Today’s “what you might not know you don’t know” topic: Knee Pain!

Topic #1: Sources of Knee Pain

Hi Team, here's my thought of the day on things that might open your eyes to a new aspect of your training that you could be leaving out. If you missed my intro to why I'm doing it you can read my first post here

Running injury, knee painI started my Masters degree wanting to study knee pain in runners and jumpers, because nearly everyone gets it at some point, and lots of people say they understand it - but just as many people are getting it! What I learned in my first year of researching all the best rehab medicine and strength & conditioning protocols is that no single approach works for everyone. This is because knee pain is always a symptom of dysfunction somewhere else (unless you fell on your knee…).

Fortunately people now understand this concept of regional interdependence pretty well - so if you’re struggling with or rehabbing from knee pain, I’m going to assume you’ve been exposed to the fundamentals of restoring normal hip and ankle mobility (eg/ you have a toe touch and full deep squat with little to no effort).

From there most everyone is pretty good at identifying that hip stability and motor control is an important factor in knee pain - so you’ve probably done your share of clamshells, glute bridges, band walks, single leg squats, etc. This stuff alone goes a long way in cleaning up a ton of knee pain - take care of mobility first, and immediately train stability and motor control through your full range of motion. 

The component I want to talk about today is the technical component of running and jumping that is often overlooked and under appreciated. I’ve worked with a number of athletes who have a great training base - they have all the range of motion they need, have a good amount of stability and strength, and yet still experience knee pain. Because running and jumping are such repetitive movements, technique (the “skill” level of the performance pyramid) becomes a major player not only in managing tissue load, but also in determining performance.

The super common issue that people tend to forget about cleaning up once they’ve done their basic rehab is to get out of knee dominant running and jumping patterns. What do those look like? See below:

 

Loading and landing from a jump with more knee bend than hip bending (flexion) tends to overload the knees and underutilize the hip musculature. This is where performance comes in. You’re much more powerful in a hip extension movement than a knee extension movement, so if you’re not maximizing that aspect of your jump, you’re not getting everything you can from your performance. 

For running it shows up in the long-striders who heel plant, decelerating and overloading the knee every step. The ideal gait has a mid-foot plant with the hip actively extending (think pulling back) so that your very strong glute and hamstring muscles take up that load instead of your quads. This corresponds with about 180 strides per minute - a faster turnover than most of default to. Again this translates directly into performance - heel planting and decelerating under-utilizes the hips and slows you down every stride.

Both of these technical errors have easy fixes once you identify the problem - but you need to know what you’re looking for. Then it’s a matter of training that new technique in various stages of motor learning and skill acquisition so it becomes your body’s default pattern. 

So that’s my quick insight on the knee pain trends that I’ve seen - hopefully this can help anyone struggling to find the solution they’re looking for. 

As always I am more than happy to answer questions or provide some more guidance if that doesn’t work for you - there are certainly outliers to this approach as well, but I’ll leave that for another post 🙂

Happy Training!

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