Knee problems come in many shapes and sizes whether it be from new or old injuries, painful bending or squatting, jumping or springing pains, or being on your feet all day, every day for work. What if I was to say this article may have the answer to fix most knee problems with one method? Hard to believe? Well, over the many years and varying knee issues Ive had the pleasure to work on, there are three things that must be done to start the process of having pain free knees;
1. A healthy popliteus muscle.
2. Consciously unlocking the knee when standing.
3. Good arches in your feet.
The first two are easy to deal with, but the last can go two ways, so lets get started!
1. A Healthy Popliteus Muscle
The Popliteus Muscle is the deepest muscle of the posterior knee that attaches from the lateral femur to the posterior medial tibia.
Its action is to unlock the knee and internally rotate the tibia. However in practice I have found that an unhealthy popliteus can create quite a lot of problems.
Firstly, when the knee has an injury be it acute or chronic, the popliteus always overcompensates and becomes hypertonic - increases in size and activity. The increase in size puts a large strain on the front of the knee in deep knee bending like in a squat position usually causing pain in the front of the knee due to a repetitive strain injury to the patella tendon. This happens due to hinge mechanics, as an example, lets think about a door and its hinge If you were to put a stone right behind the hinge of door and then push against it, the more force you add the more pressure strains the hinge.
the hypertonicity of the muscle also causes the tibia to be slightly more pulled on into a internal rotation, making the knee feel strange in general when in movement, whether it be walking, squatting, stairs, jogging, kicking ect.
So, what can we do about this part of the problem? Three things:
1. Passive Treatment - Massage and Dry Needling,
2. Active Treatment - Either using a foam roller or trigger point ball
3. Active Rehabilitation - Standing with a fractional bend in the knee,
which brings me to the second
2. Unlocking the Knee - A Conscious Fractional Bend in the Knee When Standing
Most people that I see with knee problems have am incorrect standing position with the knees fully extended. Why? Well, we don't get taught how to stand because not many people know how or even give it a second thought until there is a problem and the human body is instinctively energy saving and will find ways to hang off ligaments to save muscle energy. By having the knee in a fully extended position when standing, the PCL and posterior capsule of the knee are put into tension and the anterior portions of the meniscus are hinged off and squished, In response to this uneasy position for the knee, guess who overcompensates? That's right!!! The popliteus, adding to its hypertonicity and chronic strain.
So the correct knee position when standing - as stated in the heading - is to have a very slight bend, so it feels like your knee is floating. It should feel like you are in a position where you can lock you knee out if you extend more or start bending freely.
this takes the pressure off the PCL, posterior capsule, and popliteus and redistributes the pressure closer to center of the menisci, and held in place by a combined effort of the big quads, hamstrings, calf muscles and other large muscles that cross the knee joint. which makes sense, make the big guys work and leave the little guy to to the fine control.
3. Good arches in your feet.
This may be the easiest or the hardest part to deal with;
A. You might not have to do anything cause your feet have a perfect arch.
B. You might have flat feet which will need rehabilitation
If you are in Catagory A, you don't even kneed to think about this step and your good to go with your healthier knees! However if you are in Category B and your feet are flat, we have some work to do. Flat feet aka pes planus, cause increase sheering and rotational forces in the knee therefore adding to the problem. Some practitioners suggest orthotics, however they are not always usable as some people, like myself and many others who live in warm climates, love to walk, run and play sports with bare feet and also wear pluggers (aka thongs, flip flops or jandles). So Id rather fix the problem without the use of external support. It can also be a bother to keep changing the orthotics between shoes AND they are expensive! especially if your feet are still growing.
To do rehabilitate the arch in the foot we need to talk about the protocol called "Small Foot"
Small Foot is the process of redeveloping the arch in the foot through stretching of the dorsum of the foot - ligaments, tendons and joints - and developing muscle activation and inceasing the tone of the short toe and foot flexors. I will cover this in depth in the next post, because its an article in itself.
In any case, I hope this post was useful to you in some way especially those with knee pain or problems. So in summary;
1. Get your popliteus checked and worked on if necessary
2. Slightly bend/unlock your knees
3. Work on the arch of your foot
Eventually I will get around to making a video that complements this post but for now if you have any questions, please post below, email, call or book in to have your knees and feet checked out!