Knäträning program

Om det gör ont under knäskålen vid ansträngning, är det ofta ett tecken på något av följande tillstånd:

1. Patellofemoralt smärtsyndrom (PFSS) – även kallat “främre knäsmärta”

• Vanlig orsak till smärta under knäskålen, särskilt hos aktiva personer.

• Smärtan förvärras ofta vid:

  • Gång i trappor (framför allt nerför)

  • Knäböjningar

  • Löpning

  • Sittande länge med böjt knä (“movie sign”)

2. Hopparknä (patellar tendinopati)

• Smärta precis nedanför knäskålen, där knäskålssenan fäster.

• Typiskt vid hopp, löpning eller snabb acceleration.

• Vanligt hos idrottare, särskilt inom basket, volleyboll, friidrott.

3. Slemsäcksinflammation (bursit)

• Inflammation i slemsäcken under eller runt knäskålen.

• Kan orsakas av upprepad belastning eller tryck.

4. Osgood-Schlatter (hos ungdomar)

• Smärta lite längre ner, vid knöl på övre delen av skenbenet (tibia).

• Drabbar växande barn/tonåringar, ofta i samband med sport.

Rekommendation:

• Vila från provocerande aktivitet.

• Kyla efter belastning.

• Styrketräning (särskilt quadriceps) och stretching.

• Om det inte förbättras: kontakta sjukgymnast eller läkare för undersökning och ev. ultraljud eller röntgen.

Vill du beskriva mer exakt var smärtan sitter och i vilka rörelser den kommer? Då kan jag ge ett mer specifikt svar.

Tack, din beskrivning stämmer mycket väl med patellofemoralt smärtsyndrom (PFSS).

Typiska kännetecken som du nämner:

• Smärta bakom eller under knäskålen

• Utlöses av:

  • Cykling med kraft

  • Knäböj

  • Trappgång, särskilt nedför

• Ingen smärta i vila

• Lindras av att vila från belastning

Det handlar oftast om en obalans eller felspårning i hur knäskålen rör sig mot lårbenet vid böjning. Vanliga bakomliggande orsaker:

• Svaghet i lårmuskulatur (särskilt vastus medialis)

• Dålig höftkontroll

• Stram baksida eller yttre lår (iliotibialbandet)

• Överbelastning eller dåligt justerad cykel

Vad du kan göra:

1. Minska belastningen tillfälligt

   • Undvik tunga knäböj, intensiva cykelpass och trappor

2. Stärk lårens framsida (quadriceps), särskilt vastus medialis

   • Övningar som straight leg raises, minibands, terminal knee extensions etc.

3. Stretch höftböjare och baksida lår

4. Rulla och stretcha IT-bandet

5. Se över cykelinställningar

   • Sadelhöjd, pedalplacering och vevlängd kan påverka trycket bakom knäskålen

Om det inte förbättras på några veckor kan en fysioterapeut hjälpa dig med specifika övningar och bedömning av rörelsemönster.

Vill du ha ett enkelt övningsprogram för detta?

Ja, det är absolut åtgärdbart, och det låter som att du redan har hittat en mycket klok anpassning med elmotorn — just att undvika tung belastning i pressade vinklar (som i en uppförsbacke) är centralt för att minska belastningen på knäskålen vid PFSS.

Att det bara gör ont vid belastning stämmer också precis med detta syndrom – det är alltså inte en strukturell skada, utan snarare en funktionsstörning som kan tränas bort eller hållas i schack med rätt strategi.

Dina åtgärder är redan på rätt spår:

• Minskad kraft vid trampning → minskar trycket på knäskålens baksida

• Undvika att passera smärtgräns → låter området läka och undviker irritation

• Bibehållen aktivitet → mycket bättre än total vila, eftersom rörelse smörjer leden

Förslag för långsiktig förbättring:

Om du vill minska risken att det återkommer (eller kunna trampa hårdare ibland):

1. Mjuk men konsekvent styrketräning

   • Fokus på quadriceps, särskilt i raka benlägen, t.ex.:

     • Bensträck i lätt motstånd

     • Höjda ben (utan vikt), hålla kvar i 5–10 sek

     • Väggsittning med lätt böjda knän

2. Rörlighet och balans mellan muskler

   • Stretch framsida & baksida lår, sätesmuskler

   • Eventuellt foam-rolling av lårens utsidor

3. Lyssna på smärtan som vägvisare

   • Smärtfri träning = ok

   • Lätt obehag = ibland ok

   • Skarp smärta = backa

Du verkar ha bra kroppskännedom och har redan gjort den viktigaste anpassningen. Om du dessutom bygger upp stabilitet kring knät lite i taget, kommer du troligen kunna trampa lite hårdare igen om du vill — men kanske aldrig på just den där uppförsbacken utan elassistans, och det är helt okej.

Certainly! Here’s the translated section:

Suggestions for Long-Term Improvement:

If you want to reduce the risk of recurrence (or be able to pedal harder at times):

1. Gentle but consistent strength training
   
   Focus on the quadriceps, especially in extended knee positions, for example:

   • Light resistance leg extensions

   • Straight-leg raises (without weight), holding for 5–10 seconds

   • Wall sits with knees slightly bent

2. Mobility and muscle balance

   • Stretch the front and back of the thighs, as well as the glutes

   • Optionally, foam-roll the outer thighs (IT band area)

3. Let pain guide you

   • Pain-free exercise = good

   • Mild discomfort = sometimes acceptable

   • Sharp pain = back off

Let me know if you want it in more formal medical English or as casual advice.

That actually makes a lot of sense — and it’s more common than it might seem.

Why the “good” leg gets overloaded:

After a stroke, the non-affected leg often becomes the primary weight-bearing and working limb, compensating for weakness or imbalance in the affected side. Over time, this can lead to overuse injuries like patellofemoral pain syndrome (PFPS), especially if:

• The gait is asymmetrical (even subtly)

• The stronger leg handles most of the load during cycling, stairs, etc.

• Muscle patterns have adapted inefficiently

In your case, that chronic compensation has likely placed excessive repeated stress on the kneecap of the good leg — especially during powerful movements like cycling uphill.

The silver lining:

You’re already doing exactly the right thing:

• Letting the affected leg contribute more now that it’s painless

• Reducing overload with e-assist

• Considering long-term strengthening and balance training

If you’re open to it, you might benefit even more from:

• A physio assessment to evaluate gait symmetry

• Targeted bilateral leg training to share the load more evenly

• Light neuromuscular coordination work on the affected leg to further support your balance

Let me know if you’d like a short program or further explanation of any of those.

Thanks for explaining — and what you describe is very typical and entirely understandable post-stroke.

You’re absolutely right:

A completely symmetrical gait after stroke is usually not possible,

even with full strength recovery, because motor control and coordination — not just muscle strength — are affected. That sideways, somewhat involuntary movement is likely due to:

• Spasticity or abnormal tone

• Altered motor patterns (from rewired brain circuits)

• Loss of fine control of specific joints, like hip, knee, or ankle

Even if strength returns, precision doesn’t always follow — especially in swing phase of gait, where smooth, coordinated movement is critical.

Why this matters for your knee:

Your stronger leg is:

• Stabilizing more

• Pushing off more

• Correcting imbalances from the affected leg’s swing

Over time, this repeated compensation can stress the patellofemoral joint, especially under load (like cycling uphill).

What can help:

You’re already adjusting wisely. For further support, consider:

1. Neuromotor retraining (for the affected leg)
   
   Small, controlled movements (even lying down or seated), to gently improve coordination — not strength, but timing and pattern.

2. Bilateral functional training
   
   Exercises like supported squats, leg presses, or step-ups where both legs share the load, but under control.

3. Dynamic gait training (with or without assistive tech)
   
   Even simple treadmill work with bodyweight support can help redistribute effort more evenly and reduce compensatory stress.

4. Patellofemoral-specific management for the good leg
   
   As we discussed: load management, quad retraining, mobility, and pain-guided progression.

Would you like me to sketch out a few practical exercises you can do that fit this context — balancing the needs of both legs?

Great question — and the answer depends on which leg is doing the work during the step-up.

Here’s how to approach it:

🔹 If the painful (good) leg is the leading leg going up:

• It bears most of the load.

• That increases stress on the knee, especially the patellofemoral joint.

• ✅ Good for quad strengthening — but only if pain-free or mild.

• ⚠️ Avoid if it causes knee pain during or after.

🔹 If the stroke-affected leg is the leading leg:

• This can be useful for motor control, but:

• If it’s unstable, you may compensate with the good leg anyway.

• ⚠️ Risk of weird sideways movement or poor tracking, unless well supported.

Safer approach for now:

Start with the painful leg as the trailing leg (i.e., the one that pushes up from the floor last):

• Let the affected leg lead the step-up (small step height).

• Focus on slow, controlled motion, holding a railing or support.

• The good/painful leg contributes less load this way.

Once that feels safe and pain-free, alternate:

• Try low step-downs (from a 10–15 cm height), where the good leg controls descent. It’s excellent for quad strength but less stress than full step-ups.

Would you like a simple progression plan — with step height, reps, etc.?

Stair walking is excellent functional training — but for your situation, it’s a double-edged sword:

✅ Benefits:

• Improves strength in both legs (especially quads and glutes)

• Challenges balance, coordination, and weight shifting

• Trains real-life motor patterns

⚠️ Risks/Challenges:

1. For the painful (good) leg:

   • Going upstairs = high patellofemoral load → may provoke pain

   • Going downstairs = even worse for the knee → higher joint compression, plus eccentric control demand

2. For the stroke-affected leg:

   • Reduced coordination or side sway may make stair walking unsafe without support

   • Difficulty lifting the foot or placing it precisely can increase fall risk

🔄 How to approach stair walking safely:

1. Use a handrail (or two if possible)
   
   It’s not cheating — it unloads the knees and increases safety.

2. Go up leading with the affected leg (if it can manage)
   
   “Up with the good, down with the bad” is the classic rule — but if your affected leg is pain-free and strong enough, use it going up. That lets the painful leg trail and push off less.

3. Go down leading with the good/painful leg — cautiously
   
   If it hurts, go sideways or step down one step at a time with both feet landing on each stair.

4. Limit reps
   
   Avoid long stair sessions. A few flights is fine; stop before pain appears.

If stair walking hurts, it’s best to treat it like strength training, not cardio:

• Low volume, high control

• Rest between bouts

• Pain = red flag to scale back

Would you like a recommendation for a good stair-walking alternative for cardio or leg work?

Great — for step-ups, start low and build gradually. Here’s a safe progression for your case:

🔹 Recommended starting height:

• 10–15 cm (4–6 inches)
  
  That’s about the height of a thick book, a low aerobic step, or the bottom stair.

Why?

• Low enough to avoid stressing the painful knee

• Allows your stroke-affected leg to focus on balance and coordination

• Easier to control posture and movement quality

🔹 Progression plan:

1. Start with 10–15 cm

   • Master slow, controlled movement (both up and down)

   • Pain-free? Stable? Then…

2. Increase to 20 cm (~8 inches)

   • About a normal stair height

   • Only if both legs can handle it comfortably

3. Max safe height for your use

   • 25–30 cm is probably the upper limit unless you’re very stable and pain-free

   • No need to go higher — quality beats height

Bonus tip:

• If using the stroke-affected leg to step up, focus on smooth lift, not speed.

• If using the painful leg to step up, ensure no sharp or delayed knee pain, even after.

Would you like a specific step-up exercise routine using that low height?