By Karyn Gallivan, MS, ATC, CSCS, NSCA-CPT, NASM-CPT
Contributor, Sports+Fitness Network
In my last post (The Feet Feel better, but Now the Knees Hurt), I discussed several common knee injuries. Whether it is chondromalacia, iliotibial band syndrome (ITBS), quadriceps, or patella tendinitis, these injuries are generally overuse injuries and a result of over-stressing the muscle or connective tissue, repetitive micro-trauma resulting from errors in training (too-much-too-soon), poor technique, muscle imbalances, or biomechanical abnormalities. If we, as Athletic Trainers, personal trainers, and coaches focus on a few of the often overlooked basics, there is a good chance of preventing these injuries altogether. This is a much better alternative than the chronic injuries that these common conditions oftentimes turn into, don’t you think?
There are a few basic activities that can be used as preventive measures to keep the knee safe for any type of activity, so training can continue uninterrupted. First, I want to remind you that the safety of the knee joint has a lot to do with the stability of the joints above and below it. If the one hip and/or ankle is unstable, then the knee joint in the middle tends to take a real beating.
Performing a few exercises will challenge your balance, especially single leg standing activities, will help to improve the stability of the ankle and hip joints, as well as the stability of the knee. Personally, I consider these activities as an extension of core training, which I discussed in The Essential Link in Fitness and Conditioning. Just as adequate core strength and stability will support the spine and pelvis during movement, adequate ankle and hip stability will support, and help keep in proper alignment, the knee during any type of training or activity. And, just as in core training, benefits to improving ankle, knee, and hip stability include improved posture, better exercise technique, and more efficient movement.
Keep in mind, that the list below is not exhaustive of the exercises possibilities that will protect the knee. They are, however, the most basic activities that I can teach athletes and clients, and have them keep doing as part of their warm-up routine, so these basics are never neglected. Also, I have tried to use very common names for these activities, so they can be easily search for online. Finding pictures, or short video clips, of these being performed will help you become better at teaching them and knowing what to look for in terms of mistakes or imbalances. Here they are, along with my most commonly used verbal cues:
- Single leg balance –standing on one leg, foot and toes gripping the ground, knee not locked, but quadriceps engaged, pelvis should stay level (keeping hands on hips helps).
- Four-way hip exercises (first without resistance band, then with band) –the instructions are basically the same as in #1. However, keep in mind that the leg being challenged is the standing –not the moving- leg. Standing on one leg, move the opposite leg into abduction/adduction, flexion/extension. This creates a challenge for the standing leg –begin with small motions, progress to larger motions only when balance is maintained and pelvis remains stable on the standing leg. When athlete/client is proficient, add a bit of a challenge by using some light exercise tubing for the swinging leg. Begin with small, slow motions, and progress from there.
- Single-leg mini-squat –Consider this an extension of single leg balance. Standing on one leg, have athlete/client squat down, using a very small motion, and return to standing. Progress to a larger range of motions or add light weight to increase the challenge.
- Step-ups/step downs –using a 6”-8” step, slowly step up and down, focusing on keeping the toes pointed straight ahead and keeping the patella in line with the big and second toe. Be sure to watch for the foot collapsing in to excessive pronation, or the knee collapsing medially. Controlling for these two mistakes, will allow the foot, ankle, and hip stabilizers (foot and toe flexors, gactroc/soleus, and gluteus medius/minimus) to have a better biomechanical position from which to work.
Strengthening the foot, ankle, and hip stabilizers (foot and toe flexors, gactroc/soleus, and gluteus medius/minimus) will help keep the knee safer. All of these exercises can be made more challenging as the need arises. Progress from a stable surface to an unstable surface –but only after your client/athlete has mastered the current challenge.