(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

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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

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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

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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

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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)

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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

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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

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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

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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