If you have good knees now (whether they have been injured previously or not), then we want them to stay that way – happy knees are active knees and there are things we can do to keep your knees smiling for years to come. The knee is a simple hinge joint, which means it has a lot of sagittal plane movement (flexion and extension), a little bit of rotation and a small amount of frontal plane movement (adduction and abduction). Due to the knee having very limited frontal (sideways) and transverse (rotational) movement, it has a variety of strategically placed structures to support it. These structures include the anterior and posterior cruciate ligaments, the medial and lateral collateral ligaments, and the medial and lateral meniscus. These structures work to prevent excessive joint movement in the form of joint shear, rotation and lateral bend, leaving the knee able to do its main job of flexion and extension mostly unrestricted. These structures are passive to a degree and so much of our knee movement is stabilised and controlled by the surrounding dynamic myofascial structures.

The knee is dynamically tensioned and controlled by some of the most powerful muscles in the body. The four quadriceps blend into the patella tendon, which attaches itself to the anterior tibia. The patella (knee cap) itself is designed to increase leverage for more quadriceps power; however, imbalances in quadriceps’ strength can lead to the patella not sliding smoothly through the related grooves in the femur and tibia, leading to ‘Mal Tracking Patella’, a source of wear, tear and pain on the under surface of the knee cap.

The three hamstrings – semimembranosus, semitendinosus and bicep femoris – are powerful influences on dynamic knee control. Bicep femoris, in particular, is the most powerful of the three and, if tight, can contribute to externally rotated legs/feet. The sartorius, gracilis and semitendinosus all blend into the pes anserine, a tendon which attaches to the medial knee. This tendon gets its name from the Latin for Goose’s Foot, which alludes to the blending of the three muscles into the supporting tendon being similar to that of the toes of the large semi-aquatic bird.

On the lateral side of the knee, we have the iliotibial band (ITB), a thick, flat band of fascia famed for its strength, with rumours that you could hang a small car from it (although I hope it’s never been tried, as it’s a pretty grim image). The ITB acts as a direct link from the knee to the powerful gluteus group of muscles at the hip. This direct fascial connection gives the muscles of the hip great influence over knee stabilisation. Finally, attaching from below into the posterior knee we have the gastrocnemius (calf) and soleus (lies just underneath the calf) muscles assisting with the knee’s dynamic stabilisation. You may start to get a picture from reading the above that the knee is surrounded on all sides by powerful muscles; any weakness or tightness creating imbalance around the joint can destabilise its positioning under load and create potential for injury.

Now that we have a picture of the supporting structures for our knobbly friends the knees, what strategies can we employ to keep them as the happy hinges we want them to be?

Lighten up

Common sense tells you that, if you are carrying excess weight, it's going to put your body under more mechanical stress. Greater mass equals greater force for all joints in the body and it’s not uncommon for knees and lower back in particular to complain about the extra strain. For anybody experiencing joint problems, achieving a healthy weight should be a priority; optimal weight is joint friendly and has a host of other health benefits too.

Power up your proprioception

Our joints and surrounding soft tissues are packed with tiny sensors called proprioceptors. These senses report information back to the central nervous system about body positioning, range of movement, stretch, tension, speed of movement, spatial awareness and pressure. Particularly post injury or following prolonged inactivity, a reduction in proprioception may be experienced and so the sensors may need to be ‘retuned’. The best way to do this is to train the joint with as much variation as possible. Really work through all of your exercise variables, changing speed, angles, load, range of motion and surface. The more you move your joints using these variables, the better they get at learning how to react and control the joints of these environments safely. Try these simple variations to create hundreds of drills/variations of your favourite exercises:

• Speed: Slow, medium, fast.
• Angles (Direction): North, East, South, West and points in between.
• Angles (Height): Low, mid, high.
• Load: Light, medium, heavy.
• Range: Short, mid, long.
• Surface: Hard, medium, soft.

These variables can be used in isolation or in combination. For example, you might drill squats at short, mid and long range and repeat that on hard, medium and soft surfaces. The more variables you combine, the higher the skill set of the exercise. Having all of these options for different exercises lends itself extremely well to versatile movement tools like ViPR. If we combine the above variables with the ViPR Programming System (LMT-1), we have bounteous options for creativity. Take care not to overwhelm a client with too many variables but create systematic progression to help them be successful.

One term that sticks with me is from the FitPro Convention Loughborough. Coach Peter Twist (@coachpetertwist) stated that for healthy, athletic movement we should be creating a “sensory blizzard, a storm of stimulus for the neural system”. Just don’t get your clients lost in the storm if you get my meaning.

Get stable

The knee joint sits above the foot and ankle and so, when we are up and moving around, the knee is forced to respond to every twist, turn and bend the foot/ankle makes. This also means that any limited or excessive movement in the foot/ankle is often directly compensated for by the knee joint. If the foot and ankle is lacking, the knee has to pick up the slack. Foot dysfunction, therefore, can be a cause of knee pain, wear and tear. A good example of this would be lack of stability in the medial arch of the foot. An unstable foot arch that collapses under strain can lead to destabilisation of the knee, creating excessive abduction (medial bend) and/or medial rotation. This exposes the medial joint structures to stress and increases the risk of injury. If you have a foot dysfunction or suspect you do, get it professionally checked out. Common biomechanical foot dysfunctions may include flat feet, high arches, limited big toe flexion and more. Putting time and effort into healthy feet with a professional will be positive for your knees and many other joints up the kinetic chain. Good roots make for healthy trees.

The powerful muscles of the hip also have direct influence over the knee, as we discovered from the knee anatomy intro. The hip muscles will work in unison to help support and stabilise the knee, co-contracting and using tension or ‘Tensgrity’ to create a mobile but robust structure. Any muscle imbalance in the hip will likely show up at the knee too. I often see examples of muscle imbalance at the hip when clients jump and land with lack of control. Upon hitting the ground, the knees can lose stability and dive inwards, coming together at the midline (genus valgus). This is often a sign that the lateral muscles of the hip are weak and lack the strength to pull on the iliotibial band to tension the knee and maintain alignment. The solution in this example is to build lateral hip strength, performing dynamic frontal plane hip exercises such as the ViPR Ice Skater drill.

Get strong

The soft tissues surrounding the knee have to deal with high levels of force, particularly when exposed to activities such as running, jumping or heavy lifting. To reduce risk of sprains, strains and tendonitis, we can strength train. Systematically building the strength of the surrounding musculature of the knee increases the tissue tolerance of force, raising our threshold of injury risk. If the strength training plan is well balanced – by that I mean it builds strength equally all around the knee – it reduces the likelihood of muscle imbalance and further mitigates injury risk. I’m a firm believer that the knees should be trained functionally with integrated movement patterns, rather than isolating and training individual muscle groups. Key functional exercises for happy knees include squats, deadlifts (and other hip hinges), lunges, step ups and jumping. Whole-body exercise with ViPR promotes this functional approach and helps integrate the knee into positive movement patterns. Strong muscles help with power particularly when working at speed.

Powerful muscles around the knee can accelerate the movement of the joint but also crucially decelerate the movement of the joint. Powerful muscular deceleration can help us prevent the knee from shooting off into weak angles under force, such as when we land from a jump or try to change direction quickly. By now you should be starting to build the picture that the secret to healthy knees is really mobile, strong feet and hips. To quote a wise physio, Gary Gray (@garywynngray), “The knee is the dumbest joint in the human body; it’s a slave to the foot and hip.”

It’s time to get practical, so how do we bring this all together for happier knees? There is so much to consider when we think about all of the above, but we have boxes we can tick. Firstly, maintain your weight; secondly, get functional feet; and thirdly, strength train your lower body. I think a great way to build a framework for a healthy knee programme is to start with the functional movement patterns that are significant for the knee:

• Squat
• Lunge
• Deadlift/Hip Hinge
• Step Up/Down
• Jump/Hop

From there, we can filter in the variables systematically to ensure we train all possible knee functions:

• Speed: Slow, medium, fast.
• Angles (Direction): North, East, South, West.
• Angles (Height): Low, mid, high.
• Load: Light, medium, heavy.
• Range: Short, mid, long.
• Surface: Hard, medium, soft.

When beginning a knee strengthening programme, we should consider logical progression. By this, I mean starting at the easier end of the continuum on all variables and progressing gradually over time; for example, beginning with lighter loads and gradually progressing to heavy loads over time. There are literally hundreds of variations of knee exercises that we can develop and it’s great to get creative with this. For starters, though, I’m going to show you some of the drills that I use for beginner, intermediate and advanced clientele.

Summary

If you already have knee pain, you should seek professional support for a rehabilitation programme. Pushing through knee pain is never a good idea, although it’s not unusual to get joint noise from knees while exercising (crepitus). This is usually not problematic, providing it’s not accompanied by pain. Healthy knees are active knees (hips and feet). If your knees are feeling good now, make an effort to keep them that way; they don’t always last a lifetime but they can and you will be glad you made the effort, as the passing of time attempts to take its toll on our busy, bony hinges.

Featured drills

Knee warm-up:

• Dynamic Pigeon Stretch
• Dynamic Frog Stretch
• Kneeling Quad/Hamstring Stretch
• Single Leg Balance Reach

Beginner:

• ViPR Staggered Stance Squat and Reach
• ViPR Common Lunge, Short/Mid/Long
• ViPR Thread the Needle
• ViPR Step Up Knee Drive
• Mini Band Jump Squat

Intermediate:

• ViPR Front Squat, Short/Mid/Full Range
• ViPR Uncommon Lunge Slow/Medium/Fast
• Deadlift Wide/Narrow
• ViPR Weighted Step Down
• Common Jump Matrix

Advanced:

• Bosu ViPR Squat Fast/Slow
• ViPR Running Direction Change Lunge
• Single Leg Pogo Jump
• Bench Jump Up, Step Down
• Multidirectional Hop

Stephen Tongue is Head of Education for ViPR and was first introduced to and trained on ViPR by inventor Michol Dalcourt back in 2011. Stephen’s passion for movement training and success as a Freelance Personal Trainer and Presenter led to him joining the ViPR Master Trainer Team at FitPro back in 2013. Stephen has remained a part of the team until this day as well as picking up Master trainer positions with other big fitness brands such as TRX, PowerPlate and MyZone. Stephen has regularly created content throughout his career for national and industry magazines, news bulletins, blogs and social media. His enthusiasm for ViPR training throughout his career has never waivered and now he looks forward to leading the direction of ViPR education.