everyone have the night off except asked a few of us that were competing to come in and just do one routine on the event we were competing to help our confidence. I came in, warmed up and got ready for my floor routine. I was still competing that double full last pass and had been nailing in all year. However something went wrong this time and while my recovering right knee did fine, my left leg did only a 1.5 twist while my body did a double. I screamed out some expletives and was laying on the floor. The ATCs ran over and after a few quick tests told me I tore my ACL and would need surgery. Back to the surgeon I went who confirmed this was in fact the case, and that in addition I tore my MCL and LCL as well as both medial and lateral meniscus. Back to the OR I went and back to PT and recovery.
To say I was frustrated would be an understatement. But to say I was determined would also be an understatement. I attacked rehab head on, at times spending hours in the campus gym on the stationary bike, just trying to build some basic strength back.
Fast forward a year and I was back in the gym, feeling strong with a new found love for swinging bars and a few new knee ligaments. Basics in the gym felt great, but as soon as I started to advance my skills I had pain in my knees. Sometimes it was the right, sometimes it was the left, sometimes both, but the consistent thing was that I could not get through a tumbling or vault assignment without significant pain. I was frustrated, my coach was frustrated and eventually I made the tough decision to leave the sport that had shaped me.
There is a lot I could add here, but since this blog is about knee pain I want to fast forward to the part where I figured it out and got out of knee pain --> I eventually joined the diving team, and as part of our training we had a weight room program. Shortly after I started the coach noticed I pushed my knees forward and in as soon as the weight got a bit heavy. I also usually had some pain at this point. They had me do a few drills to fix this, and within weeks I was building my squat completely pain free. I realized I also pushed my knee forward and in when I ran, walked down the stairs, and jumped rope, all things that normally gave me pain. I fixed this, and my pain went away.
So Sara, now that we know your life story, what is the take away from all of this??
Is it that you shouldn't lift weights because thats when your knees did something wrong that caused you pain?
NO! This was actually how I found the solution to my problem. Prior to this, a lot of my rehab involved basic exercises which I was completely fine with. As soon as things got harder and more complex, the problems came out. When tumbling, gymnasts can experience forces through their legs equivelant to more than 10x bodyweight. If they have mechanical faults squatting 1.5-2x body weight, you can bet those things will be worse when tumbling. We may just not see it as easily because it happens so fast.
Is it that all of the Doctors and PTs you saw when you were young didn't know what they were doing?
No, I had some wonderful healthcare professionals. However, the problem was either 1 - they were looking for a structural problem (what things looked like inside) when I had a functional problem (how I was moving) or 2 - they didn't challenge me enough to see this problem - I was completely fine with basic exercises, but when things got harder is when the problem came out.
Is it to not push your knees forward and in when you squat?
No, well yes, but no. It IS to get evaluated by a movement professional who can determine what your/your gymnasts mechanics are like and if they are potentially putting them at higher risk for injury.
If your gymnast has knee pain, the time to get it fixed is now. The diagnoses that I mentioned above (growing pains, patellofemoral pain syndrome, patellar tendonitis) don't just happen for no reason. You need to find someone who will get to the bottom of that and get rid of it for good, not just teach you how to manage it with modalities (ice, anti-inflammatories, or fancy braces and machines)
If you are interested in learning more about the 3 types of knee pain I see in gymnasts and how to fix them, click here to sign up for my live webinar on this topic. Even if you cannot make it, or you are reading this after the fact, sign up to receive a link to a replay.
If reading this resonates with you, and your gymnast is in the cycle I was as a teenager, back and forth to PT and cryotherapy and in the gym and out of the gym and at the pharmacy, click here to fill out a form so I can get some more information and see if I can help you get to the root cause of your gymnasts knee pain, and get rid of it once and for all.