So many people today complain about knee pain – the good news though is that most of the time you don’t need surgery, orthotics or tons of glucosamine. You may have knee pain for a number of reasons but by far the most common is due to poor alignment. Poor alignment is often due to muscle imbalances which can occur anywhere in the kinetic chain (foot, knee, hip and or core).
Before I get too carried away – it is very important to get any injury checked out by a professional – this article is not designed to diagnose your injury but educate you and show you some simple methods you can use to help eliminate your knee pain caused by faulty alignment.
The knee is a very complex joint – it is best described as a hinge joint, but it is slightly different to other hinge joints in the body due the patella (kneecap), which acts as a pulley. Let’s briefly look at the anatomy of the knee: there are 3 main bones that make up the knee joint – the femur, the tibia and the patella. Lots of muscles attach to the knee – the main one’s we will focus on are the Quadriceps and Hamstrings. Four muscles make up the Quads – Vastus Medialis, Vastus Lateralis, Vastus Intermedius and Rectus Femoris. Three muscles make up the Hamstrings – Semitendinosus, Semimembranosus and Biceps Femoris. Four ligaments also add support to the knee and they are – the medial collateral ligament, the lateral collateral ligament, the anterior cruciate ligament and posterior cruciate ligament. It is also really important to mention the Illiotibial band which runs down the outside of the leg from the glutes (butt) to your knee attaching on the patella.
Hopefully your still with me – so if there is no structural damage to you knee (torn ligaments etc) and you experience knee pain chances are it is cause by faulty posture/ poor alignment of the knee. The centre of your knee cap should sit directly over your second toe (the one next to your big toe). If it does not then you have faulty alignment. Don’t stress it is not the end of the world! I am not a gambling man but i bet it’s sitting over or inside you big toe??!! Here comes the good stuff – now let’s look at the kinetic chain – is your foot, hips, core or all three causing the knee pain?
We can go into more depth and run through some tests but I have found that usually there is weakness in all three; the core, foot and hip – so let’s get straight into what you can do to reduce your knee pain.
Where to start? The best place to start addressing knee pain is the Illiotibial band (ITB), this is usually very tight – you can stretch it but it is quite difficult to stretch because it is mostly connective tissue (it’s like trying to stretch a leather belt) using a foam roller is a far more effective than stretching. It is normally really painful at first but the more you use the foam roller the easier it gets. Foam Rolling should always be done before a run / workout.
VMO (Vastus Medialis) is usually quite weak in people with knee pain, the VMO is the major stabiliser of the knee – I have found the best exercise to strengthen it is VMO Squats. It is important to note that the VMO really only works in the last 15⁰ of extension (straightening your leg) so this exercise is not a full range squat – but upper partial range to predominantly train VMO.
Glute Med (Gluteus Medius) is the major stabiliser of the pelvis. A weak glute med means the pelvis and femur become unstable – your femur will rotate inwards. There are many Jane Fonda style exercises that can strengthen your Glute med but I like to use a tube walk as activation before moving into proper Squats.
Now we come to the core – you can do VMO Squats and Tube walks until the cows come home – but if you fail to address core function you are wasting your time. If you have a weak core – you cannot stabilise your pelvis or low back. This can create an anterior pelvic tilt (APT) (if your pelvis was a bucket of water, water would pour out the front). 99 times out of 100 an APT is coupled with weak glutes (meds & maxs), weak hamstrings (although they may feel tight) short tight quads, ITB’s and pronated feet. If you don’t strengthen your core you are only masking the symptoms of your knee pain and it will return.
In summary don’t just look at the sight of pain as the cause – you need to look at the bigger picture and understand that the body is a series of systems and you should never every look at one part in isolation.