Knee Pain: What You Need to Know About the Core to Prevent Knee Injury – Part 4

By djpope

April 20, 2012

abdominals, abs, anterior pelvic tilt, core, Crossfit, dan pope, genus valgus, injury prevention, Janda, knee injury, knee pain, Lower Crossed Syndrome, strength training, Stretching

Annie’s got some abs

If you’re still following this series so far then kudos to you!  We’ve discussed some pretty complex bio-mechanics of the foot, knee and hip.  Hopefully you aren’t too confused.

If you missed part 1 where we explain how the hip and foot affect motion at the knee click HERE:  In part II we spoke about addressing the foot to troubleshoot problems that may occur at the knee.  You can find that article HERE:  In the third installment we discussed the hip’s role in knee biomechanics.  Check it out HERE:

I apologize but I’m about to make things even more complex.  Drumroll please….

The core also affects the knee. 

Big surprise right?  Now I bet you’re getting the idea that everything above or below the knee is going to have some affect on the knee.  Here’s how the core comes into play.  It all starts with the pelvis.  The pelvis is a bowl shaped bone that sits between your hips.  Your spine and femurs (thigh bones) attach directly into the pelvis.

The Sexiest Bone in the Body, the Pelvis

Muscles attach to the pelvis in all different directions.  These muscles directly affect the position of the pelvis.  We can influence the position of our pelvis by strengthening certain muscle groups and lengthening(stretching) others.

What we’re concerned with is anterior and posterior tilt of the pelvis.

Hopefully this picture can help illuminate this phenomenon

For the athlete, we want to keep a neutral position that is somewhere in between a large anterior tilt, and a large posterior tilt as shown in the image above.

Unfortunately, a lot of athletes end up with an anterior tilt of the pelvis.  An anterior tilt can put some crappy forces across the lower back that leads to back pain and it can also affect the knee.  Anterior Pelvic Tilt is part of a disorder called  lower crossed syndrome, a term popularized by the late Dr. Janda.

Lower Crossed Syndrome – Thanks Janda

As we can see from the image above our lower crossed patient is in need of some glute and abdominal strengthening coupled with iliopsoas and erector spinae stretching in order to rotate the pelvis back to a normal position(good posture).

***Keep in mind that not everyone is going to have a lower crossed syndrome and some will have different specific areas they’ll have to work on to promote balance.  Lower Crossed Syndrome is just a common problem seen in many athletes.

At this point you’re probably asking, well how does this happen to affect my knees?  It’s difficult to conceptualize but check out my video again about how the hip and foot affect the knee.  Fast forward to 1:00 and watch.

When I squeeze my butt muscles I’m also posteriorly rotating my pelvis.  You can’t see it from the front view but its happening.  As I squeeze my glutes and rotate my pelvis posteriorly(or back to neutral if I’m anteriorly rotated at rest) my knees are also pushed outward into a healthy position.

Final verdict:

  • Lower Crossed Syndrome(Anterior pelvic tilt) = Knee in/genus valgus position = bad

So how do we fix the problem?

1. Strengthen the Glutes, Hamstrings and Abdominals

Posterior Rotation of the pelvis, or in the lower crossed patient, getting back to neutral.

As you can see, if we can get these muscles to be more active at rest and with movement they are going to help us stay in a better pelvic position and save our knees.

Fortunately for us we’ve already gone over several exercises to strengthen the glutes and hamstrings in the hip article previously.  You can check these out HERE:

In addition to strengthening the glutes and hamstrings, you’ll need to hit the rectus abdominis and oblique muscles of the abdomen.  I’m a big fan of Plank Exercises and Dead Bug variations to help strengthen the abdominals:

Dead Bug:  Make sure to keep your lower back flat against the floor

Plank Variations:

For the advanced athlete, stir the pot:

Finally, The Chop popularized by Gray Cook.  This exercise is awesome because it combines the abdominals and glutes in a functional position.

2. Stretch the Hip Flexors and Erector Spinae

Hip Flexors are chronically tight in most people, especially those who sit for a good portion of the day.  My favorite stretch is a deep lunge with a band for a bit of an added stretch.  I first saw this stretch from Kelly Starret but couldn’t find his video demonstrating the exercise but the video below illustrates it perfectly.  Try to keep your pelvis rotated posteriorly and squeeze your glute on the side where your knee is down to ensure you’re stretching your hip flexor and not further extending your lumbar spine.  You should feel a stretch in the front of your hip on the leg where your knee is down.

When it comes to stretching the erector spinae into flexion I’d be cautious.  Those with a history of disc herniations or pain in this position should stay away from this stretch.  If anyone is familiar with Stuart McGill’s work you’ll know he has made popular the notion that those with more lower back flexibility are more at risk for lower back pain.  That being said, the child’s pose does not put the spine into any extreme ranges of motion yet accomplishes our goal of gently lengthening the erector spinae.  Here’s a pretty good demo video:

Stay tuned next week where we discuss how the pinky effects the knee.  Kidding!  Seriously though, if you’ve made it through this series and can understanding the topics presented here you’re well on your way to saving either your own or someone else’s knees.   If you have anything else to add to this discussion or you just think I’m crazy in general please let me know!

Yours in good health,

Dan Pope

P.S. Remember this information is not to be used for the diagnosis or treatment of  knee problems.  Consult a professional if you are concerned you may have some type of knee injury.

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