My Recent Knee Injury: How Quadricep Imbalances Lead to Knee Pain & Instability.
This past Saturday I severely sprained my right knee. I would like to believe that I am a fairly strong woman with good joint stability. However, on Saturday, I was proven wrong. Most of you may know that my degree is in Exercise Science. This makes my mechanism of injury a little more embarrassing. Yet, instead of letting my embarrassment get the best of me I choose to use my experience as a learning tool for myself & to share with you.
My visit to the ER was as fun as one may imagine. A lot of waiting accompanied by some painful exploration of my injury by the doctors with a few x-rays included. Once the films were developed & the doctors had read them they asked if I wanted to take a look for myself. “Of course I would!” They wheeled me into the computer room, normally only occupied by physicians, patiently making room for my wheelchair so we could get to the furthest screen, & pulled up the pictures. Immediately I noticed that my patella was tracking way off to the right. Considering that the patella was still freely moving during the assessment & it’s positioning not part of my injury, per se, the doctor pointed out that I have a significant imbalance in my quadriceps which led to a predisposition to the very injury I suffered. Let me explain.
I would like to introduce you to the front side of your knee. The quadriceps muscle group is comprised of four distinct muscles that converge on the patella (knee cap) creating the Patellar Tendon. This tendon encompasses the patella and continues on to insert into the Tibia (large bone of the lower leg we call the shin). The four muscles are:
1) Rectus Femoris- located in center of the thigh
2) Vastus Lateralis – located to the outside of the thigh
3) Vastus Intermedius – located in center of the thigh, under Rectus Femoris
4) Vastus Medialis – located on the inside aspect of the thigh.
All four muscles are responsible for knee extension (straightening your lower leg).
Many of us walking humans often find that we have knee pain in our later years, some in early years. You may have been told by me or others in the health care or fitness field to ‘roll out your ITB’ to relieve knee pain. The ITB (Iliotibial band) is that thick, strong tendon that tends to be sore located on the outside aspect of your upper leg. *see photo below*
The reasoning behind these ‘self torture techniques’ involving a seemingly innocent cylinder of dense foam is to loosen up the ITB, which crosses the knee joint & inserts on the outside of your leg. A tight ITB can pull on your lower leg causing the knee to track incorrectly thus leading to knee pain.
Well, in all of my wisdom, I never thought to teach you guys & gals to look at your knee like I suggest you view your shoulder. There is a tug of war going on in both joints! The most used muscles are the primary movers & shakers pulling you out of balance in your movement due to these muscles being stronger & possibly shorter. These ‘bully’ muscles over tax the opposing muscles that are tasked with getting you upright & in proper posture or allowing your joint to track correctly (in this case, your Vastus Medialis), leading to pain & instability. While rolling out your ITB, along with the lateral quadricep, is still necessary in most cases & will produce results I am now suggesting that you also make sure your are strengthening your Vastus Medialis.
“How do I do that?”, you may ask… Here are some videos to show you just that. I hope you find them helpful.
Recently a PT colleague suggested that I also suggested I discuss the strength of the Gluteus Medius & how it is also involved in poor tracking of the knee. So, now let’s take a look at your Gluteus muscle group.
This group includes three distinct muscles. The one we are most familiar with is the Gluteus Maximus, shown below. It’s job is to extend the leg (moves it back) and to help move the leg towards the midline (towards your other leg).
Next, there is the Gluteus Medius. The work of this smaller muscle, located under it’s big brother, is to rotate the hip inward (think about your leg being straight out & moving your leg to point your toes inward) and to move your leg to center, along with the Gluteus Maximus.
The last muscle, not shown, is the Gluteus Minimus. As the name suggests, it is the tiniest of the group. It can be found under both the other two, assisting the Gluteus Medius in its functions.
Now, how the Gluteus Medius works to keep your knees safe is by keeping your pelvis stable and helps your knee from internally rotating when bending. This rotation can load the inner knee, setting you up for potential injury. If you want to check the strength your own Gluteus Medius is by doing a one legged squat in a mirror to see how your leg tracks.
Hip/glute exercises that you can do at home are:
1) The Clamshell (can also be done with a band around your knees for extra effort)
Massage therapy is indicated to further help these balancing acts buy breaking down the connective tissue that binds muscle fibers & holds the stronger, shorter muscles in an established pattern, assists in deeper stretching, and releases painful trigger points. With having the appropriate massage techniques applied along with self care & strengthening of the opposing, weaker muscles you will have a multifaceted approach that will provide you with fast results & stronger, pain free knees!
Yours in Health, Wellness, & Balance