At some point in time most people experience a niggle, or worse, in their knee, so it’s unsurprising that knee pain is one of the most common injuries that people hobble into a physiotherapist's clinic with! So what can cause this pain and what can you do to prevent it? We’ve asked our good friend, qualified physiotherapist and Pilates teacher, Anna Clayton, to share her expert knowledge…
What Sports and Exercises Are Associated With Knee Pain?
Essentially, the knee moves like a hinge. There is stability from cruciate ligaments inside the knee that resist excessive forward/backward gliding movements of the thigh on the shin and the ligaments down each side of the knee prevent side-to-side movements… keeping you pain-free.
Knee injuries are likely to be caused by sports such as tennis, badminton, hockey or football that all involve sudden changes of direction. Workouts such as Crossfit, plyometric training and skipping are also classic knee pain culprits, as the knee is subjected to more force on loading when landing. Here, the quads work eccentrically to control mobility and movement at the knee and help decelerate speed.
Jumping, twisting, hopping, lunging, squatting, moving sideways and even running backwards or up and down stairs are all movements our knees are subjected to that can trigger pain and injury. However, with good strength and stability the knee should be able to tolerate higher levels of stress.
What Has Caused Your Injury?
You’re plain unlucky!
You have poor joint stability – this is the hypermobility of ligaments that ‘give’ more before they limit joint movement
Muscles of the lower leg are not stabilising the joint – think of the front and back of the body (quads and hamstrings / shin and calf muscles)
Poor balance and proprioception = where your brain perceives your limb to be in relation to the rest of you. This is typically poor after an injury but improves with balance exercises that challenge your neural system as well as muscles.
You’ve been overtraining - excessive repetitive loading can exceed your body’s natural tolerance to loading and movement – graded progression is key.
You’ve suffered illness - occasionally the body needs to be weaned back to higher intensity exercise and a prolonged period of rest can lead to some natural de-conditioning… remember to be kind to yourself when you head back to the gym!
How Can You Prevent or Rehabilitate From Injury?
Incorporate one and two legged balances, lunge movements with trunk rotation and standing on wobble cushions into your routine. Even just standing on one leg whilst you brush your teeth can be a great way to sneak in stability work for the lower leg! These activities challenge the whole lower leg (the kinetic chain) from the trunk down – and the knee is an important connection point for the transference of your weight to the ground.
Anything that provides resistance and loading through the muscles will give you some muscle endurance or muscle strength, depending on the repetitions or load. This can be anything from free weights or bodyweight exercises, to using a theraband, a couple cans of beans or even small children! You can make it prescriptive with exercise machines and move in one plane, or move in a more fluid range by combining multiple movements with your selected weight. However, make sure to check your posture, technique and build up range and resistance gradually.
People talk a lot about core stability, and a physio should be able to check that you are engaging the lower abdominals correctly. It’s not enough to suck your belly in and hold your breath as that is not engaging the lower abdominals into play. You want to feel as though the lower belly draws in towards the back of the spine without bringing your ribcage into the action.
Maintain about 50% of a lower abdominal activation throughout your training exercises, but do relax after each rep, it’s not a competition to maintain this all day. Try practicing this whilst doing day to day tasks, such as making the tea, brushing your teeth or checking your phone...its as important as pelvic floor training (that’s a whole other article!)
Sport Specific Activities
Make sure your training is relevant to what you are doing. There is no point doing loads of core work on your back if you need to keep stability when you stand and rotate the upper body. Use the movements of your sport, add resistance with the trunk activation mentioned above and build a muscle memory with stability and repetition. Similarly, train functionally. Move and challenge the body using different planes of movement – twist, reach, bend and squat! You can work specifically around a knee joint or a shoulder in defined ranges, then move to larger movements that support the smaller specific movements.
This blog was written by Anna Clayton: Anna works at Bury Physiotherapy Clinic as a Senior Musculoskeletal Physiotherapist and has recently completed a MSc in Advanced Physiotherapy. She teaches regular Pilates classes including a Pink Pilates; specifically for breast cancer patients. At the clinic she offers patients acupuncture alongside other treatment techniques to help people back to normal day to day activities, sports and hobbies - she is all for functional movement! Anna enjoys keeping fit and active with regular running (the odd half or full marathon), occasional cycling and was a rower and heptathlete in her youth.