IMPACT Online Exclusive: This Joint Is Jumping--Five Techniques to Achieve Better Knee Health | news-and-articles

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IMPACT Magazine > Sport Medicine > News and Articles > IMPACT Online Exclusive: This Joint Is Jumping--Five Techniques to Achieve Better Knee Health

IMPACT Online Exclusive: This Joint Is Jumping--Five Techniques to Achieve Better Knee Health

Knee injuries keep football players off the field, hockey players off the ice, and runners off their favourite trails, but staying active and continuing to do the things we love is critical for overall health.

Obviously, the rough nature of professional sport makes it a short-term or medium-term activity, but for health reasons, staying active should last a lifetime. Several strategies—utilizing an integrative approach—can be implemented to keep the knees healthy and keep you moving pain free.

The knee is a hinge joint that functions to extend and flex the leg, with small amounts of rotation also occurring. There are four ligaments that protect the knee and a cushy meniscus that helps absorb force—much like shocks do on a truck. These structures can be damaged by a crushing blow or through wear and tear over a period of time. Beyond these primary structures, there are other soft tissues that support the knee, and for the long-term health of the knee joint, these are just as important as the ligaments and meniscus.

Muscle imbalances, hamstring/quadriceps weakness, or mechanical abnormalities are a catalyst to the degeneration process that can ultimately lead to knee pain, and this cascade of events might not be as inevitable as most people think. Precautions can be taken to avoid it.

Improving Knee Health

First of all, it is critical to understand that the knee is sort of a biological “fall guy” because it is located between two mobile joints: the ankles and the hips. If there is a lack of mobility within these joints, then greater demand is placed on the knee and problems can arise.

Knee pain is a commonly used term that can refer to multiple things:
•    Is the pain lateral to the knee? Perhaps it is IT-Band Syndrome
•    Is the pain underneath the kneecap or just medial? Possibly it is a patellar tracking disorder.

Five techniques have been clinically proven to reduce knee pain, reduce knee injuries, and improve overall performance:
1)    Improve posterior chain strength
2)    Fire up the glutes
3)    Improve your running technique
4)    Increase mobility of the ankle and hip joint
5)    Release chronic myofascial tension

Technique 1: Improve Posterior Chain Strength!

Force producers—the glutes, hamstrings, hip flexors, and quadriceps—stabilize the knee by working together. Overdominance in the quads or weakness in the posterior chain can result in knee instability.

One of the most common reasons a runner complains of anterior knee pain is weakness in the hamstrings. When the foot makes contact with the ground, aside from the quadriceps and knee ligaments stabilizing the knee, so do the hamstrings. Due to their direct attachment to the tibia, the hamstrings play an important role in stabilizing the knee, primarily against shear forces. If the hamstrings are weak from a muscle imbalance, soft-tissue restriction, or mechanical flaw in the stride, the tibia translates forward, leading to anterior knee pain. Strength training improves posterior stability and is one of the most effective ways to improve knee health.

Technique 2: Fire up the Glutes!

There are several ways the glutes can become disengaged. One occurs simply when we don’t use them enough. Another is when shortened and tight hip flexors prevent the glutes from adequately doing their job. (See also, "The Psoas") We live in an “over-flexed” society, which means we sit a lot, and ultimately the hip flexors become short and tight. Stretches and treatments to release these shortened and stiff hip flexors are often required.

The gluteus maximus is a large muscle attached to the iliotibial band (ITB). The gluteus medius also directly attaches to the femur: these muscles are primarily for flexion, abduction, and external rotation. Interestingly, injuries to the Anterior Cruciate Ligament (one of the four major ligaments of the knee) occur when the leg is adducted and internally rotated. In addition, IT-band pain and patella-femoral pain can be reduced when the gluteus muscles are working properly to minimize hip adduction and internal rotation.

Getting the gluteus to fire

Bridges, dead lifts, and single leg squats (see also, "Training on One Leg") are excellent exercises to activate the glutes. The gluteus maximus is a big strong muscle that plays a key role maintaining proper knee health.

Technique 3: Improve Your Running Technique!

An improved running technique will take you a long way toward maximum knee health. If you lean back when running, or even while approaching a hill, this will throw the leg out front, increasing impact forces to the knee, shins, hip, and back. And if your running lean is too far forward, this will increase tension to the Achilles, calves, and hamstrings, and increase impact forces to the lower extremity.

The faster you go, the greater the degree of lean, but, remember, the lean should be from the ankles, not the waist. Leaning forward a few degrees from the ankles keeps the body aligned, allows the force of gravity to help propel you, and also makes it easier for you to land below your centre, essentially landing on your mid-foot.

Picture a runner not leaning adequately, their core not engaged, and making contact with the heel out in front. These factors add tension, shearing forces, and compression to the knee. Landing below the centre is called “releasing the brakes” and will dramatically reduce compression forces to the knee.

Technique 4: Increase Mobility of the Ankle and Hip Joint!

“Look above and below the problem to find the source of the problem.”

This quote is used often, but it makes sense. When knee pain is present, the knee is often compensating for a lack of mobility elsewhere. For example, ankle and hip mobility is a prerequisite for knee health. If ankle and hip mobility are limited, knee problems can occur. If you are performing a squat and there is a lack of movement in the hips, in order to continue the squat, another structure must provide this movement. In this case the lower back or knee will compensate for the lack of mobility.

So, mobility in the ankles and hips will improve the overall health of the knees. To get mobility for the hips, side-to-side and front-to-back leg swings can get the hips moving more freely. Ankle mobility exercises can be as simple as ankle rolls. For more exercises, please refer to www.magnificentmobility.com. The most relevant and useful time to practice mobility is right before the workout. These are called dynamic flexibility exercises, and they take the joints through a functional range of motion, and the muscles are primed for activity and lengthening.

Technique 5: Release Chronic Myofascial Tension!

Running, walking, jumping, and sleeping with the toes pointed down are activities that work the calves and plantar flexors. These activities shorten the tissue and this results in a muscle imbalance from overuse. The shortened and restricted tissue limits ankle mobility, and (as discussed above) this lack of mobility in one region affects the joints and soft tissue above and below that region. In this case, the knee is impacted above and the Achilles and plantar fascia area is impacted below.

Every time we train, repetitive motion causes microtrauma, especially to areas that are overused. The body responds by laying down thick fibrotic tissue to protect itself from further injury. Imagine pouring glue on the muscles and ligaments. Something similar occurs when scar tissue accumulates from an acute injury or after years of repetitive strain. Like glue, the scar tissue restricts normal movement and weakens the muscle’s natural ability to contract and lengthen—basically the muscle’s extensibility is lost.

Effective soft tissue treatments, such as Active Release Treatments, are geared towards manually breaking up restrictive scar tissue, restoring a normal range of motion, and improving resiliency of the tissue. This is applicable to runners because they often have tight calves and tight hip flexors that alter the running stride. Research has shown that tight calves and hip flexors are directly correlated to knee pain. Soft-tissue treatments that are aimed at decreasing stiffness and removing scar tissue and adhesions in the lower leg will ultimately restore ankle mobility and improve knee health.

Integration of different techniques is paramount to the patient’s health. These top five strategies are derived from a broad background of runners and are basic and easy to implement. We all have different backgrounds and it’s often helpful to use a wide range of techniques to resolve injuries and reduce pain.

About the Author

Dr. Cole Ellis, D.C., specializes in soft tissue and overuse injuries, and is the proponent of leading-edge treatments such as Active Release Treatments and the Graston Technique. He was a therapist for the 2008 U.S. Olympic Trials. He is the author of The Stay Active Manifesto and a panel expert for Competitor Magazine. Visit www.coleellis.com for more information.