Kathryn Tionko

The Solution to Knee Injury and Pain Pilates Training for Knee Rehabilitation The Solution to Knee Injury and Pain Table of Contents Overview 3 Introduction 4 Anatomy of the Knee 5 Knee Joint 6 Femur 7 Patella 8 Cruciate Ligament 9 Collateral Ligaments 10 Sports-related Knee Injuries 11 Knee Pain 12 Jumper’s Knee 13 Osgood-Schlatter’s Disease 14 Popliteal Cyst 15 Iliotibial Band Injury 16 Anterior Cruciate Ligament Injury 17 Posterior Cruciate Ligament Injury 18 Housemaid’s Knee 19 What is Pilates? 20 Principles of Pilates 21 Pilates for Strengthening the Knee 22 - 23 Pilates for Strengthening the Leg 24 - 29 Other Forms of Exercises for the Knee 30 - 33 Benefits of Pilates 33 Tips on How to Prevent Knee Pain 34 - 39 Page 1 of 39 The Solution to Knee Injury and Pain Overview Knee pain affects a great number of the population and will possibly turn into an even significant clinical challenge with incidents of sports related injuries and obesity getting higher. Physiological and symptomatic assistance using some of the common medical rehabilitations may be inadequate as a result of their ineffectiveness and unusual side effects. Pilates exercises are one of the fastest developing trends in health. They offer safe and effective techniques to manage knee pain. When practiced consistently, Pilates may produce various health benefits and advantages. These health benefits may differ from one person to another depending on the regularity and intensity of practice. Page 2 of 39 The Solution to Knee Injury and Pain Introduction to the Solution to Knee Injury and Pain Knee injuries have been the common and most highly publicized occurrence among athletes. Sports involving physical contacts often lead to injuries of muscles, joints, or ligaments. The most common conditions that lead to injuries in Gaelic football games are collision, 22%, and twisting/turning, 19%. Both situations cause stress on the knee and predispose the knee to injury and severe damage. Lower limb injuries are major occurrences in leading Gaelic footballers, accounting for 77% of all physical injuries. Thirty two percent of these injuries take place to either the knee or ankle ligaments, and 16% of these occur on either knee or ankle tendons. Once the knee is injured, more than one structure is typically included. Any strength substantial enough to harm one structure can create damage to other structures also. Anatomy of the knee, most common knee injuries, and knee rehabilitation using Pilates exercises are described in this book. Page 3 of 39 The Solution to Knee Injury and Pain Anatomy of the Knee Page 4 of 39 The Solution to Knee Injury and Pain Knee Joint The knee joint may look simple but underneath that simplicity is a complex form of joint. It is said to be the largest and the most amazing, yet also the most abused joints in the human body. The knee joint is made up of three parts: A. Medial Condylar Joint which is located between the medial condyle of femur and the medial condyle of the tibia. B. Lateral Condylar Joint which is located between the lateral condyle of the femur and the lateral condyle of the tibia C. Patellofemoral Joint is located between the patella and the patellar surface of the femur. The patella or kneecap serves to protect the front part of the knee. The joints in the knee work together to create a modified hinge joint that do not only allow flexion and extension movements, but also rotation and side to side movements. The knee joint bears the weight of the body. When a person is in a sitting position, the tibia and femur barely touch. But when the person is in a standing position, the tibia and femur lock together to form a stable element. Page 5 of 39 The Solution to Knee Injury and Pain Femur The femur is the longest and strongest bone found in the thigh area that extends from the hip down to the knee. The average adult human femur measures 48 cm (19 in) in length and 2.34 cm (0.92 in) in diameter. The femur can support up to 30 times the weight of an adult. It can resist forces of 1,800 to 2,500 pounds. Hence, it is not easily fractured. Car accident or a fall from an extreme height can result to a break in the femur. Femoral fracture can take three to six months to heal. Page 6 of 39 The Solution to Knee Injury and Pain Patella A saucer-shaped bone located at the front part of the knee. It serves to protect the femoral end, thighbone, and the tibia (the large bone of the foreleg). The kneecap glides up and down as the leg bends and straightens. Page 7 of 39 The Solution to Knee Injury and Pain Cruciate Ligaments Cruciate ligaments are the major stabilizers of the knees. This is commonly injured by sudden twisting movements. It is made up of two types: A. Anterior Cruciate Ligament - prevents the tibia from sliding out in front of the knee by resisting anterior translation and medial rotation of the tibia B. Posterior Cruciate Ligament – prevents the tibia from sliding backward by resisting posterior translation and lateral rotation of the tibia Posterior cruciate ligament is broader and stronger than the anterior cruciate ligament. Page 8 of 39 The Solution to Knee Injury and Pain Collateral Ligaments The collateral ligaments functions like ropes at the sides of the knee, protecting it against forces which would tend to open it or move it sideways. There are two types of collateral ligaments in the knee: A. Medial Collateral Ligament (MCL) - runs between the inner surfaces of the femur and the tibia and works by resisting forces acting from the outer surface of the knee valgus forces. B. Lateral Collateral Ligament (LCL) - travels from the outer surface of the femur to the head of the fibula and works by resisting impacts from the inner surface of the knee varus forces. Page 9 of 39 The Solution to Knee Injury and Pain Sports-related Knee Injuries Page 10 of 39 The Solution to Knee Injury and Pain Knee Pain Definition: Knee pain is one of the most common orthopedic problems occurring among athletes. It can be associated with overuse or gradual onset and acute or sudden onset. Runners are prone to knee pain. When stresses on the knee are repeated for a number of times without giving room for recovery, then pain gradually occurs. Knee pain is considered acute when there is pain and inflammation. Runner's knee is also known as patellofemoral pain. It is common in athletes like runners, cyclists, skiers and soccer players. Kneeling and stair climbing, squatting, and sitting for a prolonged period should be avoided. Common causes of knee pain in runners: •Iliotibial band •Patella pain syndrome •Patella tendon pain •Popliteus injury Signs and symptoms of knee pain: •Difficulty in walking on the affected side •Injury that causes deformity •Pain occurring at night and or while resting •Pain that persists for days •Difficulty in bending the knee •Swelling of the calf area or in areas surrounding the joint •Fever •Redness •Warmth Page 11 of 39 The Solution to Knee Injury and Pain Jumper’s Knee Definition: It is a common condition that causes pain in the anterior part of the knee. It is an overuse injury resulting to repetitive overloading of the knee extensors. Jumper’s knee also happens when the patella tendon / ligament joins the kneecap (patella) to the shin bone or tibia. This tendon is extremely strong allowing the quadriceps muscles to straighten the leg in jumping in order to propel the individual off the ground as well as functioning in stabilizing their landing. Jumper's knee is most common in weight lifters, football, cricket, tennis, and badminton players. It is also known as quadriceps tendinopathy. Common causes: •Intensity and frequency of physical activity •Being overweight •Tight leg muscles •Misalignment of the leg •Raised knee cap Signs and symptoms: •Pain at the bottom of the kneecap or patellar tendon •Swelling in the knee joint or •Pain while jumping, running, or walking downhill or downstairs •Pain with bending or straightening the leg. •Tenderness behind the kneecap. Page 12 of 39 The Solution to Knee Injury and Pain Osgood-Schlatter’s Disease Definition: Osgood Schlatter disease is a common cause of knee pain in children and young athletes between 10-15 years of age. Young adolescents who play in certain sports, including soccer, gymnastics, basketball, and distance running, are most at risk for this disease. Common causes of Osgood Schlatter: •Repeated exercise •Excessive, repetitive pulling of the quadriceps muscle on the patellar tendon attached to the tibial tuberosity Signs and symptoms: •Pain above and below the knee which worsens during strenuous activities •Tenderness in the tibial tuberosity Page 13 of 39 The Solution to Knee Injury and Pain Popliteal Cyst Definition: It is a firm, walnut-sized, fluid-filled lump behind the knee. Baker’s cyst is also known as popliteal cyst. Common causes: •Increased pressure within the knee joint due to accumulation of fluid •In younger athletes, it may be a torn cartilage meniscus •Arthritis in older athletes Signs and symptom: •A rounded swelling •A sensation of pressure in the back of the joint which can go down into the calf muscle. •Difficulties in bending the joint. •Aching and tenderness after exercise. •Redness around the lump indicating that it is filled with fluid. Page 14 of 39 The Solution to Knee Injury and Pain Iliotibial Band Injury Definition: Iliotibial band syndrome is also known as runner’s knee or Iliotibial band friction syndrome. Common causes: •A naturally tight or wide IT band •Weak hip muscles such as gluteus medius •Overpronation •Overuse •Excessive hill running •Running on a surface leg length difference Signs and symptoms: •Pain over the outside of the knee joint •Swelling at the location of discomfort •A snapping or popping sensation as the knee is bent •Tightness in the iliotibial band •Pain triggered by running, particularly downhill. •Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part. •Weakness in hip abduction. •Tender trigger points in the gluteal area Page 15 of 39 The Solution to Knee Injury and Pain Anterior Cruciate Ligament Injury Definition: An anterior cruciate ligament, or ACL, injury is a tear in one of the knee ligaments that joins the upper leg bone with the lower leg bone. The ACL keeps the knee stable. Injuries range from mild, such as a small tear, to severe, such as when the ligament tears completely or when the ligament and part of the bone separate from the rest of the bone. ACL injuries are common in sports that involve sudden changes of direction, such as football, and soccer. Most are non-contact injuries that occur during sudden twisting motion (for example, when the feet are planted one way and the knees are turned another way) or when landing from a jump. Common causes: Your ACL can be injured if your knee joint is bent backward, twisted, or bent side to side. Signs and symptoms: •Feeling or hearing a pop in the knee at the time of injury. •Pain on the outside and back of the knee. •The knee swelling within the first few hours of the injury. This may be a sign of bleeding inside the knee joint. Swelling that occurs suddenly is usually a sign of a serious knee injury. •Limited knee movement because of pain or swelling or both. •The knee feeling unstable, buckling, or giving out. Page 16 of 39 The Solution to Knee Injury and Pain Posterior Cruciate Ligament Injury Definition: The posterior cruciate ligament is located in the back of the knee. It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament keeps the tibia from moving backwards too far. PCL injuries account for about 20 of knee ligament injuries, however, the PCL is seldom talked about because these injuries are often left undiagnosed. Common causes: •dashboard injury – occurs when the knee is bent, and an object forcefully strikes the shin backwards •knee hyperflexion – an athlete falls on the front of their knee Signs and symptoms: •Knee swelling and tenderness in the space behind the knee (popliteal fossa) •Knee joint instability •Knee joint pain Page 17 of 39 The Solution to Knee Injury and Pain Housemaid’s Knee Definition: A bursa is a small fluid filled sac designed to help soft tissue slide easily over the underlying bone. They arise at various joints throughout the body, such as the shoulder, elbow and knee. Prepatellar bursitis is the inflammation of the pre-patellar bursa, which lies in front of the patella or kneecap. Under normal conditions its function is to reduce the friction between the patellar tendon and overlying skin when bending the knee. Common causes: •direct blow or fall on the knee •Infection as a result of surface injury Signs and symptoms of knee pain: •Pain and tenderness on the kneecap •Kneecap may be swollen and warm to the touch. •Difficulty kneeling. •An abscess or fluid filled lump may be visible over the patella. •Tender lump floating underneath the skin on the kneecap. Page 18 of 39 The Solution to Knee Injury and Pain Pilates What is Pilates? Pilates is a whole body exercise system, developed by Joseph Pilates during, and in the years preceding the first World War. The focus of Pilates is on enhancing the core strength (deep abdominal, back and pelvic floor muscles) and developing posture through a series of low impact and low repetition stretching and conditioning exercises. Pilates is based upon an understanding of human anatomy and is designed to stretch, strengthen and restore the body. Pilates strengthens the muscles and gives a more sleek, toned appearance without adding muscle bulk. There is also a strong 'mind over matter' belief. Page 19 of 39 The Solution to Knee Injury and Pain Principles of Pilates CENTERING Bringing the focus of all exercises to the centre or core of the body CONCENTRATION Maximum benefit will be achieved if full concentration and commitment is placed on each exercise. CONTROL Each exercise is done with complete muscular control PRECISION Awareness of each body part's positioning and movement is maintained throughout all exercises BREATHE Integration of breathing patterns and center on using a full breath FLOW Pilates exercises should be done in a a flowing manner with grace & ease Page 20 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Knees Pilates All Four Exercise The All Four Pilates exercise is a knee exercise that isolates and strengthens the gluteus. 1. Get on all fours with hands directly underneath shoulders and back unrounded. 2. Slowly lift one knee off the floor by two to three inches, and swing leg slowly outward, though leg should not go very far out. Hold for two seconds. 3. Slowly bring leg back down to the floor. 4. Repeat on other side, then complete the set 10 more times. Page 21 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Knees Pilates Prone Knee Pull-In Exercise This exercise helps to firm and strengthen the knees. A fitness ball is required for this exercise. 1. Climb onto ball and move forward until ball is beneath the knees. 2. With hands on floor directly underneath the shoulders, slowly roll ball toward the abdomen, keeping knees and legs straight. 3. Crunch once, then slowly return to starting position. 4. Repeat 10 times. Page 22 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs Pilates Single Leg Lift Exercise A fitness ball is required for this exercise. 1. Lie on the back and place ankles and feet on top of fitness ball. 2. In one swift motion, remove left foot from ball and bring into the air, bend toward abdomen and then lengthen to ceiling and return to ball. 3. At all times, do not tuck the hips to the floor; instead, work to keep the body’s core straight. Repeat with right foot, then repeat set 10 times. Page 23 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs The Lying Leg Lift It is a fundamental Pilates exercise that works the muscles of your outer thigh. 1. Lie on your right side and use your right hand to support your head. 2. Place your left arm across your body and place your palm flat on the floor for stability. 3. Move your legs slightly forward so that there is a slight bend in your waist. 4. With your hips and feet stacked, pull your belly button into your spine and stabilize your core. 5. Slowly lift your left leg as high as you comfortably can. With control, lower your leg back down. 6. Complete eight repetitions and then switch sides. Page 24 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs The Pilates Bicycle Exercise It targets your quadriceps, hamstrings and hip muscles. 1. Assume the same position described above with your hips stacked and a slight bend in your waist. 2. Lift your left leg so that it is parallel with the floor. Inhale and, keeping your leg straight, slowly take it to the back as far as you comfortably can and then bend your knee. 3. Keeping your knee bent, bring your leg to the front as far as you comfortably can and then extend your knee. 4. Take your leg back to repeat the movement. Perform four repetitions and then switch directions. 5. After completing four repetitions, switch sides to complete the bicycle in both directions with your right leg. Page 25 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs The Leg Kick Exercise The leg kick exercise uses your leg and hip muscles. 1. Begin in the position described above. Lift your left leg so that it is parallel with the floor. 2. With control, move it to the front as far as you can, slowly take it to the back and then return to the front. 3. Repeat the movement eight times and then switch to perform the exercise with your right leg. Page 26 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs Scissors Scissors is a challenging exercise that works leg and hip muscles. 1. Lie on your left side with your left arm extended straight above your head so that your head can rest on your upper arm. 2. Place your right arm across your body with your palm on the floor for stability. Your body should be in a straight line with your hips stacked. 3. Pull your belly button into your spine to stabilize your core. Contract your abdominal muscles and lift both legs off the floor. 4. Take your left leg to the front while simultaneously moving your right leg to the back. 5. Quickly switch positions with your legs and continue to alternate them back and forth in a scissor-like motion. 6. Complete 16 repetitions and then switch to your right side and repeat the exercise. Page 27 of 39 The Solution to Knee Injury and Pain Pilates Exercises to Strengthen the Legs The Bridge with leg Circles The bridge with leg circles is a challenging exercise that works your legs, glutes, back and core. 1. Lie on your back with your left leg bent and your foot flat on the floor. 2. Extend your right leg straight up. Pull your belly button into your spine and stabilize your core. 4. Push through your left heel to slowly lift your hips off the floor until they become aligned with your knee and shoulders. 5. Hold this position and circle your right leg clockwise four times then switch directions to counter-clockwise and perform four circles. 6. Slowly lower your back and hips to the floor. Repeat the exercise with your left leg. Page 28 of 39 The Solution to Knee Injury and Pain Other Forms of Knee Exercises QUAD SETTING 1. Sit on the floor with both legs straight in front of you. 2. Place a foam roller or a rolled up towel under your knee as shown. 3. Contract the quad muscles so that the foot lifts off the floor and the knee straightens. SINGLE LEG SQUAT 1. Stand on one leg with the other knee bent. 2. Use a wall or banister to help keep your balance. 3. Bend the standing leg and push your buttocks out behind you. 4. Start with only a small movement. 5. Make sure your hips stay level, don't let one drop down. 6. Don't allow your knee to move forwards past your toes. Variations & progressions: Rest the nonstanding leg on a bench or chair behind you Page 29 of 39 The Solution to Knee Injury and Pain Other Forms of Knee Exercises LUNGES 1. Step forwards with one foot in a long stride. 2. Make sure your feet are in line and pointing straight forwards. 3. Keep your back upright as you slowly bend and lower the back knee towards the floor, raising the heel off the floor. 4. At the same time bend the front knee, making sure it doesn't go past your toes. 5. Don't let the back knee touch the floor before returning to the starting position SWISS BALL SINGLE LEG SQUAT 1. Stand with your back to the wall and your feet hip width apart, toes pointing straight forwards. 2. Place the ball between your lower back and the wall. 3. Lift one foot off the floor and bring it out in front of you slightly. 4. Start to bend the knee and lower yourself down into a squat position, the ball will roll down the wall with you. 5. Keep your back parallel to the wall and stop once your thigh is parallel to the floor. 6. Your knee should not move forwards past your toes, if it does, stand further from the wall. 7. Push yourself back up to the starting position Page 30 of 39 The Solution to Knee Injury and Pain Other Forms of Knee Exercises STANDING LEG CURL 1. Stand with both feet together and something to hold on to. 2. Slowly bend your knee towards your buttocks. 3. Hold at the top point before slowly returning back to the starting position ISOMETRIC KNEE FLEXION 1. The athlete is seated as shown (alternatively they can lay on their front) 2. Starting with the leg almost straight, the therapist resists as the athlete tries to bend their knee. 3. The athlete should only use around 50% effort at the most. 4. Hold the contraction for around 10 seconds. 5. There shouldn’t be any movement. Page 31 of 39 The Solution to Knee Injury and Pain Other Forms of Knee Exercises ISOMETRIC KNEE EXTENSION 1. The patient lays on their front with the knee bent. 2. The therapist holds the front of the ankle or lower leg. 3. The patient tries to straighten their knee by pushing their foot down. 4. They should only use up to 50% maximal force. 5. The therapist resists this force so that there is no movement. Page 32 of 39 The Solution to Knee Injury and Pain Benefits of Pilates Exercises 1. Whole-body fitness Pilates does not over-develop only a part of the body. It develops the body integrally. 2. Adaptable to all needs With thousands of imaginable workouts and variations, Pilates workouts can be designed to individual needs. 3. Promotes strength Pilates is focused on building toned muscles and as well as on the functional needs of the person. 4. Improves flexibility Flexibility refers to how far a muscle group can expanse, and how much range of motion (ROM) we have at a particular joint. In Pilates, increase in length and stretch of the muscles and range of motion within the joints are being enhanced. 5. Increase muscular strength Pilates increases muscular strength specifically in the abs portion. 6. Improves posture Pilates trains the body on proper postures in order to develop proper alignment of bones. 7. Promotes weight loss Pilates makes the body physically fit by increasing muscle tone and flexibility by combining aerobic exercises and toning tools. Page 33 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain Carrying as few as ten extra pounds can affect the use of your knees. Proper diet and exercise can help you remove excess pounds and limit the pressure on this joint. Page 34 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain The knee is a joint that supports a lot of weight. To keep it working, strengthen it with weight-bearing exercises. Using a program targeted at improving joint health can help you strengthen the muscles and ligaments that support the knee so that the patella (knee cap) doesn’t shift or move during normal activities. Page 35 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain Stretching isn’t just good for a warm-up before exercise. Making a habit of performing some sort of stretching each day can increase the pliability of your muscles. When muscles move better they can help support joints better. There is less chance of injury. Page 36 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain Part of joint pain could be attributed to poor body mechanics. When we fail to stand or sit properly, joints are pushed out of alignment. Tendons and ligaments can be stretched over time and this can add to pain on the knee. Pressure is evenly distributed across your hip, knee and ankle when you use proper posture. Any changes can affect the knee. So, your knee pain may be the result of a weakness in another part of the body. Page 37 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain Avoid exercises that put a lot of pressure on the knee. This can be a team sport like hockey or soccer. It can also happen in the workplace. Improper technique when bending or lifting can affect the health of the knee. Bending from the knee protects the back, but putting the balance in your glutes protects the knee. Page 38 of 39 The Solution to Knee Injury and Pain Tips on How to Prevent Knee Pain When you feel pain in your knee, stop what you are doing. Contrary to popular opinion, pain is not a sign of any type of physical gain. Choose a less strenuous exercise, especially if you are getting back to exercising after a sedentary life. See a doctor to learn how to deal with your particular pain. Page 39 of 39