Greetings all!!!
I will have to say that I'm very fortunate to have all the friends I have in my life. These friends have helped me when I was down and couldn't manage to do things on my own. My family is the same way. They both take hits for me. I feel blessed, and sometimes I feel like I take advantage of their generosity.
Well, the knee is the same way. The knee is the hit taker for the hips and the ankle. It's "caught between a rock and a hard place with no place to go." When the foot or the hip are not doing their jobs, the good ole' knee steps up and picks up the slack for them. However, because the knee is so generous it can even take the hit for a gunked up thoracic spine or a weak core musculature.
I find that in my practice, the biggest complaint is lower back pain followed by a very close knee pain. Knee pain comes in so many forms from a plethora of reasons like structural deformities, trauma, overuse, etc. I strongly believe that many of these injuries can be prevented or the serverity of the injury lessened with a knowledge and application of functional anatomy and Chain Reaction Biomechanics.
FUNCTIONAL ANATOMY:
I've heard the knee described as a "poorly designed structure." WHOA!!! Everytime I hear that I ask people why they say that? The answer I usally get is some derivation of "it's so easily injured" or "it's unstable". Well, I personally believe nothing could be further from the truth. The WISDOM of the body and WISDOM of whoever designed the body, definitely did not stop at the knee. If we look use our Applied Functional Science 3-D glasses, we can see the magic of the knee. Here's a quick anatomical snapshot of the knee:
Bones: Tibia and Femur and Femur and Patella
Major Ligaments: Anterior and Posterior Cruciate Ligaments (ACL and PCL), Medial and Lateral Collateral Ligaments (MCL and LCL), Patellar Ligament (aka Patella tendon)
Cartilage: Extenal and Internal Firbro-cartilage or the MENISCUS (plural: Menisci) and Hyaline Cartilage
Bursae: 14 various bursae located throught the knee complex
Nerves: Innervated by the Femoral, Obturator and Sciatic nerves
Major Muscles that cross the knee: Quadriceps, Hamstrings, Gluteus Maximus, Tensor Fascia Latae, Sartorius, Gracilis, Poplitieus, Gastrocnemius
CHAIN REACTION BIOMECHANICS:
Looking at the knee we see that it is a 3-D joint that moves in 3 planes of motion. However, the knee is interesting in that many people only see and appreciate the flexion/extension motions of the knee. I believe that is because those two motions are the ones that we PREDOMINATELY see, but that does not mean that the other motions are not as important if not more important to the knee and throughout the body. Here's what happens at the knee in walking in the front leg.
Sagital Plane: Because the ankle is going through dorsiflexion and the hip is going through flexion, we have KNEE FLEXION or bending.
Frontal Plane: Because the foot is going through eversion and the hip is going through adduction, we have KNEE ABUDCTION or shifting in towards the midline of the body.
Transverse Plane: Because the foot and lower leg are internally rotating and the femur is internally rotating but the the tibia is rotating faster than the femur, we get KNEE INTERNAL ROTATION or rotating inward.
These movements in the frontal and transverse planes are more subtle especially the frontal plane motion but the motion should be there. If not, we may be getting into a situation where the other two planes are having to absorb the frontal plane motion in their plane and overtime, that can lead to an overuse injury. Yes, the knee can be its own best friend and take a hit for itself but just in another plane of motion. Crazy, huh!?!!?
As the leg in wallking goes to being the back leg, the sagital and frontal plane motions are reversed, but the transverse plane motion remains the same.
Now this is not as complex as it seems. The body moves in a rhythm. When the natural rhythm is off, then you get into a place where something has to take the hit for the dysynchrony. In my experience, its either the lower back or the knee that is taken the hit for the foot, hip or thoracic spine.
As I stated before, there are MANY injuries that can happen to the knee. Tendonitis, ACL tears, patellafemoral pain syndrome, IT band syndrome, bursitis, etc. The list goes on and on unfortunately. Having a basic understanding of the knee and its biomechanics, allows us to create functional strategies and techniques for prevention, training and conditioning and rehabiliation if necessary.
FUNCTIONAL STRATEGY AND TECHNIQUE:
This is not a subsitution for medical advice. Check with your physician before you begin any new movenment program.
Let's say that an athlete with knee tendonitis has been cleared by a doctor and PT to return to activity at a decreased level but still needs to continue some work to decrease the pain further and strengthen the muscles of the knee. Well, would it help to go right to the knee and focus on it? Well, with what you know, the knee is the friend who takes the hit for its friends the foot and hip. It's stuck between a rock and hard plaace with nowhere to go. Yes, continue having the athlete ice their knees if the tendonitis is persistent and reduce unneccesary physical activity. We have our athletes use THE STICK, which is basically a tool that you can use to self-massage. (Click on the link to learn more)
To begin, I'd choose either the foot or the hip to start. Because i have been discussin the hip, lets pick that one. A GREAT way to get started is the KNEELING MATRIX. (will post as soon as I can find my digital camcorder cord). The kneeling matrix will focus on the mobility of the hip. I suggest you put either a foam mat, towel, blanket, yoga mat (triple folded) under the knee so that you will be smashing your knee into the hard floor for a extended period of time. Hold each stretch for at least 30 seconds and then do 10-15 oscillations from mid to almost end range. After you do that for BOTH legs, go through a very simple and easy LUNGE MATRIX. Just step between intial and mid range reaching both hands down and away from your knees about 12 inches. This lunge matrix will help to mobilize the hips and load and unload the neuromuscular system. If any of these lunges hurt, stop that lunge immediately. Do not aggregate that knee anymore.
After you do that work, you can ice and rest. This is a very basic but powerful strategy and technique that you can use.
I hope this introduction helps. The knee is really a great friend as I'm sure many of you are to your friends. Sometimes, we have to understand where our friends are coming from to be able to assist them better and vice versa. There may be times when you are asking for a lot from your friends and they put a lot of energy and effort into assisting you and other times it may be the other way around. However, as we tap into our wisdom, we realize that after a while, someone is going to get worn down from assisting their friend in need. At that time, the worn down friend needs to back up, take a moment to rest and then devise other strategies that will help our friend in need. Maybe we have given them all the help we can and its time to go in a different direction.
Our knee is the same way. Sometimes it needs a time to rest, heal and have its friends the foot or hip, take a look at themselves and say "Hey! I am not doing all I can to help the rest of the body and my little buddy the knee is really getting beat up. What can be done for us to make us more successful? Maybe if the person we live inside would mobilize then strengthen us in the 3 planes of motion, we could be a better help to everyone." You would be surprised what a little 3-d loving will get you.
Happy Thursday!
Will
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