T NATION _ 18 Tips for Bulletproof Knees.pdf

10/4/13T NATION | 18 Tips for Bulletproof Knees Building & Fueling High-Performance Muscle™ Sign In | Sign Up 18 Tips for Bulletproof Knees by Mike Robertson Tech note: This article contains videos delivered in Flash. You will need the latest version of the Flash Player (at least version 7) to view them. If you cannot see the videos, please CLICK HERE to download and install the latest player now. It is free, quick, and easy. Having a bum knee sucks, so I decided to come up with a bulletproof plan to get your knees feeling healthy and working as well as humanly possible. Wait! Were you about to X out of this article already? Maybe go check and see if any new hotties have posted their photos elsewhere on the site? Well, don't. Why? Because you don't want to go through this, do you? I didn't think so. Yes, this article is about knee health. No, that's not as sexy as biceps and big bench presses, but maybe I can scare you into caring with the photo above. You see, a year and a half ago, I had perfectly healthy knees, and I was coming off the best training cycle of my entire life. Long story short: A ski trip led to an arthroscope and a knee that may never return to normal. Fixing knees is my business. I've studied their architecture, how they function, the most cutting edge research, common injuries, and what the best and the brightest in the industry are doing to fix even the most stubborn knees. I'd love to say I'm doing it all for you, but obviously there's a little self-interest involved here as well! If you've ever had a knee injury, this is the article for you. I'm going to get you up-tospeed with some new concepts (along with reviewing some old ones) that are sure to get your knees as healthy as possible. Never had a knee injury? Then this is an even better article for you. If you follow the ideas here, you'll be a lot less likely to have a knee injury in the first place. 18 Tips for Bulletproof Knees 1) Purchase some knee sleeves. www.t-nation.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 1/14 right? You know what else? That's a big part of the problem! The fact of the matter is that knee issues are typically due to issues at other areas of the body. Here are some drills to help out: In the first exercise. Eric Cressey and I covered about a zillion hip mobility exercises in our Magnificent Mobility DVD. pal! Beyond improving your training performance for numerous reasons. However. and then stay tall and try to "shoot" your knees over your toes. yet often ignored for various reasons such as "I'm in a hurry" or "I don't need to warm-up because I'm 22 and therefore ten feet tall and impervious to harm. Just put them on before the workout. but when we have knee issues. or worse yet. I find it easiest to place this board in front of www.10/4/13 T NATION | 18 Tips for Bulletproof Knees I'll make this first one easy on you.t-nation. 2) Don't skimp on your warm-up! This idea is beautiful in its simplicity. so I'd highly suggest checking it out. or whatever you want to call it. In this second exercise. and bask in the joy that healthy knees bring to you. but back pain as well. where do we focus most of our attention? The knees. This could be quad-dominant day. hip-dominant day. you're going to place a small board underneath your toes to put you into a dorsiflexed position. not the knees themselves. and this area is often poorly addressed." Well. warming up reduces the viscosity of synovial fluid (the stuff that fills your joint space).com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 2/14 . Rest your hands on the wall. Lack of hip mobility in all planes can not only lead to knee pain. providing better lubrication and healthier joints in general. all you're going to do is set up next to a wall with your feet a few inches away from it (you may even want to start with your toes touching the wall at first). buy some knee sleeves. not addressed at all! After reviewing Mike Boyle's Functional Strength Coach DVD series. warm-up thoroughly. I realized how poor sagittal plane ankle mobility is in many athletes. and wear them every time you train your legs. one area we didn't cover as in-depth was ankle mobility. 3) Want healthy knees? Focus on ankle and hip mobility! It may sound counterintuitive. Go out. "leg" day. I'd love to see what that lack of warm-up is doing to your joints. place all your weight on your heels. especially those with patello-femoral (PF) pain. is due to soft-tissue imbalances between the stronger/tighter lateral knee structures and the weaker/inhibited medial knee structures (the VMO). In research by Ireland et al. This anterior knee pain. Sure. in many cases. In phases where motor control and recruitment are the priority (for instance. The obvious solution here would be to isolate and then strengthen the VMO. terminal knee extensions (TKEs) hit the VMO. While staying tall. Don't worry if there isn't a ton of range of motion at first. In maintenance phases (where I'm focusing on max strength). 4) Get your glutes firing. they found that athletes with patello-femoral pain had significantly decreased strength in both hip abduction and hip external rotation. I may perform three or even four sets of these exercises before training.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 3/14 . X-Band walks are perfect here. we should be getting some activation work in to make sure those muscles are stimulated and ready to go. as most who have patello-femoral pain are only worried about isolating the vastus medialis obliquus (VMO). I may only do one set before training. How much is significant? These subjects were 26% weaker in hip abduction and 36% weaker in hip external rotation! Now that we know what movements to train. but it's not "isolated. This is another area that not nearly enough of us are addressing. (1). in the early off-season or a transition phase). it'll improve as you practice it. we're talking about getting your gluteus maximus and posterior fibers of the gluteus medius firing." www. So before we do low-body work. there doesn't appear to be any true VMO "isolation" exercises. and use those glutes and you should be just fine. but it just doesn't seem to be that easy.t-nation. 5) Forget about isolating the VMO! A lot of athletes and lifters are interested in getting that VMO to fire. This will prevent you from using the "Weeble-Wooble" substitution pattern that typically occurs in hip abduction movements. you're again going to try and "shoot" your knees over your toes.10/4/13 T NATION | 18 Tips for Bulletproof Knees the wall so you can balance yourself with your hands. tall. You'll see in the video that the set-up is a little funky. what muscles are most affected? Specifically. resulting in knee pain. In fact. Stay tight. This muscle imbalance leads to a lateral (outside) pulling of the patella into the femoral condyle. so hopefully seeing it will make it easier than me trying to explain it! Big things to focus on here include turning the toes out slightly and bracing the core throughout. "The concept of VMO isolation through specific exercise should no longer be part of our lexicon. leg extensions etc. • Improving the motor control and strength of the gluteals • Stretching the quads and calves www.g.t-nation. massage/ART) for the lateral structures (all of the above plus the lateral retinaculum) • Improving general quad strength (via quad sets.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 4/14 . (2) flat out state. For instance. I feel a more comprehensive plan of attack is necessary.) TKEs could definitely be part of the program. Malone et al.10/4/13 T NATION | 18 Tips for Bulletproof Knees In an article discussing muscular control of the patella. just understand they aren't a true isolation exercise. a comprehensive patello-femoral pain program could include any (or all) of the following: • Foam rolling of the lateral structures (primarily the vastus lateralis and iliotibial band) • Direct soft tissue work (e." Instead. there are also those times when you need to take a step back and work toward a total-body overhaul. Problem was. I just don't see the need for direct VMO "isolation" exercises in that treatment program. then do leg extensions. that just can't happen. I'd rather have a bullet in my head than be seen struggling with 40 pounds on the leg extension. requiring a specific and individualevaluation and treatment program. and if you're injured. working on regaining mobility. isolation exercises totally suck. it can take some time to get things sorted out. lunging. Following my knee scope. but for whatever reason people still fail to listen to their body and grasp the concept: If it hurts. playing basketball. Just like any other time one muscle is weak. Take the time sooner rather than later to do this. running. or any other pain-provoking activities. www. If your body has been functioning in an ineffective fashion for a long time. and then progressing back into singleleg exercises. Each and every time you step in the gym you need to work on being better. and need. but it's what I needed to get my strength back. your knees may not hurt now. I started back into training with basic proprioceptive exercises. Remember that sometimes taking an extra day or two off isn't a bad thing if you can train harder (or pain-free) the next time around. So I begrudgingly got on the leg extension machine and watched myself struggle with 40 pounds. but I can guarantee they will in the future! When I say that we have to balance your training. stop doing it! This can include squatting. As well. and then forget about it when planning the next one. rather help them prevent the need for rehab! However. you better make up for it with some serious hamstring and glute dominant work down the line. we aren't talking within the training day or even the training week." 7) Stop pain provoking activities! This is the simplest tip I'll give. to change. follow it. my quads were flat-out weak. especially if strength and/or performance are your primary goals.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 5/14 . I was reinforcing another muscle imbalance. "Time magnifies all programming errors. as their use hasn't been justified in research at this point in time. As Alwyn Cosgrove always says. However. and then maybe get some hamstring work in if they aren't totally wiped at the end of their workout. Seriously. another one is forced to compensate. They'll squat. 8) Don't be afraid to isolate after traumatic injury. What you did (or didn't do) in this cycle directly affects ensuing cycles. So if you did a ton of quad-dominant work in one cycle.t-nation. then lunge. If you don't follow this rule. You need to address the longterm health of your body when you lay out your programming! Don't just plan one cycle. Most of the time. So by not isolating my quads. 6) Get some balance in your training. Your second grade PE teacher could give you the same advice. I'm not trying to rehab people here.10/4/13 T NATION | 18 Tips for Bulletproof Knees It should be noted that each and every knee is different. I'm still shocked at how many people don't adhere to this rule. in a rehabilitation setting the rules can. remember this motto: "A muscle that's weak in isolation will be weak in integration. the more proficient you are at single-leg exercises. The end-goal is to increase tissue tolerance and get to a point where we can perform single-leg exercises without compensation. I'm a firm believer that the better our stability is in the frontal (and transverse) planes. but single-leg exercises move us out of the sagittal plane and force our bodies to learn stabilization patterns in the frontal plane. In layman's terms. even if it means resorting to machines for a short time. So what's the easiest way to rectify the situation? If you said "Get their glutes stronger. far too many of us stick solely to the "big" exercises in the gym. single-leg exercises can do wonders for preventing (or rehabilitating) injuries.t-nation. the better we'll be able to perform in sagittal plane exercises. 9) Do some single-leg work." Do what it takes to get the strength back. specifically the VMO and gluteals 5) Destroy the "light bulb" effect Let's focus briefly on point number four. Why do single-leg work? Here are just a few reasons I cited in my Single Leg Supplements article: 1) Decrease strength imbalances between right and left legs 2) Providing a change of pace in your training 3) Improved balance and proprioception 4) Strengthen key knee stabilizers. good mornings.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 6/14 . and then working to strengthen them within your www. I'm all for big squats.10/4/13 T NATION | 18 Tips for Bulletproof Knees If nothing else. By working to activate the gluteals pre-workout." you get the gold star for the day. the better you can become at double-leg exercises! 10) Get your glutes and hamstrings stronger! We discussed above how people with patello-femoral pain have significantly less strength in their gluteals. and pulls. Beyond that. and also need to improve gluteal strength as well? For these reasons alone. Remember how we discussed above that those with knee issues need to improve general quadriceps strength. Mike's article became a whole lot more interesting. Couple this flawed posture with the fact that more and more females participate in quad dominant sports such as basketball. As I'm writing this. but we can't forget about our other big hip extensors. RDL's. This genetic predisposition lends them to flawed posture and movement patterns where the quads and adductors do most of the work. or lumbar spine for that matter!) www. while the hamstrings and glutes do minimal work.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 7/14 . these people have terrible posterior chain strength.10/4/13 T NATION | 18 Tips for Bulletproof Knees workout. Instead. But what about the hamstrings? Have you ever seen someone who just can't sit back when they squat? Or lands on their toes when they lunge? Flat out. I can envision people taking it to the Nth degree and performing depth drops off a ten foot wall. Before we take it there. and this just isn't a good thing if you value your knee joints (or ankles. and pull-throughs. all the force is being absorbed by your joints. let me clarify my point a little bit. It's important to note that we want the glutes to be our primary hip extensor. it's important to note that while a lot of women who suffer ACL tears are genetically predisposed (via a large Q-Angle and wide pelvis). but try to focus on bringing up total strength of the posterior chain while also optimizing recruitment patterns. and you have a recipe for disaster! Every female athlete I work with is going to get a steady dose of posterior chain work: glute-hams." you're not allowing your muscles and tendons to absorb force. deadlifts. Suddenly. they could do a lot for themselves by following this tip alone. you'll be well on your way to healthier knees in the future. What I'd like all trainees to have is at least a basic knowledge of how to absorb force. reverse hypers. 11) Learn to absorb force. hips. It can be difficult.t-nation. Finally. soccer and the like. If you were to jump up in the air and then land with your knees straight and a loud "thud. Focusing on squeezing the glutes at the top of all movements can go a long way. the hamstrings. but you'd be amazed at how many clients and athletes I work with who tell me.10/4/13 T NATION | 18 Tips for Bulletproof Knees The vertical jump is actually a great test and exercise to utilize.t-nation. it can be troublesome for a number of reasons. read through them and make sure your technique is spot-on. So what if your body is out of alignment? Well. but the benefits far outweigh the time and energy it takes to get you there. it hurts my (insert body part here). just walking around could be a chore. and I can virtually guarantee one part of your knee joint is taking the brunt of the load. Land with soft knees. "I can't do X exercise. To make it worse. Optimal alignment may not be easy. we'll assume it hurts their knees. Here's the problem though: It's not the exercise that's hurting them. 13) Learn how to lift! This may sound really stupid. Jump up in the air and try to minimize the sound when you hit the ground. you're probably squatting. which is kind of like speeding with that same faulty alignment. but for those with knee issues I'd like to take a closer look at the rectus femoris instead.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 8/14 ." Since this is a knee article. but now I'm not so sure. It wouldn't kill you to be a little more athletic. Improving your technique is one of the best things you can do to stay healthy. www. I'm not trying to make you into an elite athlete with this recommendation. as it's been the scapegoat for everything from sore knees to bad backs. it's their god-awful lifting technique that's the problem! I'm amazed at how many people can't perform even the most basic exercises in the weightroom. The squat is a great example. There have been numerous technical articles written on T-Nation for everything from single-leg exercises to squats and deadlifts. Sure. not their performance of that exercise that's the real problem. and lunging heavily as well. just give you some food for thought. would it? 12) Get your body in proper alignment! Ever see a car that's out of alignment? Notice how it wears down those tires quickly? And the gas mileage you get is downright atrocious to boot. as well as improving your strength and physique. so if you think your form may be off. 14) Beware the irritated rectus femoris! I used to think the psoas was the devil when it came to flawed posture and injuries. It's going to catch up to you one of these days when the tires blow! Check out the Neanderthal No More series if you're in need of a tune-up. yet they're so convinced it's the exercise that's at fault. and lower into a half squat to absorb the force. soft feet. deadlifting. Notice how his upper thigh is parallel to the ground. To get even more bang-for-your-buck. Coaching cues would include keeping the chest up. you're fine. but his lower thigh isn't perpendicular. effectively stretching the rectus femoris from both sides.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 9/14 . a two-joint hip flexor that crosses both the hip and the knee. try this stretch: It's very similar to a regular lunge stretch. and squeezing the stretch-side glutes. you have a short or stiff rectus femoris. grab one knee and pull it to your chest while laying all the way back with the head and neck relaxed. I'm sure you're wondering. you need to focus on your rectus femoris. If your lower leg is perpendicular to the ground. If you failed the test above.10/4/13 T NATION | 18 Tips for Bulletproof Knees First off. if your lower leg is not at perpendicular. posteriorly tilting the pelvis. but by having your back foot elevated we take your hip into extension and knee into flexion. try pairing this stretch with some glute www. "How do I know if my rectus is a problem?" Try the modified Thomas Test to find out: Sit on the edge of a table or counter with your buttocks on the edge. The gentlemen in the picture below is a great example. From here. What you're looking for here is the position of the lower leg in relation to the ground. I'd be willing to bet that more than a few of you are going to fail this test miserably! So what do you need to do if this is the case? Rather than stretching your one joint hip flexors. Focus on staying tall throughout.t-nation. However. have asthma. especially dietary fats. 15) Eat an anti-inflammatory diet. which tend to be pro-inflammatory. but the health of our joints as well. will help to prevent the occurrence and progression of systemic inflammation associated with mild infection. this isn't my area of expertise.t-nation." Balancing our fatty acid profile isn't just one of the best things we can do to improve our overall health. while increasing the intake of omega-3 fatty acids (alpha-linolenic acid). CSCS and a specialist in the realm of autoimmune disease. Positive changes in your diet could be a huge influence on your joint health later in life. (If you'd like to learn more about Tammy. we're quickly learning that an inflammatory diet is NOT a good thing. we're also seeing that joint destruction could very well be systemic too. You can do a search on PubMed with 'joint destruction' and 'inflammation' and see the number of hits you get. poor diet. Diet plays a role in inflammation. But what else is out there? I believe to keep our joints healthy we need a threepronged approach with our supplements: 1. so I called in the big guns for this topic. whether you're at risk for heart disease. and even omega-6 fatty acids (arachadonic acid). or just want to keep your joints healthy. and obesity. Cutting back on saturated fat.proactivitysupport. please check out her website at www. Granted. A healthy diet plays a big role when it comes to maintaining healthy joints. which are anti-inflammatory. While we don't have all the answers yet. we ingest directly affect our body's production of eicosanoids (hormone-like substances) and the ratio of pro-inflammatory to anti-inflammatory prostaglandins. being excessively heavy. and general wear-and-tear can wreak havoc on your joints. MS. The fats. Here's what Tammy Thomas.com).10/4/13 T NATION | 18 Tips for Bulletproof Knees activation work to further restore the balance around your hips. when your joints were in far better shape? I know I would be. Glucosamine and chondroitin (for their possible joint-regenerating effects) www. RD. Researchers know that inflammation plays a definite role in joint destruction. While we've known for quite some time that poor biomechanical alignment. more specifically the fatty acids. I'll be frank here — I'm not willing to wait around to find out! What if we found out in 15 or 20 years that glucosamine and chondroitin really do what they say? Wouldn't you be kicking yourself for not taking them sooner.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 10/14 . had to say on the topic: "There are too many scientific articles to cite regarding joint destruction and inflammation. 16) Take Joint Regenerating/Protecting Supplements While the jury may be out on the ability of certain supplements to protect and/or regenerate our joints. com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 11/14 .t-nation. proper supplementation could be a great way to minimize the effects of those drawbacks. 17) Get some soft tissue work done. Fish oil supplements (to help balance fatty acid profile) 3. especially if the rewards are as great as some say. www.10/4/13 T NATION | 18 Tips for Bulletproof Knees 2. but it does have a few drawbacks on the inside (especially concerning the joints). This is another addition to your program that can give you huge paybacks over the long-term. However. Heavy weight training may look great on the outside. Antioxidants (for healthy connective tissue) Here's what I take on a daily basis: 1500 mg glucosamine/1200 mg chondroitin 500 mg Vitamin C 200 IU Vitamin E 100 mcg Selenium 4 caps Flameout STORE WORKOUTS ARTICLES FORUMS VIDEO While some of these practices may be on the fringe. I'm willing to take calculated risks. t-nation. a more general deep tissue massage will help normalize your tissue tone and help you realize better quality of movement. This prospective study (3) examined 282 athletes enrolled in phys ed classes and took them through a battery of tests to determine baseline statistics. researchers determined that athletes who had developed PF pain had significantly tighter quadriceps and gastrocnemi than their healthy counterparts.10/4/13 T NATION | 18 Tips for Bulletproof Knees First. For instance.g. This allows you to work different areas of the muscle and get an even better response. but I think you'll notice a big difference when rolling the top of your thigh! Now as great as the foam roller is. if you haven't purchased a foam roller] yet. as they'll be able to get rid of adhesions and scar tissue that have built up over the course of your training career. If you've never had soft-tissue work done before. After running statistical analyses on these subjects. check out our Feel Better for 10 Bucks article. so why aren't you? If you aren't sure how to use one. Two years later they followed up. While most studies are retrospective in nature (e. Something we didn't discuss in the foam rolling article is changing the length of the muscle while you're working it. try this for your rectus femoris and quads: Roll these areas like you normally would. You may not feel it at the bottom of the quads. what are you waiting for? I'd venture to say almost any performance coach worth his salt is using one. they examine an issue afterthere's a problem) very few look at it in the opposite fashion. I'd start with a solid ART provider. and 24 of the 282 had developed patellofemoral pain. it still pales in comparison to specific softtissue work performed by a specialist.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 12/14 . it's interesting to note that the gastrocnemius can wreak havoc on both sides of the joint. The gastrocnemius is the "calf" muscle that crosses your knee joint. and can therefore contribute to posterior knee pain as well. This isn't really something that can be described in words. and then continue rolling but bend your knee. After that. So what's the moral of this story? Stretch your quads and calves! As well. All the more reason to stretch those puppies out if you ask me! www. but you'll know the feeling when you effortlessly drop into a deep squat for the first time! 18) Stretch your quads and calves! I recently came across an interesting prospective study regarding patello-femoral pain. 2002. is the Director of Custom Athletics and President of Robertson Training Systems in Indianapolis. A two-year prospective study... Vanderstraeten G. Ballantyne B. Lysens R.28(4):480-9. Cambier D. 3) Witvrouw E. Now all you have to do is use the info to reap the benefits! I'm looking forward to some great success stories to follow! About the Author Mike Robertson. 21(3):349-62. Mike received his Masters in Sports Biomechanics from the Human Performance Lab at Ball State University.. Indiana.33:671676.. check out his web page at www. If you'd like to purchase a copy of Mike's Magnificent Mobility DVD. Walsh WM. 2003. © 1998 — 2006 Testosterone.. 2) Malone T. www.W.. U. Intrinsic risk factors for the development of anterior knee pain in an athletic population. LLC.. American Journal of Sports Medicine. C. Wilson J.com. M..S. Davis I.. Davies G. References 1) Ireland M. All Rights Reserved.S...t-nation.. Muscular Control of the Patella. please click HERE. Hip Strength in Females with and without Patello-Femoral Pain. To contact Mike or sign-up for his FREE newsletter.robertsontrainingsystems. Journal of Orthopaedic and Sports Physical Therapy.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 13/14 .A.10/4/13 Conclusion T NATION | 18 Tips for Bulletproof Knees You have all the tips you need to keep your knees healthy and feeling great. 2000.S.C. Clinical Sports Medicine. and has been a competitive powerlifter for the last 5 years.S. Bellemans J. t-nation.com 800-525-1940 © 1998-2013 T NATION LLC www.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees 14/14 .10/4/13 T NATION | 18 Tips for Bulletproof Knees PUBLISHED 06-26-06 23:39 Discuss | Rate | Add Favorite | Print Version T NATION Home Workouts Articles Forums Video New & Featured Support STORE Supplements All Supplements Top Sellers Favorites Other Products Clothing Books Equipment Articles Supplements Goals Ingredients Authors Tags COMPANY Privacy Policy Acceptable Use Policy Biotest Supplement Advice Technical Support service@t-nation.