NASM CES Chapter 12: Corrective Strategies for the Knee 5

If you have not yet signed up for the NASM CES certification, receive a big discount here.

Get your copy of the NASM CES exam cheat sheet. It helps immensely for studying for the exam.

Make sure to check out Trainer Academy for premium NASM CES study materials. They will reduce study time by 50% and have an exam pass guarantee. Read my full review on them here. You can save $100 on their MVP study system with the code: PTPSUB

Chapter Goals:

  • Know the basic functional anatomy of the knee.
  • Find the mechanisms that are common in knee injuries.
  • Discuss the influence of altered knee movement on the kinetic chain.
  • Find the right systematic assessment strategies for the knee. 
  • Be able to find the right strategies for corrective exercise on the knee. 

Introduction

Injuries of the lower body account for over 66 percent of all injuries.

The knee happens to be one of those parts more commonly injured.

The knee is between the foot and ankle complex and the hip complex.

The knee is susceptible to dysfunctions of the lower kinetic chain.

One of the more severe injuries to the knee is ACL rupture.

This occurs during single foot contact in physical activity. 

We will discuss some of the other common injuries throughout this chapter. 

Review of Knee Functional Anatomy

The knee is a part of the kinetic chain and is greatly affected by the joints close to it.

That is the foot and ankle complex and the LPHC.

They both play major roles in the knee structures. 

Bones and Joints

The knee joint is a synovial joint comprising two articulations: the tibiofemoral and patellofemoral.

The tibia and the femur comprise the tibiofemoral joint, and the patella and femur comprise the patellofemoral joint.

The fibula is an attachment site of the biceps femoris and it crosses and affects the knee.

The knee is intended to flex and extend, and it’s capable of some other motions due to the architecture and allowing reaction in the frontal and transverse planes. 

The tibiofemoral joint is one of the more complex joints in the body. When in an open chain position, the knee extends in the last 30 degrees and the tibia externally rotates on the femur to lock the knee into extension, making the ligaments taut.

When in a closed chain position, the overhead squat or single leg squat, the femur internally rotates on the tibia. 

The patella and the femur form the patellofemoral articulation.

This joint and the quads are called the extensor mechanism since the motions at this joint aid in extending the knee. 

Muscles

Many muscles in the LPHC and lower leg function in the knee.

Weakness of the hip external rotators and the gluteus medius and maximus might cause the TFL, adductor complex, vastus lateralis, and gastrocnemius overactivation.

The key muscles associated with the knee will be the gastrocnemius and soleus, the adductor complex, the medial and lateral hamstring complex, the tensor fascia latae and IT band, the quadriceps, and the glute med and max. 

Altered Knee Movement

Adolescent athletes commonly injure the knee in some way.

The highest knee injury rate is from 15 – 24 years old.

Knee injuries also have accounted for 60 percent of high school sports related surgeries.

Female athletes are found to have 4 – 6 times more of a chance of having a major knee injury throughout their sports career. 

Exclusive PTP CPT Offers


Gold Standard Cert
NASM Gold Standard Personal Trainer Certification - Save 25&percnt off
Most Popular Cert
ISSA - Most Popular Online Personal Trainer Certification 3 Certs for
Best Study Materials
TA - Trainer Academy - Best Study Materials for Personal Trainer Certification Online - See MVP discount
A Good Option
ACE Certification- A Good Fitness Course Online Option - 25&percnt off
A Good Option
NCSF Certification - A Good Option - Save 25%
Best CPT for you?
Best CPT For You? Take the Personal Trainer Certification Online quiz and Get a Personalized Recommendation Just for You

The multidirectional forces on the knee joint in physical activity explain the types of severe knee injuries, like ruptures of the ACL. 

Static Malalignments

These can lead to increased PFP and knee injury.

Common static malalignments include pes planus of the foot, increased 1 angle, anterior pelvic tilt, and decreased flexibility of the quads, hamstrings, and IT band.

Abnormal Muscle Activation Patterns

These can lead to PFP, ACL injury, and other knee injuries.

Abnormal contraction intensities and onset timing of the VMO and vastus lateralis have been shown in people with PFP. 

Dynamic Malalignment

This may occur during movement due to bad neuromuscular control and dynamic stability of the trunk and the rest of the lower body.

Abnormal patterns of the LPHC compromise dynamic stability and result in these dynamic malalignments. 

Knee Dysfunction and the Regional Interdependence Model

The knee is, again, greatly affected by the joints that are superior and inferior to it.

This is the foot and ankle complex and the hip. During the assessment of movements, when the foot over pronates, the foot will externally rotate and evert in the movement. There is an increase in tibial rotation, femoral adduction, and hip internal rotation.

The movement for compensation results in knee valgus positioning, leading to the limitation of neuromuscular control.

On the contrary, if the foot supinates, there is a possible tightness of the gastrocnemius and soleus complex, creating external tibial rotation from the tightness of the biceps femoris, weakness of the musculature of the adductors, and piriformis tightness. 

Assessment Results for the Knee

To limit the risk of lower body injuries, we should begin with the integrated assessment process and follow it with targeted corrective exercise strategies.

The dynamic and static knee posture is influenced highly by our hip, foot, and ankle complex mobility.

Know the various results that can come from the different knee assessments. 

Static Posture

In the static posture assessment, the fitness professionals are going to compare the client’s posture to the architypes that are discussed throughout Janda’s postural syndrome, pes planus syndrome, and also Kendall’s spinal postures.

The knee is the focus here, but the kinetic checkpoint above and below must be considered with it. 

Clients with an anterior pelvic tilt will also see a muscle imbalance affecting the lower extremities.

Dysfunction of the ankle, like what is seen in pes planus distortion syndrome, may cause static postural malalignments in the knee.

The pes planus is seen as having flattened feet and knee valgus. 

Transitional Movement Assessments

Overhead Squat Assessment

When doing this movement, the key compensation impairment to look for is knee varus, valgus, and dominance.

Both the knee varus and dominance are going to be rare, though.

Study the figures in this chapter section and ensure you know what these conditions look like. 

Single Leg Squat

This is an important transitional assessment to find the potential for injury in the knee joint.

It gives a deeper look into the knee function for those who can do it.

This is true for advanced athletes who can put their bodies in the best overhead squat.

Squatting on one leg also might reveal some things wrong with your squat that you do on two legs.

The main thing we will look for here is going to be knee valgus, but knee varus may be seen in some that have overactive femoral external rotators. 

Loaded Movement Assessment

The loaded variant of squatting can be put into the client’s workout to assess their dynamic posture under the hip whenever they are with a fitness professional in the gym.

Sometimes we see a client able to track their knees under their body weight, but with load added on, we may see these imbalances. 

Exclusive PTP CPT Offers


Gold Standard Cert
NASM Gold Standard Personal Trainer Certification - Save 25&percnt off
Most Popular Cert
ISSA - Most Popular Online Personal Trainer Certification 3 Certs for
Best Study Materials
TA - Trainer Academy - Best Study Materials for Personal Trainer Certification Online - See MVP discount
A Good Option
ACE Certification- A Good Fitness Course Online Option - 25&percnt off
A Good Option
NCSF Certification - A Good Option - Save 25%
Best CPT for you?
Best CPT For You? Take the Personal Trainer Certification Online quiz and Get a Personalized Recommendation Just for You

Dynamic Movement Assessments

When doing the depth jump with your more advanced clients, look at them from the anterior view to find the knee position upon striking the ground and through the eccentric phase of landing.

Many impairments will be seen during deceleration.

Knee valgus will be the most common compensation, with some occurrence of knee varus, too. 

Mobility Assessments

The flexibility of the muscles above and below the knee can impact its alignment.

We see knee varus, valgus, or dominance here.

The hip flexors, quads, adductors, and hamstrings can be tested with the modified Thomas test, prone knee flexion test, adductor test, and active knee extension test.

It should be considered that many of the muscles mentioned in this chapter will cross both the hip and the knee. 

Corrective Strategies for the Knee

Knee Valgus

We should start with the inhibiting phase of corrective exercise and this uses myofascial rolling.

The muscles that are worked here will be the adductors, the TFL and IT band, and the biceps femoris.

Follow the guidelines mentioned for this in the previous chapter on inhibition.

Next, we will Lengthen after the inhibited phase and this will use static stretching.

The muscles worked on will again be the adductors, the TFL and IT band, and the biceps femoris.

Follow the recommendation of the 30 second hold. 

The third phase of the continuum will be the activation phase and we will use isolated strengthening on the gluteus max and gluteus med.

Then follow the guidelines used for activation mentioned in that chapter. 

The integration phase is last, which uses integrated dynamic movement.

We will use the supported squat with a mini band around the knees and the wall jump.

We will follow the guidelines laid out in the chapter on integration. 

Follow the steps as they are shown in the pictures to look at what that will look like specifically for the knee now. 

Knee Varus

We will start with the inhibited phase and use SMR again.

The muscles to be worked will be the piriformis, the TFL and glute min, and the biceps femoris.

Follow the guidelines set up in the previous chapters we went over.

The lengthening phase will be next and we will use static stretching on the piriformis muscles, the TFL and glute min, and the biceps femoris.

Follow the guidelines set up in the previous chapters we went over.

The activate phase will use isolated strengthening for the gluteus max, adductor muscles, and medial hamstrings.

Follow the guidelines set up in the previous chapters we went over.

The integration phase is the last one and we will use integrated dynamic movement with the use of the exercises of supported squat with a medicine ball between the knees and the wall jump.

Follow the guidelines set up in the previous chapters we went over.

Follow the steps as they are shown in the pictures to look at what that will look like specifically for the knee now. 

Knee Dominance

The inhibit phase will have us utilizing the SMR on our hip flexors and our quads.

Follow the guidelines set up in the previous chapters we went over.

The second lengthening phase will also use static stretching on the hip flexors and the quads.

Follow the guidelines set up in the previous chapters we went over.

The activation phase will be third and uses isolated strengthening focusing on the glute max, hamstring, and abs muscles.

Follow the guidelines set up in the previous chapters we went over.

Integration, the final part, will have us using the integrated dynamic movement exercises, which are the supported squat and the wall jump, to improve.

Follow the guidelines set up in the previous chapters we went over.

Follow the steps as they are shown in the pictures to look at what that will look like specifically for the knee now. 

Common Issues Associated with the Knee

The hinged knee joint is going to be highly vulnerable to being injured.

Altered kinetic chain dysfunctions relating to the LPHC and the foot and ankle complex play a role in these common knee injuries.

These will be some of the more common knee injuries, but it is always important to consider that previous statement that it is not always necessarily the knee by itself that is the problem. 

Patellar Tendinopathy

The patellar tendon starts on the base of the patella and inserts into the tibial tuberosity.

It is needed for knee kinematics.

The extensor mechanism and the patellar tendon often give the force needed to extend the knee in open chain positions.

When people perform their activities of daily living, they have isometric, concentric, and eccentric forces all acting on the knee.

These increase exponentially with activities of greater force, like running.

This patellar tendinopathy is common in overuse and shows up mainly as pain at the patella’s base. 

The risk factors for this issue are:

  • Knee valgus and varus
  • An increase in Q angle
  • Poor quad and complex hamstring flexibility
  • Poor eccentric deceleration ability
  • Overtraining and playing on hard surfaces.

Patellofemoral Syndrome

One of the common causes that are accepted for this is the abnormal tracking of the patella in the femoral trochlea or the patellar groove.

The stress increases when not in the proper line.

We see the pain in the patella with this injury.

Iliotibial Band Syndrome

IT band syndrome results from inflammation and irritation in the distal part of the IT band as it hits the lateral femoral condyle and compresses the fat pad in that area.

This bursitis can also be caused.

It can often occur from a lack of flexibility in the tensor fascia latae.

Overuse will be the most common reason for any of this. 

Anterior Cruciate Ligament Injury

As we have discussed a few times already in this chapter, this is one of the more severe types of injuries to the knee that can occur, and it is a rupture of this specific ligament.

Many ACL injuries happen each year, mostly from indirect contact.

The many forces that our knee is used for absorbing will affect these injuries. 

NASM CES Chapter 12: Corrective Strategies for the Knee 6
NASM CES Chapter 12: Corrective Strategies for the Knee 7
NASM CES Chapter 12: Corrective Strategies for the Knee 8

Tyler Read - Certified Personal Trainer with PTPioneer

Tyler Read


All Posts

PTPioneer Editorial Integrity


All content published on PTPioneer is checked and reviewed extensively by our staff of experienced personal trainers, nutrition coaches, and other Fitness Experts. This is to make sure that the content you are reading is fact-checked for accuracy, contains up-to-date information, and is relevant. We only add trustworthy citations that you can find at the bottom of each article. You can read more about our editorial integrity here.

Ask me a question and I will reply ASAP

40 NASM CES Practice Q's

Get The Sectret Cheat Sheet For The ISSA Exam

18749

NASM CES exam cheat sheet

Get The Sectret Cheat Sheet For The CSCS Exam

18749

Get The Sectret Cheat Sheet For The ACSM Exam

18749

Get The Sectret Cheat Sheet For The NASM CES Exam

18749

Get The Sectret Cheat Sheet For The ISSA Nutritionist Exam

18749

Get The Sectret Cheat Sheet For The NCSF CPT Exam

18749

Get The Sectret Cheat Sheet For The NASM CNC Exam

18749

Get The Sectret Cheat Sheet For The NASM PES Exam

18749

Get The Sectret Cheat Sheet For The NASM CES Exam

18749

Get the top 5 Tips for Passing the ACE CPT

18749

Get the top 5 Tips for Passing the NASM CPT

18749

Get The Sectret Cheat Sheet For The NSCA CPT Exam

18749

Get The Sectret Cheat Sheet For The ACE Exam

18749

Get The Sectret Cheat Sheet For The NASM Exam

18749