Here is part 2 of my knee pain and knee injury series.

If you missed part 1, you can see it here.

Anatomy of the Knee cont.

Next to the femur, the tibia is the largest bone in the body. It is the weight bearing bone of the lower leg. The upper end of the tibia joins with the femur and its lower end joins with the talus, the bone that forms the lower part of the ankle. The fibula is located on the outer side of the leg. Unlike the tibia, this bone is non-weight bearing. Instead, it functions as an ankle joint stabilizer and as an attachment site for one of the four major knee ligaments and the biceps femoris tendon. The lower end of the fibula protrudes on the lateral side of the ankle.

Patella

Menisci

I have got a lot of great feedback from my last post on knee pain, knee injuries and ACL injuries.

If you missed it, you can check it out here.

Overview of Knee Pain

The knee is the largest joint in the human body. In the most recent report of the U.S. Department of Health and Human Services, the knee is also one of the most commonly injured joints. Each year, more than 5.5 million orthopaedic visits are made due to knee injuries. The joint’s high susceptibility to injuries is mainly attributed to its intrinsic anatomical structure and its function during weight-bearing. Moreover, because of the increasing problem of obesity and a sedentary lifestyle, knee injuries are one of the leading causes of disability in modern society.

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I got a lot of great feedback from my last ACL Injury article.

I decided to do a bit of a video on knee pain and ACL injuries.

3 ACL Injury Exercise Mistakes

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Here is another interview from Orange County.

In Orange County, I was at a fitness conference.

The funny thing is you can hear all the plane overhead from the local airport.

In the interview, I am chatting with Rochelle Gravance.

Rochelle is big in to knee pain.

It is so great to run into another person that focuses on injuries.

I know one of the big injuries I get are knee injuries.  I know a fair bit about knee pain and injuries but I am always looking for new tips and tricks.  I love hearing what others that specialize in injuries have to say and what is new in the research.  Last week, I reviewed a research article on exercise and patellofemoral pain syndrome, check it out here.

In the video she talks about a few key tips to remember when training a client with knee pain.

What to Do If you Have a Client with Knee Pain?

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When I was in Indianapolis earlier this year at the NCAA Final Four, I stopped by to

visit Mike Robertson and we did a quick video for you.

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Mike and I did a quick interview for you so you have a better idea of what to expect from the courses/seminar.

Lets get to the interview.

What You will Learn in the Seminars with Mike Robertson

In Part 1 of the interview, Mike Robertson will share with you:

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Bulletproofing Your Client’s Knees and Lower Back Seminar with Mike Robertson [ 12:37 ] Play Now | Play in Popup | Download

I received a question from a personal trainer who has a number of clients with meniscal injuries; she was looking for some suggestions on program design and exercises.

There is a lot to consider when it comes to lower body injuries and exercises.  I go through all kinds of exercises for the lower body in the following courses:

Exercises Rehabilitation of the Knee

Balance Training for the Rehab Client

I will focus on a few key points to remember when strengthening the knee that has a meniscus injury.

What Does the Meniscus Do?

Taking a step back, the menisci act to spread the load of the body’s weight and reduce friction during knee movement.  When your client talks about “torn cartilage in the knee” they are often talking about meniscus.

5 Keys to Help Your Clients with a Meniscus Injury

Time Load on the Meniscus

Look at your client and see the amount of time they spend standing, walking, running and exercising during the day.  All of these activities puts load on the meniscus and if the meniscus is damaged, it will lead to inflammation.  It is important to load the meniscus, but the amount of time they load their meniscus needs to be monitored and your client needs to address any inflammation they have.

Plus a decrease in the load during the day on the meniscus will allow the meniscus to heal better and allow your client to do more during their exercise program when it comes to weight bearing and leg strengthening exercises.

Get on the Bike

Whatever your opinion is of the bike, the bike is great to strengthen the injured knee while putting low load on the internal structures of the knee, like the meniscus.

Get your client on the bike in order to strengthen the muscle around the knee.

Collapsing Feet

If your client has excessive pronation (flat feet) during gait, this will lead to increase medial load on the knee.  If their cartilage issue is the medial meniscus, this will put greater stress on their meniscus when doing day to day activities.  You need to assess you client to see if this is making the meniscus symptoms worse and slowing down their recovery.

Other Knee Strengthening Exercises

A lot of the common exercises given for the meniscus injury are hip flexion and hip extension exercises.  This is important, but does not address knee extension.  Few exercises that your client can do to strengthen the quadriceps:

Supine Tubing Leg Press

In a supine position straightening the legs out against resistive tubing.

Changing Stance Width

With the typical closed chain exercises like squats and lunges can be tough for a client with meniscus issues.  What you can do is play around with the hip width that your client performs the exercises.  Sometime varying the distance between their feet will decrease the load on the injured area of the meniscus and allow them to perform the exercise.

I have to thank Barb for the question about meniscus injuries and exercises.

Do let me know what you think of the post and if you have any tips for other fitness professionals on exercise and meniscus injuries.

Rick Kaselj, MS

Before I go, one last thing.

The picture above gives you an idea of how it looks in the knee.

1 = meniscus

2 = femur (thigh bone)

3 = tibia (shin bone)

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I was digging in the journals again and came across this journal article.

I know it is an old one; from 1994.

I think the main point is a good one, plus I have been on a bit of a knee injury exercises, kick as of late.

Plus, I am always looking to improve the Exercise Rehabilitation of the Knee course.

If you have a client that has had anterior cruciate ligament surgery, there is a lot to consider.

Something that I have not thought about is how the ACL graft will do when walking down hill.

Will walking down hill lead to re-injuring the ACL?

Keep reading to find out.

Downhill Walking After ACL Surgery

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I just wrapped up my Exercise Rehabilitation of the Knee course at Douglas College.

I learn so much from the fitness professionals that attend.  They all have great questions and I wanted to share one with you.

I got a great question from one of the registrants about knees passing the toes.

Commonly taught in fitness certification is the fact that you should not have the knees passing the toes.  My response to this is, it depends on the situation.

The Deal on the Knees Passing the Toes

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What to do if you Have Knee Pain if your Kness Pass Your Toes [ 2:47 ] Play Now | Play in Popup | Download

Doing Some Early Morning Research

I was up early this morning. 

What I try to do once a month is to see what is new in the exercise rehabilitation world. 

There are a lot of okay places to go but I have a list of journals that I try to visit to see what is new and if there is any new information that will improve my courses or new exercises for my clients.

Let me share with you a little of what I found:

Curve Progression in Idiopathic Scoliosis: Follow-up Study to Skeletal Maturity
Spine: 1 April 2009 – Volume 34 – Issue 7 – pp 697-700

This is article is at a great time.  I am just wrapping up the scoliosis and exercise manual.  It shows that Cobb angle is still the best predictor of long-term curve progression.  This content is already in the upcoming manual and if you have subscribed to the exercise and injuries manuals, you will learn more about Cobb angle and a pre-screen for scoliosis, next week.

Take Home Message – Know what Cobb Angle is and it is the besting indicator of the scoliosis getting worse in a client.

Patellofemoral Joint Force and Stress during the Wall Squat and One-Leg Squat.
Medicine & Science in Sports & Exercise. 41(4):879-888, April 2009.

This was very interesting article.  The research is nice but what I am looking at is how can it help with my clients.  I have a number of clients that report anterior knee pain with a wall squat.  I modify their technique in order to decrease that stress.  I never knew that I could change the joint angle of the squat in order to decrease the stress on the knee joint.

This is a nugget of information I will be adding to them Exercise Rehabilitation of the Lower Body courses:

“When the goal is to minimize patellofemoral compressive force and stress, it may be prudent to use a smaller knee angle range between 0[degrees] and 50[degrees] compared with a larger knee angle range between 60[degrees] and 90[degrees].”

Take Home Messages:

1 – Wall squat creates more force on the patella than a single leg squat. 

2 – Having the foot a short ways or a long ways from the wall created equal force on the patella in the wall squat except between 60 to 90 degrees of knee bend.

3 – A wall squat between 0 to 50 degrees of knee bend creates less force on the patella than one performed at 60 to 90 degrees of knee bend.

Breakdance Injuries and Overuse Syndromes in Amateurs and Professionals
Am J Sports Med April 2009 vol. 37 no. 4 797-802

Sometimes there is some fun research out there.  I thought breakdancing died in the 80s.  I do know one friend that goes and competes in breakdancing.  I have yet to rehab a breakdancer but I will remember their recommendations:

“Breakdance injuries and overuse should not be underestimated. Physicians should be aware of the common risks in this highly acrobatic kind of dancing.”

 Take Home Message – Breakdancing is dangerous like every other sport.

I only got to three journals, I guess I will have to do a little more reading.

Let me know what you think of the above, leave a comment.

Have  a great weekend.

P.S. – I have the Exercise Rehabilitation of the Upper Body courses that I am presenting at the end of the month.  For more information, click here.

- Rick Kaselj