Knee pain is one of the most common problems that an athlete can encounter when
competing in any sport. There are multiple different types of knee pain such as:
1. To the patellar tendon (also known as Jumper’s Knee)
2. Generalized knee pain, known as Patellofemoral Pain Syndrome (PFPS)
3. An ACL or meniscus tear, which can cause you to cut your season short. The majority of ACL
The majority of ACL injuries are non-contact injuries, which means that they most likely occurred while
cutting or making a sharp turn. The good news is that these injuries, including
The good news is that the probability of these injuries can be reduced with the 4 steps that I have outlined below.
1. Improve Quadriceps Mobility
The quadriceps (quads) muscle are the group of muscles to the anterior (front) of the thigh. Our quads usually have some source of tightness, which can result in general knee pain as well as pain to the patellar tendon.
The tightness of the muscle pulls on the patellar tendon and causing uncomfortable forces on the knee and excessive pulling forces on the tendon.
Getting that mobility back in those quads is the goal, especially after an intense squat or leg day. The best way to improve your mobility is gentle foam rolling for 1-2 minutes starting closest to the knee and working your way up to the top of the thigh. The next best thing to do is the couch stretch. Do two sets this for 1 minute on each leg.
2. Improve Ankle Dorsiflexion Mobility
One area that is commonly limited, but not thought of as a factor in knee pain, is our ankle.
When we squat our knees will move forward, but if our ankles run out of flexibility, our knees will be unable to continue
forward causing them to move inward or outward to compensate. Most often the knee will go
towards the midline, and the arch will collapse placing abnormal stresses at the knee and
increasing the chance of ACL tear.
A simple stretch to use is a runner’s stretch which should be
completed for 2-3 sets of 1 minute daily to both the gastroc (back leg straight) and soleus (back knee slightly bent).
3. Increasing Hip Strength and Knee Stability
One of the primary causes of knee pain is lack of hip (glute) strength and coordination.
The glutes are the main controller of the femur in regards to rotation and more specifically external
rotation. Because the femur makes up half of the knee joint, the glutes are one of the most
important muscle groups in regards to stabilizing the knee. If the glutes are not
activating correctly during the sport, the knee will likely rotate inwards and cave in. We call this a valgus
knee, where there are both compressive & tension (stretch) forces on the knee joint and unusual stresses to the patellar tendon. This rotation is also the most common position seen in an ACL injury. By strengthening and learning how to use your glutes, you will protect and prevent excessive stress to the knee.
Here are a few exercises to start out with to increase your hip strength and knee stability. Consider doing 3 sets of 15-20 reps to improve your mind and muscle connection (neuromuscular control) for 1-2 weeks followed by 4sets of 6-10 reps with increased resistance to improve strength.
a) Lateral Banded Monster Walk
- Place band slightly above knee
- Always keep knees lined up over your toes throughout entire movement
- Get into a ¼-½ squat and stay in this position until exercise is done
- Take 10-15 steps in one direction and repeat in opposite direction
b) Single Leg Step Down
- This movement should be slow and controlled
- Most important is to keep the knee lined up over the toes and your hips level
- Hinge your butt back to start the movement
- Gently tap the heel down and return to the starting position
- Can add weight once becomes easier
c) Banded Squat
- Place the band directly above the knees
- As you squat down push your knees out against the band
- Continue to maintain this position throughout the entire squat
- You can also add this to squatting with a barbell to increase resistance
d) Glute Bridges/Hip Thruster
- As they become easier, advance to the hip thruster You can use a barbell, dumbbell, bands, or chains ● Keep
- You can use a barbell, dumbbell, bands, or chains Keep
- Keep you knees lined up over your toes, squeeze the glutes and press up until you form a straight line with your body
- Hold for 2-3 seconds at the top of the movement
4. Jumping and Landing Mechanics
Although hip strength and stability is important, it is worthless if you cannot incorporate it into a functional activity like jumping which is required for your sport. The key is to have a variety of both single and double leg hops, as well as training with jumping in different planes of motion including forward, backward, and to the side.
Sports are unpredictable and you need to be adaptable to whatever the sport requires on that day. With jump and landing training it is important that are practicing with good mechanics. The two most important rules are, keep the knees lined up over the toes and hinge at the hips to absorb impact. This will not only prevent major injury when landing such as an ACL tear, but it will also shift the forces to the hips instead of the knees. This will prevent overuse injury, as well as help, improve power output by using the larger hip muscles. It is important to include some aspect of jump/landing training at least 3x/week for 10 min and as long as you follow these two rules, then your training will improve your performance and decrease the chance of injury.
- Keep the knees lined up over the toes
- Hinge the butt back as you land to absorb the force of the land in the larger hip musculature instead of the knee.
Jordan Cardoza PT, DPT, CSCS
http://basicmvmtpt.wixsite.com/basicmvmtpt IG: Basicmvmtpt