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Jessica Bento, Physical Therapist/DVRT Education Director (Co-Creator of DVRT Restoration Certification, DVRT Shoulder & Pelvic Control Courses)
I became inspired to write today’s post about knee health because I got an email from some fitness newsletter (how do you get on lists you don’t even subscribe to?!) and the title was “How To Strengthen Your Knees”. I thought, what the heck, let’s see what they have to say about knee health.
Wow! I wasn’t too surprised as the article largely focused on really outdated and overly simplistic ideas. Most articles do the standard knee anatomy and don’t get me wrong, knowing anatomy is not a bad thing, but only if it impacts what you do is it truly meaningful.
For example, most when talking about knee health will talk about the knees and then maybe the quads. That is such a TINY part of the story when it comes to understanding knee health. That is because we have to focus on how the knee actually functions during movement or a more functional anatomy approach to training knee health. How do I mean? Well, I’ve outlined 3 important concepts of functional anatomy that can dramatically change how we think and train for knee health.
The Knee Is A “Dumb” Joint
In physical therapy school, I remember teachers referencing the knee as a relatively “dumb” joint. What do they mean by that? The knee is pretty much a hinge joint. There is a tiny bit of lateral motion but it is primarily a back and forth type of motion. If we get too much lateral motion and/or rotational forces that will negatively impact our knee health.
That means when our knees are giving us issues the cause isn’t typically the knee itself. Sure, your knee can hurt but we have to look at what is above and below the knee to really understand what is impacting our knee health. Typically that means the foot/ankle below and the hips above. Really it isn’t about one or the other, it is often a combination of both.
Addressing the action of the foot and ankle along with mobility is done a multitude of ways, but it is important we want to try to keep movements as part of the restoration of mobility and function. There are a few examples of me showing these concepts below.
Creating stability at the core and integrating the hips with these ankle mobility and foot stability drills makes them far more effective in restoring knee health.
Using bands is very effective in giving feedback to the lifter on how to use their feet and keeping them active during the movement. While lunging might seem counterintuitive to knee health the truth is getting the feet and hips to work with the core correctly make a profound difference.
Foot/ankle mobility is very important to knee health, but so is making sure that the feet are actually active during our drills. So, again, we want to take mobility with the strength to put them together gives us much better results.
Hamstrings Are Crucial
Most people think of the hamstrings as muscles that flex the knee like in a leg curl. However, the hamstrings are really designed in locomotion to decelerate the leg and actually protect the knee. They are part of a kinetic chain of muscles that work synergistically to help knee health and function.
Don’t tell Josh I stole his slide, he will never let me live it down!
That is why training the hamstrings in a functional way is so important, especially on deceleration but also with the hips, NOT in isolation!
Scroll through these images to see how we can do so from a foundational level on the ground and where our knee health training will go!
Whatever we do on the ground though we want to take to more functional positions like standing where we learn to control the foot, knee, hip, and core through space more effectively.
These are some great progressions on how we could build better deceleration strength and control of the knee.
Hip Mobility and Strong Glutes
Just like our feet, the mobility and strength of our hips play a big role in our knee health. Just as the joint below the knee can impact the joint, so can the joints above. We tend to focus on ankle and hips because by their structure they should have a good amount of mobility. When they don’t possess proper movement, then we see the knee take on more stress than it should in life.
Does that mean just stretching your hips and doing some hip thrusts we see all the time? In some small degree, yes, but we have to be more thoughtful as just stretching has little impact to our functional capabilities (as the research continually shows us) and while it may make us feel good (which isn’t bad for other times) as far as helping our knees, it doesn’t help so much.
The types of movements you see Robin Paget demonstrate above don’t all look like obvious hip mobility drills. However, the fact we are either moving the hip in different planes of motions (there are 3 planes that our body moves in during real-world motion) or learning to resist movement of the planes, we do so by integrating core stability at the same time. The load and position of the Ultimate Sandbag is a great way to give us feedback on using our core correctly.
Most people don’t realize that like the knee, the hips are largely impacted by what is happening above and below the joint. For the hip, that means the lower leg/foot and the core above. If we don’t have stability from these two places we tend to develop that tightness to protect our body as we do in addressing our knee health.
These concepts may leave some really scratching their heads and I get it. When I was a young physical therapist I focused a lot on quads and other things that I thought and had learned were the right things. Yet, when it came to helping my patients feel better I often wasn’t delivering the results I wanted. Thinking differently has allowed me to not only help more people but to help them in more dramatic ways. This isn’t craziness either, just using science and making it come to life in our training. Find out how I coach some of these important aspects in the video below.
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