By Dr. Chris Patrick, PT, DPT, CSCS
Pain is your body’s check engine light. When that light comes on in your apparatus, it goes to the shop to be fixed–not just ignored. Your body should be no different. When pain is telling you that something is wrong, you should not ignore it or “turn it off” with medications. The underlying issues need to be addressed.
Knee pain has been documented as one of the most common injuries in athletics 1 and is a very common complaint on the fire ground. It not only affects your quality of life, but your job performance as well. Tasks such as getting in and out of a truck, stretching a hose line, and climbing a ladder can be greatly affected by knee pain.
Risk Factors
The knee is a hinge joint with mechanics similar to a door hinge. It is sandwiched between two mobile joints, the hip, and the foot, which both play a role in its mechanics during movement. If there are limitations such as a decrease in strength, mobility, or lack of stability at either the hip or the foot, this will cause movement faults that affect the knee.
In a majority of cases seen clinically, there are not issues specifically at the knee itself, but contributions from the joints above and below. Some of the most commonly seen knee injuries in active individuals include iliotibial band syndrome, patellofemoral compression syndrome, patellar/quad tendinopathy, and biomechanical dysfunction (movement faults). While these are not the only causes of knee pain, they contribute to a large majority found in active individuals. Wobbly knees, knocked knees, and knee pain. Does this sound like you? These can all occur secondary to poor foot and hip coordination.
The Hip
One issue that affects the knees’ mechanics is weak hip external rotators. These muscles help to stabilize the femur to keep the knee from collapsing inward during functional mobility. Strength and stability here are essential, especially for tasks requiring lifting/carrying heavy loads, and for resilience during motions such as landing from the apparatus.
The Foot
Your feet are the foundation of the lower body. Think of them as a house of cards: if your feet are unstable and falling into malalignment, the entire rest of the body is going to be affected. In individuals where over pronation (collapse of the arch and rolling in of the foot) is present, the movement fault causes the knee to rotate inwards and puts lateral force on the patella (kneecap) 2. This not only places the knee in a poor position for movement but increases irritation and shearing forces at the knee itself. Research has demonstrated that 37-50% of total forces during landing are absorbed through the foot and ankle 3. So, with an unstable foot or a rigid “high arch,” the body is not properly absorbing the load, and force is being placed on other joints. Limitations of stability can be corrected with training focusing on single limb stability exercises, as well as with a properly prescribed semi-rigid orthotic.
Training
The fire ground is a very dynamic environment encompassing all planes of motion, and your training must mirror that. Training in one plane of motion is a disservice, because that is not reality. In the real world, you do not move in isolated planes of motion, but in combinations. Your muscles work in synergistic patterns and utilize combinations of muscles at different points in time to complete a desired movement. A key component to training is functional carryover. This is vital when the goal is fire ground fitness. Training should match the tasks’ demands for optimal performance.
Intervention
Included is one exercise that can be completed right in the bay with any apparatus. This exercise will help to not only strengthen and stabilize the hip but challenge quad strength and foot strength/stability.
- Starting with your foot elevated on a step and the other foot placed in front of you, lower to a tolerable range of motion.
- At your lowest position, slowly rotate your trunk inward and hold for 1-3 seconds.
- Slowly rotate outward to the opposite side and hold for 1-3 seconds, all while maintaining a stable position.
- Rise back up to your starting position. That is 1 rep.
This will challenge the internal and external rotators of the hip, as well as the stability of the lower body. This exercise can be progressed based on an individual’s tolerance by adding weight to one or both sides and holding a bar or piece of equipment in the high bar position.
Disclaimer: This is not individualized medical advice. If you are having knee pain, contact a local healthcare provider.
References:
1. DeHaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med. 1986 May-Jun;14(3):218-24. doi: 10.1177/036354658601400307. PMID: 3752362
2. Sammarco GJ, Burnstein AH, Frankel VH. Biomechanics of the ankle: a kinematic study. Orthop Clin North Am. 1973; 4(1):75-96
3. Devita P, Skelly WA. Effect of landing stiffness on joint kinetics and energetics in the lower extremity. Med Sci Sports Exerc. 1992;24(1):108-115
Chris Patrick is a Doctor of Physical Therapy and has been an active member of the Shelton Fire Department over the past 5 years. He is the Owner of Tacletics, PLLC, offering PT and Performance, as well as the head clinician for AOS Orthotics, a firefighter-owned business. He is a nationally certified strength and conditioning specialist and works with a variety of disciplines of elite and tactical athletes.
