Life After a Knee Injury

Knee issues can occur in many ways including suddenly with an impact in an accident, twisting of the lower leg, or the knee collapsing out; or over time through improper use. Whatever the origin of the problem the treatment is often the same - seeking medical attention, surgery if necessary, than physiotherapy. But, physiotherapy only gets you so far. Sadly in this day and age of H.M.O.'s we are often limited in the assistance we receive. I know when I was recovering from surgery, the insurance only covered about 12 sessions with a Physical Therapist. After that, I was on my own.

Luckily there are some easy ways to improve the function of your knee joint after physiotherapy. First. lets take a look at the most common origin of knee pain, poor alignment.

The foot is designed to fall flat onto the ground as we walk, rolling from the ball through the heel. This dissipates the impact force of our weight striking the ground. Sadly, as we age, we tend to have tight vs. weak muscles. In the lower leg, this results in the foot landing at an angle. This means the force of the impact isn't dissipated as it should be, by traveling the straight line from the heel out through the top of the head. In an off angle, the force will crash into the first obstacle - the knee - so that each step strikes the joint. Therefore, to help ease the discomfort, we need to straighten the foot's impact with the ground.

This may sound slightly easier than it is. Pain doesn't start overnight. It can be assumed (if there was no sudden accident) that you've had this mis-alignment for quite a while. This means you must re-teach the brain how to recruit the correct muscle groups.

Looking further at the misalignment will help determine which muscles are weak and which are pulled tight.

For those who wear the outer edges of their shoes:

This means the foot is tilted slightly down on the outside and up on the inside . The tilt pulls (or stretches) the outside of the calf / ankle, elongating them, and contracts the inside of the ankle/calf. Traveling further up the leg we come to the knee, again the outside of the knee/thigh is being elongated and the inside of the knee/thigh is being contracted. Exaggerated versions of this imbalance look like "Bow Legs."

The exact opposite is true for those who wear-out the inside edge of their shoes:

This means the foot is tilted slightly down on the inside and up on the outside. The tilt pulls (or stretches) the inside of the calf / ankle, elongating them, and contracts the outside of the ankle/calf. Traveling further up the leg we come to the knee, again the inside of the knee/thigh is being elongated and the outside of the knee/thigh is being contracted. Exaggerated versions of this imbalance look like "Knocked Knees."

So what does that mean? Well the muscles that are elongated or stretched are in a constant state of pull. This is like an elastic band that is pulled taut for an extended period of time. Eventually the muscle fibers might give, resulting in a tear. The muscles that are contracted are shrinking, squeezing the fibers to the point that flexibility is extremely limited. Therefore, the elongated muscles must be contracted or strengthened, and the tight muscles must be stretched.

Furthermore, we must re-teach the brain, the neuro-muscular system, to call up the proper muscles for walking and movement. This means forcing the body into the correct position, and maintaining it throughout an exercise that is repeated many times. The more it is repeated, the more easily the mind will learn the proper alignment.

Note:Stretches should not be painful. You should feel a little bit of tension, that is slowly released, but it should not be painful. If it is painful than you are going too far. The same goes for strength training. If your knee hurts while performing the exercise, than you've A: Too much weight, or B: Are moving out of alignment. ALWAYS Speak To Your Physician Prior To Beginning A New Workout Program.

Fixing The Problem:

Stretches: To stretch the areas that are tight, you will need a towel or strap. Lay on a mat or the floor. Wrap the strap around the ball of one foot. The other foot should be flat on the floor with the knee bent. Abs should be tight to support the spine. Stretch at least 2 - 3 times a day, hold each stretch for a minimum of 10 seconds.
1) Straighten leg away from you, keeping a good grip on the strap. Slowly, keeping the leg straight, lift the leg bringing the foot toward your head. Keep
your rear in contact with the floor. Stop lifting when you feel a slight tension in the calf, and back of the thigh (hamstring).
2) Keeping the leg in #1 position. Separate the strap into each hand. Slowly pull with the left hand. Keep the toes pulled back through your head.
**Note: If you wear the inside edge of your shoe than you want to stretch the inside of your calf/ankle; if your wear the outside edge than you
want to stretch the outside. With this stretch.
3) Again keeping the leg straight, lead with the strap, pulling the leg across your body. Keep both hips firmly on the floor. This will stretch the outside
edge of the thigh, the IT Band, which is tight in just about everyone.
4) Again keeping the leg straight, lead with the strap, pulling the leg outside, away from your body. Keep both hips firmly on the floor. This will stretch the
inside edge of the thigh and groin, which is also tight in just about everyone.

Exercises: Again remember to always watch your positioning. You must keep your knee directly over your ankle, and in line with your first two toes. It should also be straight from the hip. If the knee goes wide or too far forward, than you are putting pressure in the joint instead of the weaker muscles. I always suggest very little to no weight at first, doing only a single set of no more than 10 repetitions. Than give it two days, to see how the knee recuperated. If there is no new discomfort, than I try 2 full sets. Again waiting two days. If it still doesn't bring on new pain, than we begin incorporating weights. Begin with 5 - 10Reps, 1 Set and increase to 12 - 18 Reps, 2-4 Sets.

Chair Leg Kicks: (eventually you could try this sitting on a stability ball or wearing an ankle weight)
Sit on the edge of a chair or bench. Place hands on chair slightly behind you for balance (gripping the edge slightly). Place your feet flat on the floor. Roll your
shoulders back and tighten your abs. Lift one foot a couple of inches off of the floor (keeping knee bent). Slowly Kick foot toward the ceiling until the leg is
straight. Release the knee back to 90. Lower the floor back to the floor. (*If you start to cramp in the hip joint, stretch then repeat without lifting the foot off of
the floor before kicking).
- In this exercise, you want to watch the toes of the foot to ensure they point directly overhead, and do not point at an angle. This will build the muscle directly above the knee joint and it will assist in force absorption.

Calf Raises: (eventually you can hold a weight to your chest or in both hands)
Stand tall, with the option of bracing a hand on a counter if needed. With the knees soft and the body tall (no leaning forward). Slowly raise up onto the balls of the feet. Be conscious of the flatness of the ball of the foot, so you are distributing the weight evenly. Slowly lower the heels back to the floor.
- While maintaining proper flatness of the foot, we work the connective tissue of the ankle properly. This will help reposition the foot so the impact of movement does not injure the knee further.

Ball Wall Squats: (eventually you can hold a weight to your chest or in both hands)
Place ball between your lower back and the wall. Walk your feet forward until you are leaning back into the ball. Roll your shoulders back and contract your abs. Slowly, lower the ball toward the floor bending your knees to 90 degrees. Knees should be directly over the ankles. Push through the heels to straighten (but not lock) the legs.
- This exercise allows the legs to put the body where it needs it for a proper squat. Often, we tend to lean forward into the knee, just for balance when performing a squat. With the body leaning back into the ball in this exercise, the body weigh is distributed directly to the heels.