Achy knees and creaky joints are common among anyone who has spend much time trying to be athletic. No matter what the itis or chronic pain in the knee, there are usually a few things that can be done to help alleviate it. Those things are copious amounts of drugs and surgery ha! just kidding! The fact of the matter is, if there is a non- acute, aka chronic issue in the knee, it is about 99% of the time caused by something mechanical. What do I mean by that? I mean that there is something wrong with your movement pattern that is causing undue stress on your knee joint. This is the case with most joints, and the problem usually lies with something either up or down stream. With the knee joint, there are two things that you should be concerned with; creating slack and stability.
Creating Slack
In my last mobility post I spoke about the kinetic chain and how ankle mobility can cause all kinds of problems up the kinetic chain. If you are having knee pain a good place to start would be down stream and that?s with the ankle. You can check out my ankle mobility post here! If you are lacking mobility in your ankle, this can create extra tension on the knee joint. If you create a better range of motion at the ankle, this can help with knee pain by alleviating pressure aka creating slack.
If your ankle is all loose and supple then you have to begin moving up the chain or upstream for all you country thinking folk. The next stop would be the calf muscles. Your Gastrocnemius muscle (side bar ms word thinks I misspelled that word. Apparently they are not up on their anatomy terms) also known as the very large calf muscle, crosses the knee joint. If you have tension there, it will create tension in the knee joint and can potentially cause problems with your knee movement patterns. Foam rolling and lacrosse balls can help the Gastroc improve its mobility, if you don’t have a foam roller, barbells work as well! Here is a video to discuss that.
Stretching the gastroc and soleus complex will also help with creating more slack in the knee joint.
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Moving upstream, we will now check out the muscles above the knee. The quadriceps (this word is in ms word?s dictionary!) hip flexors and Illio-tibial band can get all junked up (yes this is a technical term). The major issues I see here are flexibility and myofascial trigger points. Often times the flexibility issues are addressed with simple stretching. The problem that sometimes occurs in the case of knee pain, is traditional quadriceps stretches put the knee in a more painful position. What should we do? Find a stretch that still accomplishes the job, but doesn?t put the knee in a deep bend, or spend some quality time with lacrosse balls working on your hamstring, quads, and IT-Band. ?Here is a video to help here:
Hamstring tightness can be another issue that causes knee pain. The hamstrings can be rolled or stretched in a variety of ways like this:
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Click here for a great article on the hamstring!
Another major issue I see with hamstring tightness in an athletic population is tightness of the flexor causes an anterior rotation of the pelvis. This puts the hamstring in an elongated non-ideal position. It makes the hamstring feel tight (because it is pulled tight like a guitar string), but stretching will not help it in this situation. The most important thing to do here, is actually strengthen the hamstring and spend some quality time on loosening up the hip flexors.
Now that we have spent quality time working on creating slack both up and downstream, it is time to look at the stability portion of alleviating knee pain.
Many times, the knee has issues due to the quadriceps strength to hamstring strength ratio. Usually it?s been my experience that people with chronic knee pain are anteriorly or quadriceps dominant. When this happens the hamstrings don?t engage as much as they should in movements like the squat, and the knee will slide forward causing sheer forces on the tendons and ligaments of the knee joint. If this continues without being addressed, all those ugly words like chondromalasia, patellar tendonitis, jumpers knee, etc start to appear.
How do we fix this? The best way to fix these problems is with the box squat. Squat to a position that can be done pain free, then work on engaging and teaching the proper movement patterns to create hamstring recruitment. Here is a great video on how and why to do this:
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It is my belief that squatting can fix 99% of non-surgical knee problems if done correctly. We begin with body weight and progress safely up, but if taught and executed correctly, the hamstring will become stronger and work in harmony with the quadriceps. This will take unload the heavy tension on the quads and create a better movement at the knee joint.
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