Nothing stops a dedicated athlete from training like a debilitating injury. One common scenario is feeling discomfort, modifying activity, taking some time off, and then going back to normal activity only to have the injury show up again. Athletes need to understand that injuries do not just "go away". The pain may decrease in intensity, but unless some specific rehabilitation and training is done, the injury is likely to re-occur. Rest, ice, and pain medications are important, but will only be useful for a limited time.  Preventing injury is more important than dealing with the injury after it has occurred.  Knee problems are common in athletes, but the chance of injury can be diminished with a careful training plan. Knee injuries from blunt trauma or a “pounding” movement may not be preventable, but those arising from overuse or muscle imbalances can usually be avoided. In other words, a soccer player’s plant and twist or a rugby player getting hit on the outside of the leg will cause direct, blunt trauma to the ligaments and would be hard to avoid. Patellar tendon pain, on the other hand, can be controlled. However, it’s important to consider that an athlete who has strong balanced muscles and moves in bio-mechanically correct patterns may be able to decrease the amount of ligament damage done in the aforementioned blunt trauma scenario.

An athlete’s flexibility usually needs to be addressed, since most athletes do not include a regular stretching program into their training plans. Tight muscles are more likely to be strained. In addition, they create constant tension through the tendons onto the bones. This tension and stress may lead to abnormal movement patterns and thus sets the athlete up for injury. Common tightness occurs on the outside of the leg on the Iliotibial band which runs from the hip, crosses the knee joint, and connects on the lower leg bone near the kneecap. This tightness pulls the kneecap out, and often, the athlete feels pain at the knee tendons. To add to this injury, athletes usually have weakness in one of the quadricep muscles, and as a result, the knee has little tension to keep it tracking properly. The vastus medialis is the tear-drop shaped muscle on the inside of the leg; it’s responsible for the last 30 degrees of knee extension. To help the kneecap track properly, and to help prevent tendon pain, it is important to stretch the quadricep, the hip flexors, and the IT band, and also to strengthen the VMO and leg adductors.  

Too much, too soon, too often leads to pain. Athletes may lift heavy for long periods of time, or they may run fast/long for an extended time. Tendons, ligaments, and muscles surrounding the knee are put under high loads and they break down. A similar phenomenon occurs when the athlete increases the intensity of their exercise too quickly. The sudden increase places demand on tissue that has yet to adapt, so it gets injured. To prevent these types of injuries, the athlete should have carefully structured programs with gradual progression. The long term program should also have periods of rest and decreased demands.

Dedicated athletes rarely like to vary their routine, but this often causes problems and leads to injury. Rest for the body does not always mean stopping activity. Rest, and injury prevention, may be achieved by modifying a routine. Think about the demands that running, jumping, cycling, and weight lifting place on the knee. The athlete that always runs/rides the same route, or does the same exercises, is setting themselves up for knee injury. Varying the terrain, the program, the sets/reps, and the exercises will dramatically decrease the potential for knee injury.  

Extremes in range of motion (steep hills, bad angles on a bike set up, deep squats) put unnecessary stress on the knee and lead to injury. Most athletes are aware that the knee is not supposed to move over the toes because it can lead to injury. Anytime the tibia (one of the lower leg bones) moves forward an excessive amount, the kneecap tendon is put on stretch and is at risk for damage. Too much movement and excessive strain on the tendons will elicit pain. Athletes wishing to decrease their potential for injury should spend as little time as possible in ”end ranges of motion”, and should ensure that their movements are bio-mechanically correct. These factors help ensure that the knee is kept safely in its normal ranges.

The keys to preventing knee pain are: stretch the tightness, strengthen the weakness, vary activity, monitor extremes in movement, and gradually progress exercises. Do not push though knee pain. Remember, there is no need for injury or discomfort.

Manny Escalante, Jr. MA, ATC, CPT has a Master's Degree in Sports Medicine, is a Certified Athletic Trainer, and Certified Personal Trainer. He works with clients on a daily basis as well as writes and lectures on health and fitness topics. Manny has competed in bodybuilding, is a 3 time Ironman Triathlon Finisher and will be competing in ultra-marathons in the near future.