How to Eliminate Knee Pain

If you have been training for an extended period of time, you may have or know someone with specific knee issues. With the proper education, many of these issues can be “nipped in the bud” before progressing into something worse.

An overview of the knee joint:

The knee joint happens to be the largest joint in the body and is extremely important for things like weight bearing activity and locomotion. The bones involved in movements of the knee joint are the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). Since the fibula does not articulate with the femur, it is not considered part of the knee joint even though it serves to attach some of the structures of the knee. The tibiofemoral joint, or knee joint proper, is a hinge joint since it moves between flexion and extension with negligible side-to-side movement, like a hinge.

There are four ligaments that provide static stability to the knee joint. The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and the medial collateral ligament (MCL) all provide static stability to the knee in their respective directions. In addition to the regular articular cartilage covering the end of the bone, there is a special cartilage known as menisci (lateral meniscus and medial meniscus) between the bones. The menisci serve to provide additional stability, absorb shock, reduce stress, increase joint conformity, and enhance lubrication. The rectus femoris, sartorious, vastus medialis, vastus intermedus, and the vastus lateralis are the muscles that provide movement and dynamic stability to the anterior side of the knee. Posteriorly, the biceps femoris, semimembranosus, semitendinosus, gracilis, popliteus, and the gastrocnemius provide movement and dynamic stability. The science of the knee goes way deeper but I want to provide you with applicable info before you doze off.

Common injuries of the knee:

ACL injuries are most common and are the most likely of the four main ligaments to require surgery. As we’ve all seen, that doesn’t mean an end to an athletic career. ACL sprains often occur in activities involving sudden changes in direction combined with acceleration or deceleration of the body. Examples of this would be cutting, landing, or stopping movements. This can be seen in sports such as basketball or football where a player has a foot planted and attempts to cut or pivot. Another mechanism to an ACL injury is knee hyperextension with internal tibial rotation. An example of this phenomenon would be a basketball player landing following a jump. The final mechanism to an ACL tear is excessive anterior translation of the tibia. This can happen when a skier falls backwards.

Females are more prone to ACL injuries than their male counterparts. There are many theories as to why this is the case. My own opinion is that it is due to a lack of strength and stability surrounding the joint partly caused by a higher level of the hormone estrogen. Younger people such as teenagers and young adults are also more at risk for an ACL injury. This is due to both their higher activity level and higher flexibility (less stable) level.

Other common lower leg injuries include PCL injuries, MCL injuries, and meniscus injuries. PCL and MCL injuries are more commonly the result of impact. For example, a football player can be hit on the lateral side of his knee causing abduction of the tibia. The MCL is stretched beyond capacity resulting in an injury. Another common injury I wanted to point out is called I-T band friction syndrome also called “runner’s knee.” During running, the tensor fascia lata develops tension to stabilize the pelvis when the knee is flexed. This causes friction of the posterior edge of the iliotibial band against the lateral condyle of the femur around the time of foot strike. This leads to inflammation of the knee joint capsule and subsequent pain and tenderness around the lateral portion of the knee.

What’s a fitness enthusiast to do?

Flexibility in certain muscles is key to avoid unnecessary abnormal stress on the knee joint. These muscles include quads, hamstrings, iliotibial band, calves, and piriformis. Below you will find one good stretch for each. Just like any injury, the best treatment is prevention.

Exercise Description: Standing quad stretch Instructions
1. Standing with a shoulder width stance and hang onto an object for support.

2. Bring one foot up and grab with your hand.

3. Pull your foot up until you feel a stretch on the front of your thigh.

4. Hold for 20-30 seconds and repeat with the other leg.

Exercise Description: Supine Hamstring Stretch Instructions
1. Lie on back and place rope or towel over the foot. Other leg should remain flat on floor at all times.

2. Slowly straighten knee until stretch is felt in back of thigh.

3. Hold for 20-30 seconds. Repeat as prescribed.

4. Remember to keep the low back straight to isolate stretch in hamstring.

Exercise Description: ITB Stretch
Instructions
1. Place right leg over left leg in standing.

2. Lean trunk to the right feeling stretch in left ITB Band.

3. Hold for 20-30 seconds.

4. Place left leg over right, lean trunk to the left feeling stretch in right ITB, and repeat.

Exercise Description: Wall Stretch (Calves)
Instructions
1. Stand facing a wall with the feet shoulder-width apart and the toes about 12 inches (30 centimeters) from the wall.

2. Lean forward and place the hands on the wall.

3. Step back about two feet (61 centimeters) with the left leg and slightly flex the right knee.

4. Fully extend the left knee and keep the left heel on the floor

5. Allow the elbows to flex to move the hips and torso closer to the wall until a stretch is felt.

6. Hold for 20-30 seconds and repeat the stretch with the right leg positioned behind the body (i.e., step back with the right leg).

Exercise Description: Piriformis Stretch
Instructions
1. Lie back and bring one knee towards your chest.

2. Gently pull knee towards opposite shoulder until a stretch is felt in the hip area.

3. Hold for 20-30 seconds. Repeat as prescribed.

4. Remember to keep the low back straight in a neutral position.
(Courtesy of fitness generator)

Paying close attention to form is paramount both during exercise and during any other movements you witness your client perform. Things to watch out for would be squatting down to far, excessive kneeling, and knee valgus (knee abduction) with tibial rotation. The latter can occur during extreme pivoting.

The VMO (vastus medialis obliquis) tends to be the weakest link of the knee complex which is unfortunate because it’s also perhaps the most important. A strong VMO will take pressure off of the meniscus and ligaments of the knee so strengthening this area can help prevent a rupture. One exercise I do with some of my clients that works wonders for VMO strength and knee stability is called stability ball squats squeezing a ball between the thighs. This is performed similar to a stability ball squat but now a ball is added between the knees of the client for an isometric contraction. For additional info from rehab experts, refer to Protecting the Athlete’s Knee, written by physical therapists and certified strength and conditioning specialists Brian Schiff and Brian Smith.

Wrapping up the knee

As with most things, a holistic approach is the best way to approach injury prevention. If an individual is doing strengthening and stretching exercises but is fifty to a hundred pounds overweight, they are an injury waiting to happen. I had a client named Keith who attended one of my boot camps. He was suffering from quad and shoulder injures. Keith was a star high school athlete. Fifteen years and a CPA certification later, he didn’t realize that his body wouldn’t be able to handle the same stress it did when he was lean and mean in high school. Weekend warriors need to take precaution by incorporating consistent workouts and positive nutritional strategies into their lives.

Now you know all about the structure of the knees as well as some common injuries associated with them. You are also armed with tools to help you protect your knees. Be sure to realize that since you are a weight trainee, you are in an ideal situation to keep your knees healthy. With proper guidance on training and mechanics, you should be able to avoid most injuries.

Billy Hofacker is a personal fitness trainer certified through both the NSCA and the ISSA. For more information on injury prevention and other fitness topics, call Billy at (631) 225-7831.