Introduction
Knee injuries are among the most prevalent musculoskeletal injuries in sports. Statistics indicate that knee injuries constitute 10-25% of all sports-related injuries. Research has demonstrated that specific exercises can significantly reduce the risk of knee injuries. This post highlights the importance of preventing knee injuries for all athletes, from elite competitors to weekend warriors.
Understanding the structure of the knee and mechanisms of injury
The knee comprises of several crucial components:
Ligaments- the ACL, PCL, LCL and MCL are the four main ligaments found within the knee. Damage to these ligaments occurs through sudden changes in direction
Menisci- These cartilage structures act as shock absorbers between the main bones of the knee joint and may be damaged through degeneration.
Tendons- the patellar tendon and quadriceps tendon are the two main tendons in the knee and may be damaged as a result of repetitive actions
Understanding the most common causes of knee injuries
In order to prevent knee injuries it is important to understand their most common causes:
- Improper technique- incorrect form during exercise or sport may lead to injury
- Overuse- repetitive motions may effect the knee joint and its surrounding tissues
- Muscular imbalances- altered strength ratios between the main two muscle groups surrounding the knee joint, the hamstrings and quadriceps may result in injury
- Underlying health conditions- conditions such as osteoarthritis (OA) may lead to degenerative changes around the knee joint leading to injury and pain
Identifying the root cause of a knee injury is crucial for effective prevention and mitigation.
Essential exercises for stronger knees
Evidence- based programmes for knee injury prevention focus on five main areas:
| Strength | Plyometrics | Flexibility | Running | Core stability |
| Squats
Lunges Nordic curls | Vertical jumps
Single leg hopping Lateral jumps | Quadriceps
Hamstrings Hip adductors Hip flexors Calves | Forward
Backward Zigzag Changing direction Bounding | Plank
Side plank Copenhagen plank |
Tips when completing the above exercises:
- For strengthening exercises repeat exercises for 3 sets of 8-12 reps ensuring proper form and cushioning on the knees when performing Nordic curls
- For flexibility exercises, if using static stretching hold to stretch for 20s for sufficient lengthening
- For core stability exercises ensure pelvis is in alignment with the rest of the body, avoid dipping and compensating by shifting the weight
Prevention exercises should be performed for at least 20 minutes multiple times a week (2-3 times weekly).
The importance of proper warm up and cool down routines
Research shows that a proper warm up will raise body temperature and alter the viscosity of body tissue, requiring a greater force and length of stretch to tear a muscle. A warm-up may consist of:
- Cardiovascular warm-up: jogging backwards, forwards, high knees
- Dynamic stretching: leg swings, side lunges, walking lunges, dynamic calf stretch
- Sport- specific drills: forward backward double jumps, lateral single leg jumps while passing a ball etc.,
A cool down should include light jogging and static stretching focusing on the glutes, hamstrings and quadriceps to lengthen and prevent stiffness in the musculature surrounding the knee.
Choosing the right footwear for knee support
The selection of the correct footwear will vary depending on the activity. Ensure that the choice of shoe supports the type of activity and terrain being trained on and does not alter the position of the foot leading to alterations of forces travelling up the foot. The general things to look for in running shoes are:
- Good heel support
- Adequate cushioning
- Flexible midfoot
- Proper arch support
Tips for maintaining healthy knees during physical activity
- Pacing activity: gradually increase the intensity, load and duration of activity
- Allowing adequate recovery time: ensure sufficient rest between sessions
- Proper technique: using the correct form to reduce stress on the knees
- Supportive gear: use knee braces or supports if deemed necessary, especially during contact and high- impact events
Closing
The prevention of knee injuries is essential for all athletes and active individuals. Understanding the key structures of the knee and the common mechanisms of injury helps in recognising the importance of proper technique, addressing muscular imbalance and managing underlying health conditions. Through the incorporation of targeted exercises that focus on strength, flexibility, plyometrics, running and core stability we can build resilient knees, less susceptible to injury.
By integrating the above strategies into your routine, you can significantly reduce the risk of knee injuries, ensuring pain- free activity, better performance and better overall joint health.
Call to action
Although rehabilitation is a specialty at RISE, it is crucial to focus on preventing injuries before they occur. Book an appointment now with any of the experienced physiotherapists and strength and conditioning coaches for a consultation, and to be provided with a tailored session aimed at reducing your chance of injury and boosting your performance.
Written by our own Rise Physiotherapist, Lara Bonello.
Should you wish to book an appointment with Lara, book your appointment here:
Sources:
- Arundale, A.J.H., et al, 2023. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy, [online] 53(1), pp.CPG1-CPG34. Available at: https://www.jospt.org/doi/10.2519/jospt.2023.0301
- Daneshjoo, A., et al., 2013, Effects of the 11+ and Harmoknee Warm-up Programs on Physical Performance Measures in Professional Soccer Players. Journal of Sports Science and Medicine.
- Donnell-Fink, et al., 2015. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLOS ONE, [online] 10(12), p.e0144063. Available at: https://doi.org/10.1371/journal.pone.0144063
- Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention: Clinical Practice Guidelines 2018 Academy of Orthopaedic Physical Therapy and the Journal of Orthopaedic & Sports Physical Therapy