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First, let me make it clear that this doesn't feel like bad pain. It feels more like an overtraining/overuse type pain. If this were bad pain I'd be going straight to a doctor or physical therapist.

My Background/Physiology

  • 30 year old male
  • Very active in high school/college ('95-'03)
    • Including football, baseball, basketball, wrestling, track, and cross country
  • Ran marathons from 2005-2007
  • Sedentary from 2007 until February 2011
  • 6' tall, 215 lbs, 23.4% body fat (target weight: 185 lbs)
  • Large frame (8" wrist circumfrence)
  • Limited flexibility

In late February I began basic cardio focused workouts at the office gym. I did this for about 3 weeks and I started going to a CrossFit gym a little over 5 days a week (3 on 1 off). This gym's CrossFit style workouts are very beginner centric and rarely include more than 15 reps of anything. I have been working at home on my flexibility and mobility doing many of the exercises shown on the Mobility WOD.

Diet/Supplementation

I take daily multivitamin and fish-oil supplements. I'm currently eating a high protein, high fat, low-ish carb diet. My carb sources are primarily bananas, apples, and sweet potatoes. Basically paleo, but I cheat one day a week.

Thirty minutes before each workout I drink a pre-workout amino acid cocktail which includes Beta-alanine, L-Leucine, L-Isoleucine, L-Valine, L-Arginine, L-Taurine, L-Carnitine, alpha-Ketoglutarate, and Citrulline. Within 15 minutes of finishing each workout I drink a combination of a protein mix and a post-workout amino acid elixir which includes L-Glutamine, L-Leucine, L-Isoleucine, L-Valine, L-Arginine, and Citrulline.

With this diet and supplementation I have never experienced significant soreness the day after a workout, except for the first week of CrossFit. Even on days where I killed my back due to my poor clean form I have been fine the next day.

Get to the Point

Yesterday's workout was as follows:

2RFT

  • 10 pullups
  • 100m sprint
  • 10 jumping squats
  • 100m sprint
  • 10 push ups
  • 100m sprint
  • 10 box jumps
  • 100m sprint
  • 10 dead lifts (175#)
  • 100m sprint
  • 10 jumping lunges
  • 100m sprint

I completed it in just over 16 minutes. I was definitely gassed halfway through the second round. My sprints had become a jogging shuffle, and I had to do regular lunges in place of jumping lunges. This was definitely not the most intense workout I have done, but it did have more jumping than usual. After the workout my quads and calves were sore, but not exceptionally so.

I woke up this morning with a very very stiff right knee. It hurts to put it into full extension, and it hurts even more to bear weight on it in full extension. With my knee slightly bent everything is fine. After I have sat at my desk for a bit with my knee at 90 degrees I cannot walk very well for the first minute. I have a distinct limp. After about a minute or two of walking it is more or less fine as long as I avoid full extension (I don't normally lock my knees out when walking anyway). The pain is focused on the medial and lateral sides of my lower knee, maybe even below the actual knee.

Let me show you where it hurts:

medial pain locationlateral pain locationmedial flexion painfull flexion torqued

I should mention that the pain is also triggered when my knee is in extreme flexion, and also with my hip in simultaneous flexion, abduction, and lateral rotation. That last picture demonstrates this: flexing my knee as far as it can go and cranking my ankle up towards my chin.

I don't feel any point tenderness anywhere on my knees. I've pressed and poked everywhere with rather extreme force and have felt no tenderness. Almost forgot, when my knee is in full extension I felt some slight discomfort on the medial side at the end of my hamstring behind my knee. I can bounce on my toes flexing both my ankles and knees on landing without feeling pain, as long as I avoid full extension.

Question(s)

So is this just an overuse injury? Is it even an injury or just fatigue? Does it have a name? What could have caused this: the jumping, the running? Thankfully today is my rest day, so I have all day today, and most of tomorrow to recover.

What should I avoid or try to be aware of during my workouts to prevent this?

Misc. Stuff that might be relevant

I've been working out in Vibram FiveFingers for the past week and a half. I have had to adapt my running gait to accomodate this. I was previously a heel striker, which is impossible in barefoot shoes, so I'm now trying to do a forefoot strike. I can definitely feel the difference in my calves.

Also, I obsessively roll out my muscles before and after every workout using both The Stick and a Rumble Roller. After last night's workout I think I did neglect my calves a bit, because they didn't feel that bad. I focused on my quads back and glutes.

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What a well written and not quite concise question Hobodave. Plus I love your legs. Get well soon sweety! –  Holocryptic Apr 20 '11 at 20:40
    
the spot you point out seems to be your meniscus –  kjy112 Apr 21 '11 at 16:30
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3 Answers

In my opinion, there is nothing "beginner" about exercises in sets of 10 and explosive movements...even if it is only a 16 minute workout. When you train your body, you tear muscles so that your body can repair them in the time between workouts. It's great that you're not usually sore, because that leads me to believe that you are recovering properly. However, tendons and ligaments do not tend to strengthen and/or recover as quickly as muscle tissues, so when you do lots of explosive movements and low to moderate reps sets (as opposed to high rep sets), your muscles have the ability to keep up with the increasingly difficult workouts, but your connective tissues tend to lag behind. Under continued stress over time, you'll set yourself up for injury. You could be experiencing a soreness in the connective tissues that are beginning to wear down, and you really should switch your training to higher rep sets and elliminate explosive movements for a couple weeks and then transition back to your current training program and see if the pain persists.

The vibrams are going to cause you to move in a way that your are not conditioned for, so there are going to be pains in one place one day and they'll move to another place the next. You can easily acrue an injury wearing them for the types of workouts you're doing if you make a cold turkey transition.

You should treat this as if it were an injury. Take some ibuprofen, and ice both knees several times a day for 20 minutes. I'd back off of the rolling for a couple days too because it could contribute to inflammation while your body is trying to heal.

Another thought (although from the area you're complaining about, I really don't think this is it) is that your glutes and/or piraformous are tight. It is not uncommon for tightness in the glutes to cause pain in the knee. In fact, any imbalance in flexibility between the quads, hamstrings, glutes, or hip flexors can cause pain in the knee. It's just most common that it's tightness somewhere in your butt.

If this is the case, there are 2 stretches you should try.

Sit on the floor with the right leg straight in front of you, and the left foot on the ground on the right side of the right knee. Wrap your right elbow around your left knee, and pull it toward the center of your chest. Repeat on other side.

Sit in a chair with your right ankle on your left knee. Sit upright and lean the lower part of your rib cage down toward your right shin.

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Totally agree that his workouts are a bit over the top for one not habituated to working out. –  Ivo Flipse Apr 21 '11 at 7:56
    
Thanks for the advice and thorough answer Natalie. I'm definitely taking the Vibram advice to heart; I suspected this was related somehow. I won't be following your advice regarding the changes to my workout routines as I feel they are too conservative for me. This is based primarily on the cues my body is giving me, detailed in my answer here. I do feel it is safe and sound advice for general cases though. –  hobodave Apr 22 '11 at 20:48
    
Here's an article I found enlightening by Kelly Starrett, DPT regarding ibuprofen: sanfranciscocrossfit.blogspot.com/2009/06/… –  hobodave Apr 27 '11 at 21:38
    
Interesting link @hobodave :-) I generally try to stay away from using medicine, when I know its my own fault its hurting like that :P –  Ivo Flipse Apr 27 '11 at 23:07
    
I agree that ibuprofen shouldn't be taken to relieve sore muscles or on a regular basis as some people do. However, I stand by the belief that it is beneficial in the case of an injury. Speaking of injuries, you never updated us after your physical therapy appointment. –  Natalie Barnett Apr 28 '11 at 0:49
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up vote 2 down vote accepted

So I've "diagnosed" myself with a mild MCL/ACL strain.

The following morning I woke with no pain in my knee in normal ROM. When fully extended (slightly hyper) I felt a little bit of pain. I stretched my hamstrings and calves thoroughly throughout the day.

After driving and sitting at my desk my knee would stiffen up again, so I got up and walked every 20 minutes at work. I also took ibuprofen throughout the day.

I felt that resting for two weeks was uncalled for and unnecessary given the relatively quick recovery thus far. I've decided that I'll avoid running and heavy jumping for these 3 on-days and reevaluate my condition daily.

Injury +2 days

I went to the gym and instead of doing the 3 mile run WOD I did:

4 RFT

  • 10 kettlebell overhead swings (1 pood)
  • 6 sandbag cleans (80 lb)
  • 5 GHD situps

6:03

I felt some twinges in my knee during the cleans, but I found that focusing really hard on preventing my right foot from pronating and my right knee from turning inward I avoided all pain. I also felt fine doing 5 minutes of jump rope during my warmup.

It's a bit of a funny coincidence but the same day I asked my question here the Mobility WOD posted a video about poor hip ROM. Kelly's description of my squatting technique (feet turned out) is spot-on, and I found that the mobility exercises shown in the linked video really helped me keep my knees from shooting inward and putting strain on my MCL/ACL.

Injury +3 days

Today I decided to go all out and try a modified Fran today. Success!

21-15-9

  • 65# Thrusters
  • Blue-band assisted pullups

8:34

Conclusion

I wore the Vibram's both days without issue. I actually think they're making me more aware of my foot, knee and hip position and preventing the poor form that sturdier shoes allow me to use safely.

I need to be super conscious of keeping my knees spread when squatting. I've found the following cues help me:

  • Attempting to "spread the ground" with my feet
  • Focusing on sending my hips straight down instead of back
  • Focusing on "twisting" the ground with my feet by externally rotating my hips
  • Focusing on using my hamstrings and glutes to extend out of the squat
    • (I find that as I fatigue my knees shoot inward and I use my quads to stand up)

I've also begun to supplement with Glucosamine, but I don't expect to see results until 2-3 weeks later.

I'm going to refrain from box jumps, jumping air squats, and jumping lunges until I feel no pain whatsoever in my knee.

Followup (Injury +8 days)

I continued to stick to my CrossFit schedule. I accomplished one of the most intense CF workouts on I+4: Murph (scaled pull/push ups and squats by 1/2). I wore sneakers instead of Vibrams. Neither the running nor air squats were an issue for my knee.

I+6's workout had my a little worried: 60 seconds jumping squats with a 45-lb barbell. This is exactly what injured my knee to begin with. Luckily I saw my PT earlier this day. She confirmed that I have an ACL strain due to my overly aggressive jumping air squats in combination with poor form. My ridiculously short and weak hamstrings prevent me from getting deep in the squat without losing anterior pelvis tilt. As my hamstrings get tight they pull my pelvis and the rest of my body forward, shifting my weight toward my toes. I compensate for this by shooting my knees forward over my toes. This puts an enormous amount of shear on my knee joint. It's really important to keep your tibia vertical if you have a weak/injured ACL.

The PT did some PNF hamstring and quad stretches with me, and prescribed lots of box squats with vertical tibias. I'm to do 50 of these a day, keeping my knees back and maintaining my lumbar curve. As they get easier I am to lower the box until I get down to my ankles (this will take a while). She had me try some jumping squats with a PVC pipe and corrected my form here as well, again emphasizing keeping my knees back.

I performed 33 45-lb jumping squats in 60 seconds without any knee pain!

None of the basic CF movements have been deemed off-limits by my PT. For exercises, like the push-press, where my knees are supposed to come forward I have to compensate by taking a wider stance and opening my hips up. This allows me to keep my knees back further, but still get the benefit of a powerful hip extension. (I sacrifice sheer power by compensating this way, but I don't injure myself).

Here are some videos that are must watch for fully understanding and working with sore knees:

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I don't think you had a strain to your ACL and/or MCL, because it could not possible heal in 3 days. You said the pain around your knees was new since you started wearing your vibrams. I understand that you are able to be more aware of your foot when you're wearing them, but they caused the instability in the first place. Your right knee is rotating inward because your feet do not have the arch support that they do in standard tennis shoes. Not because the vibrams are bad for you, but because it's not what you're used to. Also, if you're removing explosive movements, you are taking my advise. –  Natalie Barnett Apr 23 '11 at 1:01
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Look here to see exactly where the ACL, MCL, and patellar tendon are located, and you'll see that they are not in the locations that you pointed at in the images...breg.com/patient_education/knee.html –  Natalie Barnett Apr 23 '11 at 1:20
    
@Natalie: Thanks for the followup. I appreciate your contribution and the effort you put into your answer. I also appreciate your desire to correct my assessment of my anatomy. My pictures aren't exactly the best because this isn't a point pain, it's more of a general region. I noted this in my question; my finger is more or less defining the rough location of a broader pain area. Nonetheless, I'm confident in my assessment of my injury. My right ankle is prone to over pronation which causes a valgus stress on my knee. –  hobodave Apr 23 '11 at 1:44
    
The valgus rotation most definitely strains my MCL. This rotation coupled with the internal rotation of my tibia due to the collapsed arch also torques my ACL. As noted in the link you provided the MCL/ACL are commonly injured together due to this exact combination of forces. This is also noted in the Mobility WOD video I referenced in my answer. I have a physical therapy appointment Monday. I intend to update my answer with the results. –  hobodave Apr 23 '11 at 1:50
    
How did your physical therapy appointment go? –  Natalie Barnett Apr 27 '11 at 3:03
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I have a torn meniscus and the pain and swelling was around for 2 weeks. I have also had an ACL sprai years ago, and I also severed the ACL and needed a rebuild years ago.

If the mneniscus was torn, or even strained, they'd be pain around the middle part of the knee, on either side, it would feel like bruising. If it is slightly torn, they'd be broad swelling over the top of the knee, and the side, just under where the quad comes down.

I only know this as, once more, I have torn my meniscus and am sat here in a state of swelling and pain.

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