Things to look at when assessing an athlete’s knee issues:
Can they control the sagittal plan?
Can they resist valgus/varus forces and control the frontal plan?
Is there any patellar tracking that could be from tight quadriceps muscles?
Is there a rotation at the femur or the patella when the athlete is standing?
When they squat what moves first; hip or knees?
Are there any muscular imbalances?
Is there a loss of core stability at any point throughout the squat
These are some of the things you need to look at and assess when you have an athlete with knee pain or has returned after rehab on their knee
The Box Squat / Low bar squat
The box squat and low bar squat (when performed correctly) are great ways to squat for athletes with knee issues. The first reason is the levers the body has while performing these squats. During the low bar and box squat, the athlete’s hips are much further back versus someone performing a high bar/front squat, and this creates a greater hip moment arm and smaller knee moment arm which just means more work is being done by the hip extensors compared to the knee extensors. With a larger hip moment arm, the degree of flexion at the knee is also decreased which prevents excessive pressure in the knee joint. These squats will help build lots of strength in the athlete’s core, back, and hip extensors, these muscles can contribute to relieving stress at the knee as well as improve the athlete’s stability while moving through space. The result can be a healthier knee.
Additional Things to Help the Knee
If the quadriceps are tight and pull on the knee, this can cause excess stress on the patellar and quadriceps tendon all of which affect the knee cap. When the muscles and tendons are pulling on the patella, this can cause patellar tracking disorder or patellofemoral syndrome. When the patella does not sit correctly in the patellofemoral groove, this can wear down the cartilage under the knee which leads to patellofemoral syndrome. To correct this, you can have the athlete stretch the quads by performing the couch stretch and by foam rolling the area. It should be noted that if the quadriceps are very tight, it can cause the knee to buckle while moving which could result in a knee injury, that is why stretching the quads is also important.
Banded glute activations is another great activity for athletes with knee pain. If the stabilizing muscles of the hip are not active, this can affect an athlete’s ability to handle varus or valgus forces at the knee. Performing different banded glute activation can improve this stability as well as aid in correcting any lateral shift the athlete may have in the squat which would affect the health of their knee.
Single leg step ups and step downs onto or from an elevated surface can help the athlete control the movement of their knee. When this drill is done correctly, the athlete will have to monitor the ascent and descent while preventing any unwanted lateral or medial tracking of the knee joint. When athletes master one height, you can increase the elevation to increase the difficulty for the athlete.
Core activation is also essential if the core is not active the pelvis may not be set up for optimal squatting technique. And when the pelvis is not set up correctly then this affects the hip joint which affects the knee joint which then affects the ankle joint. It starts with an active set up when an athlete has good core activation they are setting themselves up for success.
What’s The Goal?
Obviously, we want the athlete’s knee pain to subside, but there are a few things that we want beside pain-free squats, and they relate directly back to what we look for when an athlete is squatting. The technique is important, and we want to see control of the joints. This includes eliminating any undesired spinal flexion or overextension, a lateral shift in the pelvis, and valgus fault at the knee. Bottom line, we want the optimal movement pattern for the athlete, and optimal movement will produce pain-free movement.