Nothing is as scary or as debilitating as a knee injury. Yet everyone—athletes and fitness enthusiasts alike—constantly ignore chronic knee pain. And I was one of them. There came a point when walking up steps was a death sentence. But there was no way I was going to miss my squatting session, even if the pain reached a new high. I just thought it was the nature of the beast—that there was nothing I could do to fix it. So I saw it as a badge of honor. It was more like a badge of stupidity.
Sometime in 2009 I posted a rather gruesome video to YouTube. No, no heads were chopped off. And no, blood wasn’t spewing into the next county. It was just a close up of my knee being flexed and extended while all sorts of nasty clicks, pops, and cracks radiated from my patellar tendon. Although I knew it wasn’t exactly “healthy,” I knew that my knee—for all intents and purposes—was structurally sound. There were no torn ligaments. No mangled menisci. But my patellar tendon was on the fritz, and I had no idea why.
Instead of idly accepting a life of chronic knee pain, I made dramatic lifestyle changes. I didn’t want to struggle getting in and out of cars at the age 21. So, I experimented. About six months into my quest, I knew I had something. And one year later I collected and organized what I found into a grand theory and accompanying routine so that I could test it on others.
KNEE = ELBOW
One thing that sparked my interest—and paved my road of rehabilitation—was understanding that the lower limb shares a lot of similarities with the upper limb. The ankle and wrist are mobile yet fragile. The knee and elbow are facilitators—strong links in a connected chain. And the hip and shoulder are the complex, powerful, and responsible joints that connect the limbs to the body.
After being around the strength and health world for a while, you notice things. At that point I had done a boatload of interning and personal studies, so I was pretty in-tune with industry.
The elbow was (and still is) a hot spot for lifters. Golfer’s elbow became a frequent topic of discussion among general fitness trainees. 99% of the remedies for golfer’s elbow involved ditching the straight bar and moving something that allowed a hammer or neutral grip. This advice holds true to this day.
It took me a while to be able to step back far enough to conceptualize this, but this advice basically says that elbow health is determined by the position of the wrist. There were no super-secret rehab exercises. Just simply avoiding straight bars in an effort to stop putting the elbow in a compromised position.
I paralleled this with my knee rehab, which consisted of bunches of TKE’s, Petersen step ups, leg extensions, hamstring curls, hamstring stretches, and quad stretches—all things that focus directly on the knee.
But if the elbow didn’t need direct rehab, why would the knee? This made sense to me at the time because my knee was getting worse. And now that I’ve helped many people, I notice that TKE’s and like movements don’t work with more severe cases of tendonitis.
THE EQUATION OF LEGEND
In cases of chronic knee pain, from the crudest look, the patellar tendon hates life. It’s your job to find out why, and how to fix it. Most times, the answer isn’t to pound it with more dysfunctional movement. If your knee hurts when you squat, and you keep squatting through the pain, you’re never going to be healthy.
The knee can rotate somewhat and is a rather special joint, but when compared to the hip and shoulder it’s boring. (It’s funny how so much dysfunction can manifest itself in such a simple structure.) So I made a bold prediction, and one I still believe in: most chronic knee pain has nothing to do with the knee itself.
Overall movement of the knee depends on both the hip and ankle. Don’t believe me? Rotate your ankle and stand on the side of your foot (invert your ankle). Try to collapse your knee inward. It’s not going to happen. There are more examples, but the idea is that the knee—and the elbow—are facilitators when used in larger compound movements. They connect the powerhouse of the chain (hips and shoulders) to the distributors and manipulators of the chain (hands and feet).
So I created this mega fancy calculus like complicated equation to explain this Einstein like phenomenon, and it goes something like this:
FOOT + HIP = KNEE
While I’m sure this holds truth in most knee injuries—even the severe ones—this recipe is primarily targeted to chronic issues such as tendonitis, tendonosis (jumper’s knee), and even patellar tracking problems. They are all born from similar dysfunctions.
Suffering from tendonitis as a college basketball tryout, my 19 year old self wished there was a guide written specifically for athletes and debilitating chronic knee pain. Fast forward to now, I confidently hold the systematic and structured system I once wished I had.
There’s an abundance of knee information out there, but not much narrowing in on the chronic troubles that athletes face—the stuff that’s not serious enough for surgery, yet still bothersome in life and on the field. And let’s face it: recovery from a torn meniscus is going to be different than recovery from tendonitis. I wanted to focus on those nagging chronic knee issues that athletes face because I was once in their shoes.
Athlete’s Guide to Chronic Knee Pain: Theories and Solutions for Patellar Tendonitis, Jumper’s Knee, and Patellar Tracking begins with a small memoir so that readers can immediately tell whether or not they can benefit from the information. Followed are the theories and solutions for beating chronic knee pain, ending with an eight week rehabilitation program to follow.
It’s only a matter of time before this theory is widely accepted as the research is slowly emerging to support it. There are a lot of studies out there, but here’s a handful:
Chester, R, Smith, TO, Sweeting, J, Dixon, D, Wood, S, & Song, F. (2008). The relative timing of vmo and vl in the aetiology of anterior knee pain: a systematic review and meta-analysis. BMC Musculoskelet Disord., 1(9), 64.
Dolak, KL, Silkman, C, McKeon, J, Hosey, RG, Lattermann, C, & Uhl, TL. (2011). Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther, 41(8), 560-70.
Karst, GM, & Willet, GM. (1995). Onset timing of electromyographic activity in the vastus medialis oblique and vastus lateralis muscles in subjects with and without patellofemoral pain syndrome. Phys Ther, 75(9), 813-23.
M¿lgaard, C, Rathleff, MS, & Simonsen, O. (2011). Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc, 101(3), 215-22.
Smith, TO, Bowyer, D, Dixon, J, Stephenson, R, Chester, R, & Donell, ST. (2009). Can vastus medialis oblique be preferentially activated? a systematic review of electromyographic studies. Physiother Theory Pract, 25(2), 69-98.
Sheehy, P, Burdett, RG, Irrgang, JJ, & VanSwearingen, J. (1998). An electromyographic study of vastus medialis oblique and vastus lateralis activity while ascending and descending steps. J Orthop Sports Phys Ther, 27(6), 423-9.
Willson, JD, Kernozek, TW, Arndt, RL, Reznichek, DA, & Straker, J. (2011). Gluteal muscle activation during running in females with and without patellofemoral pain syndrome.Clin Biomech (Bristol, Avon), 26(7), 735-40.
So if either you or one of your athletes is suffering from chronic knee pain, check out An Athlete’s Guide to Chronic Knee Pain. Or you can live with the regret of failing to reach your athletic peak, hating life every day, and slouching your way through pain. Just saying.
By Anthony Mychal