The knee, the elbow’s cousin, used to be more like the elbow. But then we went from four legs to two, and everything changed.
The knee is now so complex and high profile that some researchers at the University of California at Davis – um, or maybe elsewhere – are pretty sure the knee has its own press agent. And just the other day on X, the elbow posted a photo of the knee with a quote from Guillermo del Toro: “The sign of a true friendship is when you can forgive success”.
My point – and I do have one – is this:
The knee doesn’t just bend and straighten. It also twists, and it even glides/rolls like a rocking chair on a skating rink. These additional movements are crucial, not just to bending and straightening the knee, but also to allowing your body to turn freely without wrenching your joints from tailbone to neck.
The knee is the main reason you can make quick changes of direction. Any athlete who is about to move has their knees bent. That’s because you can’t turn or quickly propel yourself if your knees aren’t bent. The propulsion comes from rapidly unbending the knees using the quads and other muscles. The turning comes from a rotational movement in the knees that happens passively when you use muscles elsewhere in your body.
Sharing the Work of Rotation
Don’t identify too much with a diagnosis and miss the reality that almost all injury is more of a movement problem than a structural one. A meniscus, for example, may be the source of pain, but it’s not the cause of pain. Even when you’ve been diagnosed (by a doctor, friend, or internet search) with a specific injury, look at movement in the spot and elsewhere if you really want to understand the problem and the solution.
Pretend to hear and respond to a loud noise behind you and pay attention to what actually turns. Spoiler alert: Most turning happens in your lower ribs and your knees. People with restricted ribcages put a lot more stress on their knees and vice versa.
A knee problem may have originated with upper body – ribcage – immobility, which overtaxed the rotational ability of the knee. And if your knees are healing, you can take stress off them by helping your spine, and especially your lower ribs, to rotate. You can do that easily by lying on your back with feet flat and knees up and alternating dropping your knees to each side.
Healthy ankle and foot movement is also important to knee health because If the ankle can’t move, the knee has to compensate. Turning when your foot/ankle is fixed (as in a sneaker on a gym floor) or moving on an ungrounded foot (as when you’re pole dancing and you step down onto your 6-inch pump while twisting and sliding with speed) are experiences we’ve all had that are very stressful for the knee because if it is bent, it absorbs all that motion passively.
The hips also contribute to knee health. When one hip is restricted, the opposite side knee takes a lot of stress because of balance and weight-bearing changes that affect your gait. I used to say that youth = spinal twist, and my colleague Joan Arnold used to correct me, saying youth = hip joint mobility. Turned out she was right, but both things are crucial for knee health (and youthfulness).
Mobilize your own knees
The knee is often restricted in rotation, and that puts strain on the meniscus and the ACL, structures so terrifying that the mere mention of them makes powerful men cry (and powerful women wince slightly, then get on with whatever they were doing).
As you may know, the leg bone is connected to the hip bone. The joints above and below a problem joint are always affected or implicated in injury and dysfunction. Problems in a hip often spread to the other knee, and vice versa. Take care of one set of joints to help the other.
When you’re working with clients, you can check knee rotation by keeping their lower leg up so the knee stays in flexion and turning the tibia in and out. If the end feel isn’t springy, and the excursion isn’t much, milk the joint into the direction restricted, in that position, with the knee on a pillow or with the tibia in your knee or lap.
Demystifying and Unsticking Menisci
The menisci, or knee discs, rotate forward and backward with rotation. In normal internal rotation of the tibia, the lateral meniscus moves forward, and you can feel it, just lateral to the patellar tendon. When you externally rotate the tibia, the medial meniscus becomes palpable medial to the patellar ligament. Each disc should move out of range when the tibia rotates away from it. If it stays forward, when you mobilize the knee, milk the protruding disc backward while rotating the tibia toward it.
Hip — the helpful neighbor
Check hip rotation and try drawing the hip out of the joint while encouraging rotation (you can do this nicely if the knee is bent quite a bit with the patient face up and you grab ‘n’ drag the upper thigh toward the knee as you rotate). At worst, this will ease the knee, at best, the knee will be able to function normally. As you might imagine, the knee and hip are often restricted – and overworking – in opposite directions.
Mobilize and massage the feet and ankles and have the person move their foot all around. Quasi-rotational multiplanar movement in the foot is also crucial to the knee’s healthy movement.
Try this stuff out. If you need help figuring out how to mobilize the knee or do anything else I described here, let me know, and I’ll set up a class or train you privately.