This type of pain normally is life altering and prevents people from doing what they love (i.e. exercise). Generally people that have knee-pain are forced to follow one of two path’s.
- Number one, head to a medical authority (physician, chiro, your mom, etc.) and be told to stop.
- Number two, avoid the warning sign of pain, push through it and end up being forced to stop, because you are injured.
We all know the trouble that this creates such as weight-gain and a psychotic rage developed as a result of inability to lift heavy things or run great distances. Fortunately there is something you can do to prevent this but I think we must first talk about how your knee works and then we can understand the five most common causes of knee pain.
“We must understand our body better, to take care of it better.”
The train and the track
To understand how the knee works I think it’s best to think of how a train travels on a track. The train (knee cap) travels on a track (thigh) that has 27 muscles attaching to it. That is a lot of muscles that can influence the path that the kneecap (patella bone) travels. The train is easily influenced by muscles that are out of balance with one another and can force our train of the track. Anatomically what is occurring is that tendons gets pulled from the femoral groove they travel on, ligaments get strained in directions they aren’t supposed and our knee can’t absorb impact well. We know this is the case when we hear cracking and popping in our knee or we see a knee that darts inwards while we squat or run. These visual and auditory cues are big signs that something is wrong, limiting performance gains and increasing the chances of injury. Here are the five causes for how poor knee tracking and the inability to cushion impact becomes a problem.
“A cracking, popping, or run-away knee is not normal.”
Cause number 1 – Poor ankle Mobility
The number one postural deviation we see amongst Crossfit athletes, is a lack of ankle mobility. Whether it is our traditional choices in footwear (high heeled shoes, running shoes, etc.) or the type of exercises we have traditional chosen to do, it is very common to see athletes who lack dorsiflexion. Another way of saying this, is that we have athletes who are great at standing on their toes, but lack the ability to pull their toes upwards.
This is a big problem because of the number of squatting type exercise’s we must do, during which we are vertically lowering our body towards the ground. We have to understand that true strength isn’t just lifting a weight explosively, it is also the ability to “load” the muscle up first. We do this by allowing it to first stretch out like a rubber band. This is the very reason why if I asked you to jump up as high as you can you would first bend at the knees and hips before you took off.
If you lack proper ankle dorsiflexion, you will not be able to decelerate your body properly and end up with a knee that travels to a bad position. This is problematic for any exercise that involves bending at the hip, knee and ankle. Bad position during these exercises turn’s the knee into that train that travels off it’s track and ultimately turns it into a wreck.
“Your knee is a slave to your foot and hip.”
Cause number 2 – Poor Foot Stability
It is all too often that athletes who complain of knee pain also have a history of pains in their arch on the same foot. The link between to two is a dysfunctional foot. If an athlete has flat feet that turn out in abduction (duck stance) then this indicative of an athlete that is having difficulty in transferring weight from one leg to the other during activities such as walking and running.
What we need to understand is that it is the job of the arch to roll across the surface of the ground and transfer the forces of impact upwards to the rest of the body. A foot that is flat is kind of like a car that has bad brakes and can’t slow down effectively as it rolls inward. This collapsing foot is connected to the ankle which is a union of the bones which form to make our lower leg (tibia and fibula). The lower leg is divided from the upper leg by the knee. If the foot rolls in too much (overpronation), it pulls the knee along with it. This creates a major stress on the ligaments that hold the knee together. Thus, a myriad of symptoms follow such as anterior-medial knee pain, chondromalacia, and unfortunately ACL tears.
“You don’t lift with your legs, you lift with your butt.”
Cause number 3 – Posterior Weakness
Your knee is a hard worker but isn’t very smart. So far, we all understand that it is influenced heavily by what the foot tells it do but we really need to appreciate just how much influence our posterior muscles tell it what to do as well. To do so, we need a little anatomy lesson:
We all know where our butt is located but we must understand that the glute maximus attaches into the lower leg via the IT band on the side of our leg. Knowing this and remembering that we rely on a “rubberband” effect for muscles to generate force, makes us realize the importance of having glutes that can properly lengthen and accept load as we decelerate into the squat position. Without this ability, a Crossfit coach will see an athlete whose knee won’t track properly and “cave” inwards.
**side-note: I tell athletes when I have them foam roll their IT band and I hear them scream, then I know that this is an indicator that their glutes are on vacation and the poor IT band is taking all the stress for it.**
“Your musculo-skeletal system is set up like a giant tug-of-war match.”
Cause number 4 – Poor Core Stability
Our bodies are set up as a series of alternation sections of mobile and stabile parts. The greater majority of Crossfit exercises involve flexion and extension of the hips. For this action to occur we rely on the spine to act as anchor for muscles like your psoas to contract and flex the hip by pulling on the femur or the quadratus lumborum to maintain stability in pelvis when transferring weight from one leg to the other. Without the stability within our core we change the distance origin and insertion points for all our muscles which ultimately prevent us from maintaining control over how joints are controlled during motion.
“Our potential is unlimited but needs to be controlled.”
Cause number 5 – Weight Changes Everything
As the saying goes: “If the bar ain’t bending, you just pretending.” The more you do, the more you ask your body to co-operate.
PR’s are an awesome reason to head to the gym each and everyday. That internal desire to perform a little better today than yesterday is vital to us becoming more “fit.” With that being said, the more we chase a movement variable goal (reps, times, max weight lifted, etc.) the more specific demand gets placed upon the body and the more specific we need to be with the action.
Movement is a cooperation between your brain and body. Yes, I know that the brain develops a pattern for how we move. Yes, I know that this pattern is largely dependent upon a balance between agonist and antagonist muscles (i.e. think back versus front, left versus right). What I can testify to knowing is that everything changes with load and fatigue. As soon as we put load on your back when you squat, whatever imbalances you have in smallest of muscles creep to the surface and alter how you move and how your brains asks you to generate force. This brings up TWO very important points:
- Movement cues are essential. Find good coaching. At some point in time you will need an extra set of eyes that lets you know when your external rotators aren’t firing and yells “KNEES OUT, HIPS BACK, CHEST UP, EYES UP!”
- Progression is a ramp, not a leap. Movement is learned and programmed pattern. Smaller incremental increases stress and trick the body less and allow it to adapt more efficiently.
If you love fitness and exercise, you don’t have to just stop doing it because you have aches and pains. There are alternatives. You may need a regression from what you are currently doing to allow your body a chance to rebuild stronger but completely stropping fitness all together is generally not a good choice.