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Lower Extremity Assessment: Correcting Imbalances & Protecting Your Kneesby Heather L. Ellis MSPT, ATC Heather Ellis works full time as a physical therapist and also as a certified athletic trainer, working in the healthcare field for over 15 years. Her other full time job is wife and mother of 2 young boys. At 39 years young, Heather was in the best shape of her life with a new mission and motivation. It is her passion to sculpt a fit and healthy lifestyle for herself and her own family. Heather finds great inspiration in inspiring and motivating others, reaching out through writing and setting a positive example for those around her. You can check out her website - http://memosfromafitmom. W orking hard to pack on muscle, eating right and ramping up the cardio are all working towards that sculpted body….all this is hard enough to balance while living and working to meet all the challenges that face us. Injury and pain becomes just one more challenge that adds significant frustration, seem- ingly stalling progress towards our goals. Addressing imbalances in strength and flexibility restrictions protects and maintains healthy joints so we can continue to push our training forward at a steady pace. Consider that gradual onset anterior knee discomfort, no ‘injury’to speak of, but it certainly can derail a lot of training programs, gradually the lower body training programs need to be revamped and tolerance/ability to perform cardio at previous intensities can very often be significantly affected. Whether you are currently suffering from some twinges, had chronic anterior knee pain or have no history, you can benefit from a good look at the health of your knees…actually we should look at the general health and balance of the lower extremities as foot /ankle as well as hip and core can most certainly affect knee pain. Let me explain…As we all used to sing…’ankle bone connect- ed to the knee bone…”the mechanics of the lower extremity is important to look at from a pre-hab or re-hab perspective. Often the knee pain is actually a symptom arising from more proximal weakness, lower extremity flexibility restrictions or altered foot mechanics. In a closed chain environment the ankle and hip certainly have strong effects on the mechanics of the knee. Take a few moments to assess lower extremity flexibility and strength. Flexibility Restrictions of the… Hamstrings: Flexibility restriction in the hamstrings can increase the demand on the quadriceps during extension of the knee which in turn places increased joint forces at the patella-femoral (PF) joint. Quadriceps: Decreased flexibility in the quadriceps can increase PF joint compressive forces. Iliotibial band (ITB): Tight lateral structures contribute to a lateral patella pull and patella tracking dysfunction. Tightness in any or all of the above structures can increase stress on the knee or alter joint mechanics contributing to an increased risk of experiencing knee pain. Also consider the Gastrocnemius and the hip flexors: de- creased flexibility here can lead to an altered gait pattern that can place abnormal stresses on the knee. Considering Strength and Muscular Balance Decreased activation/recruitment and strength of the quadri- ceps with particular consideration to the vastus medialis oblique (VMO) can create an extensor lag and contribute to increased lateral deviation of the patella and increased stress on the exten- sors with activity. Greater dynamic stabilization is necessary in terminal knee extension requiring good balance and strength throughout the quadriceps muscle group for proper patella tracking to reduce risk of anterior knee pain. Decreased strength in the lateral hip including the hip external rotators and abductors can lead to valgus collapse at the knee altering knee/PF joint mechanics contributing to knee pain. The principle here is to control mechanics of the knee from the proximal joint. Also consider controlling mechanics of the knee from the dis- tal joint, pronation at the foot/ankle creates a valgus at the knee as well. Strengthening the ankle/foot through a variety of balance and proprioceptive activities to limit/control pronation should be part of the program. If pronation is a more structural problem vs. functional, orthotics or a change in footwear may benefit. Important: Put it All in Motion Keep in mind that just improving lower extremity flexibility and improve strength will not correct your mechanics until you correct your mechanics, correct and practice your form to cor- rect mechanics as you improve your flexibility and strengthen the offending weaker muscles. Considering these strategies can help you improve your train- ing, correct imbalances and reduce some of the factors that may contribute to knee pain. Keep your training on track with a little time investment including some assessment of strength and flexibility; take the time to address the mobility restrictions and strength imbalances. If you are struggling with knee pain consult with a local MD/PT to help you get to the source of the problem. TRAINING 84. FitnessX.com • Summer/Fall 2013