Work out Article of the week: the Knee

[Mop]

Well this is a broad subject and I am going to go into it in a broad manner.

In this day and age as we get more competative as children ( sports ect) and more competative as adults our body takes a pounding, especially the knees. Oh do they ever. From tendonitis of the knee to acl injuries are common in upwards of 80% of people working out in gyms now adays.

The knee is extremly complex- 3 major muscle groups push and pull on it, 2 very important tendon and ligaments pull against it to keep in place, ever muscle from your abs / shoulders to your quad and calf have a major part of what your knee can and can not do... So lets take a look at the knee real quick for a general overview

These are 3 general articals on the knee, there are numerouse things that can go wrong with the knees, prevention is the most important thing you can do to protect your knees, but once a knee injury happens - it is taking a smart and safe approach to rehab and post rehab that makes the difference between running again and walking with a limp the rest of your life.



The cruciate ligaments are two in number. They are named anterior and posterior with regard to the positions of their attachments on the tibial plateau; the anterior cruciate ligament being attached to the anterior intercondylar area of the tibial plateau, and the posterior cruciate being attached to the posterior intercondylar area of the tibial plateau. They are named cruciate ligaments because they cross each other (like the limbs of the letter X). Both cruciate ligaments are situated within the capsule of the knee joint. However they are not within the synovial cavity of the knee joint. The cruciate ligaments receive a sensory innervation from the genicular branches of the tibial, common peroneal and obturator nerves. Sensations subserved by these sensory nerves include both pain and proprioception, and correspondingly both pain receptors and mechano-receptors have been identified within the cruciate ligaments.

The cruciate ligaments are vascularized structures; the blood supply of the cruciate ligaments being derived from the genicular branches (principally the middle genicular branch) of the popliteal artery. Thus hemarthrosis is an important clinical feature of cruciate rupture.

The function of the anterior cruciate ligament is to resist posterior displacement of the femur on the tibia.



The function of the posterior cruciate ligament is to resist anterior displacement of the femur on the tibia.

The anterior cruciate ligament lies entirely within the capsule of the knee joint but extrasynovially. Its inferior attachment (i.e., tibial attachment ) is to a facet on the medial part of the anterior intercondylar area of the tibial plateau. Its superior attachment is to a facet on the posterior part of the medial surface of the lateral femoral condyle. Thus the anterior cruciate ligament runs obliquely upwards, posteriorly and laterally from its tibial attachment to its femoral attachment. However, the fibers arising most anteriorly on the tibial plateau are attached most posteriorly on the lateral femoral condyle, and the fibers arising most posteriorly on the tibial plateau are attached most anteriorly on the femur. As a result of this arrangement the anterior cruciate ligament is slightly twisted about its long axis. Because of this helical structure, in a functional sense the anterior cruciate ligament appears to consist of two bands although morphologically it is a single structure. These are referred to as the anteromedial and posterolateral bands. Of the two, the posterolateral component makes up the greater part of the ligament.

Knee flexion is associated with a greater degree of tautness in the anteromedial component, while extension results in a greater degree of tautness in the posterolateral component. Another consequence of the spiral nature of the anterior cruciate ligament is that tension in the ligament is increased during internal rotation of the joint, while external rotation of the joint results in a decrease in ligament tension.

In the adult, the anterior cruciate ligament is 38mm long and 10mm wide on average.

[Mop]

Knee Tendonitis::


There are a few things we should discuss prior to simply dishing out any exercises. Firstly, you are experiencing pain in the right knee, which you have attributed to tendonitis. My first suggestion is this: If this is a self-diagnosis I would seek the opinion of a medical professional ASAP, and preferably one with a sports injury background. Moving on, if you are truly experiencing tendonitis, then there are several overlying issues that should be investigated prior to you continuing with you usual "hypertrophic" training regimen. Tendonitis may be defined simply as inflammation of a tendon. From a kinetic chain standpoint, let's look at what may have caused this inflammation and irritation.

Your body works in three planes of motion at all times (sagital, frontal, transverse), especially during such dynamic movements as are required by football athletes. Traditional training methods still currently used for sports such as football, often employ training methods that only adhere to the sagital plane. I.E.: leg presses, squats, leg extentions, leg curls, presses, etc. The problem with this type of training is that it does not teach the body to work in the other two planes, and almost "locks" one into the robotic sagital plane! Studies have shown that a vast majority of the current knee traumas are due to a NON-CONTACT injury, where the athlete was trying to decelerate, or land, in the transverse plane.

One must understand that the body's muscles work in SYNERGIES NOT IN ISOLATION. The muscle imbalances that can develop due to chronic isolationist sagital plane training methods may very well be the underlying cause of such knee problems as tendonitis. These muscular imbalances may well lead to faulty movement patterns, causing micro-trauma at the problem joint, over time exposing themselves as injury and pain (tendonitis). So, what do you do? To prevent causing any further irritation to the injured joint I would definitely stay away from plyometrics right now, as power training may simply reinforce the faulty movement patterns that have caused your problem in the first place.

I would begin with a corrective flexibility protocol, along with a core / neuromuscular (balance), training program that would appropriately progress you from stability based exercise back up to strength and hypertrophic exercises. To do this, I would first suggest, once again, getting the opinion of a medical professional. Next, if possible, find a fitness/performance professional who is familiar with integrated training techniques and kinetic chain concepts, such as those taught by the NASM (National Academy of Sports Medicine, ( http://www.nasm.org ). Take time to read Mike Clark’s PTontheNET.com article series “Essentials of Integrated Training”, and you may even want to look up the professional locator on the NASM website to try and find someone near you!

It is very difficult to give out specific exercises with out having done an integrated kinetic chain assessment, but a great place to start is with your flexibility. Here are a few stretches to work on. Good luck, and remember, FUNCTION FIRST, AESTHETICS LATER!

-KNEELING HIP FLEXOR STRETCH: Kneel on one leg, maintain erect posture, perform an abdominal draw-in, squeeze the glute of the leg being kneeled on, and perform a posterior tilt or "tuck" of the pelvis. Hold for 20-30 seconds, and then repeat 2-4 times per leg.

-STANDING GASTROC/SOLEUS STRETCH (calves): With erect posture, stand in a staggered stance with hands on wall/stretch bar, place a ramp/block of some sort under the forefoot of you back leg, maintain knee over 2-3rd toe, perform an abdominal draw-in and lean forward from the back ankle until you feel you first point of resistance/stretch, stop and hold for 20-30 seconds, repeat 2-4 times per leg.

-SIDE LUNGING ADDUCTOR STRETCH (inner-thigh): Stand slightly wider than shoulder width, toes pointed straight as if on skis, to stretch the right side, squeeze the right glute, lunge left until a first point of resistance is felt in the right adductor complex, hold for 20-30 seconds, repeat 2-4 times per leg.

[Mop]

Weak support muscles for the knee?::


It was anything but a smooth transition from the Manly Rugby League side back to Rugby Union for Craig Innes .

During a game in March - after only a few weeks back with the Auckland Blues rugby team- Innes twisted his knee awkwardly at the bottom of a ruck. The result was a torn cartilage (meniscus) in the left knee that would require immediate surgery to remove the injured fragment.

This is regarded as a reasonably common injury , in sports like rugby , with a quick recovery once the torn fragment is removed with an arthroscope . Most players are running within 2 weeks following the surgery and are generally back to full fitness after 4-6 weeks.

In Innes’ case however the knee continued to remain swollen and painful 4 months following the surgery and was preventing his return to the Blues.

Personal Trainer - Tony Townley saw the need for further assessment , to outline the possible causes of this slow recovery . It was decided that a full biomechanical evaluation should be undertaken to assess the overrall function of the left leg. Resistance training up to this point was severely restricted due to the constant joint irritation, although the necessity to resume full strength following this type of surgery meant that full intensity had to be resumed as soon as possible.

A muscle imbalance and lower limb assessment revealed some interesting findings .

A weight bearing test showed that Innes had a discrepancy of 15 kg more down his injured left side than the right. This test is performed by getting the client to stand on 2 calibrated scales (similar to bathroom scales ) and measuring the difference between each side . This increased weight bearing on the left was an unusual finding, as the body will often compensate for an injury through a weight bearing joint by moving away from that side - therefore reducing the load on the affected area .

In this case the extra load was obviously creating stress on the injured meniscus which was irritating the joint and therefore delaying the healing rate.

The next step was to identify the reason for this excessive weight shift.

The answer was to be found in a small, but very important, muscle on the outside of the left hip . The name of this muscle is Gluteus Medius and when tested the right was significantly stronger than the one on the left resulting in an imbalance.

The action of gluteus medius when weight bearing (ie standing or walking ) is to support the hip and basically keep the leg straight in relation to the pelvis . If this muscle fails to contract with each step the result is a sideways slumping motion toward that side (this is occasionally referred to as a Trendelenburg gait). This instability creates excessive weight transfer to the effected side and therefore can increase the load on the knee joint .

The answer based on these findings was to strengthen the offending weak muscle in an attempt to restore even loading on the left knee.

[Mop]

Proper Body Position, squat and Lunge- important for preventative injury



There is no conclusive evidence on how far the knee should extend over the toes during a squat or lunge. We, at NASM, are tackling the question from a mechanical standpoint. Our position on the question of knee alignment is that based on normal movement patterns, studied from literature as well as assessments within our clinic, a person should not need to extend their knees over their toes when squatting or lunging if they have proper range of motion at each joint. In movement as well as static posture, an individual should align their knee forward, within the line of gravity and not allow forward movement much past the toes.

The passive range of knee flexion is from 130 degrees to 140 degrees. However, knee position is also dictated by ankle dorsiflexion and hip flexion. For example, the knee can flex to 160 degrees when accompanied by hip flexion and bodyweight as your resistance. This is a normal movement and is not detrimental to a healthy knee joint as long as there is limited external load. When squatting or lunging, if a client is extending their knees over their toes, the client is lacking proper extensibility another place in the kinetic chain, possibly the hip or ankle complex if not both. Lack of extensibility yields relative flexibility. This means that in order to complete a squatting movement a person has to compensate by shifting from a predominantly sagittal plane motion at each joint into another plane of motion. An example of this can be seen in pronation-distortion syndrome. Starting from the ankle complex, if the ankle has limited dorsiflexion (sagittal plane motion) due to tight gastrocnemius/soleus muscles, the arthrokinematics are altered. The ankle joint is forced to move into the frontal and transverse planes to allow further movement.

When considering the kinetic chain, if one segment of the chain is altered, compensation must occur all the way up the chain. Limiting the motion at the talocrural joint (ankle), limits movement at the patellofemoral joint (knee). This, in turn, increases femoral internal rotation and adduction. This compensation pattern can force a person to move further into the sagittal, frontal and transverse planes beyond the toes. Some individuals will raise their heels to allow further descent into a squat or lunge because their gastroc/soleus complex is too tight. Another reason that individuals may shift their weight forward in a squat is if they are compensating at the hip by increasing hip flexion instead of knee flexion. This can also occur if the individual was never taught the proper motor patterns for squatting or lunging.

Each of these compensation patterns can shift the body’s center of gravity forward past the axis of rotation placing more strain on the patella tendon and increasing the tension on the quadriceps tendon. When the compensation patterns are addressed with proper flexibility, and an individual is taught neuromuscular control, the knees should never need to move beyond the toes in a squat or a lunge.

[araby]

nice, thanks

[liquidstayce]

some more knee articles but related to pain and injury
http://sportsmedicine.about.com/od/kneepainandinjuries/

[Shannan]

Thanks for the info guys. I have really bad knees for some reason. They have been really sore from doing my incline daily as well. When I bend them it makes a grinding noise in both knees(sounds like popping and cartledge rubbing?). My right is bothering me more than my left atm, but its the same knee I had surgery on so Im assuming thats why. Should I use knee bracer or something when I do my inclines? I am already doing stretches for my knees.

[Mop]

A brace would be hard to recommend with out knowing more honestly- they make braces for every type of knee problem. do you get the pain when it is cold or all the time?

[Shannan]

Its random. Hurts off and on, mostly when my knee goes from bent to straight. Feels sorta like it wants to bend backwards when I straighten my knee sometimes.

[Mop]

could be hyper extended or lack of flexability- you dance right?

[Shannan]

Yup, I have been active on my knees since I was 5. Dancing, track, gymnastics, kickboxing ect.

[Narrock]

Anything else?

[Mop]

probally from Gymnastics most likely, just years of impact, it is like soccer players they get the same thing. Things that help

a patella band it is fairly cheap helps keep the knee in line.
Ice when it hurts if you can, especially if you are out dancing the day before

[Phlegm]

maybe it's amputation time