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By Charles Staley, B.Sc,
MSS
Director, Staley Training Systems
(Co-authored by Dr. Sal Arria)
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Knee problems of varying descriptions
are as common as five pound plates in gyms and health clubs
throughout the world. Anyone who has recently experienced
knee surgery will attest to their awareness of this fact,
as they quickly begin to notice legions of zipper-like knee
scars among their gymgoing peers.
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The prevalence of these cases can
be attributed largely to the fact that the knee is an anatomical
vortex of sorts, where the body's largest and strongest muscle groups
converge upon the tiny, yet in most cases hardy, kneecap. Add to
this a lack of basic anatomical knowledge, improper exercise technique
and/or selection, and unsuitable workout gear, and the prescription
for disaster becomes compounded exponentially.
In this discussion we will examine
several factors which collectively, have the potential of determining
your predisposition for experiencing knee symptoms. Much of this
information has received minimal exposure from industry magazines
and trade journals in the past, and therefore should be of considerable
interest to current and prospective fitness professionals and health
care specialists.
Knee Anatomy and Biomechanics
Keeping your knees healthy and asymptomatic
begins with developing a functional understanding of how this unique
joint is constructed (anatomy) and how it does and doesn't function
(biomechanics). The knee is relatively simple to understand from
a mechanical perspective, but please refer to the appropriate illustrations
as you read this section— doing so will enhance your comprehension
of the discussion.
The knee is an unarthroidal (meaning
movement in one direction only) hingetype joint, roughly equivalent
to a door hinge for practical purposes. Five different types of
structures are involved in the knee's functional anatomy— bones,
ligaments, tendons, muscles, and articular cartilage. Here then,
is a brief definition of these structures:
Bone: Purposeful human movement
would not be possible without bones. The four bony structures which
are involved in knee function are the femur, or thigh bone, the
tibea and fibula (the shin bones), and of course, the patella, or
kneecap.
Ligaments: Fibrous and very
tough connective tissue which connects bone to bone, providing stability
and integrity to the joint. Two sets of ligaments help to stabilize
the knee joint— the anterior and posterior cruxiates, which
are deeply located within the knee, and serve to limit rotation
and hyper-extension, and the co-laterals, one on either side of
the knee. The co-laterals protect the knee from being moved from
side to side, and help to establish the integrity of the joint by
keeping the tibea and femur attached to one another.
Tendons: Fibrous bands that
that connect muscles to their bony attachments. In the knee, the
patellar tendon connects the quadriceps muscles to the patella,
and then in turn to the upper shin.
Muscle: We all have a clear idea as to what muscles are, but let's
examine the ones that cross (via their tendinous attachments) the
knee joint. First are the quadriceps, the powerful muscles of the
anterior (front) thigh. Next are the hamstrings, or the leg biceps,
located on the posterior thigh. Finally, the gastrocnemious, the
most superficial calf muscle, crosses behind the knee joint, where
it contributes as a knee flexor.
Articular Cartilage: You've
heard of "torn cartilage" in knee injuries before. cartilage
is the connective tissue which provides for a smooth articulation
between bones at the joint. Cartilage also acts as a shock absorber.
The meniscus is the knee's only cartilage. Located on the tibeal
plateau, it cradles the femoral condyle, or the rounded knobs of
the lower femur. Since the tibeal plateau is flat, and the femoral
condyle is rounded, the meniscus provides a better "fit"
between these two structures.
Training Gear For Healthy Knees
For most, training attire is primarily
a matter of vanity— looking good while you're training. But
two pieces of standard training gear— your shoes and knee wraps—
should be carefully selected and applied, not only to maximize comfort
and short term safety, but more importantly, to ensure the long
term health of your knees.
Your shoes are literally where the
rubber hits the road. We urge you to think of your shoes as the
foundation of your leg training sessions. Wearing old or broken
down fitness shoes for heavy squatting or leg pressing is like putting
old, worn-out tires on a race car! There are several reasons to
avoid training in your "tennies:"
First, most general purpose fitness
shoes simply lack adequate stability, and have little or no arch
support for heavy lifting. As you squat, your feet may develop a
tendency to pronate, or "cave in" toward the inner side.
When this happens, the knees
are also forced inward, leading to a constant strain on the medial
collateral ligament, excessive shear force on the meniscus, and
improper patellar tracking, which in turn can lead to chondromalacia
(to be discussed shortly).
If your feet tend to pronate anyway,
or if you're prone to being "knock knee'd" (and these
two conditions are very often associated with one another), it becomes
even more important to select good training shoes. Another important
reason for using specialized shoes for squatting or other heavy
leg training movements is that they provide a deep and solid heel
cup, which prevents the foot from rocking and rolling laterally
(to the outside) when it is compressed under heavy loads.
Finally, there is a difference between
a shoe being worn out and being broken down. Even if your shoes
look fine, they still may offer no arch or heel support at all,
either because they never had any to start with, or because after
a handful of heavy leg sessions, the supports have compressed to
the point to where they no longer function as they were intended.
Think about it— a tennis shoe is meant to support a 160 pound
tennis player, NOT a 600 pound leg press! Loads like these cause
the shoe to break down without visual signs of wearing out.
We strongly recommend that you choose
a heavy-duty training shoe (please see corresponding list of companies
that offer these shoes) that you use for training, and training
only. Use a stable running shoe or cross trainer for everything
else.
Knee wraps have long been a mainstay
for competitive powerlifters, and for good reason. When properly
used, wraps can dramatically improve knee safety during heavy squatting
and leg training sessions. Whenever you contract your quadriceps
muscles, the patellar ligament "wants" to pull away from
it's attachment at the upper front aspect of the tibea. During squatting,
for example, the heavier you go, the lower you go, and the faster
you descend, the more this tendency is compounded. Please refer
to the sidebar below on proper knee wrapping.
You'll notice that the wrap is tightly
wound in a cylindrical fashion around the upper shin (where the
patellar ligament attaches), then more loosely wound over the kneecap
itself (this is important to avoid grinding the patella into the
femoral condyle, creating a case of chondromalacia for yourself),
then tightly wound over the lower third of the thigh. The rationale
for wrapping the knees prior to heavy squatting is that it reduced
the pulling forces on the patellar ligament at it's attachment to
the shin. This translates to significantly reduced chances of avulsing
(detaching) your patellar ligament during heavy leg movements.
According to Dr. Paul Ward, knee wraps
also provide several other benefits beyond
protection of the attachment site of the patellar ligament. These
benefits include keeping the knees warm, which improves blood flow
and tissue elasticity, reducing the possibility of muscle tears
during high-intensity leg pressing or squatting. Additionally, knee
wraps assist the patella in tracking normally over the femoral condyle,
reducing the possibility of developing chondromalacia.
“...make
sure that your knees are tracking directly over your feet...”
Stance Variables Affecting Knee
Health
Whenever you squat, hack squat, or
leg press, your foot position is an important variable in determining
not only the results you'll obtain from the exercise, but also the
safety of your knee joints. Although each individual must determine
their own best stance exercise per exercise (based on their own
anatomical peculiarities such as height and leg length), the following
variables must be taken into consideration:
1) The quadriceps muscles can contract
more efficiently when the feet are pointing slightly (about 25 to
30 degrees) outward as opposed to straight ahead. If you squat with
a very wide stance, your adductors tend to assist the quads. This
can result in stress to the medial collateral ligament, abnormal
cartilage loading, and improper patellar tracking.
2) During the decent phase of any
type of squat, do not allow the knees to move more than 2-3 inches
forward of their locked position. The further your knees travel
over your feet, the greater the shearing forces on the patellar
tendon and ligament. To avoid this, descend into the squat as if
you were sitting back and down into a chair. Don't worry if you
lean forward a bit as long as you maintain a tight and arched back,
and keep your bodyweight over the center of your feet. The ultimate
objective is to keep the shins as vertical as possible throughout
the entire movement.
3) In any leg training movement, make
sure that your knees are tracking directly over your feet, not to
the inside or outside. Many lifters turn their knees inward during
the concentric phase of a heavy squat, and they usually aren't aware
of it. Give your clients immediate feedback, since after all, they
shouldn't be looking at their feet during the lift! If a client
turns the knees inward, insist that they back off on weight until
more correct movement patterns are mastered. Consider videotaping
the squat session to provide unquestionable evidence when needed.
4) During the concentric portion of
squatting or leg pressing of any kind, instruct your clients to
"push from the heels." This not only enforces a vertical
plane of the shins, but also allows the quads to contract with maximum
efficiency. Balance will improve as well, which adds an extra margin
of safety.
5) Although many top bodybuilders
advocate a very close stance for the purpose of "isolating
the quads," when squatting, remember the inherent tradeoffs
in all ergogenic (work-enhancing) techniques. In this case, any
leg training technique that isolates the quads also intensifies
the shearing forces to the patellar tendon and ligament. A lucky
few have knees that can take this type of punishment, but for most
of us, a slightly wider stance, with toes pointing slightly outward
and shins vertical, is a much safer and still very effective alternative.
6) Finally, teach your clients to
be efficient in the exit out of the rack, and getting "set"
in the squat stance. After lifting the weight off of the pins, the
lifter should take just one step backward as immediately assume
the squatting stance. This takes time to master, but eventually
all the minute adjustments can be pared down substantially. Once
set in the stance, cue your clients to keep their feet "nailed
down" for the duration of the set. Many people "fidget"
with their feet and toes between reps which can cause a variety
of problems ranging from a break in concentration to a loss of balance.
How to Use the Knee Wraps
Knee wraps are only effective if used
properly. So, if you've never used them before, take a moment to
read this:
Sit on a chair or bench. Begin with
the wrap completely rolled up (this makes the process much easier
than fighting with a six foot tangle of cloth). With your leg straight,
start applying the wrap on the upper portion of your shin. Wrapping
from "in" to "out," (counterclockwise for the
left leg, clockwise for the right), anchor the wrap by applying
2-3 layers on the upper shin, then move upward, overlapping each
previous layer by one-half the width of the wrap. When wrapping
around the patella, make sure the wrap is a bit loose to avoid excessive
pressure on the kneecap. Apply the wrap tightly again as you move
past the knee, stopping somewhere on the lower third of the thigh.
Tuck the end of the wrap under the previous layer to secure it.
Repeat for the other leg.
Common Problems of the Knee
Chondromalacia: Degenerative
changes (roughening) of the underside of the kneecap. Causes pain
when rising out of a chair or when climbing stairs. Think about
getting a grain of sand under your eyelid— the synovial fluid
acts the same way! Tight quads are responsible for 80% of chondromalacia.
Other causes include repetitive overuse, genu valgum ("knock-knees"),
and a shallow lateral femoral condyle.
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Patellofemoral Pain Syndrome
(PFPS): Exemplified by pain in front of patella, which
intensifies during activity. Also, pain during extended
sitting, and/or walking up stairs. PFPS is further characterized
by crepitus (noise), without instability. PFPS is considered
to be a tracking problem of the patella, caused by an imbalance
between the medial and lateral quadriceps. The damage to
the underside of the patella is not unlike uneven tread
wear in a car that needs the tires rotated.
Unstable Knee Joint:
Knee suddenly gives out. This is often caused by old injuries
which have overstretched the knee ligaments.
Locked Knee: The usual
cause of locked knees is a torn meniscus or a loose body
within the joint capsule.
Swelling/Tightness: Nearly
always indicates an internal injury. See physician immediately.
Crepitus: Noisy knees
are no reason for concern, UNLESS accompanied by pain and/or
swelling.
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About The Author
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His colleagues call him an iconoclast,
a visionary, a rule-breaker. His clients call him “The
Secret Weapon” for his ability to see what other coaches
miss. Charles calls himself a “geek” who struggled
in Phys Ed throughout school. Whatever you call him, Charles’
methods are ahead of their time and quickly produce serious
results. His counter-intuitive approach and self-effacing
demeanor have lead to appearances on NBC’s The TODAY
Show and The CBS Early Show.
Currently, Charles competes
in Olympic-style weightlifting on the master’s circuit,
with a 3-year goal of qualifying for the 2009 Master’s
World Championships.
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