Down Low – Knee Injuries

June 7th, 2010 | Fitness

Ok girls, we are more prone to knee injuries and especially ACL tears, lucky us! It is said to possibly be due to a couple differences in biomechanics as a result of different angles and rotations. One factor might be our big hips and therefore different angles as resulting forces then men. Also we tend to have more internal rotation on landings and more leg dominance than men. All of these mechanisms contribute to larger stress and torque on the ligaments. Yeah I know, us girls get the best of everything, but if you are going to go big, then you are going to have to take care of your knees. I am going to break down some exercises to help prevent knee injuries, especially ligament sprains, like our friend the ACL tear. There is so much information, so I am going to keep it to the basics, give everyone a head start, but there are many more knee injuries and wakeboarding tends to be very hard on this particular joint.

ANATOMY AND COMMON KNEE INJURIES

The most common injury in wakeboarding and especially females, is an ACL tear. Your ACL is the ligament between your femur and shin bone that keeps your knee from shifting backwards. This injury is also associated with other ligament sprains such as the MCL (medial ligament), PCL (knee shifting forwards) and LCL (lateral ligament) can also be associated with the injury and each prevents the knee from moving in a certain direction.

Another common injury is meniscus tears and occurs after the knee is twisted. Your meniscus is the tissue inside your knee covering the bones to prevent bone on bone contact. Tears of the meniscus can occur in the middle or on the periphery and often require surgery to repair it. If the tear is on the periphery recovery after surgery may take 4-6 weeks, but if the tear is in the middle and supplied by blood and nerves, healing time can be as little and 10 days to 4 weeks.

For more chronic pain, you could be looking at a case of patella femoral, when the patella is shifting over improperly. This can be because of various reasons, such as a tight IT band, the tendon running from your hip down to your knee on the outside of your thigh. It is a tough one to stretch but it can be done and strengthening the inner leg muscle will help pull the knee cap back to the centre. Biking is very helpful for this condition.

Every injury if different and specific to each individual. All these should be treated by a physiotherapist to strengthen what ever is weak and stretch whatever’s tight and correct biomechanics to get you back out on the water pain free.

I am going to focus on ACL injuries specifically and increasing knee stability, but the exercises I suggest help to strengthen and stabilize the knee joint and can help to prevent all knee injuries. With any injury, a little time, instruction, work ethic and positive thinking; you’ll be back out wakeboarding before you know it and stronger than ever.

MECHANISM

There are a couple ways the knee can be stressed to cause a tear of your ACL.

(a) Landing from a height in an off balance position, especially when there is internal rotation at the knee joint, which is much more common in females or/

(b) A change in direction with a rotational force, like in a fall where you hit the water and the resistance of your board hitting the water rotates your leg one way, while your body is rotating another. Luckily both these are very common in wakeboarding.

PREVENTATIVE EXERCISES

Even just a half an hour, a few times a week, strengthening your legs to prevent knee injuries should generally be enough to reduce your risk of knee injuries. Wakeboarding is like any other sport, you have to train to improve and prevent injuries. Here are the muscle groups to work on specifically to increase stability in the knee. I am going to give you a list of exercises you can do at home, without the fancy gym equipment. The only thing you may need is a theraband which you can buy at any drug store if you don’t already have one. They come in different colours, generally increasing resistance with darker colours. With all of these exercises, speed is not important, rather slow, steady and controlled movements done properly are most beneficial. If you train your body to do the movements properly then the muscles and biomechanics will adapt to always move like that. All these exercise are to increase stability of the knee and correct for any improper movements or positions during exercises which make you more prone to knee injuries.

These are exercises that target the muscle groups needed prevent injuries like ACL tears and generally increasing stability of the knee to help prevent other knee injuries as well. Strength training, flexibility, balance and dynamic exercises are all equally important and have an important role in overall knee function. Don’t do anything half assed, all or nothing right girls?

(A) Strength

10 Leg Exercises to help prevent knee injuries and strengthen you legs

For all of the following exercises you should be completing 2-3 sets of 8-12 repetitions

KNEE EXTENSORS “quadriceps”

• Squats: The classic two legged squat, the trick is that many people do this exercise incorrectly therefore increasing your chance of injury. Start with your legs about shoulder width apart and make sure your knees stay over top of your feet and that they do not rotate inwards. To make sure you are doing your squats correctly do them side ways in a mirror to make sure that your knees are never going past your toes. Also steer clear from deep knee flexion, stop when your squat hits about a 90 degree angle.

*tip if find you are falling backwards, b/c you can’t get weight over you feet, try stretching out your calf muscles because the lack of flexibility at your ankle joint could be the problem

• Wall Sits

Keep your back flat against a wall and your knees at a 90 degree angle following the same rules as with your squats.

*tip- you can also do this with a rope attached to something steady in front of you to be more sport specific but remember to keep your back upright and shoulders back.

• Lunges

The classic lunge can be very beneficial and your can throw in a little variety if you are feeling crazy.

Take one step forward to a spot where when your lower your front knee doesn’t go over your toes. When rising give a little push off and then start again with the other leg. Lunges can be done in any direction, sideways and backwards but remember to keep that core tight and make sure your hips are solid and aren’t dropping during the lunge.

• Step Ups

Forwards and Lateral onto a solid surface 1-2 ft high. Try to use only the leg you are stepping onto with very little/no push up from the other leg. To add difficulty hold onto free weights in each hand.

KNEE FLEXORS “hamstrings”

• Ball Exercise; Hamstring curls

Soles of feet on ball with shoulder blades on floor and lift hips so it is a straight line from your shoulders to knees. Bend your knees, rolling the ball in and out, working your hamstring muscles. To increase difficulty try using one leg.

CALF MUSCLE “gastrocnemius”

• Heel Raises; on the balls of your foot, go up on your toes and back down. It is best is to do them on the edge of stairs so that your heel can drop past the ledge. Try not to hold onto anything to help with balance and proprioception and to increase difficulty you can try holding small free weights as well.

OTHER LEG MUSCLES

• Multi-direction leg raises; keeping your core string, steady and as little movement as possible lift one leg out in multiple directions. Best not to use anything to hold onto to make your core do all the work. To increase difficulty use a theraband attached your both legs at your ankles and do the same thing.
• Adductor Squeeze; (inside of thigh) – Place an exercise ball between legs and squeeze for either a set amount of time or for a set amount of repetitions.
• Hip External Rotators

“Jane Fonda”; the classic exercise where you lie on your side and raise your leg up off the ground again and again. Well this is a good one but to make sure you are working the muscles we want to work. Rotate your leg so that your toes are pointing towards the ceilings.

Clams; where you lie on your side with bent knees at 90’ and put the theraband around your knees, then lift one knee up leaving your feet on the ground and other leg on the ground.

(B) Flexibility

I am not going to go through all different stretches, just make sure that you are keeping flexible in all your muscle groups. You need to maintain mobility in all your muscles so that little strains won’t turn into big injuries. The more stretch and flexibility your muscles can withstand may help to prevent knee injuries as well as increasing blood flow. It also makes those super  steezy tweaked out grabs easier to do.

(C) Proprioception and Balance

Wobble Board: 2L pop bottle and plywood/skateboard deck

One leg à on pillow or half ball/unstable surface

To increase difficulty change weight distribution, move the other leg to different positions, hold and book out to the side, or close your eyes

(D) Dynmaic Exercises

Hop Downs – from a reasonable height girls (1-2ft), we aren’t looking to cause any injuries- absorb with knees, but not past 90 degrees and make sure your knees are not going past your toes.

Hopscotch: jump in different directions, not too far. Think of it as like a tic tac toe board and jump to different spaces in different directions, using your knees to absorb no further than 90’s with feet over toes

Running or sprinting exercises with start and stops in different directions

le/ square

TREATMENT and RECOVERY

If while you are riding you or your friend get a suspected knee injury follow these rules:

PIERS

Pressure – to reduce or minimize swelling

Ice – to reduce/minimize swelling

Elevation - to reduce swelling

Rest – to not aggravate, reinjure or further injure

Support – taping, tensor, bracing

If it is bad enough and you think something is seriously wrong, or you hear a pop or there is a lot of instability when you weight bear, go see a doctor immediately, get some x-rays or an MRI.

Controversy with support bracing:

TENSORS; are usually only used to keep ice on. Tensors and soft braces biggest benefit is mentally, through awareness of any minor movements but don’t do much to prevent injury and don’t provide adequate support.

TAPING; used when getting back into the sport after the injury, and need to be taped by trained individual, there actually is a method its not just wrap it around again and again. Improper taping doesn’t help and may make the injury worse. Usually you do not tape knees, it is complicated and uses a lot of tape, but is possible.

BRACING; properly fitted braces are the best bet for knee support. Ideally what you want is for your rehab to strengthen the muscles and improve biomechanics of the joint itself so there is no need for a brace at all. You should not have to use a brace if properly rehabilitated after approximately 1 year and if you not properly rehabilitated, then get properly rehabilitated.

The hardest recovery is most likely going to be the mental recovery from the pain and consequences of the injury. You have to get that knee strong and healthier than it was before the injury and that stability and confidence should help you get back on the water, progressing and going bigger then before.

If you have already had a knee injury then your best bet is to get to a physiotherapist, who can nurse the muscles back to health and take you through the steps to get that leg stronger then before. Without rehabilitation you are putting yourself at risk for reoccurrence or worse injury, decreased strength and stability, osteoarthritic problems later in life and worst of all setting yourself up for not being able to wakeboard again. So forget the tough guy persona, we know your tough, you are a wakeboard chick, so get the help you need to get back on the water ASAP. Depending on the severity of your tear, you may need surgery. You should not completely immobilize the joint, you have to keep mobility and strength or its harder to rehabilitate. The physiotherapist will take you through the needed steps to slowly increase range of motion and strength to get you back out wakeboarding sooner, faster than you thought and healthier than ever.

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