By: Ernesto Medina (www.ernestomedinadc.com)
In Motion Sports and Family Chiropractic
2165 Fourth St.
Livermore, Ca 94550
A couple of months ago I suffered a knee injury that is common in the Jiu-Jitsu world…a “popped knee.” While a popped knee isn’t the medical term for it, it’s the term we all use to describe the feeling of the knee popping, followed by intense pain, swelling and a stiff knee. In really bad cases, you may not be able to put weight on that leg, bend it or even straighten it all the way, thus keeping you away from your training. So the question is…what is really going on and what can I do to get back to training ASAP?
First…everybody’s favorite, a little anatomy. In the pics below you can see the basic anatomy of the knee, without muscles and tendons, just bones, ligaments and cartilage. The ligaments are what attach bone to bone. The muscles and tendons cross from one side of the knee to the other attaching to different bones to support and stabilize the knee during movement. The most likely scenario is that one way or another the knee got caught up, twisted or you stepped awkwardly causing the knee to collapse inward or outward over stretching the ligaments on either the inside/outside of the knee. The second possibility is that you hyper extended the knee getting knee barred, stepping off a curb wrong, etc. If that’s the case and the knee popped you strained, and in severe cases may have severely torn the medial collateral ligament, lateral collateral ligament, meniscus, ACL or PCL. The only way to confirm a tear is with an MRI, but there are a few things your healthcare provider (like myself… LOL) are trained to look for to help in a diagnosis.
First, did the knee swell? And if it did, did it swell immediately or after a few hours? Did it bruise? Immediate swelling and bruising is usually indicative of a muscle tear/strain. Ligament/Meniscal injury takes a few hours to see any noticeable swelling because of poor blood profusion…which is also the reason why ligament injuries take so long to heal. Blood carries oxygen and nutrients to all tissues to keep them healthy. Poor blood supply = poor healing. The second thing to look for… if the knee didn’t swell too badly and you can move it around does the knee lock or suddenly click not allowing full extension or flexion? If yes, this may be indicative of a meniscal tear. The meniscus sits in between the femur bone and tibia bone (refer to diagram above) acting as a cushion between the two. It literally moves and glides in between the two bones every time you bend the knee. When torn, it catches and gets stuck not allowing full flexion or extension of the knee until it pops loose. See diagram below. But hope is not lost, I recently read an article in a scientific journal stating conservative treatment (manipulation, rehab, etc) was just as effective in treating and maintaining a torn meniscus as surgery. The article did not specify the type of tear, but conservative treatments should always be explored before jumping into surgery. I have personally seen a small handful of patients at our office with mensical tears that chose to take the conservative route and are doing just fine. SMR is a huge tool that is way underutilized to help manage and prevent injuries. Foam rolling, lacrosse ball work and compression strapping the muscles of the leg helps to ensure those muscles are continually firing properly to stabilize and support the knee during movement. Any scar tissue and adhesions that build up as a result of heavy workouts is kneaded out to ensure proper and full contraction of muscular tissue. Those of you familiar with The Alexander method of SMR should definitely take the seminar. The class far exceeded my expectations and you learn tools that can benefit you the rest of your life.
In my injury, I had immediate pain and discomfort and couldn’t walk for about 20 min, and then I had full range of motion and was able to walk with no problem. I felt like I could have kept training. The next morning, I could not move my knee AT ALL. It was literally stuck in one position…it took me about 45 min to get to my bathroom which was only about 10 steps away. Through the night, all the swelling had surrounded the joint capsule basically locking it in place. Looking at it from the outside, the knee didn’t even look swollen, it was all in the pockets in between the muscles and joint capsule surrounding the knee. This can be a pretty scary feeling for anybody, especially if not trained in musculoskeletal injury treatment and diagnosis. Luckily, my training and education kicked in and I knew immediately what I had to do. I slowly started mobilizing the joint. Flexing and extending my leg slowly and repeatedly using my hands, not the muscles of my leg. If I tried using my leg muscles the pain was too great and my knee would just get stuck. So every time I manually flexed my knee in, I would gain half an inch. It took about 20 min, but I was finally able to flex and extend my knee almost completely, put weight on my leg and then limp to work. Once at work, the real treatment began. A combination of electrical stimulation, soft tissue manipulation and adjusting (joint manipulation) of the foot and knee ensured that proper mechanics were restored to the entire kinetic chain beginning from the foot all the way to the hip and pelvis. When injured, the body tends to create compensatory patterns to guard and protect the initial injury. If not corrected, that protection mechanism remains long after the injury is gone leading to weaknesses along the kinetic chain and secondary injuries. The final touch, Rocktape to stabilize and brace my knee while still providing a safe amount of range of motion until my next treatment. After 3 treatments and 2 weeks later, I was back squatting again. One week after that I was back to Jiu-Jitsu at 70% maximum output. In 4 weeks total time I was back at 100%. Considering the extent of the injury, I think that was pretty damn fast. Now I can easily manage the injury and prevent any aggravation by using the SMR techniques I know.
Overuse injuries such as tendonitis, tendonosis and bursitis are many times a result of poor joint mechanics and soft tissue adhesions that build up over time from so much use. Often times they can be treated over time by manually breaking up the scar tissue and adhesions, and restoring proper joint mechanics. Below is a picture of the many bursae that exist in the knee alone. Their purpose is to cushion and minimize friction in between tendons, muscles and bones. Too much friction = inflammation = bursitis. But that is another topic…