Knee Injuries: Prevention and Management
Knee injuries are one of the most common injuries seen in sports today. Even those who train in the gym regularly are not immune to this type of injury.
It’s not just contact sports that have a high rate of these injuries. Around ¾ of all ACL injuries occur without any contact. The most common reported mechanism of injury is when the individual is changing direction, usually very fast, in a cutting motion (stepping from one side to the other at speed).
If the structures around the knee are unable to cope with the force exerted upon them, what we generally see is a dislocated knee and/or a torn ligament along with it, the most common being the ACL.
The ACL (anterior cruciate ligament) connects to your femur and your tibia, making it a big player when it comes to stabilizing the knee. The meniscus is a small piece of cartilage between your femur and tibia and acts as shock absorbers for the knee.
There are two main structural factors that contribute to knee injuries, specifically an ACL tear. The first is the Vastus Medialis Oblique (VMO) and the second is the quadriceps and hamstrings ratio. In the gym, squatting to 90 degrees (most people believe that going past 90 degrees will injure the knees when in fact it does not) and not training the hamstrings as a knee flexor and hip extensor are factors that can contribute to knee injuries.
In addition to these, poor mobility in the hips and ankles will be a contributing factor.
The hamstrings play a vital role in preventing knee injuries including ACL tears. When you decelerate, the tibia glides forwards which places strain on your ACL. The hamstrings kick in and prevent the tibia from moving forward too far.
If the hamstrings are not strong enough, if they are not sitting in the right anatomical position, or if they are full of adhesions, they are not going to be able to work effectively which will often result in an injury.
This is why we place such an emphasis on training the hamstrings, both as knee flexors (leg bending the knee) and hip extensors (bending forward).
What we see a lot of, especially in elite levels of sport, are poor strength training programs and rehab programs.
Common practice with ACL rehabilitation programs will include a period of time using manual therapy (hands-on) and then you progress to active based therapy (exercise). You will see a lot of single leg squats, jumping, running, bounding, etc.
This is wrong.
How can you expect an athlete who cannot perform a bodyweight split squat or even a step up to be able to jump? If you cannot perform basic structural balance exercises, you cannot run, jump, bound, etc.
These exercises highlight the imbalances and weaknesses that contributed to the injury in the first place. If anything, they should be used as an assessment tool or a tool to measure progress.
So, how can we address these issues and prevent knee injuries on and off the field?
Firstly, you need to know where you are weak, unstable or immobile. Once you know where your issues are you can better select your exercises.
In general, we find these movements are beneficial:
· TKE with band
· Poliquin Step Ups
· Petersen Step Ups
· Step ups
· Split squats
· Leg curls (standing, lying, kneeling and seated with varying foot positions)
· Back Extensions (flat and 45 degree)
· GHD (full and top half)
Movements to avoid are those that cause pain, excessive use of leg extensions and frequent box squats, primarily due to the excessive shearing forces placed on the knees.
Regardless of your knee injury, the rehab protocol you follow will need to address your movement patterns, along with hamstring and VMO strength. At the start of the rehab process, you will respond well to manual therapy, however, after a few weeks, you will see a better response if you progress to strength training.
Laying down on a bed a getting your leg massaged will only get you so far. If you want to progress you will need to put in the work and start training.