Got Knee Pain?
The knee is one of the most commonly injured regions in the body:
- An estimated 80, 000 to 100, 000 anterior cruciate injuries (ACL) occur annually in the US
- Approximately 70% of these are non-contact (i.e. related to poor biomechanics)
- There is a strong correlation with ACL injuries and future arthritis in that knee
The anatomical location of the knee joint it such, that it is greatly influenced by the neighboring joints above (lumbo-pelvic-hip complex) and below (foot and ankle complex).
I have heard it said that the knee goes where the foot directs it and the hip permits it, i.e. It is greatly influenced by the mobility of these joints.
Bone and Joints
The primary bones making up the knee joint include:
- Femur (thigh bone)
- Tibia (inner leg bone)
- Fibula (outer leg bone)
- Patella (knee cap)
Proximally (above the knee joint) the femur joins with the pelvis to make up the iliofemoral joint. The pelvis and sacrum join to make the sacroiliac joint.
Distally (below the knee joint), the tibia and fibula help form the ankle (talocrural) joint.
There are a number of muscles in the lower leg and lumbo-pelvic-hip complex that can influence the knee.
- Gastrocnemius/Soleus (posterior lower leg)
- Adductors (Inner thigh)
- Hamstrings (Posterior thigh)
- Tensor fascia latae/IT- Band (Anterior and Lateral hip and thigh)
- Quadriceps (anterior thigh and hip)
- Gluteal muscles (Posterior and lateral hip)
It is essential that these muscles have optimum length, tension and strength to ensure optimum flexibility, range of motion and neuromuscular control.
Common knee Injuries Associated With Movement Deficiencies
Patellar Tendinopathy (Jumper’s Knee)
- Repeated stress from overuse on the patellar tendon results in inflammation and degeneration
- Increase risk from knee valgus (knock-knee) or knee varus (Bow-leg)
- Poor quadricep and hamstring flexibility can lead to increased risk
- Women more susceptible (8x) due to an increase in the Q angle (a measurement of the angle between the quadriceps muscles and the patella tendon that provides information about the alignment of the knee joint)
Iliotibial Band Syndrome (Runner’s knee)
- Inflammation of the distal part of the iliotibial tendon as it inserts into the outer part of the femur at the knee joint or less commonly proximally at the hip, where it can cause bursitis
- Common in runners, cyclists and tennis players, as an overuse injury
- Factors such as an over active Tensor fascia latae pulling on the IT- Band, as well as weakness in the hip abductors, greatly influence proper mechanics, resulting in friction and eventually inflammation
- Abnormal tracking of the patella due to altered activation of the muscle surrounding the knee as well as weakness in the hip musculature (Gluteus medius and maximus)
- Patella tracking can also be affected by an abnormal Q-angle
Anterior Cruciate Ligament (ACL) Injury
- Commonly due to altered or insufficient lower extremity neuromusculoskeletal control from muscle imbalances and joint misalignments (Pelvis, knee and ankle)
- Valgus torque (knees tending more towards adduction, which is more common in women), affects frontal plane stability (side to side movements) and greatly increases the risk of injury during side-to-side movement and landing from a jump
A Systematic Approach to Identifying and Correcting Knee Impairments
An integrated assessment of the knee should involve:
Static Posture- Look for pronation at the ankle resulting in knee adduction stress
Movement Assessment (e.g. Overhead Squat)- Knee´s move in (valgus); Knee´s move out (Varus)
Jump Assessment- Look at landing mechanics, e.g. knee valgus and poor foot placement
Range of motion- Of the Hip, Knee and Ankle
Manual Muscle Testing – Muscles around the Hip, Knee and Ankle
Joint Palpation- Ankle, knee, Lumbo-Pelvic-Hip
Sample of A Corrective Approach to Knee Injuries
Piriformis (Knees move out in squat)
|Hold tender area 30-60 seconds|
Piriformis (Knees move out in squat)
|Joint Mobilization||Manual therapy||Ankle
|Mobilization with pain-free movement|
|Activate||Isolated strengthening exercises
Adductors and medial hamstrings (knees move in on squat)
|Integrate||Functional dynamic exercises||Ball squats
- The majority of injuries in both college and high school athletes involve the lower extremity, with the knee being the most common area
- The knee is linked to and impacted by proximal (lumbo-pelvic-hip complex) and distal (foot and ankle) joints via relationships in the kinetic chain
- Most knee injuries involve neuromuscular deficits such as joint misalignment, muscle imbalances and poor neuromuscular control, often perpetuated by overuse
- An integrative assessment should consist of:
Static Posture Assessment
Range of motion
Manual Muscle Testing
- A comprehensive treatment plan should involve:
Inhibiting and Lengthening overactive muscles
Activating underactive muscles
Integrating full body functional dynamic movements
Got knee pain?
Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training. Lippincott Williams & Wilkins.
NASM- CES Class http://shop.nasm.org/p-87-corrective-exercise-workshop.aspx
I am teaching 5/15 in Bellevue at Fitness Forward. Details below: