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Knee Safety
By Dr. Greg Shepard
Published: Winter 1996

Knee injuries are among the most feared of athletic injuries and perhaps the least understood. Knee injuries have ended many careers, ended seasons and ended normal lifestyles. Many, if not most, knee injuries can be prevented and certainly their severity can be reduced. If a knee injurie does occur, recovery time can be shortened. When I see an athlete go down with a knee injury, two thoughts immediately cross my mind: One, the athlete or coach simply did not know how to prevent this injury or two, the athlete refused to do what he was supposed to do. I will concede the fact that sometimes nothing could have been done to prevent a certain knee injury because of the way it happened but I believe the majority of knee injuries to athletes are preventable.  

Injury prevention to the knees depends on two factors. First, you must strengthen the muscles, tendons and ligaments which surround the knee joint. Second, you must perform every physical action with the knee in perfect alignment. Perfect alignment means straight alignment which must occur on the field, on the court, in the weight room, during stretching and, indeed, everywhere even sitting in a chair.  

Important Tip: A great strength coach must be a great observer. This article will help you become more aware of knees and what to look for in proper alignment and when to look for it. I will highlight three main problem areas. Squats: on the upward movement, knees have a tendency to pinch in causing too much stretch on the medial collateral ligaments. Cleans: on the upward movement, knees will again pinch in or even touch. Picking up a weight: (As in a Clean or Dead Lift) Look for the knees pinching in at the start of just picking up a weight. 

LEG EXTENSIONS: This is perhaps the most common of all exercises done to strengthen the knee joint area. Knee extensions are done to rehab a knee after surgery. This exercise strengthens the Quadricep muscles plus the tendons which connect the quads to the knee joint area. There is also strong evidence that leg extensions will strengthen the ligaments in the knee joint. Do Leg Extensions 2-3 times per week and 2-3 sets of ten repetitions. STATUS: An Auxiliary Exercise OTHER BENEFITS: Strong Quads are of benefit in a variety of athletic movements. 
LEG CURLS: This exercise strengthens the three Hamstring muscles and the tendons which connect the Hamstrings to the knee joint area. Again, there is strong evidence that Leg Curls will also strengthen the ligaments in the knee joint. Do Leg Curls 2-3 times per week and 2-3 sets of ten repetitions. STATUS: An Auxiliary Exercise OTHER BENEFITS: Will help prevent Hamstring injuries and help develop greater speed and jumping power. 
PARALLEL SQUATS: Parallel Squats were once thought by coaches and doctors to be a cause of knee injuries. The opposite is true if they are done correctly with straight alignment. Correct Parallel Squats will strengthen the muscles, tendons and ligaments which surround the knee from top to bottom. Show me a team with a lot of knee injuries and I will show you a team that does not Parallel Squat or that does not Parallel Squat with straight alignment. Doing Parallel Squats is like taking out an insurance policy. Put in the correct time, effort and technique and you can practically eliminate knee injuries from your program. You should do two Squat workouts per week and since this is a Core Lift, you should vary your sets and reps. STATUS: A Top Priority BFS Core Lift OTHER BENEFITS: Monumental in many areas of athletic improvement including hip, leg, speed and jumping power.  
OTHER EXERCISES: Lunges, Box Squats, Front Squats and many other exercises will have a positive effect in preventing knee injuries as long as they are done with the knees in straight alignment. 
SQUATTING ALIGNMENT: I like to sit all my athlets in the bleachers. Their hips should be at least one foot apart in order to be unrestricted in assuming a correct alignment squatting position. Tell them to get their feet in a squatting stance or as we say at BFS, "Get into an Athletic Stance." The athletes may turn their toes out slightly for balance. Have them "sit tall" and "spread their chest" which will get their backs and upper body into a correct squatting position. (See Figure 1) In this photo, I am checking Luther Elliss' knees for correct alignment. (Luther is a 6-5 300 pound star Defensive Tackle for Detroit) My finger is pointing at the middle of his knee. If I were to drop a string straight down, where would it land? In this case, in this photo, the string would land in the middle of his foot which is perfect. (Photos will be added at a later date)  If you had 50 athletes in the bleachers, it would take less than two minutes to identify all the athletes who would not fit this perfect alignment format. It would also only take about two minutes to correct any alignment problems. There are three ways to look at knees for correct squatting alignment: Knees out, in or forward.
Knees Out: (See Figure 2)  You will be able to see this problem easily whether the athletes are in the bleachers or actually squatting.  The knees-out problem can easily be corrected by just widening out the athlete's stance.  Widen out the stance until the knees are aligned directly over the toes.  Squatting with the knees out will put unwanted pressure on the lateral collateral ligaments.
Knees In: (See Figure 3)  This problem is quite common with women athletes and junior high age boys. Again, you will be able to see the knees-in problem from the bleachers or squatting.  When squatting the knees-in problem will surface on the way up.  The knees are usually alright on the way down when squatting.  The knees-in problem is more difficult to correct and puts unwanted pressure on the medial collateral ligaments.  The first step is to yell "knees" to the athlete while squatting.  This is a signal to force the knees out over the toes. 
This signal may or may not work the first time.  If not, the second correction technique is to lightly slap the inside of the athlete's knee as shown in Figure 4.  This gives the athlete a kinesthetic feel of the problem.  The cure usually happens after only a few light slaps.  If the problem persists, then video taping the athlete squat so he/she can see themselves will almost always do the trick in those few extreme cases.
Knees Forward:  (See Figure 5)  Many beginning squatters will want to lift their hills off the ground and bring their knees forward as the main part of their descent pattern.  This puts too much pressure on the patella area besides being horribly ineffective.  You may correct the knee-forward problem by letting the athlete hold on to a partner's hands for balance as in Figure 6.  The athlete should "sit tall" and "spread the chest" with
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