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training legs/quads with knee cap arthritis

Posted: Thu Aug 15, 2013 10:02 am
by FragenAnsLeben
I the problem is that: I have osteoarthritis of my right knee cap and trochlea due to severe dysplasia. I have some cartilage left, but have already a bone edema on the knee cap. Also my knee cap is unstable, due to that dysplasia. Luckily my knee is decently stable, due to some strength. I'm an athlete since childhood and lifting weights for about 10 years. I'm female 33yo, bw 60-63 kg, depending on season.
I think I have very good knowledge about training, but think, maybe there is something out there I have missed yet.

The problem is to train legs and especially quads under the given condition. I had a long bout of activation of that arthritis until one years ago, so I know that knee definately has it's limits. Right now I have worked up myself back to the following weights:
deadlift: 50-55 kg for 5x5 or 3x6-7
back squat: 40 kg for 2x5
front squat: 30 kg for 2x10
streight leg DL: 40 kg for 3x8

That's roughly what I can manage. I do either normal DL plus very light squat once per week or SLDL plus squat with weights like above. I throw in db lunges and farmers walk, TGU when my knee feels like it can take a little more, also depending on what volume I do outside of the gym that involves knees (cycling, swimming, walking).

I would like to know, if I can improve leg training and especially quad training without stressing the posterior knee too much. I know that this is contradictory. On the other hand since I brought up my quads again I have less symptoms. If I train them too much, I get again more problems.
Leg extension is out of question. Even light weights cause symptoms there.

I train 1-2 per week in the gym, depending ony season and 1-3 times I do something outdoors, also depending on season.

Maybe someone has a suggestion for me. Thanks in advance.

Re: training legs/quads with knee cap arthritis

Posted: Fri Aug 16, 2013 6:26 am
by Jungledoc
Well, it sounds like you have already answered your own question quite will. You have tried different things, kept loading light and found out what you can and what you can't handle.

I have a few thoughts. First on squats, make sure that you hips initiate the movement. Then go to parallel, but not much below. Go down with good control, slow down at the bottom, then start "gently" as you start up. You won't lift as much weight as you would if you got a good stretch and rebound at the bottom, but I think it will be better for your knees.

I would thing that DLs wouldn't be too bad. Have you tried using lower volume to allow you to take the load a bit heavier? Down to 3s or 2s, at least part of the time. The RDLs are a good idea, and you may be able to get overall improvement by maximizing these.

Have you ever tried pull-throughs? If you can get over thinking about how it looks to other people, it could be a lift that would help your PC without stressing the knees too much.

Those are what come to mind right off. Plus continue your cautious ways. When you find something that works for you, slowly build some volume, then cautiously increase the weight, then rebuild volume. Micro weights might come in handy!

Re: training legs/quads with knee cap arthritis

Posted: Sun Aug 18, 2013 3:30 pm
by newbienewb
Let me start by saying I am NOT and expert. With that being said, my wife suffers from very bad arthritis in both her knees. If she squats she cannot lift herself back up with out severe pain. We started doing box squats and she has been able to add weight regularly without hurting her knees or even feeling pain afterwards.

Re: training legs/quads with knee cap arthritis

Posted: Mon Aug 19, 2013 7:33 am
by Jungledoc
That's interesting, and good to know. How deep does she go? How wide a stance? How heavy is she lifting?

I'm just full of questions.

Re: training legs/quads with knee cap arthritis

Posted: Mon Aug 19, 2013 10:33 am
by newbienewb
How deep does she go? How wide a stance? How heavy is she lifting?
She does not go below parallel. Our thought was that if she can stand up from a chair without any pain then what would happen if we put weight on her back? We started out with a chair and now she uses my weight bench. We have been doing this for a few months now and started very slowly. She is now up to 70 lbs. doing 3x5. Her stance is wider than shoulder width. She is doing the low bar version. Doing high bar does hurt her knees.

She does not use any knee supports yet. But I am sure that will change eventually. Also paying very close attention to pushing your knees out when lifting is very important. DO NOT let them buckle inwards. If we start running into problems with knees trying to buckle inwards we will lower the weight and raise the reps. until we hit a goal amount of reps with perfect form.

When lifting from the seated position make sure to lead with your chest up. This causes you to lift at your heals and not your toes. That is very important as well. This puts less pressure on the knees.

Again, I am not an expert on this. We have just found that this works for us.

Re: training legs/quads with knee cap arthritis

Posted: Mon Aug 19, 2013 12:31 pm
by ephs
willkommen im forum!

Re: training legs/quads with knee cap arthritis

Posted: Mon Aug 19, 2013 4:27 pm
by Jungledoc
Newb, that's all good information.

I have arthritis in my knees, including the kneecap, but squatting has never bothered me. I guess my back is bad enough that this is the limiting factor!

Yes, I would have thought that a relatively wide stance would be an advantage, and that keeping the knees out would be important.

Does she do a general strength regimen? Are there other lifts that are limited by the arthritis?

Re: training legs/quads with knee cap arthritis

Posted: Tue Aug 20, 2013 8:57 am
by newbienewb
She does do the basic compound movements. Press, bench, deadlifts, etc.. SO far the deadlift have not caused any problems but she is still in the lighter weight. I am surprised by this because she cannot do certain cardio that has a similar stance. I suspect that this movement will eventually cause issues though.

She did do some knee exercises that was prescribed by her physical therapist. But all it did was make her knee sore afterwards and never really made them better. Basically according to her doctor she has no cartilage left in her knees. It is bone on bone. That and she did blow out both her knees during basic training when she was younger.

Re: training legs/quads with knee cap arthritis

Posted: Tue Aug 20, 2013 10:21 pm
by Jungledoc
Well, with DL I'd expect the knees to take more of the strain. I'm glad they are working for her.

It's a funny thing about arthritis, especially in the knees, the pain doesn't correlate very well to the condition of the cartilage. The pain comes, not from within the joint, but from the "periarticular" tissues, i.e., the stuff around the joint.