"I know of no more encouraging fact that the unquestionable ability of man to elevate his life by
a conscious endeavor" Henry David Thoreau
Welcome back, hopefully you have been gaining some insight into the importance of joint mobility. In last week's blog we spoke about the spine along with three common dysfunctions and some solutions. This is part 3 of the joint mobility series we are going to look at the knee. The knee is one of the most commonly injured joints right behind the ankle. So let's look at some statistics: 15% of all sports injuries involve the knee, 50% of knee injuries result in a visit to the doctors office, 75% of surgeries done on professional football players involve ligament and cartilage tears. It is a common injury with basketball players as well accounting for approximately 42% of their injuries. In addition, the Mayo clinic reported in their 2012 METEOR1 study that people who opted for a meniscectomy had a much higher risk of developing arthritis/osteoarthritis. Suffice to say joint health is very important particularly the knee. In case you are not familiar with some terms that are in this article, please refer to the glossary at the end .
So what exactly is the knee? The knee is where the femur and the tibia meet; it's a hinge joint with some medial rotation. While it is often injured, it is noted to be a very stable joint. The knee's stability comes from the geometry of the bones, muscles and ligaments. The muscles attached to the knee are the quadriceps which consists of the vastus medialis, vastus lateralis, vastus intermedius and rectus femoris. They attach at the top of the patella or knee cap and begin at the front of the spine. The quadriceps are responsible for knee extension. Just like last week muscles are working at cross purposes but in unison. The hamstrings are responsible for knee flexion as well as providing medial support to the knee. The ligaments would be on "TMZ for the joints" they are celebrities, which are the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. The ligaments work to stabilize the knee externally and internally with the help of the menisci. The menisci are thin c-shaped pieces of cartilage on which the knee glides. There are medial and lateral menisci. The medial meniscus is attached to the MCL. The joint is protected by the patella or kneecap.
The dysfunctions we are looking at today is patellafemoral syndrome or runner's knee and Iliotibial band syndrome. Runners knee stems from overuse or repetitive motion. It can come from running, jumping, volleyball, cycling, basketball and crew. A number of factors contribute to runners knee: Misalignment of the kneecap, complete or partial dislocation, tightness, imbalance or weakness of thigh muscles, and flat feet. Chondromalacia Patella is the softening or wearing away of the cartilage behind the kneecap; it may manifest itself in pain in the back or hip. In cases where the cause is misalignment, vigorous exercise can cause excessive stress and wear on the cartilage of the kneecap. This in turn will cause pain in the underlying bone and irritation of the joint lining. The pain is usually under or around the bottom of the kneecap, it can be exacerbated by walking up or down stairs, kneeling, squatting and/or sitting with bent knees for to long. Iliotibial band syndrome or IT band syndrome is common in up to 12% of runners, usually described as a burning sensation in the outside of the leg. A recent study has cleared up the actual function of the IT Band. Previously it was thought the IT band would snap back and forth over the lateral femoral condyle, causing inflammation. In the Fairclough2 study it was proven that back and forth movement was an illusion, what you are seeing is alternating tension in the TFL and the glute max. The shifting of tension from anterior to the posterior fibers of the IT band creates the illusion that the band is displacing forward and backward. The IT band acts as a compressor to the femur lending strength and preventing it from bending in single leg stances. The authors of the study note that the IT band is never inflamed itself rather its the distal part of the vastus lateralis muscle. You may ask why these conditions are in this article together because they can go hand in hand all to often. They can give you an idea of what you may be looking at dysfunction wise and what needs to be addressed.
Onto the solutions!
When it comes to runners knee rest ice compression elevation to start. Then you move onto strengthening weak muscles and stretch tight muscles. Some of the usual suspects will be involved look for hip tightness, calf tightness weak hamstrings and/or glutes. If your concerned with IT band syndrome it is suggested that you strengthen the hip abductors and external rotators. Another concern could be a tight TFL, tight hip flexors and even glute max tightness all three increase strain on the band. So staying loose will help you tremendously. Before working out or running, warm up and then do some soft tissue release, then move onto stretches. As you move out of a corrective exercise phase increase your training intensity and/or workload slowly. Also if you are running go to the local running store and get outfitted for correct shoes. It would be worth your while to get a movement assessment to determine what corrective exercise plan would get you into optimal condition. I hope you have enjoyed this week's installment. Please share this blog. Next week we move onto the ankles.
Please see below for links :
http://www.youtube.com/user/TheBrentBrookbush
1.Meniscal Tear With Osteoarthritis (MeTeOR) Study. Accessed April 13, 2012.
2.Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.J Anat, 2006;208:309-316.
Glossary
Distal means further away from the body
Proximal means closer to the body
Medial means towards the center line of the body
Lateral means away from the center line of the body
Anterior means the front of the body
Posterior means the back of the body
Glossary
Distal means further away from the body
Proximal means closer to the body
Medial means towards the center line of the body
Lateral means away from the center line of the body
Anterior means the front of the body
Posterior means the back of the body
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