Avoiding and managing knee injuries
Injury management is key to the ability to maintain consistency of training. One of the key injuries we are seeing at the moment is a knee related injury called runner’s knee. Managing this injury correctly is critical.
Runners knee is typically caused by Iliotibial band (ITB) issues.
Your hips have to provide stability while you are running and for many of us, you may have already corrected this partially with orthotics and a good shoe fit. But another factor affecting stability can be pelvic strength. The muscles in the hips and low back are important for pelvic stability, and the gluteus medius is often involved in IT band problems.
The gluteus medius originates in the outer rim of the pelvis and inserts onto the superior aspect of the greater trochanter (thigh bone)at the top of your femur. It functions to abduct the leg, or move it away from the midline, and it plays an important role in providing lateral hip stability.
Runners tend to be very strong going straight forward but lack the lateral strength of tennis and basketball players. A weakness in the gluteus medius means that another muscle, called the Tensor Facsia Latae (TFL) is over-recruited.
The TFL, found on the front of your hip and slightly to the outside, acts to provide knee stability by working with gluteus maximus to contract the Iliotibial band.
So, if your gluteus medius is weak, your TFL has to work too hard, increasing the tension on your IT band, which can result in problems at the knee. This can cause unwanted tension through the hips, low back and hamstrings and can also result in increased tension through the hip flexors, which can tilt the pelvis forward, making the hamstrings feel tight even though they are actually being overstretched.
Here are a couple of stretches and an exercise that hopefully will get you on the right track.
Stretch #1: Hips and IT band
Place your body at such a distance from a wall that you feel a mild pull at your hip, down your IT band or both. As the stretching sensation eases, move your body closer to the wall. But remember, stretching always needs to be done pain free. Stretch both sides for at least 60 seconds to 2 minutes.
I like this stretch because you can get into it and relax or read a book or watch TV and spend some time with it.
Stretch #2: Hamstrings
This hamstring stretch is good because you are not weight bearing, so you don't end up overloading the hamstrings as when you bend over and touch your toes. Using a belt or strap, pull your leg toward you with the knee slightly bent. The other leg should be flat on the floor. Hold the stretch for 60 seconds to 2 minutes.
For a twist, try this: When you have pulled on the strap to the point where you feel a mild pull in the hamstring, push your leg against the strap. Don't let your leg move, simply push into the resistance. Count for six seconds and relax. At this point you can pull your leg further into the stretch. You can do the contract relax two to three times while stretching.
Clamshell exercise
This exercise will help strengthen the gluteus medius.
- Position yourself in a three-quarter-prone pose with your arm under your head for support. Keeping the lower leg straight, bend the knee of the upper leg and hook your foot behind the knee of the lower leg.
- Start with the knee of the upper leg on the ground.
- Slowly lift the knee of the upper leg just past horizontal, then lower back to the ground. Start with about 10-15 reps on each side and increase by 5 reps per week as it becomes easier.
The Plank Exercise
We have been using this exercise at run training but should really be part of any program involving physical activity.
Lie flat on the ground with your hands up at your ears and your elbows beside your ribs. Keep your feet together.
Now lift your body up off the ground like it is a plank. Your back should be in a straight line and your head should be aligned with the rest of your body. Ideally your elbows will be under your shoulders.
Hold this position for a period of 15- 60 secs and then rest for the same period of time. Do this for 4 repeats.
I like this exercise because it can be done while watching tv or reading. I normally choose an hour of tv and do this during every commercial for 4 reps.