Fixing Your Knees

Recently, I posted the exact program I used with a female college hockey player this season to help restore functional ability and minimize pain related to chondromalacia and patellofemoral syndrome.  If you missed it, go check it out here: The Knee Pain Program

I wouldn’t consider myself a knee expert, far from it actually.  But I would consider Mike Robertson a knee expert, and I’ve learned a lot from studying his work.

Quick Side Note: Mike and Eric Cressey put out, in my opinion, the best product in strength and conditioning to date: Building the Efficient Athlete.  It’s the only product in the industry that really addresses functional anatomy, which is crucial to understanding both performance and reasons for injury.  I highly recommend it to anyone that is serious about taking their performance (or that of their athletes) to the next level.

One of the major things I’ve picked up from him is to look at the hip for clues as to why the knee hurts.  This year I noticed a common theme in my female hockey players: Most of them had noticeably internally rotated femurs while standing.  You can tell this by having someone stand in front of you without shoes on and look at the direction their knees point from the front and back.

For those of you that aren’t functional anatomy geeks (yet!), the patella (or knee cap) sits between two bumps on the bottom of the femur called condyles.  To help you picture this, curl the knuckles of your pointer and middle finger on your right hand and then spread those fingers apart.  This is indicative of your femoral condyles (on your right leg).  Now place your pointer finger of your left hand between the groove, acting as your patella.  Now rotate your right hand inward, without changing the location of your left finger.  What you’ll find is that your left finger will pull out of that groove slightly.

This is exactly what happens when someone has an internally rotated femur.  Basically this means that anytime the athlete bends their knee, the patella won’t be tracking in the groove, but rubbing up against that lateral (or outside) femoral condyle.  You can imagine why this friction may create problems and lead to knee pain!

You can begin to address this by both stretching the internal rotators of the hip (mostly the adductors/muscles of the inner thigh), but the best thing to do is strengthen the hell out of your hip external rotators.  Referring back to the program, I address this with “isolation” and activation exercises: Side Lying Hip Abduction/External Rotation Holds, Close Stance Glute Bridge Hold w/ MiniBand and Lateral MiniBand Walk; and then lead into more functional movement patterns: Split Squat Iso-Hold w/ Toe Pull, 3-Way Squat Circuit; and Reverse Lunge.  The idea is to activate/excite the muscle, then integrate it into normal movement.  After all, being really strong on your back or side won’t help at all if you aren’t strong on your feet (or skates).

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