Oh, the knee, whipping boy of the hip and foot. Innocent bystander that takes a beating from its neighbours. If you suffer from knee pain, you should know that there are very few primary knee conditions (that is those arising from the knee itself). MOST knee pain that is chronic or of insidious onset (comes on out of the blue) is likely due to bio-mechanical flaws in hip or foot movement. I would estimate that a good 80-90% of the time it is the hip that is the knee’s biggest enemy. Hip dysfunction can lead to many knee problems. The most common mechanism is a breakdown in hip stabilization (often due to either shortening of the muscles, or weakness in the muscles, or BOTH). This breakdown leads to a shift in the balance between hip external rotators and hip internal rotators, leaving the internal rotators to rotate the femur (thigh bone) inwards, leading to a valgus stress on the knee (knee bends inwards). This is similar to a wheel misalignment in your car, with the result being improper wear on areas that should not be involved. Over time the stress and strain builds, and the result is pain that comes on out of the blue. Many people try to determine if it was the yoga class they did on the weekend, or the squats they did in the gym. It was NOT. It would have been the next thing if not that. This is a “Straw that Broke the Camel’s Back” scenario, where tension builds up and the system finally fails. But fear not, we can help! Below are corrective exercises aimed at helping unwind the problems. Be sure to do them carefully and correctly for best results.
GENERAL KNEE TIGHTNESS / DISCOMFORT (AKA PATELLOFEMORAL SYNDROME)
Knees can get stiff and uncomfortable, and we call that “patellofemoral syndrome”, which basically means a problem involving the knee cap (patella) and the femur (thigh bone). It is not very descriptive, but it basically implies that the muscles that come down the leg from the hip (the Quadriceps muscles in the front, and Hamstrings in the back) are being overused (some or all of them). This is a general overuse situation where the muscles have become tighter than normal and need to be stretched out. The following videos are typical stretches that will assist in releasing tension in the hip muscles, and help relieve the feeling of tension in your hips. One note is that patellofemoral syndrome is a kind of continuum in that as it worsens, achy pain in the knee cap area can worsen and become sharp pain, and in adolescents it can lead to Osgood-Schlatter Disease where kids that are growing are also active. The long bones grow faster than the muscles do, thus causing the muscles to become under tension. With activity (like running in soccer, jumping in baskeball, etc.) the muscles tighten even more. Over time, the tension in the muscle leads to pulling of the tendon on the attachment to the tibial bone (tibial tuberosity). In kids, tendons beat out bones for strength, and the result is flakes of the bone are pulled off (called an avulsion fracture). This leads to extreme pain at the tibial tuberosity, and can result in the tell-tale “knob” that appears there over time. Understanding the progression of this “disease” allows you to begin stretching and rolling out your quadriceps before this issue arises. As you start to grow, increase your stretching appropriately. Don’t wait for pain before you do, at that point it may be too late!
TFL Foam Rolling
TFL Ball Rolling
Sometimes people want to create names for things, just simply for the sake of naming something. This is the case with “Runner’s Knee”, and “Jumper’s Knee”. If you understand anatomy, and bio-mechanics, you would realize that they are part of the same continuum of Patellofemoral Syndrome. Runner’s knee is simply another name for patellofemoral syndrome, where there is pain around the knee cap from over tension in the quadriceps. On the other hand, “Jumper’s Knee” is pain in the lower part of the knee cap down to the patellar tendon attachment in the tibial tubercle. Two sides of the same coin. I will therefore not really have different videos for any of the three of these, I separate them out in case a health care professional has called your injury one of these, and you have come here looking for how to fix it. Just understand that all three are THE SAME. If you want exercises for any of them, go to the Patellofemoral Syndrome Section and follow those stretches.
This is perhaps my favourite musculoskeletal topic of conversation. Improving the running gait can lead to significant gains not only in time, but also in runs without pain. By correcting some simple biomechanical flaws, you can go from being an okay runner who has pain with running to an elite runner with no pain while running. The exercises here are a starting point on the way to your ultimate goal.
There are a lot of exercises here, so they are grouped into two categories, beginner and advance. Start with the beginner ones, as they will not cause you harm if you do them wrong. Get good at those, and then move on to the advanced ones, as they are trickier to do correctly. Above all, take care doing them, do them slow and correctly, and consult a health care professional if you are unsure if they are right for you. As a side note, these are EXACTLY the same exercises as for the hip, as both the knee and hip are dependent on these muscles to function properly for good running form. You can watch either set of videos, they are the same.
Start with these, they are low impact activation exercises to activate the main muscles used in proper running techniques. Do them several times a day for at least 2-4 weeks before progressing on to the more difficult “advanced” exercises below these ones.
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Once you are confident you are doing the beginner ones correctly, and they have become easy, you should proceed to these advanced exercises to really improve your overall foot swing control and shock absorption which will help mitigate the ground reaction forces and other sources of injury in your run.
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WHOLE LEG REHABILITATION
Sometimes your hip bothers you, or your knee bothers you, or perhaps your ankle does, BUT sometimes they are all linked, and one may be causing pain in another. Often the hip dictates the health of the entire leg. Since the Hip and Foot can affect the Knee, it is often a good idea to rehabilitate ALL THREE TOGETHER. That’s what this Whole Leg Rehabilitation program will do. Start at level one, and work up to level 5 over time. DO NOT progress from each level to the next until you can easily do ALL of the exercises on that level. When you’re ready, follow THIS LINK to the Whole Leg Rehabilitation page.