Elvis Has Left the Building

Elvis Has Left the Building

For the past two weeks I’ve focused on forward alignment of the feet for standing and walking. Today I want to move a little farther up the leg and discuss those glass knees of yours, you know, the ones that creak and ache every time you even think about bending them. This piece isn’t going to tell you how to reverse arthritis or get rid of that disgusting crunching you get each time you attempt to pick up your socks from the floor. Rather, I want to discuss how to optimize your knee movement to prevent things from getting any worse.

For the majority of us, standing in place and not moving a muscle doesn’t tax our knees all that much. It’s when we go to get out of our favorite chair or climb the never-ending stairs to transfer at virtually any NYC subway station that those knees begin to show their age. So what can we do to help ourselves out on a daily basis?

Image courtesy of wiscboneandjoint.com

Image courtesy of wiscboneandjoint.com

Let’s start off with a very basic anatomy lesson. The knee joint can actually be divided into two joints: the patellofemoral joint and the tibiofemoral joint, named for the bones that make up each of these joints. The patellofemoral joint is made up of the patella (knee cap) and the femur (thigh bone). This joint creates mechanical advantage for the quadriceps muscle, helping it extend (straighten) the knee. The presence of the patella increases the angle at which the quad and patella tendons insert, thus increasing leverage. Injuries at this joint are termed runner’s knee/chondromalacia patella/patellofemoral syndrome.

The tibiofemoral joint is made up of the tibia (shin bone) and the femur. It is the primary weight-bearing joint of the knee and allows for flexion and extension, along with a little bit of rotation. Additionally, the presence of two menisci add cushion and increase joint congruency. Common injuries here are ACL,PCL, and meniscal tears, along with the dreaded osteoarthritis. 

There are two different types of cartilage in the knee: fibrocartilage, which is what the two menisci are made of, and hyaline, or articular cartilage, which lines the ends of the tibia, femur, and back side of the patella. This cartilage, though far from unbreakable, is designed to withstand quite a bit of wear and tear…provided we’re moving in the correct (and by that I mean biomechanically sound with the joint surfaces loaded appropriately) way and not just twist-and-shouting our way to a knee replacement.

Image courtesy of Healthwise, Inc

Image courtesy of Healthwise, Inc

When our feet are in contact with the ground our knees absorb a large majority of the force that is generated with each step. The architecture of the knee is such that we can handle heavy loads, provided our alignment is correct. At the patellofemoral joint, the patella sits in a groove within the femur, akin to a train on a train track. Squatting, landing, or going up and down the stairs with those knees collapsing inward causes that patella-train to ride in the incorrect portion of the femur-track, creating rubbing and eventually breakdown. 

Similarly, at the tibiofemoral joint, improper mechanics - aka Elvis knees - while performing those previously mentioned motions causes stress, strain, and uneven loading at tissues not designed to handle such activity; arthritis, meniscal tears, MCL sprains, need I go on?

Check yo’self: Here’s where those stairs and that La-Z-Boy (yes, that is how it is spelled) come into play. For the next week I challenge you to observe and adjust your knee alignment each and every time you sit or stand from a supporting surface (toilets included!) and when you go up and down the stairs. Keep your knees aligned with your feet (which should be facing forward per our last two discussions) and don’t allow them to collapse inward. Contracting your glutes will help with this. I know, I know, who has time to be checking out their knees during the frantic rush-hour or in the two minutes they have for a bathroom break between clients? People who don’t want knee replacements, that’s who. Do it. Your body will thank you.