A "Knee-ded" Subject

The knee joint is interesting. The knee, which is classified as a hinge joint, accepts load from the upper body and impact from the lower leg. It resists rotation, forward translation and backward translation. The knee is integral to all lower body movements and daily activities, and is easy to injure, both from trauma and from postural and repetitive strain patterns. If you have followed my columns, the underlying theme of everything I teach is proper posture for efficient movement and good body position. Injury is injury; sports trauma, falls and stepping in holes cannot be prevented. However, the majority of knee issues we see are not from trauma, they are from faulty movement patterns in the hips/pelvis and lower leg that wear the knee down to the point of injury.

Look around the squad room or bay at some of your co-workers. How many are overweight? How many have a slight limp or lean to one side as they walk? The more the pelvis rotates forward or 'pushes forward'--termed lower crossed syndrome--the greater our body weight transfers on an angle over our knees. This essentially causes the knee to have excessive load and shear forces on it anteriorally. The second problem is weak glutes, or more specifically, weak hip external rotators. If you remember back to anatomy class, these muscles are the pirformis, tensor fascia lata and gleteal medius/minumus. When these very important muscles are weak, they are unable to keep sufficient pull on the hip externally and the knee subsequently rotates in or across your midline. This equates to some seriously altered joint mechanics, especially when you sit, kneel, step up or down, which is a necessary movement to perform the basic functions of your job.

Now that many of you are confused or scared let me break it down into three things you can do to alleviate many knee problems: stretch, massage and strength.

• The Stretch: Hip flexor, should be done on duty 2-3 times per day. Hold for 60 seconds each side and keep your back straight (see Figure 1). Stretching the hip flexor will help to lessen the forward rotation of the pelvis.
• The Self Massage: Lateral hip and IT band. This one hurts a little, but persevere through the discomfort. Slowly work the tennis ball, massage stick or foam roller from the hip to just above the knee (see Figure 2). It should take five minutes per leg and needs to be done two times per week. The more the spot hurts, the longer you need to hold pressure on it. Massaging the IT band and hip takes mechanical strain off the joint.
• The Strength Movement: Lateral tube walk or buns of steel! Simply stand on a resistance band with your feet shoulder width apart and walk sideways. Take small steps, 6-8 inches, and make sure your toes are straight, knees bent and you do not lean side to side (see Figure 3). Two sets of 15-25 steps each leg should do the trick, 2-3 times per week. Strengthening the glutes and oblique will stop the knee from rotating in and lessen strain on the joint with activities.

Bryan Fass is the author of "Fit Responder," a comprehensive wellness plan for the first responder (www.fitresponder.com) and the Fit Responder Blog (www.fitresponder.wordpress.com). Bryan has a Bachelor's Degree in Sports Medicine and is certified as a licensed athletic trainer and a strength and conditioning specialist. He was a paramedic for over eight years, and has authored four books regarding fitness, wellness and human performance. Bryan is available for consulting and speaking on Public Safety Fitness Testing along with Fitness, Wellness and Injury Prevention Programs. Contact him at bryan@firepoliceemsfitness.net