Knee stability WOW factor - Of-Course Online · Outline of course: The knee stability wow factor. As we age or do specific sports, our knees take a lot of strain which results in

Knee stability WOW factor

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©Copyright January 2015, Of-CourseOnline – Knee Stability WOW Factor (Tanya Thompson), South Africa

Contents

INTRODUCTION AND COURSE BREAKDOWN .................................................................................................................... 3

Anatomy ............................................................................................................................................................................ 4

The thought pattern of knee stability................................................................................................................................ 5

The role of the Gluteus Medius ......................................................................................................................................... 6

What does the knee feel like in certain positions? ........................................................................................................... 6

The art of precision in knee rehabilitation? ...................................................................................................................... 7

Conclusion ....................................................................................................................................................................... 13

Steps during rehabilitation process ................................................................................................................................. 13

References ....................................................................................................................................................................... 14

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INTRODUCTION AND COURSE BREAKDOWN

Outline of course: The knee stability wow factor.

As we age or do specific sports, our knees take a lot of strain which results in wear and tear of the joint or instability within the joint due to

predominant muscles or movement compensations. Before we can create a client specific movement and rehabilitation program, we need to be

familiar with the structure of the knee as well as the possible compensations that could occur during movement. When these compensations

occur, what would the possible reason for this be? Knee stability is reliant on hip and pelvic stability and therefore a hawks eye is required when

assessing client knee movement. Client movement or musculoskeletal restrictions have to be considered as this will affect the program that you

have designed for them. This course provides you with a comprehensive yet safe knee stability program with all of the additional factors i.e. hip

and pelvic position in it.

Objectives: We want the professional to provide their client or patient with a client specific knee stability program that takes injuries, sport, age and

precision in movement into account. This course will provide them with all the ‘look out for’ negative and positives in a knee program as well as

teach them ultimate positioning for maximum output of muscle contractions. If this program is followed, then their clients or patients will achieve

amazing results with long term effective movement.

Course description:

➢ Short introduction to the importance of knee stability and additional factors that play a role in knee rehabilitation.

➢ The anatomy involved in knee stability.

➢ The thought pattern of knee stability.

➢ What the knee feels like in certain positions?

➢ Comprehensive program with thorough explanations of each exercise as well as possible compensations.

➢ Tips on how to perform the movements with precision in order to obtain optimal relaxation without compensations.

➢ The conclusion of this effective home program on the individual and how this will affect their rehabilitation and functional movement.

Course requirements:

➢ Computer, Internet, Manual (to be printed off of website), stationery

➢ Small equipment (ball, foam roller, mat)

Course agenda:

1. This course is done online at a time convenient for the candidate

2. The course is presented via a video so the candidate is able to watch the course and follow the presenter from the manual

3. The course is covered in 1 session

4. The course duration is approximately 90 minutes

5. At the end of the final session, they are to complete a test at their convenience

6. They will also receive the 1-page course summary

7. A certificate will be available once they have achieved 70% on the test

Knee stability should be achievable for all!

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Refer to pre-study guide:

What anatomy should be our main focus for knee stability?

Anatomy

Gluteus Medius The mental & neurological block:

In order for our knees to move with

good form, we need our hips to

function efficiently with good

strength.

Knee stability and hip stability is not

possible if our main hip stabilizers are

weak or inactive.

Gluteus medius activation is vital for

all hip stability and therefore if it is

inefficient, it will directly affect the

knee stability.

Bad form affects stability:

The hamstrings and quadriceps form

strength for the anterior and posterior

knee. Therefore, these two areas need

to work in unison in order for the knee

to obtain efficient, functional stability.

If the precision in movement is lacking

then the muscle contraction will be

inefficient with compensations. If this

occurs, then we are setting the knee

up for further injury.

Hamstrings and Quadriceps

DO NOT FORGET THE IMPORTANCE OF ANKLE ALIGNMENT

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1. Why can we not connect efficiently for knee stability?

Our postural position is poor and this affects the position of the knee.

The relaxed state of our knees is poor (sitting with knees together, feet apart and feet laterally rotated).

We are unable to connect to the gluteals due to the lack of general functional work on a daily basis.

The effect of knock knees and bow legs on the knee and ankle.

1. Postural knock knees can cause the ankles to supinate creating tension laterally on the knee if the feet are not in line with

the knee.

Postural knock knees can have pronation or supination of the feet.

2. Postural bow legs can cause the ankles to pronate creating tension medially on the knee if the feet are not in line with the

knee.

Postural bow legs can have pronation or supination of the feet.

What influence does hip stability have on the knee?

Hip stability as well as the position of the hip will affect the knee directly due to the pressure that is placed on the knee when the

pelvis is not in alignment.

The hip joint is affected through the position of the pelvis therefore:

An anterior pelvic tilt or flexed hip will cause the knee to hyper-extend and weaken it at the back of the knee in the area of

the posterior cruciate ligament. This will cause the feet to plantar flex slightly.

Posterior pelvic tilt or extended hip can either cause the knee to hyper-extend (if the hip flexors are flexible) or to flex (if the

hip flexors are tight). Hyper-extension will cause the ankle to plantar flex and flexion of the knee will cause the ankle to dorsi

flex.

Lateral pelvic tilt will cause one hip to be higher and therefore it will have one side that has less support from the gluteus

medius.

The thought pattern of knee stability

3 important areas to assess when you are strengthening knees:

1. Pelvic position

2. Flexibility of hip flexors

3. Natural, relaxed knee position

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The gluteus medius assists the knee in staying more lateral in all movements’ i.e. climbing stairs, running, squatting and

walking. This is due to the fact that it produces hip abduction but is also one of the main hip stabilizers.

However, if the gluteus medius does not function efficiently, then the tensor fasciae lata will dominate the knee abduction in

all of the above movements. This will affect the knee greatly as the Iliotibial band will become more active due to its

attachment to the TFL. This will directly affect the knee especially the patella as well as the hip joint. There are a few

precautionary measures that you need to take to avoid the TFL from dominating the movement.

(Please note that a tight TFL will need to be released in order to effectively strengthen the gluteus medius)

a) Used closed chain gluteal work from the posterior side.

b) Do not allow the hip to go into hip flexion in open chain training as this will encourage the TFL to work due to its

function in hip flexion.

c) A lateral pelvic tilt will increase the ability of the TFL to dominate the movement.

When will the TFL dominate a movement?

1. When the pelvis is in an anterior pelvic tilt.

2. When the hip flexors are tight.

3. When you are in a posterior pelvic tilt with low muscle tone in the glutes.

4. When you have a lateral pelvic tilt especially with an anterior pelvic tilt.

5. When the gluteus medius is inactive.

6. When your sport requires stronger hip flexion than hip extension.

7. When you perform hip stability open chain with a weak mind-body connection to the gluteals.

Depending on the client performing the exercise, the knee can feel uncomfortable when performing some exercises. Care needs to

be taken that the knee is over the second toe and that the knee is not under tension in:

• Rotation (pressure on the foot from the outside at the area of the heel). This can cause the medial border of the knee to

hurt.

• Posterior pressure on the heel in a parallel position where the client is asked to press the heels down especially when the

load is higher or the work is closed chain in a supine position. The amount of load needs to be taken into consideration.

• Deep squats beyond 90˚.

• Front support or plank with extended knees. The knee could take strain due to the amount of closed chain force that the

quads are expected to do in order to maintain the knees position.

• Any supination or pronation with medial or lateral rotation at the feet as this creates constant tibial torsion.

Notes:

What does the knee feel like in certain positions?

The role of the Gluteus Medius

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In order for the knee to rehabilitate effectively, repetition of exercises in good alignment is encouraged. We cannot expect new

muscular patterns to be re-set immediately or even soon after incorporating the new program. Our subconscious mind has to store

the new, safe pattern of movement and this will only be possible through repetitions. Precision in movement is very important if you

want to achieve good results. Please take note of how we perform the exercises.

Exercise Description

Raised leg pelvic curl (on box) Pelvic curl or hinge with the feet on a box. This takes a bit of pressure off the knee joint as the

angle of flexion is larger. Please ensure a smooth articulation of the spine with good knee, hip

and ankle alignment.

Aim: Activation of hamstrings with a gentle stretch for the quadriceps

Notes:

Supine heel press (large ball) Lying on your back with your feet over a ball, you are going to press your heels into the ball.

Please check all spinal alignment. You will be working the hamstrings.

Aim: Activation of hamstrings from a greater range to with a gentle stretch for the quadriceps 90’ only which is safe for knees that cannot flex beyond 90’.

Notes:

The art of precision in knee rehabilitation?

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Supine heel press + leg extensions (large ball) Lying supine on a mat with your legs over a large ball, you are going to maintain a neutral

pelvis and gently extend one leg up to the ceiling with a fully extended knee. (Take hamstring

flexibility into account). You will be working the quadriceps.

Aim: Activation of hamstrings with the activation of the quadriceps concentrically which will give the knee anterior stability especially when the knee

flexes.

Notes:

Magic circle hip abduction Lying supine on a mat with your legs inside a magic circle just above the knee. You are going

to press your knees out against the magic circle working the hip abductors especially gluteus

medius which is important for hip and knee stability.

Aim: Strengthening of the hip stabilizers which will assist with knee stability by maintaining the knee in alignment during gait.

Notes:

Rehab glutes Lying on your side with both legs bents and the feet in line with your coccyx. Ensure that your

hips are stacked. You are going to open the top leg out whilst squeezing the heels together.

Ensure that you do not roll the top hip back but rather get a feeling of rolling it slightly

forward. This works the hip stabilizers which will assist with knee stability.

Aim: Strengthening of the hip stabilizers which will assist with knee stability by maintaining lateral alignment of the knee during gait.

Notes:

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Closed chain glutes Lying on your side with your bottom leg bent to 90˚ in front of you and the other leg’s foot

against the wall also bent at 90˚. Ensure that your bottom waist is lifted off the floor and that

your two hips are stacked on top of each other. Press your top foot into the wall and this will

create the closed chain effect making it easier for your gluteus maximus to work. Gently open

to top knee up to the ceiling with the heel still pressing into the wall.

Aim: Strengthening of the hip stabilizers i.e. gluteus medius and maximus to assist with knee stability during gait and stair climbing as well as sitting to

standing positions.

Notes:

Supine Redondo press with knee extension Lying supine on the mat with the small ball in between the knees. Ensure that you have a

neutral spine at all times. You are going to adduct your knees, pressing the ball and then

extend only one leg out so that it stays in line with the other knee. This will work the

quadriceps as well as the hip adductors. No rotation in the pelvis may occur.

Aim: Activation of the adductors and quadriceps simultaneously favouring the medial knee extensors and stabilizers.

Notes:

Supine Redondo knee press 2 Lying supine with the Redondo ball underneath one knee. The other knee is bent with the leg

resting on the bed or it is raised at a 90’ bent angel. You are going to gently press your knee

that is on the ball, into the ball. This will activate the hip extensors. You can simultaneously

extend the knee working into the quadriceps. Maintain hip, knee and ankle alignment

throughout the exercise.

Aim: Activation of hip extensors with a co-contraction of the quadriceps, therefore bringing in the element of anterior and posterior knee stability.

Notes:

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Arc rest Sitting on a mat or bed, resting your legs over an arc with your arms supporting your body.

You are going to extend one of your knees without too much changing in your pelvic position

or spine. This will be an assisted knee extension without the client or patient having to hold

their leg up with the hip flexors. You will be working the quadriceps. If the hamstrings are

tight then allow the client to lean back slightly with the support of the arms. Their spine will

be in a diagonal line and they will be able to extend their knee a little bit easier.

Aim: Activation of the quadriceps in a supported position with emphasis on posture, self-witnessed knee alignment and a gentle extension of the

hamstring muscles.

Notes:

Cadillac legs in straps or theraband extension Lying supine on the bed, you are going to work the quadriceps and hamstrings in co-

contraction. Ensure that the knee is always in alignment and that the knee cap is over the

second toe. Never hyper-extend the knees. You are going to do knee flexion to extension and

hip flexion to extension. Maintain a neutral pelvis and avoid any pelvic rotation. The pelvis will

rotate if the client is not able to maintain activation in the opposite obliques.

Aim: Co-contraction of the knee flexors and extensors with emphasis on perfect hip, knee and ankle alignment.

Notes:

Sitting to standing + magic circle and single leg • Legs together (Good VMO) or legs hip distance apart

• If you are using the magic circle then legs pressing out on the circle (Quads and hip stabilizers)

• Lifting one leg off of the floor (Unilateral quads and hip stabilizers) Maintain the patella over the second toe at all times to avoid knee rotation.

Aim: Strengthening of the knee joint for functional movements as well as encouraging hip stability throughout the movement. The single leg will encourage

unilateral stability with focused gluteal work.

Notes:

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Box sitting leg extensions Sitting on a box with a perfect posture and with the knee cap over the second toe. You are

going to maintain a neutral spine, flex at the hip as you lift the one leg off of the floor. You are

then going to extend the knee without the height of the knee changing (hamstring length will

play a role here). Ensure that they try and fully extend the knee as this will mean that the

quadriceps has reached full concentric contraction. They may not flex their lumbar spine at

any point.

Aim: A higher load of quadricep work in comparison to the supine knee extension exercises. It creates a concentric contraction of the rectus femoris as the

spine stays static (neutral) when the knee extends.

Notes:

Box step up This will mimic climbing stairs, but the correct form is vital in this exercise. Ensure that they

place the one foot on the box in a position where the knee is over the second toe, preferably

parallel if they are capable of this. The hips must stay stable and square (no jutting out of the

hip of the leg that is on the box). Their arms may be in flexion in order to ease the weight

placement. They will gently activate their gluteus maximus and medius and step up onto the

box with the use of the quadriceps. They will then need to control the movement back down.

The down is just as important as the up as this encourages concentric and eccentric work of

the muscles.

Aim: Activation of hip stabilizers (gluteus maximus and medius), hamstrings and quadriceps. Perfect alignment is very important in this exercise.

Notes:

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Standing Calves on discs (Soleus & Gastrocnemius) Standing on the discs with the feel parallel and aligned. Make sure that you client is holding

onto a pole or wall. They are also allowed to lean forward with their elbows on a bed. They

are now going to do standing calf raises with the ankle in perfect alignment and the disc must

stay dead still. You can then ask them to rotate medially and laterally with the hips so that the

disc rotates inwards and outwards. Always maintain the knee over the second toe. Do the

same with slightly bent knees as this will encourage the soleus to work more. Ankle alignment

and stability is always important when working on knee stability. Please be careful of rotation

at the knee joint if your client has had a meniscus injury.

Aim: Working the gastrocnemius which originates over the posterior knee joint to the femur, also emphasising alignment of the hip, knee and ankle.

Notes:

Knee stretch knees off – supported if necessary

(not for anterior cruciate ligament tears)

In the four point kneeling position. Ensure that your hands are directly under your shoulders

and your knees are directly under your hips. Do a slight posterior tilt with the pelvis just to

ensure that the abdominals stay activated and the hip flexors do not pull the pelvis into an

anterior tilt. Maintain shoulder stability and gently hover your knees off of the floor. The

height will depend on how weak the quadriceps are eccentrically. The higher the knees, the

easier the exercise is. You may hold this position for a period of time that the client is able to

cope with.

Aim: Eccentric quadricep activation to regain eccentric quadricep strength. Spinal position is important as the exercise should not be felt in the back but

rather in the abdominals and the quadriceps.

Notes:

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Remember that alignment and constant feedback from your client is very important. Various injuries could require all or only a few of the above exercises. If the exercise hurts then it should not be done. Remember the steps of restoration or improved joint health:

❖ Consult a doctor or physiotherapist for a diagnosis and get a report if required. This is very important as it assists you with the program that you are designing and assists with any legalities should they arise. Ensure that the professional sends you details of what they would like you to focus on and what they would like you to avoid. If they do not send a comprehensive report, ask them to please re-send the report with specifics of what they would like you to do and what you may not do.

❖ Incorporate alignment as your main factor for

efficient stability.

❖ Get the knee moving once the doctor / physiotherapist says you can (ROM). This needs to be in small ranges with no resistance. This is true for both injured and general unstable knees. Remember to assess the knee as it moves in flexion and extension if these movements are allowed.

❖ Identify the problem area/s and its imbalances. Make comprehensive notes of what the imbalances are and what you need to do to overcome them. Remember this requires a mind-body connection and therefore it will take time to get the knee to mobilize to the extent that you require.

❖ Start with non-gravity exercises. Assess whether you

need to work the muscles eccentrically or concentrically. This will affect the position that you will put the client in. Make sure it is low load and in small ranges initially. Alignment is vital

❖ No incorrect muscle mechanics may occur at any

point as this will encourage and reinforce negative movement patterns.

❖ Concentrate on the correct recruitment of muscles in

order to avoid compensatory muscles from dominating the movement

❖ Avoid any pain during the movement

❖ Eccentric / concentric contractions: it is extremely

important to incorporate eccentric and concentric contractions when strengthening the knee joint.

❖ Once the stabilization is improving, you can start to

do exercises that have resistance and are slightly weight bearing and then progress this to higher load training maintaining alignment at all times.

❖ Emotional support. Often ignored but results can be

slowed down by frustration, pain, depression and restriction.

Conclusion

Steps during rehabilitation process

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References

S. (Director). (2017, February 28). 4 Knee strengthening exercises[Video file]. Retrieved April 15, 2017, from https://www.youtube.com/watch?v=EhZSS2qYrJ4

4 knee stability exercises

Mercer, L. (n.d.). Knee stabilizing exercises. Retrieved July 12, 2018, from S. (Director). (2017, February 28). 4 Knee strengthening exercises [Video file]. Retrieved April 15, 2017, from https://www.youtube.com/watch?v=EhZSS2qYrJ4 4 knee stability exercises

Knee stability exercises for home

Thompson, T. (2018). Pilates Unlimited - The Art of Movement Equipment Course(1st ed., Vol. 1, Updated 2018). .Pretoria, Non US: Pilates Unlimited. This book covers hips, shoulders, knees and spines in relation to all 5 movement principles

Thompson, T. (Director). (2018, September 28). Knee stability[Video file]. Retrieved September 28, 2018, from https://www.youtube.com/watch?v=y7nDVJiIzbc

Effective knee stability exercise for Rectus Femoris

Thompson, T. (Director). (2017, October 15). Modified Squats[Video file]. Retrieved October, 2017, from https://www.youtube.com/watch?v=yn-psu31njs

Higher load squat to improved loaded knee stability

Fletcher, J. (2017, September 9). Ten common knee injuries and treatment. Retrieved October 12, 2017, from Ten common knee injuries and treatment

Common knee injuries

Levangie, P. K. (2011). Joint structure and function(5th ed.). Philadelphia, US: F. A. Davis Company. Anatomy of the joints and their function

Knee stability WOW factor - Of-Course Online · Outline of course: The knee stability wow factor. As we age or do specific sports, our knees take a lot of strain which results in

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