As always i will try to keep this really simple and show you how i treat knee pain and the proceedure i follow to make it systematic and logical .
Firstly unless you have been kicked on the knee or suffered direct trauma then your painful knee just happens to be a victim and the source is iether above or below the joint .
ABOVE THE KNEE JOINT .
The muscles that control the rotation of the femur are in the hip .The Gluteus maximus , medius ,minimus , piriformis and deep six .You do not even have to know the muscles just the action or pattern that we are looking at .
WHAT PATTERN AND WHY ARE THESE MUSCLES IMPORTANT?
If the femur internaly rotates with every step because the hip muscles are not strong enough to prevent this rotation then the condyles will grind against the patella and cause pain and inflammation . This can also lead to Tibial external rotation and over pronation of the foot , and with out being too boring and the bearer of bad news Plantar fasciitis can follow.
So the hip muscles need to be strong enough to stop the femur internaly rotating and maintain a neutral femur and healthy limb pattern .
BELOW THE KNEE JOINT .
The ankle needs to be mobile in pronation , suppination , plantar flexion ,dorsi flexion and combinations of these movements .Many knee issues in the NBA can be attributed to ( high tops ) the shoe surrounds the ankle joint giving it so much support that it can no longer move freely and guess what????? the knee puts up her hand and says no problem ankle , relax i will help you out and you end up with a painful knee that is working and moving far too much and a locked up ankle joint that moves very little .
WHAT TO DO ??
- Test the ankle for mobility
- Test the hip for mobility
- Test the hip for stability
ANKLE MOBILITY .
- Do not give lots of instructions , perform a deep squat and ask your client to repeat the movement .
- Do the feet stay straight and the arches maintain their integrity ?
HIP FLEXIBILTY TESTING.
- You have already tested the ankles in a Deep squat so you should remember what you saw. Just to recap watch the knees and ankles caving in or pitching forward onto the toes .
- A deep squat is a good indicator of hip flexibilty .
HIP STABILITY TESTING .
- Do not talk too much or give a load of instructions . Stand with the feet together and lift up each leg for about 10 seconds .Repeat with eyes closed .Watch for the arms waving to keep balance and genral lack of balance .
- Bridge position , hips up arms across the chest , lift one knee does the pelvis drop ?
Ok so now you have some idea about how the joints and muscles above and below the knee may be compromising it’s function and causing pain . The knee has two neighbours the hip and the ankle . Sometimes they are bad neighbours .
You may have a case of limited ankle and hip mobility . Fix these first before working on hip stability . If you are wondering about ankle stability , improving hip stability will automatically improve ankle stability but i will save that for another post .