Chronic Knee Pain

[thomas m]

Dear Friends and Family,

Having suffered with a bad knee for nearly a year now, I am writing in the hope that you may be able to offer some advice that may provide me with some light, as I am currently feeling rather disheartened. First some background (probably far too much).

I am fortunate to have studied Shaolin Kung Fu with Sifu Jordan for the previous 14 months. I have also attended regional courses with Sigung: two Chi Kung and one Kung Fu. Since beginning my training I have observed many enhancements to my health and life. I have absolutely no doubt that Shaolin Cosmos Chi Kung and Kung Fu can provide many benefits.

About ten months ago I noticed a dull pain in my right knee, which seemed come from nowhere. I was confident that with the aid of my Chi Kung it would clear in no time. However, the pain lingered, improved then worsened, improved, worsened, etc. for several months. At a review course with Siguma Joan I decided that recovering from this injury would become one of my objectives, and that six months would provide me with ample time to fully recover, this time has long since passed.

I decided to concentrate mainly on flowing. With no signs of improvement, I removed Zhang-Zhuang completely from my daily practice, practising stances only once per week in class; I also stopped walking to University. With some gradual improvement I was confident that I was on the mend. Classes began twice a week, which was excellent, but sadly my knee began to deteriorate once more. The pain was worse than it was previously.

In preparation for the UK summer camp I decided to rest completely for two weeks. During the Kung Fu course I asked Sigung for some advice, I was told not to worry, enjoy my chi-flows and reduce the time I spent doing stance training.

I certainly did enjoy my practice after the summer camp and returned to class knowing that I would work through this blockage by following Sigung's advice, it was only a matter of time. After a month or two with the knee pain getting even worse I decided to stop my Kung Fu training completely and only practice Lifting the Sky at home. I'm sure that the majority of the Kung-Fu practitioners reading this can understand how frustrating this can be.

This week Sifu began teaching in Bristol and after a six week rest I returned to class to see if there had been any improvements. After only ten breaths in horse stance and a few rather ropey combat sequences, it is clear that my knee is as bad as ever. Yesterday evening after a practice session this frustration finally turned to anger. All I want to do when I return from work is practice Kung Fu, why cant I even recover from a knee injury? I am so very envious of those who are able to practice without such limitations.

The Knee
Pain is dull and constant. My knee cap is very sensitive – even the weight of the material in my my trousers seems to aggravate the problem. It creaks and cracks quite often and generally feels worse 2-3 days after a Kung Fu session.

If anyone has any advice that they may be able to share I would be very grateful and I'm sorry this post has been a bit long. However, it has been useful to write all of this down.

Sincerest Regards,
Tom

[yeniseri]

Thomas,

There are many things that you can do and be aware of:
- Awareness of knee/toe positioning
does the knee approach the toe? If so too much weight on knee.
solution: try to keep a 90 degree angle (see below)
NOTE: When I post the diagram shifts, so I placed at left side>

|knee
|___toes

- How is your calcium intake?
- Do some hamstring and quadricep stretches
- If your workout sessions are too strenuous, followed by no activity then it will get worse so try to balance the non-workout period by some degree of stretching.

[Sifu Stier]

Hello Thomas!

Persistent knee pain resulting from or associated with martial art training often occurs when one or both knees are regularly positioned without the proper vertical alignment to the foot.

For example...when the knee is allowed to extend beyond a vertical alignment with the toes, overt stress and strain is placed on the anterior cruciate ligament beneath the center of the patella or 'knee cap'...creating soreness and/or pain at or beneath the front center of the knee. This can be corrected by observing the location of the knee cap in every forward weighted or backward weighted stance to insure that the knee isn't protruding beyond the toes. A 'plumb line' or weighted string suspended from the front of the predominantly weighted knee should come to rest directly over the toe ends...but not beyond.

Similarly...if the knee is allowed to extend sideways to the outside edge of the foot, undue stress and strain is placed on the lateral cruciate ligament and will create soreness and/or pain at the outside of the leg at or beneath the knee. And when the knee is allowed to 'collapse' inward toward the centerline of the body or the inside edge of the foot, the medial cruciate ligament can be injured and will create soreness and/or pain on the inside of the leg at or beneath the knee. These scenarios may also be corrected by observing the knee placement or location to insure proper vertical alignment with the toes and foot.

Additionally...fluctuations in the physiological health of the renal system or so called 'water element' organs (kidneys and urinary bladder) can cause either an increase or a decrease in the amount of synovial fluid secreted by the articulating membranes, tendon sheaths, and bursae of the joint...which can also generate aching, soreness, and pain. Unlike the structural misalignments mentioned earlier, this will necessitate corrective treatment from a primary health care provider. I normally use acupuncture and Chinese herbal formulae to address the internal causes...and Chinese medicinal oils or linaments externally for topical analgesic relief.

There could be other factors contributing to the problem as well...including dietary indiscretion, excessive sexual activity, and even emotional stresses and strains...but I am unable to address these without a live diagnostic assessment and case taking interview...so I'll stop here. Hope this helps you...and good luck!

[Antonius]

Hi Thomas.

You're not icing your knee, are you?

[Andrew]

I totally disagree with yeniseri ... do not forget about chi flow at all.

Andrew

[George]

Have you tried doing the "Rotating Knees" exercise? Whenever I had knee pain (admittedly nowhere near as severe as you describe) I found that it would provide almost instant pain relief. I had to rely on this quite often in the first few months of my Kungfu practice.

You will still need to find the root of the problem though. Whenever I had knee pains after Kungfu practice it was invariably due to incorrect stances/transitions, specifically the Bow Arrow stance. I remember my instructor emphasising that the front knee must never go further than the ankle. Mine did, especially during moving in stances (when I wasn't paying enough attention.) As soon as I corrected that the knees felt much better. Rotating Knees took care of the rest.

I hope you get better soon.

[Michael Udel]

Hi, Thomas,

Considering the length of time that has passed and the steps you've taken to correct the problem, it's not something that will just gradually heal or fade away. I believe there are three things that must be discovered:

1) Original cause: This isn't always needed to fix the problem, but it should be looked into to prevent repeating it. The other posts have covered all the likely causes.

2) Current damage or blockage: Because you have stopped kungfu practice altogether for an extended period and practiced what sounds like some very safe qigong to try and fix the problem, but the problem has not been helped, perhaps not helped at all, the damage needs to be repaired. The damage may be something physical like tears to the ligaments and other areas mentioned by Sifu Stier, and the damage may be a qi blockage. It may also be a combination of the two.

I think the steps you've already taken prove the damage will not go away without a new approach and/or therapy that has not already been attempted.

3) Recurrent aggravation: Sometimes referred to as lifestyle choices, some of the things mentioned by Sifu Stier, such as sexual activity and diet, may be part of the root cause, or may be able to aggravate the injury in your current state (of diminshed strength), but would otherwise not pose a problem.

Do you see what I'm getting at? Some habitual behavior or eating pattern that has never posed a problem before may now be able to perpetuate a problem brought on by a physical injury and/or energetic disruption. In order to trouble shoot the problem, you need to be a bit creative and try and get a new perspective on your normal activities in case it is relevant to your healing. This step is necessary because a less involved approach has been unsuccessful.

At the moment you don't know the origin of the injury, nor do you know the remedy. You need new ideas and new therapies, different than what you've already done, but also along the lines of what's been proven to work in these cases, which means getting the assistance of someone experienced, including those who've responded to this thread. For example, do you ice your knee?

According to what little I know about Chinese Medicine, if your knee pain is caused by, or is causing, a problem with the kidney/urinary bladder energy system, this basic fact can be discovered by any reasonably good practitioner of this art, which would be a good place to start.

I would like to respectfully offer a contrary opinion to George's mentioning the "Rotating Knees". Until you get some good information on the cause of the problem, I think you should avoid a qigong exercise with such a strong physical component that acts on the very part of your body that hurts. It's a situation where it could help, we don't know, but it's just as likely to aggravate the problem. Not worth the risk for an injury that appears to be deeply entrenched.

If you were going to try a new exercise as a trouble shooting tactic, I think "Nourishing Kidneys" would be safer, but I think even that should be avoided until you get some info. on what the problem actually is.

4) The Most Important Thing: Remain hopeful and confident of fixing the problem. Don't let feelings of discouragement linger and fester; they can slow the healing process.

Best wishes,
Michael

[beausimon]

Is there a possibility that the knee pain was due to Arthritis ?

[Jonny Say]

Dear Thomas,

I have had knee problems over the years previous to my Shaolin Kung Fu training. I was given physio and many western methods of treatment- (including insoles which I through away recently), and none of them worked. Now one of my knees is completely healed and the other is almost there! So here's some advice which has helped me in my training;

As mentioned by others watch the angle of your front knee during stances. Watch for tensions and any strains you may hold without even realising.

I also agree with George that rotating knees will be very helpful as both remedial exercise and cure. On top of this spend quality time on the art of flexible legs, don't just rush through these exercises enjoy them and train them as Chi Kung.

When moving in stances I emphasised working on both the fluidity of the movement and also the internal fluidity within my stance, and found that when you get this right it feels like moving in stances itself is massaging away the problems.

I practiced three circle stance if the pain was ever really bad (and if your desperate for Kung Fu practice you could do some of our basic hand forms from this stance or just from standing e.g single tiger, white snake etc). Also the four six stance is more gentle and I remember this was taught at the summer camp.

I also located areas I was subconciously holding tension (in life) within my legs and letting go of this helped.

So to summarise; if your desperate to train something, you can train chi flow, the art of flexible legs, some of the more gentle stances (if not too painful) and Kung Fu hand forms and patterns from standing or from gentle stances untill the problem is cleared.

All the best

[thomas m]

Think you all so much for your replies.

Antonious Sipak, I am not icing my knee. However, I did wear a knee brace at times when the pain was most severe (although not while practising); this provided some short term relief but has been totally infective in the long term, I no longer bother with it.

In regards to structural alignment, I did ask Sifu to check my stances when the symptoms first appeared, they were fine, but I may have developed some deviations since then, time to review again. I believe that the knee problem is exasperated by even the most minor strains on the knee: jumping down a few steps, walking up two steps at a time, sitting in horse/false-leg stance, etc.

Should I stop all Kung Fu training that could aggravate the problem until the symptoms are gone, i.e., anything with excessive knee bending?

I did read this (http://www.dragonrises.net/articles/IntegratedAcupunctur_332ED.pdf) article posted by AlexBaranosky. A fascinating read. Although the patient had troubles with the other knee, I did begin to realise how multifaceted these problems cam be.

Sifustier, think you for the information. Would you suggest visiting a specialist? I am fairly certain that the root of my problem does not lie in excessive sexual activity :), and I believe that I eat well. However, weekend drinking may well affect my renal system, and I'm nearing the end of my phd and therefore under quite a lot of constant stress which is impossible to leave at work, this could become worse over the next few months.

George, I have not been taught rotating knees formally, do you think that it is worth learning from the book? Sikuma Joan did teach me Nourishing Kidneys, although I do not practice it regularly.

Michael thanks for the input, I will try my best to remain positive.

Beausimon, I sincerely hope that this is not arthritis, I'm only 27.

Johnny Sihing thanks for the advice, I'm very pleased to hear that you have worked through your knee troubles, I hope to have a similar story in the not too distant future.

Best,
Tom

[Joan]

Dear Tom,

I am really sorry to hear that your knee problem continues.

At a review course with Siguma Joan I decided that recovering from this injury would become one of my objectives, and that six months would provide me with ample time to fully recover, this time has long since passed.

I am wondering if your 'objective' of curing your knees has almost become too much. While is it is very useful and productive to set aims and objectives, it is vitality important not to become too obsessive about the outcome.

When we do Nourishing Kidneys or Rotating Knees, for example, do not worry where the chi is working or where you would like the chi to work. Totally 'let go' of your 'objective' at this point.

'Letting go' is not just about going into chi flow. It is about letting go of everything- your pain, your illness, your worries, your outcome. If you are consistently thinking of, in your case -your painful knees- each time you do your Chi Kung practice, you are not 'letting go' fully. You are probably compounding the problem and the pain.

This may not be easy for you Tom, especially when you have pain and you wish to continue your Kungfu training. But the more you 'Let go' the more quickly the benefits will come.

I suggest that you do Nourishing Kidneys for 3 days and do Pushing Mountains the other 4. Don't worry why you are doing these patterns, just do them. Once a week do Self Manifested Chi Flow and Enjoy.

I hope that this helps,

Smile from the Heart,
Joan

[barrys]

Tom,

Sorry to hear about the knee and the frustration.

Good luck,

Barry

[thomas m]

Joan Sikuma,

Thank you for the advice. I think that you are right - I am obsessing over the problem and becoming attached to it. I will practice as you say, and really try to let go of my pain and all my worries.

Last night, I had an excellent practice session. It's so useful to share these issues and read everyone's invaluable comments.

Thanks also to you Barry.

Best,
Tom

[Charles David]

Dear Thomas,

Even though you may be having difficulty with your kung fu forms and combat applications, I think you are still very lucky to be able to enjoy your chi kung. I'm glad to hear that you had a good session last night. May you have many, many more enjoyable experiences in your chi kung practice.

[joko]

Hello, Thomas.

How is your knee? Have you overcome the problem?

Best regards,
Joko

[thomas m]

Hey Joko,

Thanks for your concern, really appreciated. Sadly the knee is still quite bad; however, I'm not nearly so negative about it, which is a good thing. I'm training my kung fu again but I'm taking it very easy. I do intend to complete this thread, at some point, with an account of my full recovery! Until then I'm focusing on enjoying my practice and writing my thesis.

All the best,
Tom

[barrys]

Tom,

Good to hear you are enjoying your practice. Good luck with the thesis.

Best,

Barry