We have blogged about knees before, but they do seem to get caught between foot and hip problems, poor things!
So how can we keep those knees happy?
Well we spoke about feet last week and the effect that a weak arch can have in causing issues such as bunions, however, that weak and pronated foot is also causing the poor knee some issues. If the foot is pronating, the knee will rotate medially as the whole lower leg tracks inwards. That isn't great for the poor knee, it puts a lot of load onto the medial condyles of the knee area with a compressive force, and over time that can cause damage to the cartilage designed to protect those condyles.
Let's now imagine we head into the gym and start squatting with some heavy weights, with our weak and pronating knee and therefore with a medially rotated knee. If the knee can't handle body weight with a pronated foot, it certainly can't handle a bar with a load on it, so the knee won't track straight as your client squats. It will drop in, you will see the same when a client tries to do a lunge, the knee will drop medially. The end result? Well eventually we will get a breakdown on the cartilage and osteoarthritis, but we can stop it before it gets to that point.
If you are training someone either in the gym, or clinic and you look at them performing a squat, ask them to do it very slowly and unloaded and watch how their knee tracks. Ideally it should track in a straight line, this ensures the condyles are loaded correctly and the patella can run in its grove, if the knee tracks medially, it is time to do something about it, even if they don't have any pain yet.
Take the weight off, and put a small ball between their knees, so they can't twist their knee medially, ask them to squat again slowly and see what happens. They may start to compensate by hitching their hip, twisting their pelvis or rotating their torso. If they do, get the exercise ball and put it against the wall, ask them to lean against the ball, it will give them support and therefore offload the movement making it easier, then see where any restriction is. They may have to start with a shallow squat while everything rebalances. Of course if the foot is causing the issue, perhaps think about sorting the foot out first. 😀
If the restriction is in the hip, well take a look at those glutes. When the knee drops medially, due to the pronated foot, the glute will try to protect the knee by switching on and laterally rotating the leg, the result of this, over time, is that the glute overworks, becomes tired and eventually gives up, so you can be left with a very tight, but weak glute. So if the restriction seems to be coming from the hip, try loosening or stretching the glutes and try the exercise again to see whether the glutes have switched off. You may have to go back and do some strengthening work on those glutes.
Unless their has been a traumatic injury, or there is a disease in your client, knee problems rarely originate in the knee itself, more often they are due to the forces acting upon them from a dysfunctional foot or hip so think globally when training or treating your client to get rid of the source of the problem.
If using this for CPD have a go at this question.
1. Your client comes into the gym saying they have osteoarthritis in their knee and therefore can't do any squats in their training program. Given the information above design a strength training program that can help the cause of this problem as well as slowly returning the client to full function.
2. Your client arrives in your clinic with pain in their knees, you test everything but can find no problem with the knee itself, given the information above where could this pain be coming from, what can you test and where could you start in rectifying this problem.
Then write it all up in your CPD logbook. For a FREE Reinge Education logbook, click HERE and sign up to our monthly newsletter.