Stubborn Knees: Where Pain and Preventable Injury Usually Originate

Unless there is something structurally wrong in the actual joint, which is much less common, almost all knee issues (about 98%) are caused by problems with the ankles, hips, and by an imbalance of strength between the quads and hamstrings: overactive quads and underactive hamstrings. (This can result in explicit injuries as severe as ACL tears, or it will simply serve as the cause of general, relentless, frustrating, and all too common patellofemoral pain – usually just referred to under the blanket term, “Runner’s Knee,” and which includes anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella.) But you don’t need to worry about those phrases. Bottom line: your knee area hurts, and it is usually easily attributed to a combination of issues we’re about to START to discuss in this post. There is no way I'll cover all of them here, and this particular subject (knee issues) is a MAJOR one when it comes to fitness in general...so I will just briefly begin touching on it and scratching the surface in this post and will continue to elaborate via subsequent posts. :) These knee issues albeit being common, are also usually just as curable and major injuries preventable...IF you learn about what causes the pain in the first place and how to embrace preventative stability, flexibility, and strength training. Far too many people resort to surgery too soon, or end up in a position where surgery IS required, because they either didn’t know or didn’t place enough value on proper form and training for effective neuromuscular control and function. Remember, pain happens as the body’s way of telling you that you are doing something wrong! Or using the wrong equipment - eg - bad shoes for your particular feet! - listen to your body, and make changes accordingly. You'll either listen now or you'll be forced to listen when you are taken out of commission by inhibiting injuries. I would be the latter, which is why I am now being smarter. I advise others to do the same. 6 months of casts and crutches was not an enjoyable thing, let me just tell you. ;)

Within the human body, several muscles will work synergistically to produce force, stabilize the body, and reduce force upon impact, etc. Because most people tend to be quad-dominant, they subsequently have underactive hamstrings and a much higher susceptibility to numerous types of injuries as well as general and ongoing knee pain. Increasing balanced co-activation between the quads and hamstrings has been shown to significantly decrease general knee pain as well as the risk of ACL tears and significant knee injuries that usually result from a lack of proper joint stabilization and in turn, increased knee adduction. How to go about doing that will be discussed in future posts. :)

Provided that you haven’t torn an ACL (connects the thigh bone to the shin bone in the knee), PCL (also connects the thigh bone to the shin bone in the knee), MCL (connects the thigh bone to the shin bone on the medial – or inner – side of the knee), or LCL (connects the thigh bone to the fibula, the smaller bone of the lower leg on the lateral – or outer – side of the knee), along with any meniscus or other boney structure in the knee, it is usually a safe bet to say that your issue is in your hips, ankles, and/or hamstrings and has to do with overactive/underactive coupled muscles which over time enhance faulty movement patters and poor weight/force distribution on the knees. The sooner you identify your specific issues actually leading to the formation of pain, and address those issues by embracing the power of healthy and correct muscle synergies (how your muscles and muscle groups need to work together to function appropriately), the sooner you rid yourself of pain and hopefully prevent or heal injuries that will otherwise result almost inevitably, at least at one point or another. Remember that everything affects everything else, which is why we think of our body and its movement patterns as functioning within a kinetic chain through which very few muscles work in isolation; it would be extremely difficult and rare to have an issue with, for instance, your hips…and not have that issue in some way translate into additional issues with your knees and ankles.

When it comes to muscle function and activation, the human body naturally wants to take the path of least resistance. So when the body recognizes that one muscle is far stronger than another in its synergy for any given function, it is going to fire and make the stronger muscle to do all the work, leaving the weak muscle out of the equation - which also means leaving the weak muscle's intended JOB left unfilled. To clarify that, for example, one of the most predominant causal factors of ACL injuries in runners and other athletes is an imbalance of strength between the quad and hamstring – which I’ve already mentioned in some capacity – but here’s why. One of the hamstring’s important jobs is to keep the tibia (shin bone) from sliding forward upon impact and/or as you come to a quick stop. When you have an imbalance in strength between the quads and hamstrings (meaning you have overactive quads due to weak and underactive hamstrings) it means the hamstring isn’t strong enough to do its job…so put simply, it doesn’t! This is because the quad wants to be super nice and “help it out,” except that doesn’t help you. ;) The quad basically says, “hey, no worries! I know you’re not strong enough for this, you can just chill and relax and I’ll cover everything for you!” Except that’s not possible, and thus the protective jobs of the hamstring don’t actually get performed, leaving you with far less protection (if any) against unwanted turning motions upon motions of impact, and subsequent tears, etc. It also drastically increases the likelihood that you will simply experience to no avail, ongoing general pain and discomfort, or at the very least, seemingly endless ‘cycles’ of such pain.

There is of course a TON more to all of this, as well as lots more contributing factors to knee pain and injury. In posts to follow, I'll elaborate on each of many main concepts that pertain to effective exercise and injury prevention, including:
-muscular force
-length-tension relationships
-force-velocity curve
-force-couple relationships
-muscular leverage
-arthrokinematics
-muscular synergies
-effective proprioception
`sensorimotor integration

We will then get into the MANY modalities of training that will get you progressing to being in INJURY-FREE great shape, all of which fall into the categories of stability, flexibility, strength, and endurance training...among other divisions.

There are a million terms and muscle activation concepts to understand, as well as scientific explanations for the immense importance of posture and how poor posture and poor form results in pain and injury. However, it would be impossible to get into all of that in one blog post. SO – for the purposes of this post, let’s stop here and I will elaborate more specifically on various causes and implications in subsequent posts. Also, my NEXT post to come soon – within the next couple of days or so – will provide you with a general overview of some specific exercises and ideas you can try within stabilization, flexibility, and strength training so that you can begin NOW on your path to prevention, or treatment, and/or alleviation of this knee pain or knee related injuries. As always, make decisions based on your individual needs and capacities.

Ref's

1.   Clark, Micheal, Scott Lucett, and Brian G. Sutton. NASM Essentials of Personal Fitness Training. 4th ed.
      Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012. Print.

2.  Gregory D Myer, Kevin R Ford, Jane Khoury, Paul Succop, et al. Biomechanics laboratory-based
     prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury. Br J Sports Med 
     2011;45:4 245-252 Published Online First: 17 June 2010.

3.  Kovaleski JE, Gurchiek LG, Spriggs DH. Musculoskeletal Injuries: Risks, Prevention, and Care. In: American College
     of Sports Medicine, ed. ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, 3rd ed.
     Baltimore: Williams & Wilkins, 1998:480-87.