Check out your knee alignment on this snowy day and prevent an ACL tear too!
I was working with a young athlete and she was having knee pain when lunging and landing from jumps. Her tight calves were restricting her ankles from bending (restricted dorsiflexion) as a result she was knocking her knees in when lunging and landing from jumps to compensate for the lack of range and mobility at the ankle. Not only does this potentially lead to pain under the kneecap (patella femoral syndrome) but it also puts our movers at risk for ACL tears.
The anterior cruciate ligament (ACL) lies in the middle of the knee. It runs from back of thighbone (posterior femur) through the middle of the knee to front of shinbone (anterior tibia). This stops the shin from sliding forward off the thighbone (prevents anterior translation) when landing from jumps or getting hit in the knee. It also gives stability to the knee when we twist or turn or other dynamic movements (rotational stability). The ACL can tear from impact such as in a football game or from non-impact such as a torqued knee when lunging. From a quick pubmed search 6 randomized control trials show that athletes who practice neuro muscular training on a regular basis decreased their risk of tears. Checking alignment and practicing mechanics in landing from a jump or pivoting help prevent injury to the ACL as well as injury to other structures in the knee such as the meniscus and other ligaments.
When you land from a jump be sure to roll through the foot allowing the ankle to bend, absorbing some of the impact. Then the knee bends with the kneecap in line with the second toe (see good alignment photo), followed by the hip bending with hips translating back. So from a birds eye view the knees are over the toes.
There are several imbalances that may cause poor knee alignment in landing from a jump or in other dynamic movements. Some causes are when the calves are tight or ankle joints lack range, the inner thighs are tight (decreased adductor flexibility) or the outer thigh is weak (glute medius/abductors), in these cases the knee will tend to absorb more impact and it will buckle in (see wrong alignment photo). This put increased strain on the medial meniscus, medial collateral ligament and ACL.
What to practice-
1) In front if a mirror rise up on your toes then roll through your foot bend the knee and hips. Look for knee bending over toes. Practice this exercises as if you are landing from a jump in slow motion. (see good alignment photo)
2) In this landing/squat try side stepping 5 x right then 5 x left. Make sure both your quadriceps and hamstring muscles are active. People tend to have over active quads, which also pull the tibia forward. If the two muscle groups are not balanced in strength and flexibility, the poor alignment can increase stress on knee ligaments, the infra-patella and put the ACL at risk.
3) Lastly try some small jumps maintaining good alignment and loose ankles. This will prepare you for larger jumps when playing sports or even jogging.
4) Every day practice single leg balancing without shoes on a pillow. Make sure the surface isn’t slippery so you don’t fall. (see balance photo) Not only will this exercise help strengthen your ankles, it will help with balance and prevent ankle sprains and falls.
As always, have fun, be safe and challenge yourself. If you aren’t sure you are performing the exercises correctly check in with a Physical Therapist or experience Pilates or Gyrotonic(R) instructor.