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Got Knee Pain?
Treat the source NOT the symptoms!
By Julio A. Salado, NSCA-C.P.T., USAW Coach.
This is a follow up to my original post with the same title a few years ago. I have included pictures and kept it a bit more basic. Hope you'll find it helpful.
If you are reading this, you may have had knee pain or are looking for some exercises to prevent this condition. My essay is a basic corrective exercise approach to common knee pain usually caused by lack of ankle & hip mobility. Most individuals will either have knee discomfort underneath the knee, also known as “Jumper’s Knee” or “Runner’s Knee” e.g. discomfort on the side of the leg/knee. Please recognize the difference between “discomfort” and “pain”. As I always tell my clients “we do not work through pain,” but discomfort is a red flag. Stop the exercise and learn how to address and prevent the pain.
The discomfort is the precursor to a bad situation becoming worse. Fortunately, attending to the discomfort and applying some exercise science and common sense, we usually can reverse the ailment.
If you have had consistent knee pain, I would suggest seeing a medical professional. Lastly, I highly recommend getting a thorough fitness assessment/ movement screen by a fitness professional. The information from the assessment will be used to address your posture, flexibility, movement patterns & muscle imbalances. This in turn will help you become more efficient in your workout which will lead to achieving your goals without compromising your joint health.
Most knee pain is the result of sedentary lifestyle (8-10 hours of daily sitting and/or inactivity per day), muscle imbalances, poor form while performing exercises and repetitive movements (overuse). There are other possible factors such as flat feet, posture, age, weight, type of shoes, past surgeries etc . . .
Generally, people who sit all day will have tight hamstrings, hip flexors, calf muscles, weak gluteus (buttocks) and underactive inner thigh muscles. Please note, other preventable muscular pain may arise from overuse (repetitive movement) or a sedentary lifestyle e.g. low back pain, hip drop/hike, shoulder pain, tennis elbow & neck pain.
When you have tight/overactive muscles, its’ primary functional movement might be altered. This is called reciprocal muscular inhibition. For example, tight hamstrings and tight lower back usually signal a weak gluteus muscle. The weak gluteus (buttocks) muscle’s function of being an extensor muscle will be overridden by the hamstring and lower back. This will limit your range of hip joint movement and affect the joints above and below: spine, shoulder blades, rotator cuff and also the knee.
This idea of muscle reciprocal inhibition applies to overactive calf muscles too. The joint below the knee is the ankle. Tight calf muscles, whether from sitting down all day or wearing high heels may alter you ankle mobility. The shin muscles will be unable to perform its primary role because the opposing muscle ‘the calf’ is overpowering it via its tightness. Many people get shin splints and plantar fasciitis because of tight calf muscles and limited ankle mobility.
It’s important to note that no muscles work independently. Secondly, if you have tight muscles, the opposing muscles are usually weak and needs to be strengthened. Remember, muscles wrap around our joints. When they are tight, our joints’ range of motion is affected and it travels throughout our posture and kinetic chain.
Some symptoms from overactive hamstring & calf muscles:
•Jumper’s knee- underneath the knee
•Runner’s knee- muscles on the side of your hip/leg down to your knee. (ITB,TFL)
•Low back pain
Visualize what you do when you get out of bed. The first part of your body to touch the floor is your feet. If you ever stubbed your toe, you will quickly notice the importance of ankle mobility and how it affects your posture. You will change the way you walk to protect your tender toe, unconsciously leaning on one side of the body, which stresses your hip, low back muscles and/or knee joint.
Now I will show you a few exercises to treat the source, not the symptoms, of your knee pain.
You can find these tools in your gym. Always start with foam rolling.
Foam Roll/Trigger Point:
If on a scale of 1-10, 5 being uncomfortable, you score higher than a 5, you have overactive/tight muscles. Stay on top of the painful area (trigger point) for 10-15 seconds & repeat on the other side. Do this 3 times.
Foam Roll Piriformis: Bend your left knee with your left foot under your knee. Cross your right foot over the left knee. Your right hand will be behind you for support. Place your left hand on your right knee and pull the knee towards your chest. Slowly roll over the hip on an angle. Find the trigger point and hold for 10-15 seconds. Do 3 sets.
“TFL” foam roll: Set yourself up as if you are going to do a elbow plank. Place the foam roll under the front part of your left hip, underneath your hip pointer bone (ASIS). Lift your left leg off the floor and slowly roll over the area which is the size of your pants pocket. Find the trigger point and hold for 10-15 seconds. Do 3 sets.
Stability ball hamstring curls & bridge up: Place your feet on top of the ball. Arms by your side, head resting on the floor. Lift your hips off the floor and slowly pull the ball underneath your hips. While the ball is directly under your hips, begin to press your hips towards the ceiling. Slowly, reverse the movement and repeat. Do 3 Sets of 10 Reps.
Advanced single leg stability ball hamstring curls & bridge up: Place your feet on top of the ball. Arms by your side, head resting on the floor. Lift your hips off the floor, followed by lifting your right leg off the ball and keep it raised in a 45 degree angle. Slowly pull the ball with your right leg underneath your hips. While the ball is directly under your hip, begin to press your hips towards the ceiling. Slowly, reverse the movement and repeat. Do 3 Sets of 10 Reps.
Ankle Rocks on a ½ Foam Roll: Stand in front of a wall arm’s length away. Step on to the flat side of the ½ foam roll. Feet hip width apart. Try to balance while minimizing using the wall to stabilize. Rock forward till your toes touch the floor then rock back till your heels touch the floor. Repeat 10 Reps for 3 sets.
Standing leg abduction on ½ foam roll (pigeon toe): Stand on the ½ foam roll round side up. Left foot on the foam roll and your right foot by it side in a “pigeon toe” position (foot turned inward). You may stabilize yourself by tapping on a wall with your left hand. Slowly bring your right leg laterally outward with the foot turned in (pigeon toe). Repeat 10 reps for 3 sets. For more challenge try this exercise with foam roll flat side up!
Bonus! Ball rolling with a baseball: You can do this at home or work. While sitting, place a baseball under the arch of your foot and roll till you feel a trigger point, hold for 10-15 seconds. Roll the ball underneath the arch of the foot for at least 2 minutes 2-3 times per day.
The knee is a marvel when you think how much pressure/shock it absorbs from our regular walking to work, walking up stairs, jogging and even abrupt stopping. Without a stable knee, our easiest everyday tasks become a challenge.
Incorporate these drills into your pre-workout, and with time and practice you can say “Got NO knee pain!”.