 Hi, I'm Lieutenant Commander Jim Cowan at Buds Physical Therapy. I want to talk to you on this segment about probably one of the most, if not the most common complaint that we have here at Buds, and that's knee pain. Approximately 30% of our class reports pain in the knee, and I think it comes from some things that you can work on before you come to Buds and fix fairly easily so that you don't have the common problem that we see here. So most of the problems that we see in terms of pain from the knee comes from three common locations. So this is looking at your knee as a model from the front side. This is your right knee looking from the front, okay? So you have your thigh bone, your femur bone, your knee cap, and then your lower leg bones here. So if you rotate, looking at your right knee from the side here, right, most of our common pain comes from three areas. Underneath the knee cap, where it rubs excessively hard on the knee. If the lower tendon that attaches your knee cap onto your shin bone, okay? And on the side of the knee as well. So these are the common areas where the pain comes from. Most of that problem comes from tight quadricep muscles. These muscles load the knee cap and really cause excessive friction on the back side of the knee cap. This is probably the most common sports medicine injury in the world. It's called runner's knee or patellar femoral pain. You may have been diagnosed with it in the past. And that rubbing, abnormal rubbing, really caused a lot of pain here at Buds. And soft sand running makes it even worse. So the most common thing that we're going to talk about is how to stretch out your quadricep muscle to unload that knee cap, how to stretch your hamstrings, which also let your knee open up a little bit more and take the load off that knee cap, and also how to stretch the tissue along the side of your knee, which is your IT band. And these three common flexibility areas make a tremendous improvement on how well your knee cap can track. Because if you're tight in all those muscles, it loads the knee cap up and causes really, really painful areas to occur beneath your knee cap. So the first stretch I'm going to show you is how to stretch your hamstrings properly. The keto-good hamstring stretch really starts with standing up nice and tall. Okay? You actually even want to curve your back in a little bit, because that starts the stretch on that hamstring. And then what you can do with your head up and your chest up, just make sure that you lean forward at your waist until you feel a nice hamstring stretch this way. And we recommend that you always hold a stretch at least 30 seconds in this position. And here he shows it really well. What will happen though, and you can lose the stretch, is if you let your pelvis slump, or you try to touch your toes and your back rounds out, that slumping takes the stretch off and you really lose that good stretch. So if you make sure that you really keep a nice straight back and you lean forward at your hips. We're showing more of a traditional just static stretch in this manner, although some people, me included, really do like more movement-based stretching. So another way that you could stretch your hamstrings in more of a movement-based pattern is to really keep your leg nice and straight. This also is a very good balance drill as well, and then just bending forward to touch the floor, touch a ball, touch a weight bench, slowly back and forth like this is also a very nice way to stretch those hamstrings through more movement-based. People feel that this really is a better way to stretch, and I believe that as well. Okay, the next stretch that I like is a proper quadricep stretch. This really is important for your kneecap because it unloads how much pressure occurs on that kneecap. So the proper way to really do a good quadricep stretch, that quadricep muscle goes across your hip and your knee. So it's really important that you square up on whatever you're going to use to stretch, in this case a high bench. If you were in the weight room, you could use a rack or a pole outside a bench outside, but the key is that you really push this hip forward to start the stretch. And then with that forward hip position, then you can bend the opposite knee and really drop down into a good quadricep stretch, and as always you would hold this for about 30 seconds and come out of that. Where most guys don't do this stretch properly is that one, they hike their hip out, and then oftentimes they lean forward at their waist and you immediately lose the stretch that way. And they may even rotate a little bit if they're doing like a single leg stretch. So make sure that I prefer that you put your foot up on something behind you, you really square up, get your legs together, push that hip out, and then really drop that other knee to get into a good stretch that way. Another stretch that is a movement-based stretch, like we show you with the hamstring, doesn't really focus entirely on the quad, but yet it's a very good hip stretch to keep your hip loose, which is involving the quadricep muscle, and it is more of a dynamic rotational stretch. It's just a kneeling lunge with a nice rotation back and forth. You really want to accentuate a lot of trunk rotation and feel it through that front side of hip. So the last stretch that I recommend for the knee is for the IT band. The iliotibial band is extremely commonly inflamed here. ITB stands for I Tried Buds. Everyone here at Buds has it. It's extremely painful, it's not dangerous, but it does give guys a lot of problems. That IT band starts in two places muscle-wise. One is off this front muscle under your front pocket, and the other part is off your butt cheek here in the rear area. And those muscles come together down the side of your leg and attach along the side of your knee right here, and at about 30 degrees of knee bend it rubs. And once again, soft sand makes it extremely painful here. So this stretch is very easy to do. You simply cross your legs and you lean away. Put your hand on that opposite hip, and you really just push into this front pocket. You may have to lean your trunk till you find it just right, but you should be able to push into this and feel your stretch really right under your front pocket. The second half of that stretch involves a glute, which is then going into a figure four sit, and you cross your legs, and you can drop into a sit this way. And if you want to hold on to a bench or anything like that, a bicycle, that's very good. And you really should feel that in the rear glute portion there. Okay, this is probably one of the most important segments that we're going to talk about here at Buds. All right, most of you out there preparing to come here do a great job of strengthening your lower legs with one exception. And it's really the one group that you need to be working the most before you come here, so we're going to talk a little bit about it. Most of you are doing quite a lot of quadricep strengthening. You guys have great, strong quadricep muscles, and that is great, right? You also have very good, strong hamstring muscles, and even your glute maximus from all the squatting is very strong. However, there's one group of muscles that you guys totally neglect, and it's your lateral hip muscles right here, all right? These are the main muscles that control your hip position and as well as how your knee strikes. And so in soft sand with weak hips that equates to a lot of biomechanical problems and a lot of knee pain. And the evidence really supports that a lot of elite runners with chronic knee pain have weak lateral hip groups. So it's a big focus that I want, probably the most important lower leg focus that I want you to work on before you come to Buds. All right, so if you watch this single leg squat on the box here, okay? You can notice a couple things, just keep him in there, back in. You can notice this right knee rolls inward. This whole leg collapses and rolls inward, all right? That causes tracking problems on the kneecap and rubbing and IT band problems, all right? So this weak hip allows his whole thigh to collapse inward, which is causing problems. And you'll notice his opposite hip on this side drops, okay? So that's a one spot that you can see that this hip group really is affecting his knee strike and you've got to work on that. Okay, once again, as you can see, we're going to look at this lateral hip strength. Once again, quadricep muscle is extremely strong on all of everyone that comes here. Hamstring muscle is very strong, all right? Glute, glute maximus, very strong. Glute medius, very weak, all right? If you can look at holding his leg here, this would be a three out of five. On a scale of five, that's a three, all right? As we push, most of these guys, I would say the average score on hip strength here at Buds is at best a three and a half out of five. They need to be five out of five. Every other group, I guarantee it, is probably five out of five, except this one. And it's a problem if you're running in soft sand with weak hips. All right, so I'm going to show you some of the common drills that we use to promote that lateral hip strength, to fight the big hip weakness that we see here at Buds. All right, my favorite is Monster Walks. We do it with a overhead medicine ball of 20 to 30 pounds to start getting ready for the overhead, log PT, and boat PT that is such a problem for the shoulders. So we can integrate overhead endurance along with the lateral hip strengthening drill that so many guys need. So for the Monster Walk, we'll go overhead with the ball. And it's a really nice lateral movement, all right? And around his ankles, we have some exercise band. You can find that locally at any sports store. And he'll tell you that he's really feeling that burn right here on the lateral hips, okay? And you can do these as laps around your weight room. As you get to each corner of the gym, you can do some air squats, really driving your knees to stay open and not collapse in like we showed earlier. We're just trying to avoid that knee from rolling in with good lateral hip strength. You can do 30, 40, 50 air squats on either corner of the gym as you did, some laps with this. And that's a really nice all-encompassing hip and shoulder workout. Okay, another drill we have folks work on that is really what we showed you earlier is working on the technique, watching how your knee strikes, making sure that you're aware of how a good knee should track and not roll inward excessively. So we have guys do a lot of step drills. You could step on a weight bench and look at yourself in the mirror that way. Or if you have a small step with a mirror available, that's also a very good strength drill and just technique work as well. So you can do the single leg squat like we showed earlier. The key is as you watch yourself in the mirror do this, is to have your hands at hip level here and really monitor your hips, make sure that they stay level and that they're not dropping on that opposite hip. That they really stay level, that you focus on firing that muscle and keeping your hips level. The other thing is that you're watching where your knee is tracking. You want it to track straight out and straight back, not start deviating towards midline. You really be able to work at controlling that knee squat with good form. And the last thing you want to look at is your shoulders. You don't want to lean into the stance leg because that eases the work requirement as well. So your shoulders should stay equal in level, your hips should stay equal in level, and your knees should track straight out and straight back. And you need to really work on good technique with that. Okay, so the last drill that I really like for the lateral hip strength are just side cable raises. You can do this almost every gym has some kind of cable rack available to you. So we have our students do this, single leg. It's a very nice, slow raising of that leg, focusing on the lateral hip and not cheating with the stronger glute, right? Just nice, slow sets of 10 to 12 reps, right? Nice and slow up, just about that 45 degree point. And this works the hips in two ways. This hip is actually working for the strength movement. And the opposite hip really has to be used to stabilize and balance. So it also gets a good amount of work on this as well. So pure strengthening and balance. It's a good balance exercise for any kind of knee, hip, or ankle injury. So we do this quite a lot. I do like this one. So we're going to wrap up talking about knee pain, all right? It really is in two areas that you need to focus. One is on the proper stretches of the muscles that have some influence on your knee cap, mainly your quadricep muscle, your hamstrings, and that IT band that runs along the side of your leg. You need to work on these stretches at least twice during the day. Once after your workout, during that five minutes where you're cooling off, and one other session during the day is what we recommend. A couple stretches, couple repetitions, holding for about 30 seconds is all you need to do that. But if you work on those key areas, it will have a large influence on your knee cap, how it works and how little pain that you will have while you're here, right? The other is really one of, like I said, the biggest things is neglected here. We talked about in the stress fracture segment, we're going to talk about in the knee pain segment, right? It is your lateral hip strength. You've got to work on these lateral muscles and keep them strong. They're going to be the best friend of your knee and your ankle when you come here running in soft sand. Also, we mentioned, you know, 30 to 40% of our mileage is done on unstable soft sand. So, just like we mentioned in the training tips, make sure that you're running is happening on some kind of unstable surface. Whether it is a farm road or trail running or beach if you have it, but you need to make sure that at least a 30-year mileage is on some kind of unstable surface so that your knee gets used to that requirement, right? And that combined with the right stretching and the right lateral hip strengthening should get you a long way to avoiding the knee pain that comes here at Buds. So, Lieutenant Commander Jim Cowan, here's hoping that you have some good knee health and you stay away from our clinic when you come to Buds.