Medial knee pain?

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Medial knee pain?

Postby noobSkier » Sat Nov 03, 2018 9:52 am

First 2 days on snow and I'm getting a dull pain in my right knee around the medial area. What could be changed in terms of alignment to reduce stress on that area? My soles are canted 3deg out. Thanks in advance.
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Re: Medial knee pain?

Postby AnI » Mon Nov 05, 2018 10:17 pm

Pain in certain areas of the knee is not used as a method to adjust alignment. If you did not have this pain last year, maybe you made a few jerky movements in first days on the skis which triggered this? Or maybe you had a chunk of ice on the sole of your boot which changed the angle?

If this problem were related to alignment, it could suggest that you might benefit from even more "out". This is because when you get in A-frame, you create load on ligament(s) on the inside of your knee. This, however, should best of all be validated by assessment through balancing on one ski and analysis of video. I would not fiddle with alignment just based on feeling of pain.

Alignment plates do not go past 3 degrees (if it is Sun Valley Tools) or 2.5 degrees (if it is HSS). More angle would mean shims under bindings in addition to plates.
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Re: Medial knee pain?

Postby noobSkier » Tue Nov 06, 2018 7:43 am

Thanks AnI, I went skiing yesterday and I took it easy...that definitely helped. I have another question though; the more you tip "out" your boots, do you not lose LTE tipping range to some extent? I've found that the more I tipped out my boots, the more I had to adjust the cuff inwards to keep my shin in the middle of the cuff. When I just kept the cuff at neutral & tipped out, I found it difficult to get leverage on the boot with foot eversion. It wasn't particularly noticeable for edge-locked carving, but seemed to make a huge difference in the short-turns.
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Re: Medial knee pain?

Postby AnI » Tue Nov 06, 2018 11:37 am

HSS teaches that cuffs should be adjusted without alignment plates. Practically, there are three ways to accomplish it:

1) tune cuffs before plating the boots
2) remove plates from the boots to set up cuffs, then install the plates back
3) put plastic shims with matching angle under the soles of the boots to compensate for the angle of the plates. For example, if you had 3 degrees "in" plates on your boots, you would put 3 degree "out" shims under the soles to bring under sole angle back to zero.

HSS teaches to change cuffs from the initial setting, established without plates, only if dynamic skiing shows indications that cuff needs be adjusted and improvement cannot be achieved through under-sole shimming. This is the most complex part of the practical magic of ski alignment.

Position of the cuff and under sole plating have different impacts on skiing, but these impacts partly overlap. Change of the angle of the cuff through cuff canting would change the amount of required under-sole alignment correction to a certain degree. You can safely assume that if you change the cuff angle by 2 degrees, the under-sole alignment could change in the opposite direction to somewhere between 1 and 2 degrees - but it really depends on how much cuff pressure against the leg you had and to which extent it was affecting your alignment. The ultimate goal of the process is to establish a good balance when you skiing on a flat ski, on BTE, and LTE. Ideally, you should not have restrictions with LTE tipping if alignment is done correctly - unless you are significantly knock-kneed in real life or have a significant tibia varum, then you might run into certain restrictions.

Do you have proper footbeds with proper pronation compensation (if applicable to you)? If your foot is heavily pronated, getting it on LTE would require significant effort, and your lower leg will like to stay in contact with the medial side of the cuff. I suspect that this would be the first thing to check in your situation.

It is not clear from your post if you had your boots set up by a person trained by HSS as alignment technician, or if you have been fiddling with alignment yourself, based on your best understanding and reading materials which you were able to get.
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Re: Medial knee pain?

Postby ErikCO » Tue Nov 06, 2018 12:01 pm

Also, keep in mind, that miniscus issues in the knee can show up without an obvious injury, especially if you engage in other sports off season. If a couple of days skiing and easing your body back into things doesn't solve the problem, get some video so the MA folks here can give an idea of any obvious things with technique or alignment. If they don't see anything obvious, go get the opinion of a sports medicine/ortho doc. The thing that makes me wonder about injury is the fact that you weren't having problems last year, by my understanding, changed nothing in equipment, and are having problems this year.
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Re: Medial knee pain?

Postby jbotti » Tue Nov 06, 2018 1:53 pm

noobSkier wrote:Thanks AnI, I went skiing yesterday and I took it easy...that definitely helped. I have another question though; the more you tip "out" your boots, do you not lose LTE tipping range to some extent? I've found that the more I tipped out my boots, the more I had to adjust the cuff inwards to keep my shin in the middle of the cuff. When I just kept the cuff at neutral & tipped out, I found it difficult to get leverage on the boot with foot eversion. It wasn't particularly noticeable for edge-locked carving, but seemed to make a huge difference in the short-turns.


Having skied with both (too strong a cuff alignment and too much canting out) they feel somewhat different. When you are aligned too far out you feel like you can't get off the inside edge and when you are on edge in an arc you feel the skis grinding hard versus slicing. When the cuff is too strong you generally feel some grabbiness and a little grinding mid boot when the ski is on its inside edge. Typically ski engagement is from tip or toe to heel (from the start of the arc to the end). When the cuff is too strong you feel it middle right away.

As has been said may times before self diagnosis over any forum (even this one) is a recipe for disaster with boots and alignment. And as I recall your set-up was not done by a trained HSS person. We all know how important skiing is for you, how much you ski, how hard you work at it. Shame on you for not dialing this in with the right experts even if requires a flight somewhere.

If you read HH's most recent blog post it won't take you more than a paragraph to figure out that you are in way, way, way over your head and that most calling themselves pros on alignment and canting are often close to clueless.

https://harbskisysems.blogspot.com/2018 ... ot-be.html
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Re: Medial knee pain?

Postby noobSkier » Tue Nov 06, 2018 4:10 pm

Thanks for your thoughts AnI, ErikCO & jbotti. I got some guidance last season from HH, he said that my alignment is basically ok, only that it's going to take some experimentation to dial it in all the way. What he probably meant was experimentation by HSS and not me :lol: I'll be the first to tell you that I'm in over my head and I wouldn't recommend this to anyone. It took me to 2 years of screwing around with it, countless video clips, hours of poring over the alignment manual, probably a chunk of my sanity, and it's still not right. Fortunately there is progress on this front; I'm in communication with HSS, and it looks like I'll be able to visit them at Welch Village this season.
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Re: Medial knee pain?

Postby Ken » Wed Nov 07, 2018 3:47 pm

noob, have you been to a saw bones? Xrays or MRI of that knee will probably show what's up. Age and related wear & tear take their toll. Once you know what's happening, you can try for relief. My left knee was the good one, until...one very easy day of skiing & coaching a friend, we sat down to lunch, and at the end of lunch my left knee did not want to straighten. Pain. I got it straight and continued easy skiing that day. That evening I could not walk up one stair on that leg. Xray showed nothing out of place. MRI showed a deteriorated meniscus. Not a tear, and nothing to fix. The surgeon said, "there's nothing we can't make worse with surgery." A cortisone shot in that knee has worked very well since then. There are other remedies for other maladies. See the doc.
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Re: Medial knee pain?

Postby noobSkier » Sun Nov 11, 2018 9:16 am

Ken wrote:noob, have you been to a saw bones? Xrays or MRI of that knee will probably show what's up. Age and related wear & tear take their toll. Once you know what's happening, you can try for relief. My left knee was the good one, until...one very easy day of skiing & coaching a friend, we sat down to lunch, and at the end of lunch my left knee did not want to straighten. Pain. I got it straight and continued easy skiing that day. That evening I could not walk up one stair on that leg. Xray showed nothing out of place. MRI showed a deteriorated meniscus. Not a tear, and nothing to fix. The surgeon said, "there's nothing we can't make worse with surgery." A cortisone shot in that knee has worked very well since then. There are other remedies for other maladies. See the doc.


Ok so this is pretty interesting. When I was competing in other sports I would always deal with nagging injuries with The Trigger Point Therapy Workbook by Clair Davies. For some reason this time I had just accepted that I'm going to have a bum knee. Turns out, after referencing this book, I have a severe trigger point in the upper sartorius muscle which was shooting pain to the inner knee. After working on the trigger point for 1 day, the pain completely disappeared. Highly recommend this book.
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Re: Medial knee pain?

Postby mardale » Tue Nov 13, 2018 4:24 pm

noobSkier wrote:I've found that the more I tipped out my boots, the more I had to adjust the cuff inwards to keep my shin in the middle of the cuff.

You may be going about it the wrong way, mate. The way I understand this process is that you first align the cuff so the cuff follows the leg with no canting, and then you tip the skis in our out, as needed, by canting the sole, without touching the cuff alignment anymore - unless maybe you have weird tibias and you know what you're doing (like after learning the alignment manual inside-out).
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Re: Medial knee pain?

Postby ErikCO » Tue Nov 13, 2018 9:33 pm

noobSkier wrote:
Ken wrote:noob, have you been to a saw bones? Xrays or MRI of that knee will probably show what's up. Age and related wear & tear take their toll. Once you know what's happening, you can try for relief. My left knee was the good one, until...one very easy day of skiing & coaching a friend, we sat down to lunch, and at the end of lunch my left knee did not want to straighten. Pain. I got it straight and continued easy skiing that day. That evening I could not walk up one stair on that leg. Xray showed nothing out of place. MRI showed a deteriorated meniscus. Not a tear, and nothing to fix. The surgeon said, "there's nothing we can't make worse with surgery." A cortisone shot in that knee has worked very well since then. There are other remedies for other maladies. See the doc.


Ok so this is pretty interesting. When I was competing in other sports I would always deal with nagging injuries with The Trigger Point Therapy Workbook by Clair Davies. For some reason this time I had just accepted that I'm going to have a bum knee. Turns out, after referencing this book, I have a severe trigger point in the upper sartorius muscle which was shooting pain to the inner knee. After working on the trigger point for 1 day, the pain completely disappeared. Highly recommend this book.


To add to that, if you can find a PT who does dry needling, that may also be very helpful for this. I have seen some people have extremely positive results when some of their pain is related to muscle tension and trigger points, even better than standard deep tissue/myofascial release techniques.
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Re: Medial knee pain?

Postby noobSkier » Wed Nov 14, 2018 5:32 am

mardale wrote:You may be going about it the wrong way, mate. The way I understand this process is that you first align the cuff so the cuff follows the leg with no canting, and then you tip the skis in our out, as needed, by canting the sole, without touching the cuff alignment anymore - unless maybe you have weird tibias and you know what you're doing (like after learning the alignment manual inside-out).


You are right mardale, this isn't standard practice. The backstory is that HH posted a blog last year describing my alignment issues where he said I was either over-canted or over-cuffed. First I tried to reduce the canting which initially felt good, but video analysis was showing my knees tracking inwards and inability to get higher angles. So I left the canting alone, and started moving the cuffs inwards with better results.
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