1. Get Stronger, 2. Get Faster, and (most importantly) 3. Don’t get hurt! The knee joint takes a brutal pounding in sports. This article considers ways to prepare the knee for training and reduce knee imbalances. It’s no secret that sitting at a desk all day effects joint structure by altering the elasticity of the surrounding components the longer the joints aren’t used. Establishing more equal strength between (a close to 1:1 ratio) quadriceps to hamstring strength, we see lower injury risk and less pain at the joint. Looking at elite sprinter knee joints, there’s strong evidence of greater hamstring strength yielding faster top end speed and speed endurance. Not to mention, creating equality 99% of the time means that we’re going to have to (in most cases) bring up hamstring strength. When sitting, the muscles behind the knees are taught to remain in a shortened state leading to losses in flexibility and strength. We must look at these imbalances being trained throughout the day and fix it in the weight room before those slight imbalances become magnified and lead to pain or injury.
As muscle tissue becomes more regularly used, it promotes elasticity within the muscle body, tendons, ligaments, and synovial fluid within the knee joint. The more rigid the tendons become from inactivity, the less force they will absorb by becoming rigid and less springy which puts greater stress on the joints. Ligaments need elasticity to be able to take sudden changes of force across the joint and strength training helps create that elasticity, especially through movement variation so that the ligaments maintain elastic strength from different angles. Synovial fluid becomes less viscous with movement. The less we move, the viscous knee lubricant leads to a harsher movement as the knee angle changes. This can be attributed to how a joint feels after a warm up (smooth and loose) vs. how a joint feels after sitting for a long period of time (creaky and unstable).
The warm up plays a vital role in joint health. The warm up literally warms up the muscle tissue and makes it more pliable, brings up the elasticity of the tendons, decreases joint viscosity to provide a smooth lubricant between moving bones, and clearly prepares the joint to absorb force with a decreased risk of injury. A little 5 minute warm up of walking on the treadmill is not enough to get the joint warm. Different tools like foam rollers, massage sticks, dynamic movements, or replicating less intense movements (dynamic movement) that will be done in the work out are extremely helpful.
Foam Rolling helps make muscle more pliable by pressing out contracted patches of tissue. The pressure from foam rolling and massage sticks puts a stress on the muscle that is quickly detected by nerves to help relax the muscle tissue. This releases muscle tissue that have had to compensate in incorrect movement patterns, has been overused, or have been energy deprived. The foam rolling also increases blood flow to the local area. All of these changes are occurring at the same time during foam rolling. In most cases I recommend that healthy individuals foam roll or use a massage stick for 10 reps on each muscle that’s about to be worked out. Following foam rolling, dynamic movements that closely replicate what the individual will be doing in the work out is helpful to warm up the joint itself. Both the joint and surrounding musculature must be warmed up (surrounding musculature provides stability and a warmed up joint provides a smoother gliding motion between bones). To get the blood flowing for more metabolic demanding work outs like HIIT, long distance running/biking, or even bodyweight training, a 10 minute warm up of some kind of easy cardio is helpful to get the body functioning as one unit. I usually use some sort of steady cardio-style warm up for individuals on these days with tools like the Assault Bike, Rower, or easy jogging depending on the movement the individual will be doing during the work out. The warm up should never leave you exhausted but you should feel prepared for great levels of effort in the work out. It’s important to note that this 10 minutes of easy cardio-style warm up is not the same for everyone. Some people may feel warmed up after 3 or 4 minutes (i.e. powerlifters prior to doing HIIT or weightlifters warming up for a circuit), whereas some others may need closer to 15 minutes of easy movement (i.e. runners). It depends on the person, sport, training day, etc. The warm up prepares the athlete by relaxing them into movements so they can optimize muscle activation, helps increase circulating hormones, helps get individuals into the right mindset, and starts up the energy systems that will be used in the work out. This must be a very efficient time and should be developed based on what the individual will be doing. I.E. if you’re doing heavy deadlifts, it doesn’t make sense to run for 12 minutes because you’ll dissipate the metabolic substrate you’ll need during the lift and the musculature may be less responsive when being called for a heavy movement OR if you’re about to run 8 miles in preparation for a long distance event, only foam rolling isn’t going to have you prepared to utilize oxygen absorption, prepare your cardiovascular system for advanced exercise function, or have the leg muscles around the knee ready to work in a high volume capacity. In summary, training specificity is needed in the warm up. This will help the knee joint transition from a period of rest to ready for training.
The work out itself (with regard to knee balance goals) should be approached with larger muscle movements first. This is going to help the knee function as a single unit rather than only giving priority to certain muscles. Think triple extensions, squats, deadlifts, lunges, etc. Then, as the work out progresses, smaller movements that emphasize weak points find their place to help correct imbalances. This tends to be the most traditional strength and conditioning approach to maintaining muscle balance. However, if you know any imbalances going into the work out then one weak point can be targeted with a specific exercise before beginning large movements to get that specific musculature responding well to movement with hopes of greater motor recruitment during the suffering larger movements. I.E. Activating the glute medius with belt squat walks prior to squatting movements to activate weak glutes OR -more specifically for this article- activating the hamstrings before going into a squat movement to help better stabilize the knee joint. I’ve actually found that doing hamstring targeted movements like leg curl variations may help people with knee pain during other movements like squats and lunges. The hamstrings play a large role in lower body movements and must be able to stabilize the knee against the quadriceps force production. This is only a brief description of ideas to apply into your program if you’re having any kind of knee pain and general ways to prevent knee pain – this information can also be applied to other joints.
The cool down is also important in helping the knee joint return to a resting homeostasis and helping to bring new oxygenated blood into the areas around the joint structure. This is another great time for foam rolling. There’s no doubt that muscle tissue is still activated at the end of your work out and needs to return to a normal pliable state – this will help with recovery and continue to bring in new blood to aid in the recovery process. Prior to foam rolling, I like to use some kind of easy movement for a few minutes. Using dynamic movements will reiterate and reconnect the kinetic chain if there were any primary focuses during the work out which will help you feel more balanced across your body. Also in this fatigued state, purposeful total body movements will lead to greater coordination and balance in subsequent training days. Easy cardio-style movements like biking or light jogging play an excellent role in bringing the body’s cardiovascular system back to regular functioning by providing a smooth transition in blood pressure, heart rate, and blood flow (localized muscular blood pump back to the constricted organs like the intestines and stomach) function. In the knee’s fatigued state, this is a great time to consciously think about activating musculature that you want to gain greater activation. I.E. While on the bike, actively think about using the hamstrings to move the pedals if you are quad dominant or when jogging use a “butt kicking” sequence to emphasize hamstring recruitment. These small emphases will help you be better at activating those weak points and allow you to bring up strengths in the long haul.
Knee joints tend to be taken for advantage and the musculature along the back and front sides should both be considered necessary without one over dominating the others. Your takeaway for today? Build stronger ham strings. Step 1 – Balance your imbalances. Step 2 – Build a base. Step 3 – Get those muscles strong together. This will lead to a more stable, healthy joint and the ability to increase strength while decreasing the potential for pain or injury.