(C) 2016 by Exercise ETC Inc. All rights reserved. 1
The Knee: Top Trends in Training 2016
Knee Anatomy & Mechanics
• Bones
– Femur, Tibia,
Fibula, Patella
• Ligaments
– ACL, PCL, LCL,
MCL
• Meniscus
Series Elastic Components
• Quadriceps
• Quad tendon
• Patella tendon
• IT band
• Gluteus medius/ maximus
• Hamstrings
• Gastrocnemius
Range of Motion
• Functional– 0° to 120 ° flexion
• Active/Passive– 0° to 135° flexion
– 10° hyperextension is common
Bulletproofing Your Knees
• Stretch Quadriceps & IT Bands
• Do Mobility Drills for Ankles and Hips
• Strengthen Glutes, Quads and Hamstrings
• Learn to Squat, Lunge, Jump, and Run Efficiently
Band Assisted Quad & IT Band Stretches
(C) 2016 by Exercise ETC Inc. All rights reserved. 2
Stretch & Strengthen the Quads Joint-by-Joint Approach
• Poor Hip and/or Ankle Mobility increases the mobility demands on the knee
Ankle Range of Motion
• 10-30° of dorsi-flexion w/ knee extended
• Assessment– Stand with foot 6” from
Wall
– Without lifting heal attempt to touch the wall with the knee
Hip Range of Motion
• Hip Flexion
• Hip Extension
• Hip External Rotation– In Flexion
– In Extension
• Hip Internal Rotation– In Flexion
– In Extension
Improving Dorsi-flexion
• Self-Myofascial or Active Release Stretching
– Plantar Fascia
– Gastroc/Soleus
• Tools– Racket Ball
– Tennis Ball
– Golf Ball
Ankle Mobility w/ Superband
(C) 2016 by Exercise ETC Inc. All rights reserved. 3
Strengthen Dorsi-Flexion Hamstring SMFR
Dynamic Hip Flexor | Glute Stretch
Multi-planar Hip Strengthening
• Weak Hip Abductors & External Rotators common in knee pain
• Use multi-vector and loading to optimize strength of the hip muscles
Cook Hip Lift w/ JC Band Barbell Hip Thrust
• Arguably the best direct “glute” strengthening exercise
(C) 2016 by Exercise ETC Inc. All rights reserved. 4
Crab Walk with Elastic Ring
• Perform 1st as a side-step walk laterally
• Progress to linear walking
• Maintain foot, knee and hip alignment
• Contra-lateral resistance encourages free limb/hip to maintain alignment
• ROM restricted by hip extension on free hip
Single Leg Reach / RDL
Hamstring Strengthening
• Incorporate both open and closed chain exercises
• Strengthen hamstring at knee & hip
Swiss Ball Leg Curl:Mimics actions that occur during gait
Band Assisted Sliding Leg Curls Single Leg Eccentric Leg Curls
(C) 2016 by Exercise ETC Inc. All rights reserved. 5
Prone Hamstring Curls
Nordic Hamstring Curl
• Begin with Negatives
• Try Single Leg Variations
• Use Bands for Assistance
• Use DBs, Bands, Weight Vest for Resistance
• Glute-Hamstring Bench
Functional Exercises for Strong Knees
• Squats
• Lunges
• Step-Ups
• Jump Training
Squat for Strong Knees
• A body weight Squat below “parallel” is a great example of balanced strength & flexibility at the knee
• Depth for strength training and mobility are different
But, Aren’t Squats BAD for Knees?
• Collateral and Cruciate Ligament Strain During Deep Squat in Weightlifters vs. Controls (Klein, 1961 vs. Meyers, 1971)
• Knee stress similar between 70°, 90°, and 110°of knee flexion (Salem and Powers, 2001)
• Patellar ligament strength is ~13-19x BW in healthy knee (Eijden et al 1987)
(C) 2016 by Exercise ETC Inc. All rights reserved. 6
ACL Strain During Squats
• ACL is compromised when the hamstrings are allowed slack during knee flexion
– Too much lumbar flexion
– Increasing depth
• ACL is under more stress when stopping at 70° vs. 110°
Other Concerns Regarding Deep Squats
• Meniscus Injury of Greater Concern w/ Increased Depth
• Advise body-weight squat with increasing depth for flexibility & mobility
• Parallel squat under load
Controversies in Squatting:Knees Past Your Toes?
Correcting Knee Position
• Use RNT - Reactive Neuromuscular Training Techniques
• Draw the person into the undesirable position to allow the body to auto-correct
Additional Tips for Squatting
• Descend slowly
– Quick, forceful contraction of quads during descent can stress patellar tendon
• Glute Activation Drills before Squats
• Hamstring Curls before Squats
The Goblet Squat
• Can be performed with one dumbbell held under the chin
• Allows for more erect torso while learning the basic movement
(C) 2016 by Exercise ETC Inc. All rights reserved. 7
Sit to Box – Box Squat Bulgarian Split Squat - RFESS
Step Down – Facing Step
• Descend under control
• Avoid using the non-working limb to push-off
• Start with a 6-8 inch step height
• Avoid progressing to a high step too soon– Generates high P-F
compression forces
Forward vs. Reverse Lunge
• Emphasis on the Glute
• Spine MUST remain neutral throughout
• Loads the front leg more effectively and prevents back-leg loading
• Front knee does not cross ball of the foot
Walking Lunge
• Back-Loaded Barbell, low bar position on traps
• Long stride with slight knee flexion on back leg, stretching the psoas & rectus femoris– Increases pre-stretch
opposite hamstring/glute
Lateral Lunging
(C) 2016 by Exercise ETC Inc. All rights reserved. 8
Dynamic Variable Resistance Exercise
• Sandbag Lunge
• KB Lunge
• Barbell Hanging Band Lunges
The Clock Lunge*Make it reactive!
Jumps & Landing Mechanics
• Implicated in most forms of knee pain and injury
• Teach client to land on ball of foot with chest directly above and back extended
• Immediately upon ground contact… “sit back” and drop to the heels
• Client should squat slightly to absorb the Ground Reaction Forces
Jump Training Basics
• Requires Coordination– Sustain posture
– Immediately flex knees after ground contact
• Dynamic Muscle Control– Eccentric strength
• Flexibility
• Conditioning– Role of fatigue
Assessing Explosiveness & Stability
1. Single Hop for Distance
2. 6M Timed Hop
3. Triple Hop for Distance
4. Cross-Over Hop for Distance
Hops, Jumps, and Agilities
• Double and Single Leg– Forward– Backward– Lateral– Multi-planar
• Standing Jumps
• Agility Ladder Drills
(C) 2016 by Exercise ETC Inc. All rights reserved. 9
Training Change of Direction
• Forward to Backward
• Side-to-Side
• Forward-to-Side R/L
• Jump to Run– w/ Directional Change
Multi-directional Resisted Agility Training
Learn to Run Efficiently
• Run Efficiently– Use Gravity
• Neutral Spine
– Land on the mid-foot• Front of the heal
– 90-96 strides per min
– Use the hamstrings • Pick up your foot