The knee joint is very simple in it’s design. A hinged joint that primarily moves in flexion and extension. There is also some motion that occurs just below at the tibiofemoral joint (internal and external rotation) that needs to taken into consideration during lateral and rotational movements.
Even though the motion at the knee is relatively simple, it is greatly influenced by the joints above and below. This includes the foot/ankle and hip. Because ultimately, function at those joints largely dictate positioning of the knee.
As someone who has formerly dealt with knee pain, I know how debilitating it can be. Just because pain is experienced at the knee doesn’t mean the knee joint needs to be the sole focus of your intervention. And doing so would be a shortsighted approach to resolving knee pain.
When progressing through a corrective exercise program to restore function and resolve pain at the knee, incorporating sagittal plane movements are a good starting point. This includes any movement where the body utilizes flexion and extension, and never moves laterally or rotates. For example: squat, split squat, deadlift, reverse lunge, etc. From a knee standpoint, it’s main job is to flex and extend with little rotational demand at the joint.
Sagittal plane movements, although basic on the knee joint, require stability and optimal control from the foot and hip. Because these joints have the capability of multi-planar movement, they must now stabilize to ensure the knee is tracking properly. That’s exactly why programs created to improve knee health need to take into consideration the joints above and below.
But, what’s the next step? Oftentimes, people stop with sagittal plane movements because they are unsure how to progress and continually challenge the knee.
The frontal plane can be a suitable next step and often needs to be executed with care for those with previous history of knee pain. With the addition of lateral-based movements, the knee joint has a tendency now to move from it’s safe, aligned position, to a position that can surely place more stress upon it. This includes into internal and external rotation at the tibiofemoral joint which increases stressed inside of the joint.
Several exercises that are a great starting point in the frontal plane are lateral step ups and lateral squats. Both require contribution from the foot and hip and add a new stress on the knee with the lateral-based movement. But, care must be placed on where the knee is positioned, especially early on. Deviations from pure flexion and extension can cause internal rotation and subsequent valgus at the joint. This is where caution needs to be taken to promote optimal positioning of the knee.
In the following video, let me walk you through how the lateral step up can be used as a progression to promote optimal knee health…
By: Garrett McLaughlin, MS, ATC, CSCS, ART