Tuesday, June 11, 2013

Ask Abbie: Managing Bursitis of the Knee




Bursitis-Of-the-Knee-on-the-Brain Asks:


I have bursitis/ inflammation in my right knee. It's painful, but for now the doctor recommends basic exercises to strengthen hamstrings and quadriceps, stretching, and anti-inflammation meds. I just hired a new trainer to help me lose about 15lbs and tighten up. What precautions should I take regarding my knee to avoid further injury?



Ask Abbie Answers:


Bursitis is the inflammation of the bursa sac(s) in your knee. It's under your patella tendon (the tendon that attaches your quad muscles to your shin bone and runs over your kneecap). Kneeling can inflame the bursa or a blow to the knee can cause the problem.


Bursitis can cause stiffness in the joint so the stretching that your doctor prescribed is right on target. When I worked in the sports PT clinic, we had our patients begin their sessions with a light warm-up (usually the exercise bike to start) followed by hamstring, calf and quad stretching before beginning their strength work (if the patient was further along in their rehab, they'd do the elliptical or treadmill later on in their session). If you follow the same order with your trainer, your pain should be minimal if none at all. But be sure to tell your trainer if you do feel pain with squats, static lunges (I would avoid walking lunges in the beginning) and any exercises that involve twisting or pivoting.


The strength training is great for weight loss and shaping the body and it helps with the bursitis -- win-win!


When one part of the body is injured it's not uncommon to compensate causing other parts of the body hurt. So be sure to maintain proper form when performing your other exercises. As for "precautions", you may want to avoid kneeling exercises -- hip extension, fire hydrants etc -- any hip and butt work that requires you to be on your hands and knees, modified pushups etc. They can be modified to standing or sidelying or prone position.


In your case be sure to ice after your workouts. That will minimize any swelling in the joint and it feels great (to me it does)! If you work out in a gym that also houses a physical therapy clinic or sports medicine facility, they may provide you with an ice pack or an ice cup so that you can do an ice massage. 10 minutes, no more than 15.


And rest. Rest is very important for recovery as well. If you're a beginner, do exercises for the knee 2 times a week, gradually working up to 3. The stretching can be done daily. It can take a few weeks for you to become pain-free.


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A few days later, I received this message:

Just to follow up, my knee generally feels better - surprisingly even after training my legs in the gym with my trainer. I had been avoiding leg extensions and leg presses at the advice of a physical therapist (I had some PT sessions last summer), but with the stretching and icing my knee doesn't feel worse. In fact, a little better. I've been wearing heels though. :(  laying off that might speed recovery. One more question: will squats worsen bursitis?


Ask Abbie Answers:

Yup, activity can help with aches and pains. Your PT from last summer probably had you avoid the leg press because it was early in your recovery. Wearing heels does put extra strain on the anterior part of the knee so you will feel extra pressure in your patella tendon, right under your kneecap or right above it. In general, heels alter the biomechanics of the body and not for the better. Squats won't worsen bursitis as long as you do them with correct form, recruiting the right muscles for the squat and you're not going to deep in the squat to avoid pain.


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