Wednesday, October 26, 2011

Preventing Knee Injury with Kettlebell Therapy

As I have received a lot of questions regarding knee health in the past months, I felt that addressing a couple basic screening tools and a corrective exercise to begin the path of achieving knee health would be a great topic for Kettlebell Therapy.

The knee joint is the unlucky cousin of the ankle/foot and hip.  The muscles of the hip act as a controlling guide-wire to the orientation of the femur itself.  In stance, the muscles in the ankle/foot control the orientation of the tibia. Therefore, the movement of the knee is dependent on the control at the ankle/foot as well as the strength in the hip girdle.

As discussed in the Functional Wall Squat posts, the proper mechanics of the knee in normal ambulation or squatting is that of having the knee itself follow the path of the toes, free of any knock kneed or bow legged postures.  However, it is within the window of normality to see some amounts knock kneed and/or bow legged postures in a healthy individual.  It is when these postures are accompanied with functional deviations that we then become at higher risk for injury.

Here are two screening tools for the knee:

Thessaly’s Test

This special orthopedic test is typically used by Physical Therapists and Orthopedic Surgeons to screen out meniscal tears of the knee. It is a very sensitive and specific test when done in 20 degrees of knee flexion and is quite reliable for screening out tears. Any catch or reproduction in pain is a positive test. If this is indeed positive, a medical referral may be recommended prior to further exercise.

The Drop Vertical Jump

Functionally, the knee can be stressed in several dimensions during activity.  The Drop Vertical Jump is a clever way to screen for weak hip external rotators and weak hip abductors during landing (eccentric squatting) which is basically asking for an ACL tear sometime in the future. A positive screening would be a landing with internally rotated and adducted (knock kneed) femurs. This can also screen for weakness at the ankle/foot which would result in excessive pronation during landing.

Here is how to do it:  Have person jump off of a box and land, controlling their descent. While there are variations at various performance levels, the analysis is largely the same.  The important data is checking for dynamic control at the knee which informs us of the strength and coordination at the hip and ankle/foot.

 Genu Valgum Deviation

Pronation Deviation

If this screening tests out positive, the “High Knees” exercise is a great place to start as a corrective measure. To learn more about “High Knees”, take a look at our article as published by the Physical Therapy Web Space under the section “To address hip abduction: High Knees”

Something that I constantly stress to my patients, clients, and students is that our bodies are perpetual victims of earthbound gravity. As the human body mostly functions in a bipedal mode, it is important for us to see our functional movements from a ground up perspective. For the knee, this means we must give special attention to the mechanics at the ankle/foot as it is the primary point of contact and foundation for our function in stance.

Coming up: Blasting Abs With Kettlebells. In my next post, I will introduce some foundational aspects of combining mat exercises with kettlebells.

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