Disclaimer:
The information contained in this ebook ‘The fast
road to no knee pain: the quick recovery guide’ is
for general guidance only. All information provided
“as is” with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use
of this information, and without warranty of any
kind, express or implied, including, but not limited to
warranties of performance, health and fitness for a
particular purpose.
Before taking on any exercise or treatment it is recommended that you seek professional diagnosis
and consultation from a physiotherapist or medical
practitioner. If you feel any pain or discomfort or if
your pain increases after exercise cease activity immediately. The information in this guide is not meant
to replace a professional opinion and treatment
strategy.
In no event will Physio INQ, be liable for any decision
made or action taken in reliance on information in
this guide or for an consequential, special or similar
damages, even if advised of the possibility of such
damages.
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The fast road to
no knee Pain:
The quick recovery guide
How the knee
works
Femur
(Thighbone)
Anterior
Cruciate
Ligament
(under Patellar
Tendon)
Patella
(Kneecap)
Articular
Cartilage
Qadriceps
Tendon
Meniscus
Lateral
Collateral
Ligament
Patellar
Tendon
Lateral
Collateral
Ligament
Fibula
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Tibia
(Shinbone)
physioINQ
Anterior
Cruciate
Ligament
(under Patellar
Tendon)
3
The knee is the largest joint in the body and is made
up of three main parts:
- The lower end of the thigh bone (femur)
- The upper end of the shin bone (tibia)
- The kneecap (patella)
The knee joint is at the ends of the femur and the
tibia and is protected by the patella. The ends of
the femur and tibia and the back of the patella are
covered in articular cartilage, which acts as a cushion to keep the femur, patella and tibia from grinding against each other.
On top of the tibia, extra pads of cartilage called
menisci help absorb the body’s weight. Each knee
has two menisci, the inside (medial) meniscus and
the outside (lateral) meniscus.
The muscles around the knee include the quadriceps, a large muscle at the front of the thigh, and
the hamstring, located at the back of the thigh. The
quadriceps help straighten the leg and the hamstring helps bend the knee.
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Knee pain
4
Knee pain is extremely common, as the knee joint is
vulnerable to damage and pain because it takes
the full weight of your body when you run or jump.
There are many causes of knee pain so it is important to make an accurate diagnosis to ensure an
appropriate treatment can be directed at the
cause.
Causes:
Patella femoral pain
The medical term for pain felt behind your kneecap
where your patella (kneecap) articulates with your
thigh bone (femur). Common causes of this pain include overuse of the knee, foot problems such as
flat feet, injury to the knee and reduced muscle
strength in the leg resulting in a reduced ability to
absorb stresses on the knee. This type of pain typically comes and goes and may be worse when
going up or down stairs or with certain sports. You
may also experience a grating or grinding feel in
when the knee moves and some swelling or fullness
around the kneecap.
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Arthritis
There are three different types of arthritis that can
occur in your knees. Osteoarthritis, a progressive disease that slowly wears away joint cartilage. Rheumatoid, an inflammatory disease that can strike at
any age. Post-traumatic which develops after an
injury to the knee, it can occur years after a torn
meniscus, injury to ligament or fracture of the knee.
Arthritis pain can begin suddenly, but it is more likely
to develop slowing. If your knees hurt when you
climb stairs, stand up from a sitting position or kneel
you may have arthritis. Other symptoms can be
swelling or tenderness, buckling or locking, or feeling a grinding sensation in your knees as you move.
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Meniscus Tear
Meniscus is a piece of cartilage in your knee that
cushions and stabilises the joint. It protects the
bones from wear and tear. Meniscus tears are
common in both contact and non contact sports
as all it takes is a good twist or hyper flex of the knee
joint to tear the meniscus. Symptoms include pain in
the knee, swelling, a popping sensation during the
injury, difficulty bending and straightening the leg
and a tendency for your knee to get stuck or
locked up.
Lateral
meniscus
Meniscus
front view
Tear
Front view
Medial
meniscus
Top view
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Patella Tendonitis
Is an injury that affects the tendon connecting your
kneecap (patella) to your shinbone. This tendon
plays a pivotal role in the way you use your leg muscles. It helps your muscles extend your knee so you
can kick a ball, run uphill, jump in the air.
Tissue damage and inflammation of the patellar
tendon causes pain in the front of the knee.
Most commonly occurs due to repetitive or prolonged activities like squatting, jumping and repetitive running that place strain on the patellar
tendon.
Patellar
Tendon
Pain
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ITB Syndrome
Iliotibial friction syndrome is one of the most
common causes of “runner’s knee” and can account for up to 22% of overuse injuries in runners.
Being an overuse injury it is caused by repeated
trauma rather than a specific incident. The ITB is a
long, thin band of fascia that runs down the outside
of your thigh.The most common symptoms include
sharp or burning pain just above the outer part of
the knee, pain that worsens with continuance of
running or other repetitive activities, swelling over
the outside of the knee, pain during early knee
bending.
Iliac crest
Gluteus
medius
Tensor
fascia latae
Gluteus
maximus
Vastus
lateralis
Iliotibial
band
Patella
Tibia tubercle
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Wear and tear
The knee is the second most likely joint to suffer wear
and tear. In healthy joints cartilage acts as a shock
absorber, providing a smooth surface between
bones that’s 20 times more slippery than ice. However with wear and tear, cartilage starts to disintegrate leaving the ends of the bones exposed. The
bones then grind against each other causing pain.
Genetics, nutrition and illness all have a role to play
in how long our cartilage lasts. But, also how you use
your joints is vital.
Bone-onBone Pain
No Pain
Smooth,
Healthy
Cartilage
Damaged
Cartilage
Reduced
Joint Space
Good
Joint Space
All of these are individual problems, but we see
overwhelming similar causes in our clinic.
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Biomechanical Errors
Our bodies are meant to fire in correct sequence,
like a car. One piston goes, then another does. If it
fires out of sequence, then things can get ugly. This
is what happens to our bodies in the modern era.
Presumably due to our changing habits; sitting,
working etc.
Our hips and knees are SUPPOSED to fire in the following sequence to make us move:
• CORE stabilises
• Glutes rotate, stabilise hips and keep
alignment
• Glutes initiate propulsion
• Quads and hamstrings work together
to push through the movement.
BUT this order is most commonly reversed! Most
people nowadays don’t even turn on their glutes
when they do any form of movement through the
hips! It is all hammies!!! This leads to disastrous results.
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What happens is as follows:
•
•
•
•
•
•
The hip flexors get tight.
The hamstrings get tighter
The knees internally rotate
The VMO weakens
Structures get microtrauma
The knees hurt!
But there is a way to improve this!
Follow these steps:
•
Correct your footwear!
Appropriate footwear can help relieve knee pain
by lessening stress on the knees and increasing stability. Keep the following in mind when you’re assessing your footwear.
Are they well cushioned? - This will help absorb
shock especially from the impact of walking on
hard surfaces such as concrete footpaths.
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Check the sole. - Firm midsoles help reduce
overpronation, which causes the lower leg and
knee to rotate inward each time the foot hits the
ground.
Consider whether athletic shoes - Footwear designed for fitness often has motion control and
stability features to control inward rotation of the
foot, lower leg and knee.
Steer clear of high heels - High heels are not
conducive to knee health as they place on the
kneecap to lead to significant knee trauma and
Add inserts - These can help ease pain by
adding cushioning and holding the foot in position, reducing inward rotation.
•
Reduce inflammation by RICE
Rest, Ice, Compression, Elevation is one of the
most important first treatments for many injuries.
Rest - Stop using the injured part as soon as you
realise that an injury has taken place and rest it
for about 48 hours.
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Ice - Use a bag of ice or cold pack on your knee
four to eight times per fay for 20 minutes each
time. Ice should never be placed directly on
your skin so use a towel to avoid freezing the
skin.
Compression - In an effort to reduce the swelling, use a compression bandage or elastic
wrap. It should never be painful to have a bandage on the knee, if this occurs your bandage
is too tight.
Elevation - elevate your leg on a pillow above
the level of your heart.
•
Get a diagnosis
One of the most common reasons for continuing
knee pain is that sufferers don’t consult a physiotherapist and receive a diagnosis and an individually - tailored course of exercise.
Save time and contact Physion INQ for an
appointment.
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•
Glute Medius Work
Clams
Watch this video to learn how to perform a clam.
Link:
https://www.youtube.com/watch?v=QaIeWwXf
_XI&list=UU-d
• Lay down on your side, bend knees, make sure
your hips are stable (you can place your hand on
your hip or place your back against a wall)
• Keep your heels together and open up the knee
1
Variation 1: Separate the feet
2
Variation 2: Add a weight (2-5kgs)
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Bridges
Watch this video to learn how to perform a bridge.
Link:
https://www.youtube.com/watch?v=GT42rQB66MU&index
=2&list=UU-dOd5HouEv8DKNNATsGcVg
Basic Bridge:
• Lay down with your back on the floor, knees up,
raise your feet and push down through your heel.
• Squeeze your glutes and slowly raise your buttocks up into a bridge position, hold and slowly
lower.
1
Variation 1: One leg bridge - raise one foot
off the ground.
2
Variation 2: Elevated bridge - place feet
on a box.
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ITB Roll outs
Watch this video to learn how to roll out your thigh.
Link:
https://www.youtube.com/watch?v=icSQhXgr2K8
Using a foam roller, massage the ITB by rolling up
and down your thigh.
There may be areas that are tender, hold in this position for 90secs - 5 minutes.
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Core Work- Plank
Watch this video to learn how to perform a plank.
Link:
https://www.youtube.com/watch?v=GBFejdw3TGU
• Lay down on your stomach and prop up on your
elbows, engage your pelvic floor muscles.
• Lift up your torso and pelvis so that your body
makes a horizontal line. Your only contact with the
floor should be with your elbows and knees/toes
• Actively tuck your chin in and lengthen your
spine at your upper back.
• It is normal to feel uncomfortable in this exercise
but there should be no pain.
• Hold for as long as you can maintaining the correct form as you continue to breathe normally.
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1
Variation 1: Extend one leg
2
Variation 2: Extend one leg and one arm
!
TIP: If you start to feel lower back pain it’s
an indication that you are losing form and
your abominable muscles are getting tired,
stop immediately.
Hamstring Roll Outs
Watch this video to learn how to roll out your
hamstring.
Link:
https://www.youtube.com/watch?v=BoVqPnem4Do
Instructions:
• Place the foam roller on the floor. Sit so the foam
roller is underneath your knee. Extend your legs out
straight and cross one leg over the other to add
weight.
• Roll back and forth until your hamstrings feel
loose. Repeat for the other leg.
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VMO exercises
VMO is short for “Vastus Medialis Oblique” which is
the most important quad muscle, responsible for
knee stability.
1. SITTING ISOMETRIC CONTRACTIONS
(Toes facing slightly out)
-Sit down on a flat surface with your legs straight
in front of you.
-Place a towel underneath the back of your
knee.
-Flex your quad muscle with your toes pointing
forward.
-Hold the contraction for 10 seconds. Place your
fingers on your VMO to ensure that your quad
muscle is tight and firing.
-Do about 10 reps of 10 seconds. Increase the
length of the contraction as your VMO becomes
stronger.
-Isometric Contractions for the Knee.
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2. SEATED ISOMETRIC VMO AND
ADDUCTION CONTRACTIONS
-Sit on a chair, preferably one high enough to let
your feet hang.
-Place a swiss ball between your thighs.
-Tighten your VMO’s by squeezing the medicine
ball as you tighten your quad muscles.
-Hold the contraction for 10 seconds. Place your
fingers on your VMO’s to ensure that your quad
muscles is are contracting. Increase the hold as
your VMO’s become stronger.
3. FOAM ROLLER LEG EXTENSIONS
-Sit on the ground with your legs straight in front
of you
-Place the foam roller beneath your knees
-Extend your knee by flexing your quad muscle
(do one knee at a time).
-Hold the contraction for 10 seconds for each
repetition. Do 10 sets of 10 with 10 second holds.
Increase your holds as your VMO becomes
stronger.
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4. PLIE KNEE SQUATS
-Stand with your legs shoulder with apart with
your toes pointing out as far as possible.
-Squat 1/4 of the way down.
-Come up slowly focusing on isolating your
VMO’s to bring you back to standing position.
-Do 3 sets of 10 and increase as you knees get
stronger
5. BALL SQUATS
-Place a swiss ball between a wall and your
lower back.
-Slowly squat down to a seated position so that
your thighs are parallel with the ground.
-Slowly squat back up ( Never, never lock your
knees).
-Do 3 sets of 10.
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6. SPLIT SQUATS (STATIONARY LUNGE)
-Start with your legs shoulder width apart and
take one large step forward. Have your hands at
your side or on your hips.
-Focus on placing your body-weight at the front
of quad muscle along with your heel holding
most of your weight.
-Squat down focusing on contracting your VMO
while lowering and raising your body with an upright position. Stand next to a wall or railing to
keep your balance if it is an issue (Lower down
to the point your back knee touches the ground
and raise to the point just before locking your
knee).
-Do 3 sets of 10. Increase the number of reps and
use dumbbells as your knees become stronger.
7. SINGLE 1/4 LEG SQUATS
If you’re in the early stages of knee therapy
(1-3months), I’d recommend not to do this unless
you’re confident in the strength of your knees.
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-Stand with your legs shoulder width apart.
-Raise one leg in front of you while slowly squatting with your heel holding your body weight.
You should squat a little lower than parallel with
the ground.
-Slowly squat back up focusing on contracting
your VMO through the entire motion.
8. STEP-UPS
-Stand in front of a step or a chair.
-Step up with one leg and raise yourself in an upright position while contracting your VMO with
your knee just a little bit passed your foot.
-Slowly step down ensuring that your VMO is
contracted through the entire motion.
-Repeat the process alternating your knees.
-Do 3 sets of 10(each leg).
9. STEP-DOWNS
-Stand on top of a step or stair.
-Slowly step down with your knee coming just a bit
over your foot with your body weight on your heel
while contracting your VMO.
-Slowly return to your starting position ensuring your
VMO is contracted through the entire motion.
-Do 3 sets of 10(each knee).
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McConnell Taping if it is your Patella causing pain
- Begin lying on your back, with the knee slightly
bent, but completely relaxed and a foam roller or
rolled up towel under the knee.
- Start the tape in line with the middle of the knee
cap at the outer aspect of the knee. Using your
thumb on top of the sports tape, gently push the
knee cap towards the inner aspect of the knee (figure 1) whilst simultaneously using your fingers to pull
the skin at the inner aspect of the knee towards the
knee cap.
- Finish this taping technique at the inner aspect of
the knee ensuring you have created some wrinkling
of the skin at the inner aspect of the knee (figure 2).
- Repeat this process 1 - 3 times depending on the
amount of support required.
Fig 1
Fig 2
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For more information on knee pain and to
make an appointment with a qualified physiotherapist contact Physio INQ.
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The fast road to
no knee Pain:
The quick recovery guide
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69 Phillip St, Parramatta, NSW 2150
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