21 Sep Knee Pain from a Different Angle
Knee pain is a very general term and can have many causes. One cause would be trauma. For many of us engaged in physical activities and sports that may be the cause. For the majority of people knee issues seem to creep up especially in their late 30s, 40s and 50s. Often it is associated with someone becoming more active again and picking up a sport, or fitness training to improve their body composition. All of the sudden the knee starts hurting.
To understand better the complexity of the knee we need to understand more about its anatomy.
The knee joint is one of the most complex joints in our body. It consists of
- The patellofemoral joint (knee cap to distal part of the femur)
- the tibial-femoral joint (the femur interacting with the tibia (shin bone))
- It has meniscii functioning as increasing the joint surface and working as shock absorbers. They are C-shaped.
- The ligaments attached to the femur, tibia, & fibula lending it stability and guiding movements.
- Patella Tendon attaching on the bottom of the patella and allowing the force of the anterior femoral muscles to lead to knee extension by being attached to the tibia
- The cruciate ligaments stabilizing the knee in a sagittal plane
- The collateral ligaments stabilizing the knee against folding open sideways (coronal plane)
- Bursae are little sacks filled with fluid to protect tendons going over bones, etc.)
- There is a multitude of muscles working on the knee: flexing, extending, rotation etc.
What does the hip and the foot have to do with my knee?
In addition of myriad muscles going over the knee, the hip and the muscles pulling on the hip or the foot position play a major role in your knees function. Inactive gluteal muscles can lead to changes on how the quadriceps pulls on the patella and its tendon. This can have a significant impact on patella positioning, cartilage damage, etc.
A similar situation happens when a foot is not properly supported by its arch and ankle. If your ankle collapses inwards you will have an increased risk of knee injuries due to “overuse” or rather “biomechanics”.
Basically in addition to being sensitive to traumatic injuries (i.e. in soccer, football, tennis etc) the knee is the slave to hip mechanics and foot mechanics.
How can I improve the situation if it is caused by weak hip stabilizers?
There are plenty of things you can do for the hip ranging from functional movements like deadlifts, single leg deadlifts, bridges, single leg bridges to small movements like side to side walk w/ mini-bands, bridge walks, hip hikes.
Trap bar deadlifts are great because they work hamstrings, glutes, adductors, etc. The single leg version really helps with stabilization and is the functional progression.
I would definitely recommend you supplementing these exercises with movements like loaded bridges, clamshells, etc.
Bridges are absolutely fantastic to activate the glutes in a more isolated fashion than squats and deadlifts. With bridges make sure that the back stays straight. Don’t push the weight over the toes but rather keep the weight on the whole foot or slightly more oriented towards the heel. You have various options to set up the bridge. You can either lay down on the floor, the feet even with the floor, elevate the feet or elevate the back. Elevating the back or feet increases the range of motion and is definitely preferred. If you struggle to use a bench for your back, you can set it up on a 10” box a well. Again, I would recommend to progress to single leg bridges down the road. Make sure to use adequate padding for the bar. The bar should be sitting between pubic bone and ASIS (anterior superior iliac spine)
Clamshells on the other hand are a great isolation exercise that can support the work that you are doing with the compound movements. They are just one of many exercises that can be used for this purpose: quadruped donkey kicks, quadruped fire hydrants, cable kickbacks, back extensions, etc. can all be used to supplement the big movements.
What You can do for your feet
Short foot exercises like the one in the video are a great tool to work on foot position and strengthening up intrinsic foot muscles. In addition to the isolated exercise make sure to integrate the short foot into squats, deadlifts, etc.
Knee pain at least due to postural issues and weakness don’t have to be necessarily accepted as part of life. Working on fixing muscle activation & technique training can help clean up your form, improve joint positioning and potentially enable you to be a lifelong healthy athlete.
The sooner someone starts to address these issues the better. Depending on your age and activity level, exercises and foam rolling might not be all that is needed. You might need the synergistic efforts from massage therapists, chiropractors, trainers and your own diligence to get back “on your feet”.
Do not expect immediate and permanent results.You might have had the problems for years and progress might be really slow. If you can reduce pain and increase performance, I consider the effort well worth it.
What if it is not working
Exercises are great but training can only bring you so far. As mentioned above it might take a village to get you back on track. Massages, manual therapy, chiropractic, as well as physical therapists might be necessary to get you started.
Schuenke et al. (2006). Atlas of Anatomy – General Anatomy and Musculoskeletal System. Thieme.