The only way to get permanent relief to knee pain is to fix the movements that caused the problem in the first place...
To reiterate: As with most injuries, once you’re hurt you’ll probably have to take some time off from exercises that bother your knees, not always, but normally. This is a great time to see a Physiotherapist. Some soft tissue work and manual therapy is sometimes exactly what is needed to get this area to calm down and stop hurting. While the area heals up and your knee pain starts to decrease you can get to work on fixing your movement.
Obviously, each person is different. I’m not saying that everyone is going to have the same problems with the same solutions. However, we here at Catalyst Physiotherapy see a lot of the same things over and over again with knee pain in this athletic and not so athletic population, and applying these principles have been successful. If you’ve ever been diagnosed with chondromalacia patella, patellofemoral pain syndrome or IT band syndrome then this article is for you.
Fix #1 – Promote Ankle Mobility
If you lack flexibility in the ankle (Dorsiflexion) then whenever you challenge the end range of your joint, you’ll end up compensating to complete the motions. Think about performing a deep squat or stepping down a step. If you lack ankle mobility it could be the cause of a compensation at the knee which is commonly called dynamic genu valgus. In lamen’s terms that means your knees travel inwards.
Unfortunately this applies to every exercise that challenges the flexibility of your ankle (end range dorsiflexion in physiotherapy terms). That means the same thing goes for running, lunges, pistols, jumping and landing! So let’s sort this.
Fix your Ankle Mobility:
and stretch the soleus:
Fix #2 – Promote Foot Stability
What’s important to keep in mind is that our knees movement are dictated by our hips and feet. If you’ve got poor movement (poor stability in this case) at the foot, you’ve got poor movement at the knee. When I refer to stability it means being able to support your foot in the 'proper position'.
The research supports this too, those with a flatter foot (more pronation) are more at risk for knee pain. We’ve been wearing shoes to help support our feet our entire lives, is it any surprise that our feet are weak and lack stability?
Understanding the short foot position (creating foot stability)
Fix #3 – Promote Hip External Rotation and Abduction Strength
Since our knees are a have a vital relationship with our hips it makes sense to attack the hips in order to promote efficient movement at the knee. I like to approach the hip with exercises specific to what we’d encounter in the gym.
Squatting Patterns
Lunging
Sinle leg patterms
Fix #4 – Promote Hip Mobility
If we are tight in our adductor (groin) musculature and limited in hip external rotation and flexion then we’re going to have a few issues. Limitations here will bring us right back into genu valgum (knee moving inwards) at the bottom of a squat. If we’ve got issues here we’re also opening ourselves up to hip pain and problems like femoral acetabular impingment (FAI) and subsequent hip labral tears. So what’s the fix?
Mobilize your hip flexors and adductors
Workingon hip external rotation and stretching the capsule
Fix #5 – Promote Core Stability
This picture sums up the problem at the pelvis, hip and foot that leads to a poor knee position. Take note of what’s going on at the pelvis. It’s tilting to the person’s left. If we want to fix everything that’s wrong with this picture, we need to address the core and we’re going to do this by promoting stability.
Fix: Strengthen the Glutes, Hamstrings and Trunk musculature to reset the pelvis in a neutral position and keep it there while we move or exercise.
We have to select exercises that challenge our core to combat rotation and lateral flexion, the specific forces that will lead to knee pain.
From the image below, you can see that strengthening and therefore shortening) the rectus abdominis (6-pack muscles), glutes and hamstrings will help us stay in a better pelvic position. A neutral position of the pelvis will help keep the lower limb aligned better.
Fortunately for us the exercises described to strengthen the hips have already started the process of strengthening the core.
In addition to strengthening the glutes and hamstrings, you’ll need to hit a work on a few additional exercisesto challenge core stability. I’m a big fan of certain plank exercises and dead bug variations because they challenge our core to resist rotation and that’s key for keeping our knees in proper alignment during exercise.
Dead Bug: Make sure to keep your lower back flat against the floor, or atleast in a neutral position.
Around the world plank variation
Fix #6 – Fix your technique
So when we’re looking to correct knee pain we’ve got to take a total body approach. I say it again and again. I love foam rolling and other forms of soft tissue work, manual physical therapy and taping techniques as much as the next guy but…
The only real solution to the problem is going to be fixing the movement that caused the problem in the first place.
Treat each exercise you do in the gym as a skill. Keep the weights heavy enough to get a training effect (build some strength and muscle) but light enough to ensure perfect technique. Be honest with yourself.
Part 3, prinicples of the above