Over the past several months we have all faced a multitude of change and transitions in the ways we navigate our lives. These transitions can be hard, but they also present a unique opportunity for growth and development. With the return of snow many of us are getting back into our favorite winter activities or taking up new ones in the outdoors as we look for ways to stay active in this pandemic. At the clinic, we’ve being seeing a number of people who are realizing they haven’t addressed some nagging injuries from the summer months and are experiencing pain or discomfort as they jump into a new activity.
While many of us will just push through the pain or modify our activity, the team at Ascent Health & Sport Therapy wants to help get you moving well (pain-free and stronger) so you can enjoy the amazing outdoor playground in our backyard over the winter months that lay ahead!
Let’s focus on three of the most common knee injuries we saw developing over the summer in hikers, bikers and mountain adventures alike and give you a few rehab tips to get those knees dialed in and prepared for a winter on the skis.
3 COMMON KNEE INJURIES WE SEE IN THE CLINIC
Patella Tendonitis or “Jumper’s Knee”
Often described as pain above and/or below the knee cap. ‘Tendonitis’ means inflammation of the tendon and thus this condition often presents with swelling/redness and irritation of the patellar tendon. This is often from overuse or poor mechanics of the knee and leg with repetitive movement (i.e. hiking or biking).
To treat this, we want to reduce what is aggravating the knee (i.e. improve your mechanics), we also want to load this tendon to help develop strong and robust tendon tissue. Here Dr. Zach demonstrates a couple of our go-to rehab exercises:
- SLOW HEAVY SQUAT WITH HEELS ELEVATED
1. Stand with your heels elevated on a ledge ~2-4” off the ground. We use a firm foam cushion, but you can use a large textbook, rolled up yoga mat or a couple barbell plates under each heel at home.
2. Make sure your toes are on the floor and your feet are shoulder width apart.
3. Slowly over 3-5seconds squat down as far as you can, pushing your hips back behind you and ensuring your knees travel forwards over your toes.
4. Your body will lean forwards with your back straight to counterbalance the movement.
5. Briefly pause at the bottom before steadily return to the upright position
- SLOW SPLIT SQUAT
1. Stand with your back to the step and place your good leg onto the step.
2. Hold a weight in each hand or a kettlebell to your chest as demonstrated
3. Make sure there is a large distance created between your front foot and your back foot.
4. Bend your knee, dropping your hips straight down towards the ground in a slow and controlled manner (3-5seconds)
5. Briefly pause at the bottom before straightening back up.
6. Make sure your front knee doesn’t go in front of your front toe and that your hips come straight down.
- SPANISH SQUAT
1. Start by taking a big heavy band attached to a squat rack (table leg or bannister at home should work fine) and wrapping the band behind both knees
2. Take a couple steps back so there is good tension through the band and its pulling both knees forward
3. Begin your squat by first pushing your hips back then bending at the knees
4. Squat down until both thighs reach parallel to the ground.
5. Briefly pause at the bottom before ascending to the start position
IT Band Syndrome
This condition typically presents as pain on the lateral portion (aka outside) of the knee near the attachment point of the IT band. While often mistakenly thought to be caused from an overly tight IT band (note: your IT band SHOULD be tight) the culprit is typically a weakness in the glute and hip muscles which leads to the knees collapsing inwards and subsequently overloading the lateral portions of your knees and irritating the IT band.
The key to overcoming this is developing strength, stability and endurance of the gluteal muscles. A couple of our go-to exercises to help this development are:
- WALL BANGER
1. Start fairly close to the wall with your affected hip directed to the wall, feet 6-8” apart, arms out in front of you.
2. Push your hips back and bend the knees to lower yourself into a partial squat (1/4 to ½ depth of a full squat)
3. From here begin to rotate your hips toward the wall, while your arms twist away from the wall. Perform this in a slow and controlled manner (i.e. don’t let your hips collapse into the wall).
4. Gently touch the wall with your hip before returning to the start position.
5. If easy, take a small step away from the wall and repeat until you find a range which is comfortable yet challenging to perform the remaining repetitions.
- STAR EXCURSION SQUAT
1. Stand up straight on your affected leg.
2. Place targets around you on the floor at 8 different points like a star or use tape on the floor as shown in the video.
3. Balance on your affected leg while trying to slowly touch your elevated foot to each target.
4. Ensure you keep good control in your stance leg with your knee travelling directly forwards over your toes, rather than inwards.
- RNT LUNGE
1. Start by taking a band attached to a squat rack (table leg or bannister at home should work fine) and wrap the band around the outside of your affected knee
2. The band should be pulling your knee inwards.
3. Assume a lunge position with your affected knee in front, making sure there is a large distance between your front and back foot.
4. Bend your knee, dropping your hips straight down towards the ground in a slow and controlled fashion.
5. Actively press into the band to prevent your knee from collapsing inwards
6. Briefly pause at the bottom of the lunge before straightening back up
7. Make sure your front knee doesn’t go in front of your front toe and that your hips come straight down.
Patella Femoral Pain Syndrome (PFPS)
Sometimes referred to as “Runner’s Knee” this condition is often described as pain in front of the knee or around the knee cap. Similar to issues related to the IT Band, there is strong evidence that strengthening around the hips, pelvis and spine improve biomechanical issues that lead to this condition.
An emphasis on developing control at the ankle and hips helps in both the prevention and treatment of PFPS. Here are some of our go-to rehab exercises:
- SINGLE LEG RDL/ HIP AIRPLANES
1. Start by standing with your knees slightly bent, holding a medium-sized kettlebell in the same hand as the affected leg.
2. Hinge forward at the waist and fully extend the opposite leg to the rear, lowering the kettlebell towards your shin.
3. Keep your back straight and do not allow your body to rotate.
4. Contract your gluteus and hamstrings and return to a standing position.
- SMALL FOOT MUSCLE ACTIVATION
1. Start shoe-less seated in a chair
2. Actively raise your big toe off the floor while keeping your other 4 toes down
3. Then plant your big toe and attempt to raise your other 4 toes off the ground, attempt to spread your 4 toes before returning them to the floor
4. Repeat several times. For an extra challenge, after raising your 4 toes attempt tolower them down to the floor individually.
5. Once seated is easy attempt to perform the same exercise standing.
6. Attempt to contract the muscles of your toes and arch to raise your arch without curling your toes or lifting the ball of your foot off the floor. This movement should “shorten” your foot.
Have a nagging injury you are looking for help with or maybe just curious and want to learn more? Book an appointment with one of our therapists today!