As the largest joint in the body, the knee is incredibly complex with very important jobs of bearing load and hinging to facilitate locomotion. The knee joint, made of the femur, tibia, fibula, and patella bones, is capable of flexion and extension and a small bit of rotation. The hamstrings, quads, and calf muscles cross the knee, and numerous ligaments and tendons add stability while menisci and cartilage aid in cushion and glide. As you can see, there are A LOT of moving pieces involved and if any single part isn’t functioning optimally, trouble can arise.
Because the bones of your knee don’t form or sit in very deep bony sockets, the knee relies on stability from muscles and ligaments. When these become weak or damaged, the knee becomes less stable and acute or chronic injury can occur. To complicate matters, the knee has to deal with massive forces - every running step you take transfers 3-5x your body weight through your joint!
With such high demands put on the knee, it’s no surprise that pain and injury is extremely common.
What should you do if you’ve developed a knee injury?
In order to treat a knee injury, it’s important to know its cause. Unfortunately, the complexity of the knee joint can make the specific roots of dysfunction difficult to uncover. That said, an injury is always caused by an inability to adapt to the demands applied to it.
Most knee overuse injuries are caused by non-ideal loading patterns. When muscles are overused or under-recovered, they become tight. In some cases, very tight muscles, especially the quads, can actually pull the kneecap or knee joint out of alignment or put excessive strain on structures like the patellar tendon. Ouch! In the same way, a very tight IT band, for example, can rub and pull on the knee, causing pain.
Overuse injuries can also be caused by an overload of parts that aren’t designed to receive as much force as is put on them. If biomechanics aren’t ideal, for example, in an athlete who over-strides, structures that aren’t designed to cushion excessive force, like bursa or cartilage, may start to wear down or become inflamed. Knee injuries can also be caused by acute trauma. This is commonly seen in ACL tears. These “freak” accidents are more difficult to prevent, but having better strength and stability in the joint will increase its resilience.
After the onset of new knee pain, let the joint heal by removing the stress that is aggravating it. In the initial stages of an injury, a RICE protocol (Rest, Ice, Compression, Elevation) may help to settle down acute inflammation and expedite the healing process. Rest may mean backing off of normal training to truly take a break, or to incorporate some pain-free cross training.
As the joint injury heals, it is very important to invest time and effort into addressing strength deficiencies. This will greatly increase the likelihood of a smooth, healthy return to activity and prevent future knee injuries. Often, treatment and rehab is guided by a good, sports-specific Physical Therapist who can identify areas of weakness such as inhibited glutes or quad dominance which may be overloading the knee. A Physical Therapist can also help to expedite proper healing by loosening tight or inhibited muscles and advise on potential aids such as the Ascend Brace.
Returning to normal activity or sports after a knee injury should be done gradually. Remember - injuries are caused by overload, and your body likely isn’t ready to return full-bore (but this will come!). Progress training conservatively, beginning with increasing volume before adding in intensity or speed. Continue to address any gaps in your strength and stability in order to offload your knee.
Knee pain hurts, but it doesn’t necessarily have to be forever! A smart, thorough approach to rehabilitation can go a long way in reducing knee pain and promoting longevity in your active lifestyle and sporting pursuits.
Author: Jessica O’Connell, MSc Exercise Physiology, CSEP-CEP
Jessica is a co-owner and coach of Grit Coaching, an online athletic coaching business providing custom strength and endurance programs for runners and OCR athletes. An athlete herself, Jess has represented Canada 16 times in track and field, cross country, and road running, highlighted by competing in the 2016 Rio Olympics in the 5000m and is no stranger to injury.
This article was sponsored and created in partnership with GRD Biomechanics, creators of the Ascend Brace - an innovative knee brace designed do reduce quad dominance and knee pain in active individuals. https://grdbiomechanics.com/