As a personal trainer to mostly female clients I am deeply disturbed by a rising trend that I am seeing. Women in their 30’s and 40’s who are barely able to get up from sitting position without using some sort of crutch. Knee issues are on the rise and mostly in women. I would say over 85 percent of my female clients over 40 have either moderate to major knee issues/injury.
There are a few different reasons why women are 2-8 times more likely than our male counterparts to suffer a knee injury. Studies suggest that there is a connection between knee injuries and hormone fluctuation making women at higher risk of injury during ovulation when estrogen levels are high.
Also, women tend to have more lax ligaments and the muscles around the knee are generally not as developed as males.
Another reason why women may be more susceptible to injury is due to our Q angle (the Q angle is the angle of the quadriceps muscle relative to the patella).
And lastly, women often have a muscular imbalance between the quadriceps muscle group (front of the thigh), and the hamstring muscle group (back of the thigh) with the hamstrings being the weaker of the two. The hamstrings help the ACL stabilize the knee, so when there is an imbalance between these muscle groups the risk of injury to the ACL is greatly increased.
As active, strong women we need to change this trend. What can be done to lower the incidence of knee injury? Or if you are currently suffering knee pain what can you do to help? Here are my recommendations:
1. Foam Roll
2. Strengthen Hamstrings
3. Strengthen Glutes (specifically Gluteus Medius) and Hips (specifically Adductors)
1. Foam Rolling:
IT Bands: Many times knee pain can be associated with tight IT bands. Foam rolling the IT bands is very important for proper alignment of the patella (knee cap).
How to do it: Start by lying on your side, support your body weight with your legs and arms, and lie with a foam roller or ball under the upper, outside portion of your thigh. Use your legs and arms to roll the length of your IT band along the roller, traveling right down to just above your knee joint. As you get closer to your knee, you may feel more tenderness, so be prepared to use your arms and legs to ease pressure off of your IT band. Roll up and down a few times and switch legs.
Glutes: Tightness in the gluteal muscles will contribute or increase tightness in the IT band and quads. Foam rolling the glutes will improve flexibility of the IT bands and contribute to healthy knee alignment.
How to do it: Sit on the foam roller. With both hands behind you on the floor for support, slightly bend your knees. With the help of your right hand, place your left ankle on your right knee. Keep your right hand on your right thigh. Roll your glutes over the foam roller so that your weight gets shifted to the left side. Hold this position for up to 30 counts then release the stretch. Repeat on the other side.
2. Strengthen Hamstrings:
Targeted exercises to help increase strength in the hamstrings and balance out the quad to hamstring strength ratio are very important in preventing knee injury. Here are two of my favorites:
Straight Leg Deadlift: Stand tall with your feet shoulder-width apart. Slightly bending your knees, grip a barbell using a double-overhand grip so that your hands are slightly wider than shoulder-width apart. Push your chest up, keep your back straight, and push your hips back as you lower the bar down shins to feel a good stretch in the hamstrings. Pause, then reverse the movement to return to the starting position, squeezing the qlutes at the top.
Stability Ball Hamstring Curl: Begin on the floor lying on your back with your feet on top of the ball. Position the ball so that when your legs are extended your ankles are on top of the ball. This will be your starting position. Raise your hips off of the ground, keeping your weight on the shoulder blades and your feet. Flex the knees, pulling the ball as close to you as you can, contracting the hamstrings.
After a brief pause, return to the starting position. Do this exercise slowly and make sure to keep your hips up, and squeeze the glutes and hamstrings through the entire range of motion.
3. Strengthen Glutes and Hips:
Women often tend to have weak glutes and hips. Since these muscle groups work together to stabilize the knee, exercises to strengthen them are essential in proper mobility and preventing knee injury.
The Smaller Gluteus muscle, the Gluteus medius is often neglected and weak. One of my favorite exercises to target this smaller muscle is the X band walk.
How to do it: Take a resistance band and step on it with both your feet and then cross it over and hold the other end of it with your hands. (Band should resemble the figure of an X). Bend slightly at the knees and move your feet so that they are slightly wider then shoulder width apart. Shuffle your feet sideways to the right for the desired amount of steps and then shuffle back to the left. Ensure you are focusing on squeezing the glute with each step, and keeping knees bent throughout the entire exercise.
Another great exercises to target the glutes is the Hip thrust.
How to do it: Begin seated on the ground with a bench directly behind you. Have a loaded barbell over your legs. Roll the bar so that it is directly above your hips, and lean back with your upper back on the bench. Drive through your feet to extend your hips vertically. Weight should only be supported by feet and shoulder blades. Squeeze and hold at the top for a couple of seconds and return to start position.
Strengthening exercises for the Hips (specifically the adductors): One that I like is the Band Hip Adduction.
How to do it: Anchor a band around the bottom of a squat rack or cable machine. Stand with your left side to the anchored area and put your right foot through the band, getting it around the ankle. Stand up straight and hold onto the post if needed. This will be your starting position. Keeping the knee straight, raise your right legs out to the side as far as you can, making sure to squeeze the adductors. Return to the starting position and repeat 10-12 reps. Do the same on the other side.
Where to find the bands and foam rollers that are mentioned in this article? The best place to shop for these fitness tools and all fitness tools is the Treadmill Factory. They are very knowledgeable and can help you find exactly what you need and ensure you feel comfortable using it.
If you are like me, and love to train hard, play sports, chase after your kids, and just enjoy being able to do physically challenging activites having to deal with a knee injury would be devastating. Make sure you are doing everything you can to ensure your knees stay healthy for the long haul. Roll, Strengthen and stretch-it is the key to the longevity of your knees!