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Injury Prevention for Athletes Workshop

By Mike bills, MS PT

Why do knee problems occur in the first place? In order to fully understand knee problems, you need to know a little about the makeup of the knee joint. The knee joint is the junction of two major bones of your knee fitting together to form a hinge joint, like a door. The major difference between the hinge of a door and your knee joint is the way it is made. Your knee joint is made up of the femur, (your upper leg bone) and your tibia, (your big lower leg bone). At the knee, the femur is a rounded bone. It sits on top of the tibia, which at your knee is a flat bone. So unlike the hinge of a door, or other parts of your body like your hip, the knee has no real interlocking pieces to help to give it stability. To make up for this inherent weakness, your knee has ligaments that hold it together. These ligaments include your medial collateral ligament (MCL), lateral collateral ligament (LCL), your posterior cruciate ligament (PCL), and the probably the most famous of all, your anterior cruciate Ligament (ACL). Ligaments are like ropes. They are not meant to stretch. Their job is to be tight and taught around the knee and hold the round portion of the femur in place on the flat surface of the tibia. An additional protective mechanism to try to give better support to your knees comes in in the form of the meniscus of the knee.  These are two half moon discs that are somewhat concave in design. They sit on top of the tibia and try to create a little bit of suction between the femur and the tibia.

To make the knee joint even more complex, we throw in the patella, your knee cap. This small, ‘floating’ bone is supposed to track perfectly in a little groove on the front side of the femur.  The purpose of the knee cap is to provide extra stability.

So how do common knee injuries or problems get started? It all comes down to poor mechanics. For starters, the knee joint is a very unstable joint because of its makeup as noted above. Technically, your knee is meant to only flex and extend or bend and straighten. But as a result of the way it is designed, there is the potential for rotation of the bones on one another, side to side motion of the bones on one another, as well as forward and backward motion of the bones on one another.  All of this excess movement is what causes or allows knee problems and injury to occur.

In an athlete playing a game, or even someone who is stepping off a curb, there is a lot of potential for forward slippage of the femur on the tibia. This places a lot of extra force and torque on the ligaments of the knee. With one episode of too much movement, it can cause a tear of the ligament, or with repetitive stress on the ligaments, it can cause wear and tear on them over time. When you are watching a sporting event and they talk about someone who tore their ACL, this is what happened. There was excessive slippage of the femur on the tibia and the result was that the rope, the ACL, could not hold all of that force and thus tore under the stress.  

With regular every day walking, using stairs, standing, and then in someone who runs, does a lot of jumping like a basketball player for example, you have the potential for a lot of side to side motion, as well as rotation in the knee joint. When you are simply walking, the final 20 degrees of straightening out your leg to put your foot out in front of you for that next step involves some rotation of the tibia on the femur. This torque or turning motion causes excessive friction on the meniscus. The meniscus is designed to move or rotate with the bones but very commonly it gets stuck and caught between them. This results in either a tear to the meniscus or general break down and loss of meniscus tissue over time. In the case of a basketball player jumping up for a rebound, as they extend or straighten their leg to explode up for the rebound, the rotation of the knee is occurring. Because the movement is occurring so quickly and under so much force, it is common to see the meniscus get caught between the two bones. The force of it catching causes a tear in the meniscus.

With simple activities like sitting, walking or using stairs or in the case of more advanced activities like hiking, rock climbing or running, we see issues where the knee cap does not track the way it is supposed to. The medical term for this is patellofemoral dysfunction. You may have heard it referred to as ‘runners knee’ or ‘jumpers knee’. You don’t have to be a runner or jumper to have it. When you are doing any of these activities, the knee cap is supposed to slide up and down in the groove on the front of the femur. Most commonly, in all of us, it is also moving side to side in the groove at the same time it is going up and down. This side to side motion causes the knee cap to glide up onto the sharp ridges or edges of the tunnel. The back side of the knee cap is very soft and sensitive so any movement out of the base of the tunnel tends to irritate the knee cap and cause discomfort.  

So here are the most common knee problems (other than arthritis):

  1. Ligament problems: these can occur over time or with one specific injury
  2. Meniscus problems: these can also occur over time or with one specific injury
  3. Patellofemoral dysfunction: this is the result of the knee cap tracking improperly

Any of the above knee problems will have the following symptoms:

  • Varying levels of knee pain, ache and soreness of the knee
  • Varying levels of swelling
  • Possible clicking and popping of the knee joint with movement
  • Stiff feeling in the knee when you sit or stand for any period of time
  • Inability to bend or straighten the knee all the way
  • A feeling of weakness in the knee especially with stairs, curbs, or changing position
  • Buckling of the knee or a feeling that the knee is loose

How do I prevent knee problems from occurring?

Assuming you don’t have any of the above symptoms already, then the best way to protect your knees is to ensure that you have the proper proportion of strength and flexibility of the muscles around your knee.  This includes (but not limited to) your quadriceps, hamstrings, calf and a number of other muscles that start in your hip and travel down your leg.

But what if I am already having problems with my knee as noted above? Barring a complete tear of a ligament; this would be like cutting a rope into two parts and most almost always involves a significant injury, all other knee problems can heal and fully recover if you do the proper things for them.  That is where physical therapy at Loudoun Sports Therapy Center comes in. Our expert physical therapists can evaluate your knee, listen to your symptoms and how they effect you, perform a number of specific tests and come to a definite conclusion as to whether you have a ligament, meniscus, or patellofemoral problem.  From that conclusion, we can establish a comprehensive plan of care that will correct the problem. But best of all we can get you started and finished on a treatment process that will ensure that whatever the problem is IT WILL HEAL. Yes it is possible to HEAL any of these common knee problems without surgery just as any common cut in your skin would heal.

Call Loudoun Sports Therapy Center TODAY at 703-450-4300 to handle your knee problems. CLICK HERE for a self-assessment for knee problems.

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