Knee pain, whether minor or major, is a common problem that interferes with our enjoyment of many aspects of our lives.
We get a lot of feedback and questions from clients regarding current and past issues with their knees and how to best accommodate these injuries while training.
So we decided it would be helpful to talk about some of the common concerns and problems that can happen at these joints. But first…
Public Service Announcement
Before we get into the nitty gritty, here’s an obligatory PSA: We’re not doctors, and this article and the suggestions below are no substitute for being seen by a real-live professional in person.
If you’re having ongoing aches and pains that don’t seem to improve with rest, you really should make an appointment to see a doctor or physical therapist as soon as possible.
Good, now let’s continue.
In prior articles, I’ve talked about the causes of injuries and when you should go get it checked out, so that’s a good place to start if you’d like to learn how to identify and deal with training injuries in general.
In this article, we’ll get you more familiar with the knees in particular, and I’ll explain how to keep them healthy so you can continue to enjoy your training.
I’ll also give you some insight into what may be causing stress and strain if you have recurring knee issues.
How Your Knees Work (and a few of the things that can go wrong)
Basically your knee is a hinge joint.
It has two major motions:
- Flexion (bending)
- Extension (straightening)
Your shin moves on your thigh when your foot is in the air, and your thigh moves on your shin when your foot is planted. There’s a small degree of rotation available at the joint, but only to allow for the proper mechanics of the major motions of extension and flexion.
So what’s the take home point here?
Any rotation and lateral movement beyond a certain point can cause significant damage (this is why pro football players and soccer players often suffer from knee injuries).
Make sense so far? Great, let’s keep this short anatomy lesson going! Now let’s discuss the moving parts between your hip and your knees.
Ligaments Are There To Protect You
The ligaments of the knee serve to protect the joint from excessive movement in shear (sliding), rotation, and lateral (side to side) movements.
Four major ligaments protect the knee in these planes, one on each side (the collaterals), and two in the center (the cruciates). Without these four, your lower legs would be flopping all over the place!
The menisci (medial and lateral) in between your upper and lower leg help cushion the joint to reduce friction between bony surfaces and absorb forces.
Forceful twisting at the knees place strain on these tissues and they are very commonly damaged, either from repetitive strain or from trauma.
Kneecaps (we have nothing very nice to say about them)
Your kneecap (patella) is an intermediary structure between the quadriceps muscles and its tendon, and the tendon (patellar) that attaches to your shin bone (tibia). It improves leverage to better improve the muscular force generated by the quadriceps.
Unfortunately, when movement at the patella is not optimal there can be irritations to the underside of the bone and at the patellar tendon.
This is the common source of the complaint of “crunchy” knees and, of course, the very prevalent pinpoint pain of patellar tendinitis, the bane of runners everywhere.
And more specifically the attachment site at the tibia is also a source of pain in what people call the “jumper’s knee” in both young kids and old fogey weekend warriors.
Your Muscles Absorb the Shock of Movement
The quadriceps and hamstrings are the familiar and major muscle groups of the knee, with the four quadriceps in the front of the leg converging into a common tendon to the patella and the hamstrings (biceps femoris, semimembranosus, and semitendinosus) to separate tendon attachments.
Repetitive strain and acute trauma are very common in these muscles because they provide much of the force in all daily and recreational activities.
Though it’s been en vogue to assign hamstring weakness as a major problem leading to knee injuries, the quadriceps are the major shock absorbers and stronger quads are essential to knee health.
At the inner thigh, the large hip adductors don’t cross the knee joint but three smaller muscles do (sartorius, gracilis, and the hamstring muscle mentioned above, semitendinosus), forming a single tendinous connection called the pes anserinus. There’s a bursa (fluid filled sac to reduce friction) under this tendon, which is implicated in chronic medial knee pain.
At the lateral side of the knee, the iliotibial band is a tough tissue that runs from the outside of the hip past the knee to the tibia.
The infamous “I.T. Band” syndrome is generally from increased repetitive stress from adding too much mileage too quickly.
In addition to the hamstrings, the bigger calf muscle (gastrocnemius) crosses the knee to act as a weak knee flexor, but the significance here is not that it assists in knee flexion, but that tightness can interfere with full knee extension. An inability to fully straighten the knee can cause knee joint irritation, overwork particular muscle groups, and can cause enough of a leg length difference that repetitive motions can create problems into the hip and back.
The preceding wasn’t a full list of the conditions that could cause knee pain, but the most common and likely to affect people in average recreational activities.
Actions You Can Take to Ensure Knee Health
So how can you use this information to help you with taking care of your knees?
Well the preceding anatomy primer has probably made you more aware of the knee’s role as the middleman between your hips and your feet on the ground.
Your knees can be more prone to problems when the connections from the hip to your lower limbs aren’t coordinating as well as they should.
Knee issues can be fairly complicated and have a variety of separate and intermingling causes, but we can break down basic knee issues into three major causes:
- Lack of strength
- Lack of flexibility
- Poor movement technique
Improve Your Quad Strength
Earlier, I mentioned the importance of quadriceps strength to help absorb the forces the knee is subjected to in running, jumping, and even simply taking the stairs and walking.
In particular, it’s the eccentric quad strength that is most helpful for knee joint protection. It’s the strength you have in handling forces while the quadriceps are lengthening under load. The lowering part of the squat is a good example. The same goes for strong and enduring calf muscles, they can take a lot of the load off from landing.
It’s not so much the jump that gets you, as it is the landing.
Hamstring strength at the knee is important as well, but moreso for the ability of co-contraction with the quadriceps to keep the knee joint stable during activities. With both muscle groups working together correctly, you’ll be able to lessen the shear and rotational strain at the knee.
It’s more essential to have increased hamstring strength at the hips, where they are a big contributor to hip extension along with the glutes. Good hip action provides the majority of strength in jumping and running and should be developed to its fullest to take away undue stress at the knees.
Strong hips are also helpful for preventing a “caving in” at the knee during loaded knee bending activities. When you allow your knees to fall inward, the stress on the inner and medial ligaments is substantial and is the cause of many traumatic injuries.
Do More (Specific) Stretching
Though greater hip strength is a factor for improved knee health, improved hip flexibility may be even more important, as hip flexor (rectus femoris) and hamstrings tightness can interfere with proper knee mechanics.
They can also provide a buffer for rotational stresses as well, decreased hip flexibility in rotation can transfer more forces to the knee. Freer hips give you a bit more margin of error, and that little bit can save you a world of hurt.
As mentioned earlier, calf and IT band flexibility work is helpful as well if their tightness is an issue. It is possible just to “stretch all the things!” but a more efficient way is to do a bit of self-assessment as I describe in Focused Flexibility.
Doing fewer exercises more often means an increased chance of actually doing them consistently!
Change the Way You Move
A phenomenon that I see often in the clinic in acute (single incident trauma) knee issues are the “non contact” injuries where the problem wasn’t from being tackled or even falling, but from excessive forces at the knee from poor movement patterns.
In the short video below, I illustrate the rotation and lateral bending forces upon the knee that result from a fixed foot and hip.
The shear and torsion stress at the knee, along with the weight of your body (and maybe someone else’s) can create incredible damage!
The “unhappy triad” of an ACL (anterior cruciate ligament), MCL (medial collateral ligament) and medial meniscus tears happens when the perfect storm of rotation and lateral bending under load hits the knee.
It’s not a pleasant thing to see.
When you think of the knee as the “middleman” joint between the prime movers of the strong hip, and the more mobile foot and ankle, you get a better sense of how to protect your knee in sport and daily activities.
A simple change in the way you allow your foot to move and rotate while you move can prevent a lot of knee injuries.
Good strength and flexibility aren’t of much help if poor movement patterns are placing you at a high risk for injury.
Improving your technique in running and jumping can have a huge effect on decreasing your risk of ACL injuries, as evidenced by the success of similar kinds of programs at youth organizations like Sportsmetrics.
The Cliff Notes Version to Put into Practice Immediately
The three best actionable steps for preventing knee problems and allowing current issues to heal are addressing your strength, improving your flexibility, and adjusting your movement technique.
1. Address Your Strength
- Focus on improving your quadriceps and calf strength, especially eccentric contraction control.
- Focus on improving your hip extension and rotation strength to correctly activate the hips as the prime movers in jumping and running.
2. Improve Your Flexibility
- Identify and improve the specific limiting motions of the hip and leg to decrease repetitive and acute forces at the knee. (We’ve got just the thing for that.)
3. Adjust Your Movement Technique
- Change your movement patterns in your twisting and lateral motions to decrease stress at the knee.
These basic changes will do wonders for addressing the majority of knee problems that afflict weekend warriors and professional athletes alike. I won’t guarantee that this will cure 100% of you, but it’s a solid start.
Take Care of Your Knees, and They’ll Take Care of You
This primer on knee health addresses the fundamental issues that cause the majority of knee problems, and hopefully provides you with a better understanding of the joint and how it’s affected by your training and recreation.
Injuries are no fun – they affect not just what we do for enjoyment, but every aspect of our daily lives. This is why GMB has always emphasized a practical and reasonable approach to fitness.
It’s not about settling for average or being afraid of hard work; it’s simply about being mature enough to understand that being injured prevents consistent practice.
It is much better to do less and build up slowly than to overdo it and get injured, and then not be able to train at all.
Move Freely, Without Pain
The knees are just one of many areas of the body that commonly cause issues. Get your body in order with our free Body Maintenance Guide.