Knee Health Fundamentals

Knee Health Fundamentals The first step to ending pain

fix-knee-paincom

12312012

Knee Health Fundamentals ndash for updates visit httpwwwfix-knee-paincomknee-health-fundamentals Page 1

Knee Health Fundamentals

This PDF-document will give a brief introduction to the topic of knee health and provide you with a

starting point to improve the condition of your knees We will look at the ten most common causes for

knee pain discover how you can fix them and also go through a few other aspects that are important for

knee health What are cornerstones for knee health Keep reading to find out

Contents Should I go see a doctor 3

First aid for joint injuries the RICE-protocol 3

The 10 most common causes for knee pain 5

Knee Pain Cause 1 A Bad Diet 5

Knee Pain Cause 2 Weak Gluteal Muscles 9

Knee Pain Cause 3 Weak Posterior Chain 10

Knee Pain Cause 4 Low Ankle Mobility 11

Knee Pain Cause 5 Low Hip Mobility 13

Knee Pain Cause 6 No proficiency at single-leg exercises 13

Knee Pain Cause 7 Soft-tissue restrictions 14

Knee Pain Cause 8 Unbalanced movement habits 15

Knee Pain Cause 9 Low movement quality 15

Knee Pain Cause 10 injudicious increase in training loads 16

Other important questions for knee health 17

Is your footwear causing knee pain 17

How good is your posture 18

The go-to-guys for tough cases 19

Conclusion 19

Total Knee Health 19

What is special about Total Knee Health 20


Disclaimer

This document is intended as a reference volume only not as a medical manual The information

provided is designed to help you make informed decisions about your health It is not intended as a

substitute for any treatment that may have been prescribed by your doctor If you suspect that you have

a medical problem I urge you to seek competent medical help

The information in this document is meant to supplement not replace proper exercise training All

forms of exercise pose some inherent risks I advise all readers to take full responsibility for their safety

and know their limits Be sure that you do not take risks beyond your level of experience aptitude

training and fitness The exercise and dietary programs in this book are not intended as a substitute for

any exercise routine or dietary regimen that may have been prescribed by your doctor

As with all exercise and dietary programs you should get your doctorrsquos approval before beginning

Mention of specific companies organizations authorities or people in this book does not imply

endorsement by the author nor does mention of specific companies organizations or authorities imply

that they endorse this document or its author

Some of the links in this document either through images text or audio are in fact affiliate marketing

links and if you purchase products through these links then I get paid a commission The amount of

commission varies from product to product


Should I go see a doctor Not all knee pain is created equal Depending on the circumstances under which you first noticed the

pain you will either have to go to a doctor or could wait and see if the condition improves by itself Some

characteristics of knee pain that will definitely require you to go see a professional

- you cannot bear weight on the limb

- the knee looks deformed or swollen

- the pain is very severe keeping you up at night

- the onset of the pain coincided with a fever

- the pain is not improving and constantly noticeable

- the pain is very sharp

- you cannot fully flex or extend the knee

If you have suffered an acute injury to your knee regardless of whether it was a contact injury (eg

someone bumped into your knee) or a non-contact injury (eg you landed awkwardly from a jump) you

need to have it taken care of by a professional

If you decide to take care of the injury yourself or if professional assistance is not available in the hours

after the injury you should stick to the standard protocol for treating joint injuries the RICE-protocol

First aid for joint injuries the RICE-protocol The established standard for first aid in case of joint injuries is the RICE-protocol I have written in detail

about cryotherapy and the proper application of ice packs before and Irsquod suggest you read through that

as it contains very valuable information that can take weeks off your recovery time (I know that from

personal experience) The following is a short summary of the RICE-protocol to give you an idea Please

see the above mentioned link for the full details and more important information

The main goal of the RICE-protocol is to decrease joint swelling after the injury The degree of swelling

dictates how long the recovery will take as the extra fluid will have to be transported away by the

lymphatic system which can take quite some time Preventing excessive swelling in the first hours after

the injury is of utmost importance for keeping recovery time short

Step 1 Rest

The first step of the RICE-protocol involves resting the injured joint This is of vital importance during the

first 48 hours after the injury as during that time your body scrambles its defense to stop the bleeding at

the injury site Excessive movement will prevent this process delay healing and potentially exacerbate

the injury This is why you should definitely stop your training or competition when an injury occurs

Step 2 Ice


Icing the injured joint is a very important part of the RICE-protocol The lower temperatures decrease

internal bleeding and this reduction of internal bleeding leads to less swelling of the injured joint By

keeping the swelling low and thereby restricting the number of cells in the injured area yoursquore making

sure that there is enough oxygen for all cells Since the cold therapy also reduces cell metabolism the

need for oxygen is decreased even further This is another reason why preventing excessive swelling is so

important by limiting the number of cells at the site it prevents unnecessary cell death that would occur

due to lack of oxygen

In summary the purpose of cold therapy is to slow down the metabolism of the cells decreasing

swelling the need for oxygen and unnecessary cell death Additionally the application of cold packs also

decreases inflammation and pain

This step should never be skipped Use improvised ice packs (bag of frozen vegetables) if you have to

but definitely ice the joint

Step 3 Compression

With step 3 compression we want to further decrease swelling of the injured joint By applying

compressive forces you prevent extra fluid from pooling up in the joint and you thereby cut valuable

weeks off your recovery time as it takes a long time to get rid of excessive swelling

Step 4 Elevation

By keeping the injured joint elevated (ie above heart-level) yoursquore making sure that gravity can assist in

removing unwanted fluid from the injury site This helps with decreasing swelling even further So once

you have applied compression and ice just prop your injured joint up on a table for example

Professional ice packs are superior

Letrsquos face it we never expect an injury to happen Consequently wersquore never prepared to deal with

them the proper way When it comes to applying the RICE-protocol a bag of frozen peas and a wet towel

may be all you have available on the first day of the injury but on day two you should already have

equipped yourself with a professional ice pack This allows you to take perfect care of your injury as

professional ice packs have several big advantages over the good old bag of frozen peas

- ice packs are reusable

- they are more convenient

- they offer compression and cold (with the bag of peas you compromise compression which is a

very big deal)

- they are available in perfectly fitting shapes


That being said the smartest thing to do would be to at least stock up on a few reusable ice packs as

those are cheap and very versatile There are also packs that can be used as both ice and heat packs

The 10 most common causes for knee pain On the following pages we will go through the top 10 causes for knee pain and why they are important for knee health For each point I have provided references and information about what you can do to fix those problems

Knee Pain Cause 1 A Bad Diet Irsquom sure many of you are wondering why I start a list on knee pain causes with information about dietary blunders The reason for this is very simple a proper diet provides the foundation for our health while wrong dietary choices can cause a host of diseases ranging from something as ldquosimplerdquo as tooth decay to serious issues such as diabetes and birth defects in your children Additionally therersquos always the risk of getting to a too high body fat percentage which puts additional stress on all of your joints and provides you with no benefits at all However this is not the place for an elaborate discourse on the reasons for the world-wide disease epidemic (see the literature section at the end for more information) Instead we will focus on two specific dietary aspects that have a very tangible impact on your joint health Sugar One very important factor for knee health and joint health in general is sugar intake Todayrsquos increased sugar consumption causes a myriad of negative reactions in the body leading to health problems such as tooth decay obesity diabetes ADD osteoporosis mineral deficiency allergies and many more To keep things brief we will only look at one pathway through which sugar consumption is bad for your knees increased uric acid production High levels of uric acid have been linked to gout (a type of arthritis) cardiovascular disease and type 2 diabetes (among others) However the exact reasons for elevated levels of uric acid are still being discussed although evidence clearly points towards increased sugar intake as the main culprit Depending on the individual one potential reason for this could be a higher than normal cell-death due to too much dietary fructose through high fructose corn syrup agave nectar or other concentrated sources of fructose (not fruit in general) Another potential cause for increased uric acid levels could be a parasitefungal infection These fungi live off the sugar you eat and produce uric acid If you want to know more about fungal infections I recommend the book ldquoThe Fungus Linkrdquo by Doug Kaufmann Symptoms and risk factors for a parasite infection include

Having ever taken antibiotics

Loose hard or foul smelling bowel movements

A stressful life

Pain in the area above the navel

Itching in the ears nose or rectum area

Cravings for sugar fruit or milk (if not consumed for 3 days)

Having had athletersquos foot jock itch or fungal infection under toe nails


Mood swings

Snacking on sweets drinking soda or energy drinks to keep energy level up

Skin conditions Kaufmann suggests banning sugar from your diet completely and adding a quality probiotic supplement for at least 3 months This will restore the healthy gut bacteria and help fight the fungi A healthy intestinal flora also improves your immune system making you less susceptible to illnesses Moreover those gut bacteria lead to better digestion and better absorption of nutrients They will also help with constipation and other bowel problems Omega-3 and omega-6 fatty acids The other mechanism by which a bad diet can cause knee pain can be traced back to the ratio between omega-3 and omega-6 fatty acids A healthy ratio would be anything around 12 but unfortunately 120 is a lot more common today The result is an increase in inflammatory processes in your whole body which can contribute to conditions such as heart disease asthma arthritis macular degeneration and many others Before the industrial revolution slowly changed everything getting enough omega-3 fatty acids in your diet wasnrsquot a problem For example cattle were still mostly grass-fed and thus high in omega-3 Today conventionally raised cattle are corn-fed and high in omega-6 fatty acids A similar change happened with most other animal-based produce On top of that people consume record amounts of vegetable oils which are actually extremely high in omega-6 fatty acids Just take a look at the following table and compare with the good old butter

Oil Saturated Fatty Acids Polyunsaturated Fatty Acids Omega-6 in mg

Butter 514 3 2728

Canola Oil 65 171 14503

Safflower Oil 62 143 14350

Corn Oil 129 547 53510 () Amounts per 100 g - Source nutritiondataselfcom

The more polyunsatured fatty acids the oil has the less stable it is Oils high in saturated fat on the other hand are very stable and safe for cooking Additionally a high amount of saturated fatty acids protects the less stable fatty acids (mono and polyunsaturated) from oxidation It was only in the last 60 years that saturated fatty acids in our diets were replaced by vegetable fats and while correlation certainly doesnrsquot imply causation itrsquos definitely interesting to think about the explosion of disease and obesity in the decades that followed The omega 6 ratio The omega-6 fatty acids arenrsquot the problem per se however itrsquos the ratio to omega-3 Ideally the ratio between omega-6 and omega-3 should not be higher than 21 To maintain this ratio for every two tablespoons of corn oil you ingest you would have to take one teaspoon of a high quality concentrated


omega-3 fatty acid supplement If you replace corn oil with butter yoursquod have to eat 20-times the amount of fat (ie 300 g or 106 ounces) to get the same amount of omega-6 fatty acids To improve the ratio between omega-6 and omega-3 you should switch to organic grass-finished meat products eat only dairy from organic grass-fed cattle take an omega-3 supplement and lower the intake of omega-6 fatty acids Oils that contain a lot of omega-6 are safflower oil sunflower oil corn oil sesame oil peanut oil pistachio oil pumpkin seed oil and soybean oil (which should be avoided for more than just this reason) Better alternatives are butter lard ghee red palm oil and coconut oil for cooking or extra virgin olive oil hemp seed oil walnut oil and avocado oil for salads A cheap convenient and very effective way to get enough omega-3 fatty acids into your diet would be through a liquid supplement If you donrsquot like the taste of fish oil a product such as Carlson Labs Very Finest Liquid Fish Oil is an excellent choice Take one tablespoon1 of oil with each meal and you will notice a dramatic difference within a month (you can also increase your intake of fresh-caught fish like salmon if you have the money) Here are some of the benefits

- Decreased systemic inflammation (ie lower risk of heart disease asthma arthritis macular degeneration among others)

- Decreases in body fat levels due to increased insulin sensitivity and increased metabolism (may

also prevent Type II diabetes)

- Less muscle soreness after hard workouts and faster recovery

- Lower incidence of tendonitis

As you can see most of the potential benefits stand opposed to the diseases that are rampant in our society and while the low level of omega-3 fatty acids in our diet surely isnrsquot the sole contributing factor it definitely plays a very important role One direct connection to knee pain can be made through the lower risk for developing tendonitis Imagine being able to avert months or even years of pain with one spoon of healthy oil with every meal Why vegetable oils should generally be avoided In her book ldquoDeep Nutritionrdquo Catherine Shanahan MD states that since vegetable oils contain a lot of polyunsatured fatty acids they are extremely likely to ldquoturn into toxic compounds including trans fatrdquo when heated (page 175) She continues with pointing out that because PUFAs (polyunsaturated fatty acids) are so easy to react you cannot even find pharmaceutical grade canola oil with less than 12 trans fat content Shanahan warns ldquothat even bottles of organic expeller-pressed canola oil contain as

1 Dosage recommendations vary Experts such as Charles Poliquin recommend dosages such as one tablespoon

three times per day and thatrsquos also how much I currently take I plan on reducing it to something like 1 teaspoon for breakfast and dinner but 1 tablespoon for lunch


much as five percent trans fats plus cyclic hydrocarbons (carcinogens) and oxyphytosterols (highly damaging to arteries)rdquo You have probably heard about how bad trans fats are and this is one of the very rare cases in which the general and accepted opinion on a subject is relatively close to the truth What the majority doesnrsquot know though is that trans fats are in vegetable oils and the labeling laws allow manufacturers to not mention that The reasons for avoiding vegetable oils extend far beyond their omega-6 fatty acid content Those oils severely interfere with metabolic function and can harm every part of you including your chromosomes which brings us back to the very serious matter of birth defects Itrsquos one thing to compromise my own health with bad habits but ruining the future of my children is something I cannot justify in any way The potential reduction in knee pain is merely a small added bonus in comparison to that If you would like to know more information about nutrition that is based on science as opposed to morals belief or anecdotal evidence I suggest you read through the books I list in the literature section at the end of this document Summary Letrsquos summarize the required dietary steps to provide your body with the foundation for joint health and health in general Step 1 cut vegetable oils

Remove all vegetable oils (except high quality olive oil which is mono-unsaturated and a lot safer) from

your diet completely Start paying attention to food labels and donrsquot consume products that contain

vegetable oils (those products are not healthy anyways) Ask what oil is being used for frying in

restaurants and go to another restaurant if you have to

For cooking at home you should use oils that are high in saturated fats Saturated fats are neither evil

nor unhealthy by the way Since theyrsquore saturated they very stable at high temperatures and as

opposed to vegetable oils donrsquot turn into trans fat when heated My recommendations are butter ghee

red palm oil and coconut oil

Also if yoursquore skeptical about how serious this issue really is you could either pick up the books from the

literature section (which I recommend you do either way) or you could just try a rotation diet Remove

all vegetable oils from your diet for at least a month and observe how your condition changes Then add

them back in (if you still want to) and monitor any changes in how you feel

Step 2 cut sugars especially fructose

ldquoI wouldnrsquot even pour that stuff onto my lawnrdquo ndash A very smart friend of mine about orange juice


Did you know that most juices have more sugar than Cola I couldnrsquot believe it either the first time I

heard it but itrsquos true The only staple drink in our diet has to be water Drinking sugar water (read sodas

juices sweet tea sweetened coffee etc) makes your blood sugar and insulin levels shoot through the

roof The higher your blood sugar and insulin levels the faster you age Then there are all those other

side-effects such as tooth decay yeast infections obesity ADD and diabetes

The truth is we donrsquot need concentrated sources of carbohydrates in our diet and we certainly donrsquot

need significant amounts of sugar let alone fructose There is no daily requirement for sugar Itrsquos not an

essential nutrient It wreaks havoc on your metabolism causes a ton of diseases and will ultimately

make your life miserable at some point Cut sugar intake completely

Whenever you feel weak about this just ask yourself this question

ldquoWhat are my goalsrdquo

Does eating sugary junk get your closer to those goals or not

If you want to go beyond this first step make an effort to reduce carb intake from week to week

Replace source of concentrated carbs (eg bread potatoes cereal and pasta) with vegetables salads

and organic meat fried in healthy oils Ditch the breakfast cereal in favor of two or three poached eggs2

with salad Yoursquoll ingest fewer calories and significantly more nutrients Additionally your blood sugar

wonrsquot go on a rollercoaster ride and you wonrsquot feel tired a few hours later

Letrsquos now leave the wonderful world of food and look at the other causes for knee pain

Knee Pain Cause 2 Weak Gluteal Muscles The gluteals are a very important muscle group when it comes to knee health and general athletic performance The glutes create hip-extension which is a big part of running jumping and other sports movements Additionally they are also responsible for external rotation and abduction The glutes are also relied on for resisting the opposite movements hip flexion internal rotation and adduction For example if your glutes are not strong enough or donrsquot fire properly yoursquore more likely to have an internally rotated and adducted leg (knock-kneed position) when landing from a jump Landing in this position puts more stress on your ACL ultimately placing you at a higher risk for ACL-tears Here is another reason why having strong glutes is important If your glutes are weak they canrsquot properly fulfill their primary function of hip extension As a result the hamstrings another muscle group that contributes to hip extension movements have to work overtime to produce hip extension They will become overworked get tight and are more likely to tear Many people think that because they have

2 If you want to know why dietary cholesterol wonrsquot kill you but actually make you healthier get the books I

suggest at the end


tight hamstrings they should stretch when in fact they should look for the reason why their hamstrings are tight Weak gluteals are one of the potential reasons for tight hamstrings as are tight hip flexors Weak gluteal muscles are a common occurrence today and they put you at an increased risk for injuries such as hamstring tears but you will also be more prone to tearing your ACL and meniscus for example If yoursquore lucky yoursquoll get away with knee tendinopathy instead

Single leg glute bridge and two-legged glute bridge

Can you perform a simple one-legged glute bridge without your hip sagging down significantly If you canrsquot you know what you need to be working on A few excellent exercises to retrain your gluteals can be found here httpwwwfix-knee-paincomknee-strengthening-exercises

Knee Pain Cause 3 Weak Posterior Chain ldquoPosterior chainrdquo is a term used for a number of muscles on the back side of your body The posterior chain includes your glutes your hamstrings your erector spinae and some other muscles They play an important role in all athletic movements If your posterior chain isnrsquot strong you wonrsquot run very fast or jump very high Yoursquore also more likely to get injured should you try One major factor why many of us have a weak posterior chain is because we sit a lot Sitting lengthens your hamstrings and glutes while the hip flexors are put in a shortened state Your nervous system remembers the shortened state of your hip flexors and you end up with ldquoshortrdquo hip flexors Once this has happened your hamstrings and glutes will slowly become inhibited and weaker (search for ldquoreciprocal inhibitionrdquo if you want to know more on the reasons)


You need to train your posterior chain by performing exercises that load your calves hamstrings gluteals and back muscles in a safe manner The exercises linked under ldquocause 3rdquo will get you started in that area Additionally you should check whether your hip flexors are tight or not and maybe do some stretches to fix that

This hip flexor stretch stretches the

rectus femoris and the iliopsoas Additional exercises include deadlifts glute-ham-raises and good mornings Good technique is vital for the safe execution of those exercises so make sure you perform the movements correctly The cheapest way to check your technique is by recording yourself and checking the video You could also have someone knowledgeable watch you (ie a smart friend or a coach)

Knee Pain Cause 4 Low Ankle Mobility If you lack mobility at the ankle the body will make up for that by increasing mobility at the neighboring joint the knee This is where proper footwear becomes important If you keep wearing shoes with heels your ankle mobility will not improve as the heel elevation will restrict your range of motion at the ankle Ditch the shoes in favor of a nice pair of flat-soled shoes like the Merrell Tough Glove and yoursquoll be well on your way to improving ankle mobility A lot of good information on improving ankle mobility can be found in this post by Eric Cressey He also demonstrates additional drills that put less shear stress on the knee Highly recommended


You can also work ankle and hip mobility at the same time


Knee Pain Cause 5 Low Hip Mobility The hip and ankle dictate what is going on at the knee If your hip lacks mobility you will have problems with maintaining good movement quality as your body makes up for that lost mobility by increasing mobility at the knee (and maybe the lower back which could lead to back pain) In cause 2 we already talked about the functions of the gluteals (create hip extension abduction and external rotation) If the muscles around your hip are tight your glutes will have to work overtime For example tight adductors will make producing abduction and external rotation harder In that situation your leg is also more likely to end up internally rotated and adducted when yoursquore landing from a jump This is the predominant at-risk position for ACL-tears and other serious knee injuries To improve hip mobility you could perform leg swings (front to back and side to side) lunges (squeeze your glutes) and maybe a psoas stretch The latter will also help with the training of the posterior chain since tight hip flexors inhibit the gluteal muscles The knee strengthening exercises previously mentioned will also work on flexibility of your adductors

Knee Pain Cause 6 No proficiency at single-leg exercises Try this balance on one leg and then close your eyes If you managed to stay balanced for longer than 30 seconds without flailing a lot you did well Ideally we should be able to maintain one-legged balance with our eyes closed for minutes as this would dramatically improve our body awareness for all one-legged exercises In the vast majority of sports we rely heavily on one-legged stances and even walking requires us to lift one leg off the ground The higher the movement quality we display in one-legged movements the less undue strain we put on our joints The knee strengthening exercises I mentioned before will give get you started

The King Deadlift a very advanced single-leg exercise


If you perform single-leg exercises with just your bodyweight you can train them more frequently (depending on how adapted your joints and tendons are to such training demands) which will translate to a higher movement quality on the athletic field

Knee Pain Cause 7 Soft-tissue restrictions Soft-tissue restrictions can be adhesions between muscles or with other fascia This restricts joint range of motion and thereby prevents you from attaining high movement quality Additionally those restrictions slow you down and decrease your athletic performance (like trying to race a car with the handbrake on) To take care of soft-tissue quality yourself you can use a foam roller such as the RumbleRoller which I prefer or you can use self-instrument massage via a simple stick for example Irsquove been using the RumbleRoller for over a year and am very satisfied with it Here is a list of foam-rolling exercises for knee pain and instructions about what to pay attention to

Foam rolling your quadriceps can help with knee pain


Knee Pain Cause 8 Unbalanced movement habits Have you ever seen a cat stretch and warm up for 10 minutes before running after a mouse What about a gazelle that gets chased by a cheetah The cheetah goes from 0 to 60 mph (ca 100 kmh) in about 3 seconds so therersquos not a lot of time to warm up it seems The reason why animals have to neither warm up nor stretch is because they move all day in a wide variety of ways Their bodies are primed for world class performance during all of their waking hours Everything else would equal extinction sooner rather than later We humans on the other hand have gotten into the habit of sitting most of the time and the few times we do move we do so in very repetitive patterns Take jogging for example Most people jog on a completely flat surface therersquos not a lot of variety there No obstacles you have climb over no small openings you have to crouch or even crawl through just the same motion over and over3 Our bodies adapt to this monotony and whenever we are challenged with anything outside of this small convenient spectrum we struggle Our goal should be to balance our movements For every vertical push you do you should add some vertical pulling into your program The same goes for horizontal pressing and pulling but also for upright walking and locomotion in other stances Think crouched walking crawling on your stomach walking on all fours with your back or your stomach to the ground etc This variety will expose weaknesses prepare you for the unlikely eventualities of your sport (or daily life) and make you more injury-proof Itrsquos also a simple and effective workout

Knee Pain Cause 9 Low movement quality The 9th cause for knee pain is low movement quality This could be knees that are collapsing inward when yoursquore landing from a jump or the inability to absorb force efficiently (ie making a lot noise when landing) Since good posture is the foundation for good movement quality you would also have to look for asymmetries between sides (eg is one foot more turned out then the other Is one shoulder higher than the other) as well as other postural misalignments Taking care of your soft-tissue restrictions (see cause 7) will help you improve your posture but just because you have good posture doesnrsquot mean you also have good movement quality You need to pay attention to how you move how yoursquore aligned when yoursquore moving how well yoursquore absorbing force and how graceful it feels (and looks) This is where you can tie knee pain cause 8 and 9 together You practice movement in a variety of ways and always pay attention to maintaining high movement quality At some point the quality movements you have been practicing will become automatic and thereby carry-over into your sport and daily life This happens sooner than you think

3 This lack of variety is made up for by increasing running time in hopes of becoming ldquofitrdquo The body adapts to this

stimulus by removing all unneeded muscle mass which in the case of jogging is almost all muscle mass Do you want to look like a marathoner or like a sprinter If you want to look like sprinter then train like a sprinter


Knee Pain Cause 10 injudicious increase in training loads The last knee pain cause we want to look at is an injudicious increase in training loads or in other words doing too much too soon Different parts of your body take a different time to adapt to training The first part to adapt is your central nervous system followed by your cardio-vascular system and your muscles Ligaments and tendons take a lot more time to adapt to training and changes in bone density happen only after that You need to give your body time to adapt (ie time off from training) and the necessary nutrients to do so This is where taking care of your diet and adding fish oil as well as a probiotic supplement really comes in handy You will recover a lot faster which means you can train more often and thus make faster progress your immune system will get stronger and you might even lose more body fat You have to listen to your body though as injudicious increases in your training can still get you hurt Aim for a maximum increase of 10 per week For example keeping your sets reps and tempo constant you could increase the weight by 10 Or keeping the weight and tempo constant you could increase the total reps by 10

Overuse as a cause for knee pain is commonly overlooked The interesting thing about overuse is that since the recovery ability of everyone is different the threshold at which athletes enter overuse is very individual as well As Steve Maxwell pointed out at the Nature Training Seminar in Austria 2011 the recovery ability is set at a cellular level and while you can improve recovery with certain techniques some people just recover faster than others What this means is that following someone elsersquos program will likely not yield the best results (especially if that someone is a star athlete) It also shows that just because one person can train with high intensity 4-times per week others might not be able to As a matter of fact they might even injure themselves Pain as a delayed indicator

(Pain and tendon tissue damage in patellar tendonitis tendinopathy ndash source BMJ Publishing)

The chart above illustrates how ldquodeceivingrdquo pain can be in that tissue damage starts long before we feel pain Pain is the big red warning sign that tells us something is seriously wrong but unfortunately many athletes are too ambitious to change their training They are chasing records whatever the cost


Continued overuse will lead to injury at some point which depending on the severity of the injury can mean several months of no training at all If you are particularly unlucky you might end up with a career-ending injury Personally Irsquom not a star athlete and no additional staff is monitoring my health That being the case I have to keep track of my health myself and most of the time I pay attention to every small bit of pain I notice Sometimes I can track problems back to a flawed technique sometimes I just overdid it a little and should have skipped the last set The point is if you keep track of your health and investigate any changes early and thoroughly your training will be much more efficient in the long run No nagging injuries and no time-off from training due to pain This is as true for knee pain as it is for pain in any other body part

Other important questions for knee health

Is your footwear causing knee pain Irsquom sure many people will hate me for this but it has to be done like ripping off a Band-Aid So here goes most of todayrsquos shoes will negatively impact your movement quality and thereby set you up for injury and pain For example the higher the heel of the shoe you wear the more ankle range of motion you lose The more ankle range of motion you lose the more the body has to make up for that lost range of motion by increasing range of motion at the knee This puts excessive stress on the knee and will sooner or later lead to knee pain Since your central nervous system is saving all movement information it gets it will also remember the shortened state your calves are in when walking in heels As a result you will end up with short calf muscles if you wear shoes with elevated heels (of any elevation) on a regular basis This adaptation doesnrsquot magically go away when you take your shoes off The ldquoshortrdquo calves will still be there and for biomechanical reasons they will make it harder to fully extend your knees Since you now have to extend your knees against additional resistance your knee extensors (eg quadriceps) have to work extra hard to completely straighten your knee This leads to lower performance on the athletic field on one hand and tissue overload of the knee extensors on the other (eg knee tendinopathy) The rabbit hole goes way deeper than heels though The common sneaker is just as bad if not worse than high heels There are at least two mechanisms by which the common sneaker will ruin not only your knees but also the rest of your body The first of these is because of the ldquoprotectiverdquo cushioning most shoes provide The second mechanism can be traced back to the elevation of the heel Letrsquos look at the cushioning first The proclaimed goal of the cushioning is to absorb shocks and thereby spare your joints While a nice idea in theory it just doesnrsquot work in the real world A material that absorbs shocks well does not bounce back into its original shape quickly Think of sand at the beach or even just a normal lawn Both absorb shocks very well and


allow for joint-friendly movement Now take your regular sneaker Its sole bounces back into the original state within fractions of a second The energy isnrsquot dissipated but briefly stored and then released again The sneaker does absorb something though It absorbs vital information about the shape texture elasticity and friction of the ground It also decreases point pressure on our feet by increasing the contact area with the ground The result is devastating to the body We are more likely to slip and fall because we canrsquot sense anything about the nature of the ground in the moment we put the foot down Only once we apply force do we know whether the ground is slippery or not Because the force we exert on the ground is distributed over a higher area we can now run with our heels striking the ground first This is facilitated through the usually elevated heel The higher the heel of the shoe the harder it is not to heel strike Running with the heel-striking technique will forego our natural shock-absorption (our calves) in favor of sending the energy directly upstream into our knees and the rest of our body This faulty running technique can cause a variety of symptoms ranging from knee pain lower back pain to neck pain and headaches among others The second mechanism by which the common sneaker will set you up for injury can be traced back to the combination of the elevated heel and the lack of information about the nature of the ground yoursquore walking on Walking in thin-soled shoes or barefoot you can tell every stone that is under your foot The moment your foot just touches the ground you get input about whatrsquos going on down there You will instinctively adapt your movement to protect yourself from injury before applying force to the ground Put your foot into a thick-soled sneaker and your nervous system doesnrsquot know what is going on under your foot until you put a lot of force on the ground Should you step on a stone (or another object like a tree branch the curb or the foot of your opponent in sports) with only half of your foot you will know about it once yoursquove sprained your ankle The delay of information makes it impossible for your body to react to your environment in a timely manner This situation gets exacerbated by the leverage forces the thick sole causes when your foot doesnrsquot touch the ground the way it should Try the following experiment Carefully try rolling an ankle while yoursquore barefoot Donrsquot actually sprain your ankle though just feel how easy or hard it is Now put on your favorite sneaker and repeat the experiment You will notice that the leverage forces on the ankle increase dramatically because of the thick sole and elevated heel For more information on running mechanics and why I recommend flat-soled shoes like the Merrell Tough Glove click here Proprioception shock-absorbing shoes faulty running mechanics and knee pain

How good is your posture Your central nervous system is the puppeteer pulling on the strings that control your muscles As wersquove discussed earlier the body adapts to what you do in a variety of ways At birth we all start out with a clean slate so to speak but with time our CNS gets used to a certain way of pulling the strings


Depending on your daily movement habits your CNS will learn which muscle lengths are used most often and which ones are rarely used After years of moving a certain way these movement patterns have been burned in and since the CNS wants to protect you from injury it prevents you from extending your muscles beyond a certain length This makes perfect sense because your motor control in those rarely used ranges of motion isnrsquot very good which is why getting injured is a lot more likely Unfortunately this adaptation has the negative side-effect that it prevents us from easily attaining high movement quality when we have a lifestyle of sitting 90 of our waking hours The more time you spend doing something the better you get at it and as a culture we have spent a whole lot of time practicing sitting The price we pay for this specialization varies from person to person Some people can sit all day run marathons on the weekend and still be fine Otherrsquos get knee pain just walking up and down stairs The only way to fix these problems is by improving our daily movement habits and thereby improving our posture Everything else is just treating symptoms and will not improve your condition in the long run If you want to read more about posture and how it relates to knee pain check out these two articles Basic postural problems at the hip anterior pelvic tilt and Basic postural problems internal rotation of the femur

The go-to-guys for tough cases I would be remiss if I didnrsquot point you towards my page one Go-to-Coaches On this page you can find a

number of health care professionals that will look beyond the obvious and will help you address the root

cause of your pain

Conclusion

A few minutes of proper exercise will go a long way in preventing knee pain and if you also improve your

nutrition yoursquoll achieve even greater results Ultimately only a holistic approach can really ensure long-

term knee health as the knee is rarely the culprit in times of knee pain Itrsquos only where your dysfunction

ended up causing pain

Yoursquore now equipped with enough knowledge to start your journey towards

regaining your knee health By going through all the referenced resources

and books you can make sure that your progress towards that goal is fast

and sustainable If you want the complete package without having to read

hundreds of articles and books you might want to check out my book Total

Knee Health

Total Knee Health The PDF-file you have in front of you will introduce you to the basics of the

10 pillars of knee health Making those 10 pillars as strong as possible is the


minimum requirement for healthy knees but if yoursquore going for total knee health you need to pay

attention to many other factors

In Total Knee Health you will learn about all factors that have an impact on knee health and thanks to

the detailed advice you will know exactly what to do to improve them

What is special about Total Knee Health Total Knee Health goes beyond conventional pain treatment by investigating all factors that influence

knee health The standard approach is to deal with symptoms (ie knee pain) but if you only remove

the symptoms the problem will reappear eventually Instead we will dig up the root cause of the

problem and fix it thereby solving knee pain for the last time


PS If you liked ldquoKnee Health Fundamentalsrdquo please share it with your friends so they can benefit from the information as well

Thank you


Knee Health Fundamentals

This PDF-document will give a brief introduction to the topic of knee health and provide you with a

starting point to improve the condition of your knees We will look at the ten most common causes for

knee pain discover how you can fix them and also go through a few other aspects that are important for

knee health What are cornerstones for knee health Keep reading to find out

Contents Should I go see a doctor 3

First aid for joint injuries the RICE-protocol 3

The 10 most common causes for knee pain 5

Knee Pain Cause 1 A Bad Diet 5

Knee Pain Cause 2 Weak Gluteal Muscles 9

Knee Pain Cause 3 Weak Posterior Chain 10

Knee Pain Cause 4 Low Ankle Mobility 11

Knee Pain Cause 5 Low Hip Mobility 13

Knee Pain Cause 6 No proficiency at single-leg exercises 13

Knee Pain Cause 7 Soft-tissue restrictions 14

Knee Pain Cause 8 Unbalanced movement habits 15

Knee Pain Cause 9 Low movement quality 15

Knee Pain Cause 10 injudicious increase in training loads 16

Other important questions for knee health 17

Is your footwear causing knee pain 17

How good is your posture 18

The go-to-guys for tough cases 19

Conclusion 19

Total Knee Health 19

What is special about Total Knee Health 20


Disclaimer










































Step 1 Rest





Step 2 Ice














Step 3 Compression




Step 4 Elevation













very big deal)









A stressful life






Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you


Disclaimer










































Step 1 Rest





Step 2 Ice














Step 3 Compression




Step 4 Elevation













very big deal)









A stressful life






Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you


























Step 1 Rest





Step 2 Ice














Step 3 Compression




Step 4 Elevation













very big deal)









A stressful life






Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you














Step 3 Compression




Step 4 Elevation













very big deal)









A stressful life






Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you








A stressful life






Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you


Mood swings




Butter 514 3 2728

Canola Oil 65 171 14503



















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you
















































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you






































suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you






















suggest at the end










































cause of your pain

Conclusion










Knee Health














Thank you










































cause of your pain

Conclusion










Knee Health














Thank you





































cause of your pain

Conclusion










Knee Health














Thank you
































cause of your pain

Conclusion










Knee Health














Thank you






























cause of your pain

Conclusion










Knee Health














Thank you


























cause of your pain

Conclusion










Knee Health














Thank you






















cause of your pain

Conclusion










Knee Health














Thank you

















cause of your pain

Conclusion










Knee Health














Thank you












cause of your pain

Conclusion










Knee Health














Thank you








cause of your pain

Conclusion










Knee Health














Thank you





cause of your pain

Conclusion










Knee Health














Thank you












Thank you



Thank you

Documents

Knee Health Fundamentals