Arguably the most debilitating sports and fitness injury is a knee injury. Knee injuries are second only to lower back pain in terms of prevalence. According to the Institute of Medicine, 61 million Americans suffer from knee pain, which is almost 20% of all US adults. Of those 61 million, 6.6 million visited an emergency room between 1999 and 2008. Knee injuries are serious business.

The knee injury is particularly daunting because it can leave you sidelined for weeks, if not months. Many other injuries can be worked around. For example, I took up road cycling when I injured my rotator cuff, swimming when I injured my low back, and trail running when I injured my wrist. However, it’s hard to work around the limiting and painful factors of a knee injury.

The subsequent inactivity due to a knee injury can leave you feeling hopeless. This is why taking a step back to consider your options is critical. Doing too much too soon can delay your healing, but pushing through the pain is never a good option. Here are options to consider when it comes to your achy knees and how to treat them right.

Get New Shoes

Heel height and shoe flexibility are important considerations for addressing knee pain. Elevated loads may also progress the severity of osteoarthritis in the knee. Gait problems like overpronation are also linked to knee pain. While more research is needed, when it comes to sport and fitness, the most important piece of equipment you buy are your shoes. Further, it’s not only the right type of shoes that is vital, but also the duration of wear and tear on your shoes. Like the tread on your tires, running shoes tend to have a max shelf life (about six months for running shoes). Whether you’re a runner, gym rat, or just a weekend hiker, shoes are a critical component of keeping your knees healthy.

Drop Some Weight

With more than two thirds of Americans overweight or obese, the prevalence of related knee pain is on the rise. Carrying around those extra pounds puts pressure on your knee joints. Obesity is a major cause of osteoarthritis, but even a little extra weight puts considerable pressure on your joints. For each pound of weight lost, you reduce knee joint load by 4 pounds. For example, losing 20 pounds is the equivalent of 80 less pounds per step that your knee has to bear. If you are overweight and have knee issues, address the weight first.

Don’t Mask the Problem

As anyone who has ever been injured knows, pain sucks. It’s tempting to pop pills in an effort to alleviate the pain. And why not if doing so helps you sleep better, exercise more, and feel pain free? The problem is psychological. Studies show that while some drugs are effective in regulating pain and providing temporary relief, nonsteroidal anti-inflammatory drugs (NSAIDS) may actually inhibit the healing process. NSAIDS are linked to the weakening of collagen and bone formation, which are essential elements in the healing process.

Take proper care of your recovery process and you’ll be squatting heavy in no time. [Photo credit: CrossFit Empirical]

Get a Second Opinion

Before jumping into surgery, get a second opinion and try physical therapy. A recent study found that exercise therapy is as effective as surgery for middle-aged patients with a meniscal (MCL) tear. Surgery is not only invasive, it will cost you, literally. ACL surgery (with insurance) is estimated at $800-$3000. If you don’t have insurance, it’s a staggering $20,000-$50,000.

Second, surgery may or may not work. Many famous athletes have undergone knee surgeries only to have their careers cushort or never seem the same post op. Still, surgery is a widely accepted option for alleviating acute or chronic knee pain and/or instability. Bottom line – do your due diligence before electing for surgery.

Consider Injections as a Treatment Option

A recent study in the Annals of Internal Medicine concluded that, for treatment of osteoarthritis of the knee (OA), corticosteroid and hyaluronic acid injections were the most effective options. Injured tissues can be stimulated to repair by a treatment of injecting growth factors called PRP, made from your own peripheral blood platelets. While the cost isn’t cheap, it’s worth considering injections as a treatment option.

Skip the “Rest” Part of RICE

The most basic injury treatment starts with rest, ice, compression, and elevation (RICE). But there is a growing body of evidence that suggests that the rest portion of RICE isn’t necessarily optimal. While knee injuries are indeed limiting, instead of total rest, practice ‘relative’ rest. Work around your injury with pool exercises, supine weight lifting, pilates, yoga, or an upper body ergometer. Exercise is important to continue as it stimulates the natural endorphins, adrenaline, testosterone, and pheromones that promote healing.

Optimize Neuromuscular Training (NMT)

Neuromuscular training includes agility specific drills, plyometrics, deceleration techniques, strengthening, and proximal control training. According to a recent study in the British Journal of Sports Medicine, effective adaptations of NMT can reduce injury prevalence in female athletes by 17.2-17.7%. The more variations in your training the better, and a dosage of NMT is recommended at a minimum of 20 minutes for a minimum frequency of twice a week. The study also found that participants who started younger (ACL injury is particularly pronounced in teenage female athletes) helped reduce injury. Lastly, NMT is particularly operative when accompanied by effective verbal cues such as “Watch for your knees caving inward.” The moral of the story – hire an effective coach/therapist to guide you through your NMT and knee rehab/prehab.

Stay Positive

There is an interesting study that suggests that a positive attitude can help you feel better and be more active. In fact, the study concluded that among respondents of knee pain, those with high positive affect walked significantly more steps than those with low positive affect. It’s no secret that pain can de depressing and unmotivating. The importance isn’t in avoiding pain, but in controlling your attitude to help override and counteract your mind’s tendency to depress with injury. There are many factors out of your control with rehabbing injury. Attitude is one of the factors you can control. Keeping positive can only help.

Address the Root Cause

As someone who has suffered knee injuries and endured knee surgery, I can attest to the challenges that accompany knee pain. I can also attest to the opportunities that present themselves through injury if we’re open and willing to listen. Every injury I’ve suffered has come with the experience of learning more about my body, trying new approaches, sports, and ways of training. If you’re weak in the knees, addressing the root causes and strengthening your weaknesses will ultimately help you stand tall.

Here’s a primer on working out with knee pain:

4 Safe and Effective Ways to Work Out with a Cranky Knee

The post Are You Weak in the Knees? appeared first on Breaking Muscle.

Current Knowledge on the Causes of PFPS

Don’t believe me? A quick trip to the Wikipedia page for PFPS tells us this:

The causes of PFPS are unclear, but there are several theories. Which tissues give rise to the pain is debated. Similarly, there is no consensus as to what is the best way of treating PFPS, and there is not enough evidence to support any particular management approach.

Fantastic.

So what does this mean for us? In a general sense, most movement-based joint pain that isn’t the result of an anatomical or structural abnormality is stress related. My experience has been that PFPS is caused by muscular imbalances that lead to an undue amount of pressure being placed on the front of the knee. Our bodies are incredible machines capable of impressive compensatory strategies. Unfortunately, in almost all cases those compensations lead to problems down the line.

RELATED: Beyond the FMS: How to Design Powerful Corrective Exercises

So, without further ado, here are five of the simplest interventions that will give you the most bang for your buck and can likely be accomplished with existing equipment in your gym.

1. Fire Up the Glutes

I don’t know exactly why our culture has reached an epidemic level of IGS (imaginary glute syndrome), but most patients I see, even high-level athletes, tend to have weak or inactive glutes. This causes all sorts of problems at the knee.

The primary movers of your legs are the muscles of your hips and thighs. When the muscles of your hips aren’t working properly, that means the muscles of your thighs (usually your quadriceps) have to pick up the slack.

Here is a simple and effective glute activation warm up:

1. Glute Bridges – 10x
2. Single-Leg Glute Bridges – 5-10x each side
3. Quadruped Hip Extension – 10x each side
4. Fire Hydrants – 10x each side
5. Quadruped Hip Circles – 10x each side

Here are video examples of each of these exericises:

Do two to three rounds, depending on how you feel. You may also benefit from performing a hip flexor stretch prior to these warm ups, as it will release some of the tissue on the front of your hip and should allow you to take advantage of improved hip extension.

“Really focus on squeezing your glutes at the top like you’re trying to hold a pencil between them.”

Another great way to warm up the glutes, particularly for a squat workout, is to simply do some lightweight squats. Use just the bar or a single plate, depending on your 1RM. Really focus on squeezing your glutes at the top like you’re trying to hold a pencil between them. I realize it’s a silly cue, but try it. It’s effective.

2. Hammer Your Posterior Chain

Riding on the coattails of the previous suggestion, now that your glutes are turned on, it would be a good idea to take advantage of this newfound activation and strengthen them. The three best options for specific glute activation that simultaneously reduce stress on the front of the knee are weighted glute bridges, box squats, and deadlifts.

• Weighted Glute Bridges– In physical therapy, following the glute set, a glute bridge is the go-to exercise for gluteal activation. So load that bad boy up and start bridging. But remember this is rehab, so the focus is on perfect form and technical mastery, not on PR-ing your glute bridge.

• Box Squats– These are great because they teach you to sit backwards and load up the hip. There’s a reason they’ve been a favorite of powerlifters for years. They also significantly diminish the impact of the eccentric phase of the lift. Eccentrics are a useful tool to be sure, but until you’ve got the requisite mobility and strength to move pain-free, those baselines should be your primary goal.

• Deadlifts– These work basically the same muscles as a squat, but they place a higher emphasis on lockout (gluteal recruitment) and not nearly as much stress is placed on the knee. Unless you’re really tall (over six foot), in which case deadlifts might not be a great option for you.

On all of these movements, it is important to focus on proper alignment of the knees. If your knees are constantly caving, even on a bridge, you’re missing out on activating the glute med, which is one of the most important muscles for stabilizing the knee during movement.

3. Learn to Land Like a Ninja

Landing mechanics are a problem for a lot of people, particularly in untrained individuals who have recently started an intense exercise program. You could probably go on and on about landing mechanics, but the two most significant variables I’ve seen are knee valgus and loud landings.

“If I can hear you land, I guarantee your knee can feel it.”

I think at this point we all know knee cave is bad. Don’t do it and don’t let your clients do it. But landing quietly is equally important because when you land with an audible crash, it’s physics letting everyone in the room know you just did a terrible job of absorbing the shock of that landing. If I can hear you land, I guarantee your knee can feel it. It might not be painful now, but it probably will be soon.

4. Turn Your Feet Out

The vastus medialis oblique (VMO) is one of the muscles of your quadriceps that is directly responsible for proper patellar motion. If your VMO is weak, your patella may get stuck or click as you move, which will cause pain.

A simple method of VMO strengthening is to turn your foot out. You can do this on leg raises, leg extensions, squats, or pretty much any movement that involves the quads. This will increase activation of the VMO.

RELATED: Why CrossFit Coaches Need Anatomy: Bones, Muscles, and Lifting

For the record, I’m not recommending you simply turn your feet out on everything and call it a day. This shouldn’t become your go-to technique on anything. This is a rehabilitative form tweak and should be used as such.

It’s also important to note that turn-out is relative. We all have slightly different anatomical degrees of turn-out, so what is turned out for one person may only be neutral or slightly past neutral for another.

5. Mobilize Your Adductors

Frequently, when you have weak glutes and weak hip abductors, you will also have tight adductors. Without getting too much into it, this is basically just another compensation strategy our bodies develop to mediate knee instability.

Tight adductors can cause all sorts of problems and may also prevent you from being able to perform some of the exercises outlined above. It’s hard to move your knees out when your muscles are constantly pulling them inward.

So, get on those adductors with either a foam roller or a barbell for a few minutes. You can also perform a deep squat stretch and actively push your knees apart with your hands. Hold this position for two to three minutes a few times a day. It should do wonders to unwind your wound-up adductors.

The Free Squat Stretch – Stretch instruction starts around 1:07.

Runner’s knee, jumper’s knee, call it what you want, but PFPS is no fun. Hopefully some of these simple interventions can get you out of pain and back to setting some personal records.

Photos courtesy of Shutterstock.

The post 5 Simple Solutions for Anterior Knee Pain appeared first on Breaking Muscle.