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Strength, mobility, and motor control are the three most important elements to improving movement dysfunctions. When a muscle does not have the strength or mobility to control the force applied to it, movement becomes limited.
A muscle group lacking motor control disrupts movement precision. Corrective exercises can address movement dysfunction. With the right corrective techniques, you can help clients prevent further damage to the body. Here we'll review common knee issues and how you can implement corrective exercise to help prevent and improve these conditions.
The knee is the largest joint in the human body. The main role of the knee joint is to perform flexion and extension with small amounts of internal and external rotation. The muscles responsible for flexion of the knee are the hamstrings and calves. The muscles responsible for extension of the knee are the quadriceps. To perform internal rotation, the adductors will be highly stimulated. For external rotation, the biceps femoris will be working. The iliotibial band also helps with lateral knee stabilization.
When a client experiences knee pain, it normally occurs within or around the knee joint. If your client is unable to withstand any type of load on the knee, has noticeable markings like bruises or swelling, and cannot fully flex or extend the knee, it's likely a serious injury. Your client should consult with their doctor before performing exercise.
If a client experiences a mild amount of stiffness, tightness, and discomfort, the injury may be less serious. However, this does not mean the lack of mobility should go unnoticed. Address it with prescribed corrective techniques such as stretching, foam rolling, and exercising the muscles responsible for the actions of the knee. This will help prevent further damage to the knee joint.
Knee injuries are often a result of torn ligaments. There are four ligaments in the knee that keep the knee, femur, and tibia connected and moving properly. The articular cartilage in the knee plays a major role in normal function of the knee. If both ligaments and cartilage are damaged, you can expect a client's movement to be severely limited. If this is the case, they should consult with a physical therapist for imaging tests.
The anterior cruciate ligament (ACL) is in the center of the knee and helps stabilize the tibia through rotation and forward movement. ACL injuries often occurs in athletes when they plant a leg and continue twisting the body. This causes pain in the knee from swelling and decreased stability.
The Lachman test can help confirm an ACL injury. As a client lies on their back with their knees bent 30 degrees, you can hold the femur in position and pull the lower leg up towards you. If the ACL is still intact and there is no injury you will see little movement. If the ligament is torn, you will get a loose movement when you pull the lower leg to you.
The posterior cruciate ligament (PCL) controls the backward movement of the tibia. An injury to the PCL is less common than the ACL. This is because PCL injuries occur mostly from a direct blow to the knee.
These injuries are more common in car accidents, such as when the knee directly hits the dashboard. This ligament keeps the knee from hyperextending, which is why a direct blow causes injury and pain. The forces pushes the tibia backward to an extent that the ligament cannot withstand. This degree of stretch and hyperextension causes the ligament to tear.
The medial collateral ligament (MCL) provides inner knee stability and the lateral collateral ligament (LCL) provides outer knee stability. The MCL is a stabilizer ligament and works to prevent valgus stress. It attaches on the medial portion of both the femur and tibia connecting the two bones. It is a common ligament injury caused by valgus and external rotational forces. For the LCL, when you have forces applied to the inside of the knee, the LCL stretches to protect it from moving laterally. It will tear if it moves too far laterally.
Besides ligament tears, there are still other knee problems that could cause pain in the knee joint. Muscle imbalances are a leading cause of joint pain. Over time, joint pain causes chronic pain in the leg muscles and knee.
With overuse of the knee, a client may encounter pain in and around the patella region. The patella sits in the trochlear groove, moving up and down the groove every time your client bends or straightens their knee.
When overtraining and extra stress from intense exercise like running with bad form cause the patella to misalign, it can no longer track according to the groove. This causes aggravation to the ligaments and cartilage in the knee joint, causing knee injuries and pain. This may be from patellofemoral pain syndrome or runner's knee.
Every person has muscular imbalances and structural misalignments. They may cause anatomical issues in the kinetic chain and even knee pain from repetitive rubbing and grinding on the knee cap. It is important to work towards full body balance in your clients.
To help avoid these issues, design your client's program with injury prevention in mind. Include proper warm-ups, stretching, foam rolling, and improved exercise techniques.
Implement corrective exercise for any clients approved to participate in exercise. Corrective exercises to improve knee pain may include the following:
Resistance band hamstring curls
Resistance band knee extensions
Terminal knee extensions with a band are an effective way to directly target the quads. This exercise helps restore knee and quadricep mechanics to improve activities of daily living. This leads to less chance of a patellar tracking disorder that influences the hip, leg, and foot kinematics. Runner's knee develops from issues in the feet or from improper patella tracking.
Foam rolling all surrounding muscles such as the calves, hamstrings, quadriceps, glutes, iliotibial band, and tensor fasciae latae is important in parallel to the exercises.
When clients experience knee injuries, they almost always have weak or inactive glute muscles. This can cause hamstrings and hip flexors to tighten, which need daily stretching. Performing corrective exercises like side lying clam shells or hip abduction are great ways to help strengthen the glutes. This helps to keep the knees from bearing any extra forces they cannot tolerate.
Knowing how to design a corrective exercise program to improve knee pain can enhance your clients' workouts and improve their quality of life. Working with a physical therapist can ensure safe and effective program design, so your clients get the results they want, pain free.
Design the corrective exercise routine to focus on strengthening the muscles that contribute to the knees muscle actions. This includes the hamstrings, calves, quads, and adductors, which all influence flexion, extension, internal rotation, and external rotation of the knee.
This allows the muscles to stimulate when the body feel stress, taking it away from just the knee joint. All the moving parts of the kinetic chain work together. A disruption at one link causes a compensation at another.
Proper cueing with internal and external cues helps clients perform their corrective exercises more efficiently. Imbalances make it difficult for a client to move a certain way or feel certain muscles working. The cues you provide will make all the difference.
Any client can go through the motions of exercise, but the question is: Are they feeling the stimulation of the targeted muscle groups? If not, then the joints will continue to undergo unnecessary stress.
Pursue ISSA's Corrective Exercise Specialist course to gain knowledge on the most up to date movement dysfunction solutions. Excel in understanding how to correct body mechanics through proper corrective exercise.