The knee joint performs a very simple, yet vital function in the body’s kinetic chain: It synchronizes the hip and ankle and provides the link through which the ankle and hip can communicate with each other. Most of the knee problems I address in my practice are due to the destruction of this vital link. Although knee problems usually manifest in mid- or later life, I see a lot of young men and women, even boys and girls, with dysfunctional knees. The trouble is that at an younger age, there are no external symptoms like pain that accompany the dysfunction. But they develop into full-blown disasters later on in life if left unattended. In fact, badly aligned knees are a warning bell: Lose the ability in youth to synchronize your hips and knees and you are looking at forfeiting proper locomotion itself. What can you do to stop this problem in its tracks?
Check for alignment
Stand barefoot in front of a full-length mirror wearing a pair of shorts and look at your knees. Just stand naturally and do not try to straighten out your feet. If the knees are functional, they will align right under the hips and above the ankles. Look for a straight line. You could take a black marker pen and draw a big dot on the top of the knee, and another one at the base of the leg where it joins the foot. Make sure these two dots are in a perfectly straight line. If you have a dysfunction, then the knees will either be inside or outside the imaginary vertical line joining the two dots. If you take a few steps back and then walk up to the mirror, you will notice that the dots will gyrate all over the place. There will not be a disciplined pattern or sequence in the movement. Proper synchronization is not taking place. If the knees and ankles are aligned properly, then the dots will always appear to be on one vertical plane and move in a disciplined and orderly manner.
Understand internal and external rotation
There are basically two postural conditions in the lower body that cause knee pain. The first condition is the internal rotation of the knee or what in its most pronounced form is popularly known as “knock knees”. The femur (thigh bone) is rotated inwards towards the midline of the body. This happens if the muscles of the pelvic girdle that are responsible for abducting, or moving your legs outwards from the body, are weak. When your job involves sitting for long hours, your hip flexor muscles, or the muscles in the inside of your thighs, become tight, leading to this condition. The imaginary vertical line draw from the dot on the knee will fall inside the ankle and not in the centre of it.
Take care now: Knee problems often manifest later in life if left unattended.
The second condition is called external rotation where the femur is rotated outwards. The pelvis stays pushed back, and can’t move forward properly during walking or running. The imaginary line from the knee will fall outside the ankle.
Look at your knees…a lot!
Try to identify any dysfunction in your knee by referring to the test described above. “Our unique system of bipedal locomotion was designed to be self-diagnosing. Knees either look healthy and functional or they don’t; there is an objective visual standard,” says American posture therapist Pete Egoscue, who works with elite athletes.
Correct the dysfunction
Here are some exercises that can go a long way in correcting the functioning of the knee.
• Lower body clams
Lie on one side of your body and fold your knees to 90 degrees on the same side. Keeping the ankles fixed, push out one leg so that your legs open up like a clam. Keep your thumb on the front of the hip bone and the first three fingers on the gluteal muscle or butt muscles. Open up the legs till the knees point up to the ceiling, then return to the starting position. Complete 15-20 repetitions in a slow, controlled manner. This strengthens the gluteal muscles and helps correct internal rotation of the femur.
• Progressive supine groin
This is an Egoscue exercise, devised by Pete Egoscue, to correct external rotation. Lie on your back with the lower part of one leg resting on a block or chair, knee bent at 90 degrees, while the other leg is extended and elevated on a small stepper, stack of books or something similar, just high enough so that the back and hips are still flat on the floor. Progressively lower the extended foot about 5-8 inches at a time until it rests on the floor. As you lower the leg, relax your back on the floor. Hold this position at each step for a minimum of 3 minutes. Repeat on the opposite side. This exercise is designed to strengthen the proper forward and backward movement of the leg through the muscles of the pelvic girdle. Imagine your knee as a hinge—it is designed to move forwards and backwards, not side to side, and that’s what this exercise helps it to do.
• Forget about the quads
Physiotherapists and doctors overemphasize the role of the quadriceps in the rehabilitation of the knee. As a result, we hardly ever look at the other major players that work with the knee joint—the hip-extensor muscles, or the glutes and hamstrings, which are as important, if not more than the quads in the functioning of the knees. In fact, if you have internal rotation, thanks to weak extensors, then beefed-up quads are going to cause more harm than good. The squat is a great exercise for developing the muscles that work with the knee joint, but only if done properly. Most people do squats in a way that only work the quads. Instead, when you are squatting down, push your butt out first, as if you are going to sit on a chair, and then go down. In the ascending phase of the squat, push through with the heels, hamstrings and glutes, in that order, rather than the quads.
• Avoid preventive knee bracing
Whatever the problem, avoid strapping or bracing the knee with protective support. Bracing any body part restricts its movement and that does more damage in the long run by making the muscles and joints less capable of moving functionally. A knee brace alters the relationship and interaction between the joint and the involved bones. The femur reacts to the brace by completely changing the pattern of motion in the hip joint socket—serious hip and back problems can result. A brace will only make your knees feel stable. In reality, it makes the joint more immobile and ultimately shuts it off.
Is it a gender thing?
There is a growing feeling in the medical community that women are more susceptible to knee problems than men. However, the knee joint is exactly the same for both men and women. Women though have wider hips and this sudden physiological change during puberty is more likely to cause weakened muscles in the pelvic girdle. This leads to postural dysfunction which is carried over into their adult life, causing knee pain, as well as pelvic and lower back pain, but more about that in the next article. Young girls should be taught postural awareness early in their lives to combat femur rotation. Also, women are entering sports without the benefit of the kind of physical conditioning programmes that are readily available to men. Putting a young girl on the tennis or basketball court is all right but she has to also spend time off specific sport-related activity, and do more basic physical conditioning to develop appropriate musculature and functions from head to toe.
Ranadeep Moitra is a certified coach from the National Strength and Conditioning Association of America, and has worked with the Indian cricket team, the Bengal cricket team, and the East Bengal Football Club. He currently coaches the Indian golf team.
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