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When looking at the knee from an injury perspective, we really cannot stop at the knee itself. We need to consider what is happening above and below and how it can influence the functioning of the knee. Therefore, we will introduce the concept of the Knee Complex, which will include the knee, the hip and the ankle.

The Knee Joint:

• It is a hinge joint that mostly bends and straightens (flexion//extension), and it also has some rotation.
  

• It is made of the femur, the tibia, and the patella articulating together.
  

• It is not a very stable joint meaning that the bony surfaces do not fit together in a very stable way like your hip for example. It relies on a lot of ligaments and 2 meniscus for its PASSIVE stability.
  

• Most muscles acting on the knee joint are primary movers and mostly act to control flexion and extension. They cannot control rotation or side to side motion. .

  • Quadriceps: extension

  • Hamstrings: flexion

• DYNAMIC stability in rotation and side to side is achieved by the ankle below and the hip above.
  

• To function well, the knee needs to be stable.

• It is a ball and socket joint and is extremely stable unlike the knee.
  

• It is made of the femur and acetabulum (part of the pelvis).
  

• It can move in all planes and because of its direct relationship to the knee, its position will affect the knee.
  

• Many muscles control this joint including the glutes, the adductors, the piriformis and other rotators, and your hip flexors.

• It is a hinge joint and is made of the tibia, the fibula and the talus.
  

• The bones fit well together and it is therefore fairly stable.
  

• It mostly moves in flexion//extension but also possesses a bit of sidebending and rotation.
  

• It is very well integrated with the rest of the foot which will provide much more side bending capabilities.

Knee Flexion or Quadriceps Flexibility

1. It is the ability to bend you knee backward toward your glutes.

2. One of its main limiters is the quadriceps muscle and especially the rectus femurs which is also a hip flexor.

3. When your quadriceps is lacking flexibility, it tends to introduce undue tension on the patella as it attaches to it.

The Hamstrings

1. They are a powerful group of muscles located in the back of the thigh. They generate a lot of power used to run, especially when you run fast or uphill.

2. It has been observed that they tend to be tighter in people suffering from anterior knee pain and improving their flexibility may be useful.

Ankle Dorsiflexion

1. It is the ability to move your knee over your toes when your foot is in the ground.

2. This motion is important especially in the middle of the gait cycle when your foot is on the ground.

3. When not enough motion is available, the ankle is not able to function well as a shock absorber which usually means that more stress is placed on the knee. It can also cause your foot to collapse inward which can impair knee tracking.

Hip Extension

1. It is the ability to bring your thigh back while maintaining a neutral spine. We only possess 10 to 15 degrees if but it is necessary for running.

2. The most common limiters to hip extension are your hip flexors (iliopsoas, rectus femoris, TFL).

3. Our current lifestyle tends to include too much sitting which may cause hip flexor weakness and tightness.

4. When we are limited in our hip extension, it tends to throw off the hip joint mechanics, which impairs our ability to control our knee joint while running.

Hip Rotation

1. The hip is able to rotate inward (internal rotation) or outward (external rotation).

2. A certain amount is required during the gait cycle and more is often necessary to perfect strengthening activities to improve running or when going up steep hills (power hiking).

3. Not having enough of those motions will affect to move your hip and therefore control the stability of your knee.

When looking at someone’s gait for indicators as to why they may suffer from knee pain, we need to consider the 4 main factors that have the most impact on the loads applied to your knee joint.

Step rate which is how many steps you take over 1 minute.

• The lower it is, the greater the breaking force you have to generate. This increases the load on your knee.

Heel to center of mass distance at initial which is a measure of how far ahead of you land when running.

• The greater it is, the greater the braking forces you have to generate which increases knee loading.

Foot inclination angle at initial contact (heel strike angle).

• Greater than 10 degrees is linked to greater energy absorbed by the knee.

Vertical displacement of the center of mass or how much you bounce when running.

• The greater the bounce, the more load on the knee (and the rest of the body).

MOBILITY ASSESSMENTS
In this section, we will use movement assessments to help you better understand your movement capabilities.
Equipment needed: Partner, floor space, phone with inclinometer app, chair or box, dowel.

In this section, we will focus on strategies to improve your overall knee health through light exercises to improve the mobility of your knees, hips and ankles based on how you tested.

The techniques we will use to improve your mobility are:

Self-Myofascial Release - 30-90 sec in each
This is a self-massage technique using a foam roller or ball to compress a specific area. This compression can provide temporary relaxation of the muscles, restore sliding and gliding capabilities of the connective tissue, and improve overall mobility of a given area. This is best performed pre-activity for 30-45 sec in each region or post-activity for 60-90 sec in each region

Long Hold Stretching - 45-90 sec hold
This is a technique used to lengthen muscle groups, provide improved joint positioning, and restore healthy balance to the relationship between muscles in a given area. This is best for a recovery session or following sport/gym activity.

Dynamic Stretching - 10-15 reps
This style of stretching is best for pre-activity and is to be performed in controlled brisk reps.