Prevent Knee Pain – Sun 12.18.16

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The ‘Bare Essential’ to Preventing Knee Pain

Article written by Cameron Josse
Physical Preparation Specialist, DeFranco’s Gym

This is just a portion of the article.  The full article can be found HERE

 

A Joint-By-Joint Approach to the Ankle & Knee

Mike Boyle’s “Joint-By-Joint Approach” is one of the most concise and simple approaches anyone can take to examine how their body operates in a stability/mobility relationship among joints. If you are unfamiliar with the Joint-By-Joint concept by Boyle, I encourage you to take a look at it. It can be found here. What the model shows is an alternating pattern of different joints that either tend to tightness and immobility or instability and weakness.

Joint-by-Joint-slide1

When it comes to the distal lower extremities, the ankle will tend to immobility as the knee will tend to instability. However, because our foundation is built from the ground up and our feet support all of the superior structures, the immobility at the ankle is, more often than not, the culprit in effecting knee stability.

Hunting Out the Kink in the Kinetic Chain

Taking the logic of the Joint-By-Joint Approach, we can create a cause/effect relationship among different parts of kinetic chains. Kinetic chains are segments of the body utilized in sequence to perform complex movement patterns.

When specifically discussing the ankle and the knee, what we can observe is that as the ankles become progressively more immobile, the body will then search and hunt for another location that it can find the mobility that it needs to serve a given function.

Because the ankle is inhibited due to immobilization, the next best stop along the chain is the knee. But here’s the problem: We now have a joint that serves a primary function of stability becoming unstable and weak because it is being forced to absorb the stress that the preceding joint was unable to conquer. Voila – a stable joint slowly becomes a hypermobile joint. The knee is then forced to compensate and do a job that it was never primarily meant to do and knee pain is just the next chapter in the story.

The Sight of Pain vs. the Cause of Pain

As we should all know by now, local pain is often the result of a distant cause. Going along once more with the Joint-By-Joint Approach, we can see that a dysfunction in one area can affect other areas above or below it. Let’s take the previously stated example. The knee progressively develops pain as a result of compensating for an unstable ankle. The pain is felt in the knee but the real cause is the unstable ankle. If the ankle can become mobilized, then there is a good chance that the knee pain will gradually begin to dissipate.

Restoring function to a weak link in the kinetic chain will then allow for the surrounding links in the chain to function as they should. So, restoring full mobility at the ankle joint will allow for the knee to take on its primary role of a stable joint. The ankle will successfully absorb the necessary forces associated with different movements and the knee won’t have to do the ankle’s job.

How Do I Know If I Have Full Ankle Mobility?

Allow me to make a quick comment regarding knee pain. Despite what I have stated above; there are, of course, cases of knee pain in which the ankle is not the issue. Taking the logic of the weak link in the kinetic chain, the pain could be coming from somewhere else or could be trauma-related. However, being able to restore full ankle range of motion can only help alleviate any knee pain that may be present.

So how can you tell if your ankles are well-suited to handle force and stress in different scenarios?

One way could be to visit a clinical specialist who performs a bunch of different tests around your ankle (dorsi-flexion, plantar flexion, supination, pronation, etc.) and measures the degree at which the ankle moves. This is arguably the most efficient way of determining full range of motion around the ankle joint.

“Hey, that sounds great but I really don’t want to make an appointment or go through that kind of trouble just to see if my ankle is working well. Isn’t there just something I can do at home?”

 

Lucky for us, mobility master Kelly Starrett has a quick and easy test to measure the function of the ankle. If you can successfully lower yourself into a pistol squat and maintain that position, then you have full range of motion at the ankle. As Kelly says, “there’s nothing that we do as human beings that requires more ankle range of motion than being in a good, stable pistol position.” Needless to say, if you pass this test then your ankles are pretty solid and ready for movement.

To perform the test, set your feet about one fist width apart with your feet parallel to each other and toes facing forward (see pic below).

Pistol_setup_front_side

Next, lower your hips into a very narrow squat (if your ankles really suck then you won’t even be able to do this part). Then, pick one of your feet up and extend the leg straight out in front of you and try to maintain your balance on the foot that’s on the ground. If you can maintain this position then your ankles have full range of motion and likely won’t be a factor in effecting knee pain.

full_pistol_front_side_

NOTE: If you’re a bigger guy who thinks you can’t get into this position just because you’re big, take note that the guy in these photos is a 5’10” 275 lb. powerlifter. In other words, “being big” isn’t an excuse.

Ok, I Checked My Ankles and They Suck…What Can I Do?

There are plenty of ways that ankle mobility and range of motion can be restored. Taking time to slowly work the ankle through different mobility drills pre and post-workout are common among strength programs and are a great way to help bring the ankle back to full throttle. Another option is soft tissue work to help restore the surrounding fascia and different sliding surfaces around the foot, ankle, and knee. But a very simple and effective way of helping to restore ankle mobility is to simply remove your shoes during lower body training sessions.

HHH_yoke_in_vibrams
One of the very first changes Joe DeFranco made to WWE superstar Triple H’s training was getting him to train barefoot (or with “minimalist” footwear). Triple H has stated that training barefoot has been the key to improving his ankle mobility, while drastically reducing chronic knee pain. 

Barefoot training has been used by tons of people who advocate its use and when it comes to foot/ankle function it’s pretty hard to beat. Without shoes, your foot and ankle are able to perform as nature originally intended. It is quite a unique experience to go from squatting or lunging for years with shoes to trying it without them. Most people immediately realize the weakness in the soles of their feet and the immobility at the ankles.

I originally started this trend with my athletes during their lower body warm-ups only, but I have now shifted to keeping the shoes off for all lower body exercises. The exceptions to this notion are exercises of very high ground reaction forces such as sprinting or high-intensive jump variations. But all forms of squatting, lunging, deadlifting, and low-intensive jumping or skipping can be performed without shoes and serve the athlete well. The issues of implementing ankle mobility drills or prehab take care of themselves and it serves as a simple and time-effective way of helping your knees by helping your ankles.

Things to look for when training the lower body without shoes:
  • Foot Positioning: a natural arch must be maintained while performing activities such as squatting or lunging. A foot that is too far supinated can cause the ankle to roll and sprain and a foot that is too far pronated can throw off the entire kinetic chain on the way up.
  • Knee Positioning: a common fault in performing activities with or without shoes is that the foot will tend to pronate which will then cause the knee to collapse inward. Cue the athlete to keep the kneecaps out toward the outer half of the foot which will put the knee in a safer position and will likely result in the foot attaining a natural arch.
  • Hip and Torso Position: Even if the foot and ankle are in perfect positioning, the hips can tend to be lopsided which will then throw off the torso and, consequently, the center of mass. The athlete must maintain proper positioning throughout the entire body, starting with the feet and finishing with the hips and torso.
3_foot_positions_w_TEXT
                                                                                      

It’s always a shame to see athletes hindered by nagging chronic pain or injury resulting from years of cumulative stress. The knee is subject to a lot of loading whether you are a strength athlete or a field athlete and it must be kept as healthy as possible.

Without shoes, your ankles are unrestricted in all degrees of movement. Barefoot is the simplest and most time efficient way (training economy) of mobilizing the ankle, which will have a positive impact on the knee.

If we can take small and simple approaches to helping the body function as it should, then we will find ourselves on the right path to fulfilling long, healthy competitive careers. Training can only be effective if it takes place in a sound environment – it should not be adding insult to injury.

Get your ankles right and your knees will thank you!

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