In Part 1 we looked at the huge number of injuries that girls and women sustain from playing sports, especially soccer, lacrosse and basketball. In this article we will discuss 10 ways girls and women can bulletproof their knees against trauma and injuries. Not interested in reading about this? Too boring? Perhaps you’ve never been through this?

Trust me it's not my idea of fun.

I became interested in knees shortly after arriving in China to work with the Chinese National Speed skating team in the summer of 2006. Upon arriving I was blown away with the speed, strength and athletic ability of our team. Most of our male skaters legs were measured at more then 65 cm. If you want to know how much bigger that is then your average person grab a tape measure. However to make a long story short even these supermen and women had knee problems. I spent the next four years studying the knee injuries that our team suffered and have compiled a list to prevent others from going through surgeries like the one above. I present 10 ways to bulletproof your knees.

1. Don’t skimp on your warm-up!

This idea is beautiful in its simplicity, yet often ignored for various reasons such as “I’m in a hurry” or “I don’t need to warm-up because I’m 16 and therefore ten feet tall and impervious to harm.” Well, I’d love to see what that lack of warm-up is doing to your joints!

Beyond improving your training performance for numerous reasons, warming up reduces the viscosity of synovial fluid (the stuff that fills your joint space), providing better lubrication and healthier joints in general.

2. Want healthy knees? Focus on ankle and hip mobility!

It may sound counterintuitive, but when we have knee issues, where do we focus most of our attention? The knees, right? 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, not the knees themselves. Lack of hip mobility cannot only lead to knee pain, but back pain as well. At our facility we make sure that all of our athletes have excellent mobility at the hip and ankle. Next time you have your team or child hanging around get them to do a full squat. If the mobility looks anything like the below picture I can assure you their will be problems down the road.

Here is one from our yoga friends-------->

These are some mobility drills we do at the Jungle before lifting. http://www.youtube.com/watchv=pupddxxwZcs

3. Get your glutes firing, then make them stronger

This is another area that not nearly enough of us are addressing, as most who have patello-femoral pain are only worried about isolating the vastus medialis obliquus (VMO).

In research by Ireland et al. (1), they found that athletes with patello-femoral pain had significantly decreased strength in both hip abduction and hip external rotation. 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, what muscles are most affected? Specifically, we’re talking about getting your gluteus maximus and posterior fibers of the gluteus medius firing. So before we do low-body work, we should be getting some activation work in to make sure those muscles are stimulated and ready to go. X-Band walks are perfect here. http://www.youtube.com/watch?v=C9IcLbu8ThY

Stay tight, tall, and use those glutes and you should be just fine.

For the Glute Maximus we do hip thrusts. See video. If that version is too hard you can do it with two legs. http://www.youtube.com/watch?v=baTlVyx3RS8

Every female athlete I work with is going to get a steady dose of posterior chain work!

<------ hip thrust

4. Get some balance in your training.

It stuns me how many people get this one wrong. For example instead of putting your hamstrings at the end of your workout when you’re exhausted, why not work them at the beginning? In terms of a longer point of view, one training cycle should and must focus on the development of a few qualities, not all of them. It is impossible to work on maximum strength, muscle hypertrophy, muscular endurance, muscular power, aerobic endurance, and maximum speed all at the same time. Pick a few qualities and maintain the others. That means that in terms of training over a period of months, training must be balanced.

Remember, “Time magnifies all programming errors.”

Hamstring drop------------------->

5. Not every exercise can be done by anyone!

This is the simplest tip I’ll give, but for whatever reason people still fail to listen to their body and grasp the concept: If it hurts, stop doing it! This can include squatting, lunging, running, playing basketball, or any other pain-provoking activities.

Each and every time you step in the gym you need to work on being better, and if you’re injured, that just can’t happen.

hint. There is something wrong with her technique------------------------------->

6. Do some single-leg work.

Why do single-leg work?

-Decrease strength imbalances between right and left legs

-Providing a change of pace in your training

-Improved balance and proprioception

-Strengthen key knee stabilizers, specifically the VMO and gluteals

Let’s focus briefly on point number four. Remember how we discussed above that those with knee issues need to improve general quadriceps strength, and also need to improve gluteal strength as well? For these reasons alone, single-leg exercises can do wonders for preventing (or rehabilitating) injuries.

I’m a firm believer that the more proficient you are at single-leg exercises, the better you can become at double-leg exercises!

7. Learn to jump and more importantly, land!

What I’d like all trainees to have is at least a basic knowledge of how to absorb force. If you were to jump up in the air and then land with your knees straight and a loud “thud,” you’re not allowing your muscles and tendons to absorb force. Instead, your joints are absorbing all the force, and this just isn’t a good thing if you value your knee joints (or ankles, hips, or lumbar spine for that matter!)

The vertical jump is actually a great test and exercise to utilize. Jump up in the air and try to minimize the sound when you hit the ground. Land with soft knees, soft feet, and lower into a half squat to absorb the force. I’m not trying to make you into an elite athlete with this recommendation, just give you some food for thought. It wouldn’t kill you to be a little more athletic, would it?

8. Learn how to lift!

This may sound crazy but sometimes its not the exercise that is making you hurt, it’s how your performing the exercise that is hurting you!

9. Beware the irritated rectus femoris!

“How do I know if my rectus is a problem?” What is a rectus femoris. Let just say it’s a very important muscle in sprinting. Try the modified Thomas Test to find out:

Sit on the edge of a table or counter with your buttocks on the edge. From here, grab one knee and pull it to your chest while laying all the way back with the head and neck relaxed.

What you’re looking for here is the position of the lower leg in relation to the ground. If your lower leg is perpendicular to the ground, you’re fine. However, if your lower leg is not at perpendicular, you have a short or stiff rectus femoris. The gentleman in the picture below is a great example. Notice how his upper thigh is parallel to the ground, but his lower thigh isn’t perpendicular. 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, you need to focus on your rectus femoris, a two-joint hip flexor that crosses both the hip and the knee. If you failed the test above, try this stretch:

10. Stretch your quads and calves!

I recently came across an interesting prospective study regarding patello-femoral pain. While most studies are retrospective in nature (e.g. they examine an issue after there’s a problem) very few look at it in the opposite fashion.

This prospective study (3) examined 282 athletes enrolled in phys ed classes and took them through a battery of tests to determine baseline statistics. Two years later they followed up, and 24 of the 282 had developed patellofemoral pain. After running statistical analyses on these subjects, researchers determined that athletes who had developed PF pain had significantly tighter quadriceps and gastrocnemi than their healthy counterparts. So what’s the moral of this story? Stretch your quads and calves!

As well, 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. All the more reason to stretch those puppies out if you ask me!

Conclusion

You have all the tips you need to keep your knees healthy and feeling great. 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!

If you have any questions please feel free to contact Greg @ junglestrengthinc@hotmail.com

Special thanks to Eric Cressey at Cressey Sports Performance

How to bulletproof your knees Part 2