In this article, I’m going to lay out the foundation of how you can avoid the frustration of knee pain. I also provide exercises you can use to limit your chances of getting knee injuries
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I could see he wasn’t happy. It was etched across his face as he performed an exercise that he deemed too easy.
My Client had come to me a month earlier because he had developed knee issues and wanted help so he could run again.
He was confused why he was getting these problems now. He had played rugby all his life and an enthusiastic member of the local high intense bootcamp.
“Do you sit down a lot”
“Yes, I’m a lawyer. We all do”
“Have you had any pain in other areas around your knees”
“Not really, although sometimes my calf pulls and I get the occasional twinges in my back”
“What type of exercise do you do”
“You know, the usual. Running and I go to my local bootcamp”
I knew already but the movement assessment confirmed it for me. My client was experiencing the all too common yin & yang effect of modern life. Sedentary work environment followed by all out exercise with little attention to ‘prehab’ or optimal movement.
Your knee is a joint. Its prime function is stability and the movement you require from the joint is flexion and extension. It allows slight rotation but won’t thank you for it.
The knee joint is created by the femur (thigh bone), the tibia (shin bone) and the patella. For its protection and its ability for fluid motion, these 3 bones are surrounded by cartilage and ligaments.
The ligaments create a sturdy strapping of the joint to allow strength & stability of the joint. The cartilage such as the meniscus provide a smooth surface. This aids the knees ability to have smooth motion but also absorb the load of the body as you walk, jump and run.
Additional to the cartilage, the knee joint also houses bursa which are fluid sacs that act like cushions while the knee takes a load.
Movement of the joint is created from the muscles that attach to the knee joint. When the knee flexes (bends) the hamstrings initiate this while the quadricep muscles initiate the extension (straightening) of the knee joint.
In an ideal world, your knees ability to achieve flexion and extension will serve you well right up until you’re hitting 100 years old. Bad times hit the knees when:
Gangsters through the ages have utilised the value of option ‘C. Naturally there is not much this article can advise to prevent a baseball bat to the knees other than to say, stay out of trouble.
So, I am going to focus on the first two options in this article!
The thing to constantly keep in mind is, all joints of your body are highly resilient and your knees are no exception.
As a result, when you experience knee pain it is the result of a cumulation of challenges to the knee joint rather than one direct action.
For example, lets say I assess you and find when you walk (or run) your knee turns inward as your foot lands on the floor. This is known as the ‘valgus collapse’. It is caused when the hip joint internally rotates and the femur motions inwards (adducts) upon the foot landing.
Rather than the weight of your body going through the strongest part of your knee which is through the joint, the weight directs towards the inside of the knee joint which houses a lot of the ligaments.
Think of the amount of times in a day your feet land when you walk, run or when you bend your knee such as when you get up and down from your chair.
Now think how many times it will occur in a year. You can start to see how it is inevitable your knee is going to experience ACL tears, Miniscus tears and patello-femoral pain just to name a few of the common knee joint injuries.
What I have described is just from ONE example of what can happen to the knee!
So this is when the knee joint continually moves outside of its originally intended alignment, what about when it is forced to take up another function outside of proving stability?
This tends to occur when its other surrounding joints are being lazy, namely not providing mobility. For example, Go to a wall place your foot about 12 inches away from the wall and with your hands on the wall drive your knee forward while keeping your heel on the floor.
Does your heel come off the floor?
If you lack the mobility of your ankle joint, other joints have to compensate. Yep, you’ve guessed it – the knee joint.
Your body will always take the path of least resistance. When you walk and your knee comes forward in its stride it will be up to the knee joint to provide extra movement if the ankle joint doesn’t allow the necessary mobility to cater for that stride,
What you will see is a lateral movement of the knee joint (as it can’t go forward any further), creating a wearing and tearing of the ligaments
I hope you can see that a combination of how you move in everyday life AND in exercise can create the cumulative effect of pain and injury in your knee joint.
How do we deal with this then? The following is 5 questions to Answer to assess the problem of your knees.
Your derriere is the largest muscle of the body. As a result you’d expect it to have a pretty pinnacle job, and you’d be correct! Your glutes actually have 3 parts to them; Gluteus maximus, Gluteus medius and Gluteus Minimus.
The Gluteus maximus primary job is to extend the hip (think getting up from a chair/squat or propelling for as you walk/run). The glute medius and minimus have similar jobs of internal & external rotation of your hip, moving your leg in a lateral motion (abduction & adduction) as well as helping to stabilise your hip, pelvis & femur (thigh bone).
That quite a lot of jobs right?
Excessive sitting down turns off (inhibits) your glutes. What can you imagine happens to the joints around the area (psst, your knees!) if your glutes aren’t firing on all cylinders?
If your Glute medius & Minimus are inhibited, it is not stabilising your hip when you do basic acts like walking. This means more pressure is going to be placed on your knees because the load above it (your hips) are not being stabilised.
One way you can easily check this is to place your hands on the top of your hips and go on one leg. If you find one hip drops so it is lower than the other, your glutes are likely to not be activating as well as they should be.
One of the ‘truths’ you need to realise about the body is it will always take the path of least resistance when it is being asked to do something.
Take walking for example; You place one foot forward, stride forward and for a period you’re on one leg as your rear leg propels forward to take the step.
In an ideal world, what should happen is throughout this movement your knees should remain facing forward in line with your feet. This relies on 2 factors:
If these factors aren’t present what will happen is, each time you walk/run/get up and down from a chair, the path of least resistance will be your knee going inwards (known as Valgus knees).
To get an idea of the impact this will have on the inside of your knee, give the Elvis Shimmy shake a try for a minute and get a sense of how it feels on your knee…then times it by 1000 as you are doing this lateral action EVERY DAY!
Stand in front of a mirror and relax.
Notice which direction your feet are pointing. Notice whether your kneecaps are facing forward or outward?
Now stand sideways to the mirror. Take a side glance and notice what you see. Do you have a lower back tilt causing your pelvic to tilt forward (Anterior tilt)? Is your head protruding forward, along with a forward lean on your upper back (thoracic flexion)?
All of these factors are deviations from your optimal postural alignment. In an ideal world, when you stand up straight:
Any deviation from this position and you face the increasing likelihood the joints that are responsible for stabilising you, your knees being one of these, have more pressure on them than they can handle.
At some point when watching rugby or American Football you will see a tackle where a player launches at their opponent from side on where their knee goes sideway.
If the unfortunate recipient of this tackle is particularly unlucky they will experience the “unhappy triad”. This is damage caused to 3 of the major ligaments of the knee; Anterior Cruciate Ligament, Medial Collateral Ligament and the medial meniscus.
This is worst case scenario where there is direct trauma. For us everyday folk, we can help matters by ensuring there isn’t too much lateral movement going on in our knee joint.
Aside from what I’ve talked about already, another factor is ensuring your quadriceps and hamstrings are operating correctly.
The principle function of the quadriceps and hamstring is the flexion (Hamstrings) and extension (quadriceps) but also helps in the stabilising process to prevent the knee from buckling.
In the process of getting up and down every day from a desk bound existence, we become very quad dominant without complimenting quad strength with Hamstring & glut strength. This is problematic as there is an unequal distribution of strength attempting to stabilise the knee.
One of the prime times when you need a stabiliser joint to do its job is when there is impact, such as when you jump or when running.
To aid this process the knee has shock absorbers known as Menisci which absorb force impacted on the knee. The knee also has Bursa which are fluid sacs that act as cushions in the areas where muscles & tendons move over the bony joint.
In short, we can handle impact. However, excessive impact that can come when there is misalignment and weak muscles not doing their job can see stability being compromised and these shock absorbers wearing away.
Issues such as Menisci tears and bursitis (inflammation of the bursa) can occur when there is too much strain on the knee joint due to instability.
As you look through these 5 questions, you may start to become clear on what is contributing to your knee pain. Thankfully, a lot of time there is a solution and part of that solution comes with what exercises you do on a regular basis.
In the next section I will present 6 exercise that I feel MUST be present in order to strengthen the areas around the knee and help eliminate knee pain.
Squats is an old stable in the exercise world and for good measure. A compound exercise due to its recruitment of multiple muscles, the squat activates your quads (a prime muscle group for stabilising the knee) and the muscles of your torso which prevents your torso from flexing forward as you squat.
The bridge is a very easy exercise to really activate your glutes, in particular your gluteus maximus which is responsible (amongst other things) for stabilising your hip whilst moving.
When moving you’d want your hip to be stable because if it isn’t there is extra pressure on your knee to take the load.
The bridge is a very good starter exercise and perfect for focussing on really squeezing the glutes hard. I recommend two methods. One where your knees are directly above your hips and the other where your knees are out wide, changing the angle of activation.
The hip hinge isn’t an exercise per say. It’s a movement that’s the basis for a large array of valuable exercises such as the deadlift and kettlebell swing. It is imperative to get the hip hinge right. Failure to do so results in putting the load into your lower back rather than your hips. Cue sore back and weak hamstrings!
The knee raise walk is the first exercise I describe where you are beginning to test your knee stabiliser muscles. When you walk and run you are on one leg. The knee raise walk helps you practice keeping the knee in line with your foot.
I like this simple exercise because it challenges the stability of your knee joint in a controlled manner. From the moment your rear foot drives through and raises out in front of you, you will need to stabilise your planted knee.
Lateral jumps is a great exercise to impose “mini trauma” on your knees without doing damage.
A common problem with the knee joint is placing too much pressure on the meniscus cartilage. This is especially true with people with a history of playing ‘lateral sports’ like hockey and squash.
This acts as shock absorbers and work with areas of the quadriceps like the Vastus Medialis Oblique (VMO). The VMO help keep the knee in alignment with the foot.
There are 3 muscles related to the glutes: Gluteus maximus, medius and minimus. Whilst people can work the glute maximus with the bridge exercise, the medius and minimus is commonly neglected. This can be a problem as these muscles are of key importance to knee alignment and stabilisation.
Knee pain isn’t a sign of aging. It is a sign it is not being supported enough to carry out its function of flexion and extension. By implementing these 6 exercises and applying the 5 important principles your experience of knee injuries reducing dramatically.
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