Knee Injury Epidemic - Part 2

In the first section we looked at the joint itself and the different reasons behind stress on the knee. Let's quickly recap the big 4 that we finished with.
1.) Poor Mobility in the Ankle and Hip
2.) Weak/ Undeveloped Muscles
3.) Tight Adductors
4.) Poor Proprioception

This post is essentially a prehab / rehab section. If an injury has not happened yet this does not mean that the body is in alignment or safe from a tear. Quite often people will be asymptomatic (no pain or discomfort)but score high for injury potential in screening and manual  muscle testing. I will offer a couple of different suggestions for each of the above issues.

1.) Poor Mobility- Ankle / Hip
This is section deserves special emphasis we (as a society) are fighting a losing battle on this front. As I write this and doing homework I am sitting down wearing my Nike Running Shoes. I have been up for 4 hours and spent 3 of them seated which I would estimate is pretty average. This creates tightness in the hips and ankles and limits both joints ROM. The body compensates in order to perform the movement especially if it is in a sport setting.

RX'n

Lacrosse Ball (softball works as well)
30 sec: Rolling Out ea. Hip Flexor Area

30 Sec: ea side of Warrior Lunge Stretch (add a slight lean back and twist to your closed side- this will stretch out the psoas)

Warrior Lunge

30 sec: Roll out the calves with the lax. ball
10X - Stand with your lead leg close to the wall, foot flat. Push your knee toward the wall trying to touch the wall with your knee, keeping the heel flat, then slowly back out. Progress further from the wall still trying to tough the knee. You are stretching the lead leg in this stretch, not the back.


2.) Weak / Underdeveloped Muscles
This is a muscular imbalance issue as much as it is an undeveloped muscle. As a quad dominant society we typically have strong quads but a really weak posterior chain. In the weight room emphasis needs to be put on these posterior chain muscles.


RX'N
Clam Shells -  Here is a great and simple exercise for glute training that you can coach yourself through. Laying on your side wrap a thera-band or mini-band around your knees. Knees bent at 90 degrees turn your hips in slightly. Keeping your heels together you should abduct your top leg focusing on firing your glute. It helps to put your fingers on our glutet to insure that it is causing the movement versus your TFL. Break the exercise down into steps, contract glute, open the knes slowly, return to start, and relax glute. The picture is an okay example but the movement should be smaller (knees should only be a hand length apart at the end of the movement)



Single Leg Squat (to bench) - When examining a  bilateral squat (2 feet) there is very little glute med/ max firing until the end ROM. (We mentioned earlier how weak glutes will cause the femur to adduct. and internally rotate) This is not the case in a single leg squat, where both are called on immediately to stabilize the movement and drive up. Wrap a thera-band or mini band around the legs at the knee to force you to push your knees out and eliminate the valgus action. Focus on keeping the knee straight and driving through the heel. Start with the bench as high as needed and slowly progress down toward 90 degrees.



3.) Tight Adductors
Go grab your foam roller (yes you should have one...shame on you if you don't) and roll out the last 10 inches above your knee on the inside of your leg. Now that you have done that it is likely that you are silently cursing (or loudly cursing) how much that hurt. The adductor magnus is chronically tight in most individuals(partially because it has the ability to act as both a hip flexor and extensor as well as its primary roll as an adductor. When this muscle gets extremely tight it pulls the femur into that "danger zone" that we discussed earlier.
Side note:
Although not mentioned earlier the TFL/IT band is another muscle that is chronically tight and is a culprit in
most lateral knee pains. It can be treated in the same fashion as the adductors although it does not stretch as well.

RX'N
Foam Roll!! Sometimes I feel like I am repeating myself but I cannot overstate the importance of soft tissue work in removing adhesion in the muscle. Roll out the muscle 20-30 times looking for those trigger points and really focusing in on them.

Stretch

One of the easiest ways to get a nice mild stretch for your adductors is the classic groin stretch with the soles of your feet together and elbows pushing down on your thighs.

4.) Poor Proprioception
 Understanding where your body is in space is key to preventing knee injuries. One of the big factors behind knee injuries in females is the lack of coaching they typically receive in comparison to males throughout their careers. However, just because males have received some coaching does not mean they are proficient. I advocated in an earlier post the positives on using a video camera and this is one area where I really feel it can help build understanding, especially in single leg work. Have a training partner record you performing the exercise and then review it after being critical for any valgus action during your lift. It is typically prevalent during squatting or lunging.

The other important area to address is proper jump mechanics. A common issue is loading from the knees and not hips. This typically causes the femur to IR and Add. When you are doing broad jumps or box jumps think hips back/ knees out. This movement can also be recorded and analyzed by a camera, but having a coach on hand to watch is probably your best bet.

I hope you learned something in this post. No it is not a full rehab program but I tried to touch on some of the key concepts that I think should be addressed in knee injury prevention and rehab. If you have any other questions about specifics shoot me an email at avilaca90@gmail.com