There are approximately 300,000 knee replacements performed annually. If you want to stay away from the knife and foreign implantation in your 50s, 40s, 30s, and even worse in your 10s, building a strong, healthy body is mandatory.
Before we go further, enjoy a story of a young, hyperactive child. Luckily, when I was growing up, instead of sending hyperactive John to the physician, my parents dropped me off at the local YMCA for hours on end. They threw me in the pool, court, field, and diamond to drain my energy, allowing another adult to supervise me while they took a breath of fresh air. I loved all the sports and practiced hard becoming successful at each of them, until I dislocated my knee cap at the age of 14. This injury took me away from soccer and basketball, allowing me to meet some friendly physical therapist. At the time, I loved the physical therapist I met and felt they improved my symptoms. They put me on a fancy ultrasound machine, gave me ice and one exercise (quad sets) to do daily.
In retrospect, these physical therapists were dismal. They never solved my knee problem and threw me back on the court asking for re-injury. The lack of improvement was frustrating, leading me to hang up my basketball and soccer shoes. Luckily, swimming (other than breaststroke) requires low knee stress which keep me active and increase my love for the sport. Sadly, this poor therapist halted my progress and lost me a lot of ground in the knee prevention and rehabilitation game.
In the first year of receiving my doctorate in physical therapy, I was determined to fix my stubborn knee. I hit the orthopedic books, studied the cadavers and stayed up late feeding a new infatuation with coffee. This hard work allowed me to improve my knee pain with self treatments. The resolution of pain helped me return basketball, soccer and lift (dead lift about 3x my body weight) with no knee pain! All that hard work will be handed to you in this post, the COR Knee Pain Solution.
If you’ve had a knee injury, you can relate to my woes of knee pain, if you haven’t this article is even more appropriate, because a knee injury is something I wish upon anyone. Remember it is easier to prevent than rehabilitate!
Knees need to be strong, tungsten strong (tungsten is the strongest metal)! Unfortunately, preventing knee pain and resolving most knee injuries involves work at many areas, not just the knees!
Here are some tips to build tungsten knees:
- Warm-up: Warming-up simply circulates blood and fluid throughout the body and into the joints. This creates less friction at the joint and eases movement. Don’t be “in a hurry” or think “you’re impervious” to injury, you are susceptible at any age, warm-up properly with a dynamic warm-up in all planes of motion!
- Mobilize those Hips: Our heavy sitting society encourages stiff hips. Stiff hips, puts more stress and strain on the knees leading to injury. Often times you hurt your knee, see a physical therapist focusing on the knee, return to training, then re-injury their knee. This is the reason for stubborn, reoccurring knee pain. The knee is often the result of a deficit at another body part. Poor hip mobility in every direction can lead to knee pain.
- Move those Ankles: Stiff hips in any plane of motion increases stress at the knee. Stiff ankles in the saggital (flexing and pointing) impairs squatting and deadlift strength. Remember, everyone squats and deadlifts throughout the day. Sitting on the coach, in a chair, picking up something from the floor… Mobilize those ankles to save your knees.
- Wake your Butt: Glutes control hip mobility. Many studies note poor hip external rotation and abduction in people with knee pain. Activating the glutes is tough for many, specifically gluteus maximus and posterior fibers of the gluteus medius. Successfully activating the glutes and learning how to use them is essential for knee health and injury prevention.
- Balanced Training Approach: Poor training programs often focus on one plane of strength, the saggital plane. Many people do squats, lunges, wall suits, then drink protein powder expecting to get healthy. If you follow this approach, your knees may not hurt now, but I can guarantee they will in the future! Overworking the front half of your body may look good in the mirror, but won’t improve athletic performance or prevent injuries. When I say balance in your training, we aren’t talking within the training day or even the training week. You need to address the long-term health of your body when you lay out your programming! Don’t just plan one week at a time. Write a long-term plan, follow it, and then forget about it! Or, sign-up for personal training or boot camp and have it done for you!
- Stop the Pain: This simple rule of thumb is often ignored. No matter the exercise: running, squatting, jogging, swimming, or picking your nose, if it hurts, stop! Anyone on the street can advise this brain wrenching idea. Exercising through pain often causes inflammation and perpetuates a musculoskeletal injury. If you have to miss a day off to improve your pain, do it! Missing a day instead of a week facilitates long-term success. Every time you exercise you need to work on getting better, this is impossible if you’re injured.
- Single Leg Train: Single leg training prevents heavy lifting, but helps improve leg strength and proprioception. Proprioception is the ability for a joint to know where it lies in space. A lot of research indicates those with knee pain or a history of knee injury exhibit poor proprioception. This is problematic, think about it, how can you control something if you don’t know where it is? I mean most parents can’t control their kids when they’re on a leash next to them. Moreover, single leg training finds your weak points. Many people squat, deadlift and pull, but neglect single leg efforts. Single leg training is essential to isolate and strengthen the glutes.
- Strengthen the Posterior chain (glutes and hamstrings): As mentioned earlier, the glutes need to fire for knee prevention and rehabilitation. More so, the glutes need to be stronger for patellofemoral syndrome and ACL prevention. If you have problems sitting back while you squat or sit a lot it is likely you have a weak posterior chain. These people need stronger posterior chain improves this deficiency. Working the backside of your body may not be sexy, but is essential for rehabilitation/prevention and sports performance. Every high level athlete has a strong, responsive posterior chain, don’t be left out! Remember to tighten those glutes at the top of every glute exercise.
- Improve your posture: I won’t beat my clients to death with proper posture, but poor posture can feed into problems. Think about it, if one side of your body is longer than the other, then you will be landing harder on one side than the other. This difference will increase the impact on one leg and if I guarantee your knee joint is taking a beating. Also, if you have poor posture various pressures occur at your joint. If you’re bent forward and your chest is parallel to the ground your body won’t produce a linear force while you land. This over stresses the quads more and tugs on the knee, ouch!
- Improve your technique: People tell me all the time an exercise hurts their knees. This is likely from improper technique, not the exercise. Think about it, if you perform squats wrong and your knees kiss each other, than it is likely your knees are going to hurt. Improve your technique, skim some articles on popular lifting websites or hire a personal trainer, joint a boot camp, or try a barre class. It is your form, not the exercise! If the exercise hurts the knees, check the form, if done improperly, it would hurt everyone not just you!
- Improve your hip flexor length: The rectus femoris and psoas are troublesome muscles. These two pull and tug on the pelvis altering the interaction between your knees and hips. Moreover, these tight muscles can inhibit strength of the glutes through pseduoparalysis. Improve the length of these muscles and you’ll see improved glute activation to improve your knee pain!
- Consider Improving your diet: Many diets promote high inflammation. A high inflammatory diet can cause irritation in the joint leading to joint injury. A simple fix is cutting down on saturated fats and Omega-6s while improving your Omega-3 profile. This adjustment will improve your cholesterol and body inflammation. One simple way to improve your Omega-3 profile is to add Chai seeds on your food. Professional swimmer Russ Payne told me about this addition, it is awesome! These seeds carry minimal taste and are easy to throw on anything!
- Consider losing weight: Let’s not be naive. Force is a product of mass x acceleration. If you have more mass, you knees will endure higher force demands. Losing extra pounds will decrease force on your knees saving you from pounding them into submission with every step you take! Diet is the largest contributor to weight loss. If you don’t think you can change your diet on your own, considering seeing a nutritionist or having pre-ready foods made for you! Pre-made Paleo food brings nutritious meals to your door for only a couple hundred dollars a month!
COR Knee Pain Solution
The following muscles are typically tight and put the body in a poor biomechanically position. Restoring muscle tone and is the most important aspect for rehabilitation, as well as prevention. First, get the muscles in the correction position and tone for proper strength and timing!
Tennis Balls Plantar Fascia
The plantar fascia is part of fasica (connective tissue) running from the bottom of the foot to the butt. Improving plantar fascia length improves toe touch mobility and other posterior mobility. If this structure is tight it will prevent one’s ability to bend forward. For example, perform a forward bend, then stand up and place a tennis ball or baseball under the arch of your foot. Roll the ball around, allowing your foot to relax. Perform for 90 seconds. After the tennis ball rolling, re-check the forward bend and see them improvement in your forward bend.
The calf consists of two muscles: gastrocnemius and soleus. The gastrocnemius attaches above and the soleus attaches below the knee-joint. When tight, these muscle can limit knee range of motion.
Every athlete has performed the calf stretch in their life. Unfortunately many people have flat feet which prevent optimal stretching of the calf. Think about it, as you lunge forward against the wall, your foot flattens more and the stretch is avoided.
Sit-up with one leg straight and the other bent, then place the tennis ball under the outside calf of the straight leg.
For a proper calf stretch, stand with one leg behind the other facing a wall. Use a towel to support the arch of the foot that is behind you. Bend your front knee while keeping your back knee straight. Lean forward, using the wall for balance, until you feel a stretch in the calf or the back leg. Soleus Stretch
Same ideas as above only you are standing directly over the foot you are stretching. Just bend your knee and allow your ankle to flex until you feel a stretch in the calf, closer to your heel. Use a towel to support your arch.
Iliotibial Band (ITB)
The ITB starts at the hip and attaches to the inside of the knee. When tight this muscle causes havoc in typical gait motions. Not only does a tight ITB alter normal muscle firing, but it also increases the axial pressure of the knee. This increased joint pressure puts high stress on the medial knee potentially accelerating meniscal and articial changes.
Lie on your side with a tennis ball under your lower thigh, on the bottom leg, just above your knee. Bend the top leg’s knee and place it flat in front of the bottom leg. Push through your top leg and forearms to move the tennis ball.
Tensor Fasciae Latae (TFL)
The TFL is the muscle controlling the ITB. If this muscle is tight it pulls on the ITB perpetuating everything listed above.
Lie on your side and put the tennis ball directly behind your hip. To find the proper position, find your hip bone place the ball two finger breadths behind, and then lie directly on your side with the tennis ball behind this bone. This is often tender, so ease into this position.
The quads directly attach to the patella (knee cap) and can cause unnatural tilts to the patella increases joint pressure on specific areas. Certain tilts decrease the contact area of the knee cap, leading to focal pressure. Simply stretching this muscle is efficient for improving knee cap contact area.
Kneel on one knee with your other leg forward with your foot flat on the ground. Use a table or chair to your side for balance and a pillow under your knee if padding is necessary. Line up your body over the knee that you are kneeling on. In this position do a pelvic tilt or ‘tuck under’ and you will feel a stretch in the front of your thigh. Common mistakes are arching your low back or leaning forward which negates the stretch.
Quad Foam Roll
Sometimes the quad is stubborn, requiring foam rolling as well. Work one thigh at a time,working all around the quad, not just the front!
Leg weakness, specifically hip extension and external rotation, often contributes to knee pain due to weakness. The gluteal muscles control these motions. Glute strength consists of a stable core is essential for knee pain improvement/prevention.
This sounds silly, but many people can’t fire their glutes! First, squeeze your glutes as hard as you can. Next, squeeze one glute at a time. Do you have the strength and control for the task? First things first, make sure you can fire these muscles before moving on to the next exercises.
Begin on all fours, knees under hips, hands under shoulders (nice square frame), and back straight. This is your starting position. Lift your left leg out to your side, leaving your knee bent at a 90-degree angle. This resembles a dog urinating on a fire hydrant! Isn’t that awesome! Bring your leg back down, still bent, returning to starting position. This is one rep! Easy enough right! Just make sure you keep your leg aligned with your body so you are not twisting your hips. Complete reps on both sides.
Lie on your back with one foot elevated on a bench or couch. Tighten your glutes and hamstrings to lift your body towards the ceiling. Do not arch your back, but extend your hip to maximize muscle strength.
Improving core stability is also key for those with knee pain. If the core is not stable, the body undergoes excessive movement and increased pressure on the body parts below (the knee!).
Lie on your back with your knees bent, posteriorly tilt your pelvis or “tuck under” maximally contracting your abs. Bring one knee to chest. Hold it there. Then bring the other knee to the chest. Let one leg down, then the other. Repeat.
Coordinating the glutes and core is essential for knee pain prevention and rehabilitation. A weak core often contributes to weak glutes, therefore improving the strength of both is the first step. Next, teaching them how to work together enhances timing of the muscle essential for knee prevention/rehabilitation.
On the swiss ball or chair get into a bridge position. Have your knees shoulder width apart and your hands on the floor for support. Straighten one leg, let it down and repeat with the opposite side. DO NOT LET YOUR BACK ARCH, OR PELVIS/SPINE MOVE IN ANY WAY. YOU MUST STAY ABSOLUTELY STILL.
Hip Abduction with band
Lie on your back with knees bent. Put theraband loop around the thighs, above knees. Keeping the back position, pull knees apart and then let them come together slowly and under control. You will have a tendency to arch your back when you pull your knees apart. Do not let this happen.
COR Knee Pain Solution Summary
As you see, the knee is a complex joint. Also, pain is a complex processing issue for each individual. If you are having a pain, I do suggest seeing a physical therapist. If you simply have aches and pains and/or want prevention, give these a try. Remember, each case of pain is different, so this routine will only work for 90% of knee pain cases :>)
Written by Dr. G. John Mullen, DPT, CSCS
Build healthy knees for today and forever!
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