Pain below knee from Stiff Legged Windmill and Cossacks

When I do stiff-legged windmills, I can definitely feel what I think are my adductors (inner thigh hamstring, just above the knee) stretching. But I also get discomfort medial to and just below the knee from these. It sometimes holds over into the next day. It happens with or without weight.

I just finished Deck Squats and when I went to try just getting into position for Cossacks, I get the same pain. Certainly my flexibility is lacking.. I'll eventually be doing Cossacks for a while it seems.

It only happens on one leg - it's the same knee that suffers from a popping kneecap (patellar maltracking, PFPS), though that's a different pain. That was diagnosed a long time ago, and is mitigated by hip strength / stretching work - mainly band walks, glute bridges, band abductions, lunge hip flexor, calf, and quad stretching.

Any idea what may be causing this pain below the knee? I'm in a deload week (possibly two just due to scheduling) so hopefully the rest will help, but figured I'd check and see what some of you thought. Hoping Mark Collins will stop by and see this.

Thanks in advance.

The hamstring tendons attach below the knee - this sounds very much like developing tendonitis. You're probably doing too much too soon, so stop doing the stiff legged windmill and cossacks until the pain is gone. When you are able to resume the exercises, use a much lower load, much lower volume, and progress at half the rate which you did before. Never, ever train through pain.

Hi Marc,

If you have a quick image search for 'pes anserinus' like https://www.google.co.uk/search?q=pes+anserinus&es_sm=119&source=lnms&tbm=isch&sa=X&ei=i-tiVabcKqS17gak3YDAAw&ved=0CAcQ_AUoAQ&biw=1264&bih=631

you will see that there are collectively three tendons that attach to the tibia, just below the knee on the medial side. Semitendinosus is a hamstring, while gracilis is an adductor and sartorious a mixture performing hip flexion/knee flexion/knee rotation. I would bet that it is most likely the gracilis tendon insertion that you can feel below the knee and given the fact the you have had maltracking issues of the patella on the same leg, you will have an issue with your pelvic balance. Maltracking of the patella in my experience is usually a hip imbalance which manifests at the knee - iliotibial band, gluteals, tensor fascia lata, hip flexors (rectus, femoris, psoas) etc all need looking at.

I have a shorter right leg (tibia is actually shorter) and a resultant pelvic tilt and slight lumbar spine scoliosis. I can also feel a pinch/sting just below my left knee if I go very deep into my pancake (adductor stretch) when not warmed up enough. If you give your body time to adapt to the stretches it will open out and eventually not be a problem. It's just a sign of to much tension beyond what the tendon can currently handle.

Signs of imbalance at the hips/pelvis are asymmetric ranges in your range of motion. If you sit in straddle on the floor, face each leg one at a time and lower your chest toward the leg. Different range of motion, is it more difficult to rotate over one leg? Do you feel restrictions in the lower back/ribs?

I have all the above but have still managed to gain good mobility and have had no real issues working through foundations F1-3. For those others who also experience similar asymmetries its worth getting checked out with a good therapist like an Osteopath/physio/chiropractor as they can often shed light on specific anatomical imbalances and help you toward feeling more balanced. For me, I have to pay attention to the areas which tend to hold tension more readily because of the leg length difference but its just a matter of attending to your needs and personal maintenance which we all have :-)

Hope that helps!

Wes,

Thank you very much.  I have been experiencing the same tightness and it's been very frustrating for the lower to ground work in the Side Split Stretch program.  I will ease up on the intensity and try to focus more on the stretches which work gracilis and sartorious.

Thanks Wes for the encouraging comments... You've made good progress despite the orthopedic issues, so perhaps there is some hope. I'm currently reloading and will be leaving out the lower leg work for the next few weeks. If the rest doesn't help, I'll seek out a PT. While I've been following an older hip strengthening program for the knee, it still bugs me sometimes, so perhaps a good time to get it looked at again.

Marc, I experienced sort of the same problem as you.

In my case I went too hard across the board - The accumulated strain of stiff legged windmills, stall bar pike stretches, glute ham raises etc. resulted in tendonitis below the knee. A mild case, but tendonitis none the less. My solution was to go back five progressions or so in the SLS department, cut out windmills, and be very gentle on the pike stretches. And not least, having a zero tolerance for pain.

Good idea Marc, let us know how you get on!

Thanks Wes.

Just an update... Been leaving the squats out of my workout and just focusing on doing some light rehab work around the knee. Lots of foam rolling on the calves, quads, hamstrings, and hips. Then doing some stretching of all of these areas, and focusing on stretching hamstrings and adductor a in ways that cause me to feel the stretch at other places in the leg (higher up just above and behind the knee, way up where the hammy inserts into the glute region, etc.) I figure this will relieve some pressure down where the pain is, and also stimulate some blood flow to the area. So far, I get less pain there on full knee lockout. Also, spending some time just sitting in the Cossacks end position while in my office chair, just to get the body used to it.

While I'm on this ... I know the maltracking is often caused by hip weakness (glute med, glute max, etc.) but I get the sense that in my case, it may have more to do with quad or hip flexor tightness. Whenever I stretch my hip flexors, the knee usually moves without popping for a while. Since the lunge stretch is targeting hip flexors but also stretches the quads, I'm thinking this may have something to do with it. I also found that when I used to do goblet squats (35 to 60 lbs), I would often feel it in my quads, but the knee would usually feel pretty good for the days afterward. Since doing Foundation, I've dropped these. While the deck squats are great for range of motion and conditioning, I'm not sure they stimulate he muscles in the same way... I may add back a few sets after the SLS work, once I get back to it.


Still intend to talk to a physical therapist in a few weeks after things calm down at home and at work...

Hi Marc,

Marc Nerenberg said:

While I'm on this ... I know the maltracking is often caused by hip weakness (glute med, glute max, etc.) but I get the sense that in my case, it may have more to do with quad or hip flexor tightness. Whenever I stretch my hip flexors (kit Laughlin lunge stretch), the knee usually moves without popping for a while. Since the lunge stretch is targeting hip flexors but also stretches the quads, I'm thinking this may have something to do with it. 

 

 

In my experience, its not that some of the hip muscles are weak that cause patella maltracking (aka runners knee), in fact the medial glutes tend to be very tight in runners as they use these a lot whilst running) it is the relative balance that is out ie. the balance of pull between hip flexors vs extensors, internal rotators vs external rotators.

Let's look at this further, I have never seen a case of bilateral patella maltracking (not saying its impossible) as it normally always manifests in one side and not the other. Why? 

http://www.massagetoday.com/content/images/dalton05__1_2_6093.jpg

I tried to find an image that would illustrate what I mean by pelvic balance and this is one of the best I could find. The 2 halves of the pelvis (innominate bones) are capable of rotating forward/anteriorly and backward/posteriorly relative to one another. For you I suspect your left innominate is posterior relative to your right, which will manifest as a feeling of tighter hip flexors on the left (left leg forward front split will feel easier than right leg forward). This relative shift in innominate position affects all the muscle that attach from here onto the thigh bone, including gluteus maximus and TFL which will pull more tightly on the iliotibial band and give the pain of maltracking. Also will result in a lengthened gracilis as the pubic bone is lifted superiorly, creating a stronger pull on the inferior insertion at the knee.

When you lunge stretch with the left leg backwards and strongly flex the right hip, you partially help restore balance by de-rotating the innominates toward neutral. That is why I stated earlier that all the muscles need to be taken into an account. Often there is a spinal compensation concurrent with this too, that a therapists should be able to figure out and help with.

An overall stretch regimen is definitely something you want to include in your training and now GB have released their stretch series you have help from them too on this. the split series will highlight any imbalances between the sides. I would recommend spending a little more time on the tighter sides to restore balance.

Marc Nerenberg said:

Thanks Wes.

While I'm on this ... I know the maltracking is often caused by hip weakness (glute med, glute max, etc.) but I get the sense that in my case, it may have more to do with quad or hip flexor tightness. Whenever I stretch my hip flexors (kit Laughlin lunge stretch), the knee usually moves without popping for a while. Since the lunge stretch is targeting hip flexors but also stretches the quads, I'm thinking this may have something to do with it. I also found that when I used to do goblet squats (35 to 60 lbs), I would often feel it in my quads, but the knee would usually feel pretty good for the days afterward. Since doing Foundation, I've dropped these. While the deck squats are great for range of motion and conditioning, I'm not sure they stimulate he muscles in the same way... I may add back a few sets after the SLS work, once I get back to it.

Still intend to talk to a physical therapist in a few weeks after things calm down at home and at work...

I think you know the solution to your problem. It seems you have an unstable patella-femoral joint that responds well to general quads strengthening. I would add back the goblet squats performed 5 secs up and 5 down so you really feel the quads. Also try adding back Cossack squats done slowly. It's likely you were using a bit too much momentum and the quads were not working as much as the gluteus. People with knee pain can use the glutes more than quads. The lunges you were doing for the hip flexor stretch was more than likely giving you a benefit from an isometric quads contraction. I would also add an isometric wall sit squeezing a pillow between the knees for 3-5x60 secs.

If your problem is due to a lack of quads activation you should feel a lot better within two weeks of doing these. If not it is obviously something else. Knowing the human body it is not something so simple that we can diagnose and help you over the Internet. If it was that easy I could make a living without having to do any hands on work

Wow, I can't believe the quality of responses from the two of you... Completely impressed with the the thorough answers.

I'll keep everyone posted... Thanks again, so very much.