GTP TV: Ep 5 – Now onto the knees

Okay gang. We are doing it! Goalie Training Pro episode 5!!

We’re talking about the knee today. For the video part of this, I drew all over my knee to show you. So it might be beneficial to watch the video with this one! If you can’t then continue and we’ll make sure it still works!


Click here to watch this video on YouTube if you’re having trouble >>

What we have is muscles and ligaments and bones and all that jazz. Let’s just begin at the very beginning, a very good place to start, for those of you who get the little Sound of Music thing there.

You have your patella (kneecap). It’s a bone. And you have your tibial tubercle (below the kneecap), it’s also bone. There is also your vastus lateralis (muscle on the outside of the thigh), vastus intermedius (beside the vastus lateralis), and rectus femoris (beside the vastus intermedius), which actually comes all the way up into my hip bone.

You also have your vastus medialis (inside leg), and here the fibers are kind of oblique. It’s sort of the one of the quadricep muscles that’s in a position to help keep your kneecap centered in. There is a groove that it kind of rides in, so your thigh bones, there’s not a bunch of them. Imagine there’s only these two, and then your kneecap kind of sits in a groove between the knuckles on your thigh bone. That’s where it’s happy. If your kneecap gets pulled out to the outside, it gets squished. (Like if you were squished you wouldn’t be happy either).

So if you look, you can see how the vastus lateralis, vastus intermedius, and rectus femoris are kind of all in a position to pull up or out a little bit, which again compounds that lateral glide. I’ll explain to you a little more why it’s important for a goalie to be aware of that.

All these muscles, the connective tissue, the fascia, comes all together, engulfs the kneecap and they all attach down underneath the kneecap. Really kind of one attachment. I mean they all attach to the kneecap, but that is where they exert a lot of their force. So right above the kneecap there is something called the quadriceps tendon and underneath the kneecap is the patellar tendon.

Then if we look at the ligaments, you have your MCL on the inside of the knee which is medial collateral ligament. And you have your LCL on the outside of the knee which is Lateral collateral ligament.

So we’re also going to talk about ACL and PCL injuries.

ACL and the PCL are inside your knee. They’re deep inside, like right in the middle of the knee, but they’re kind of like a criss-cross arrangement. The ACL goes sort of from, let’s just say simplify it, the back of the femur toward the front of the tibia, and it prevents … and it depends how you look at it, the femur gliding back relative to the tibia, or the tibia gliding forward relative to the femur.

The PCL, again let’s say it goes from sort of toward the front of the femur towards the back of the tibia. It prevents the femur from either gliding forward relative to the tibia or the tibia gliding back relative to the femur. So basically, my ACL prevents my tibia from going out, and my PCL prevents my femur from going out. It sort of prevents almost like a dislocation of the knee.

The knee is designed to be a hinge, not a ball and socket joint. Our knee is designed to bend in one direction. Not all over the place. When you try to bend it let’s say to the side (like in your butterfly), you can see how our muscles don’t pull around corners. It’s going to try to pull a straight line, so the muscles are going to be trying to pull my kneecap sideways. The MCL is very, very strong. It’s preventing my knee from bending this way and that way. SO when I’m smashing down in the butterfly, I’m putting a lot of stress on that MCL.

Yeah, so the knee’s supposed to hinge like your finger. But we’re goalies, and we have to do stuff that our knees don’t like. There’s going to be wear and tear on our hips. There’s going to be wear and tear on our knees because we’re doing things that aren’t sort of normal movements for our body. Just like a baseball pitcher is going to be adding a lot of wear and tear to their shoulder and their elbow, but it’s what we do. Right?

Oh, and then there are menisci. Menisci are like little circular discs, and they’re kind of like a fibrous cartilage material. What they do is they try to give some depth and some contour and a little bit of stability to the joint because the plateau of the tibia is fairly flat. It has a little notch in it, but it’s fairly flat really. The femur is pretty big, and it has those big knuckles, but there isn’t … it’s not like our hip joint that has like a good socket and a ball and it gets in there. This is a little bit precarious and then the kneecap is kind of on there as a fulcrum as we go.

It’s amazing actually our knees last just as well as they do. It really is. So the menisci they just sit on top and they give it some depth to the joint and a little bit of stability and a little more cushioning.

What I get is a lot of emails from those of you that say, “When I’m in RVH or when I go in my butterfly the inside of my knee hurts. What are some stretches I can do to stretch that out?” The answer is nothing. Nor should you. You know if you loosen up your knee so that it swings sideways, that’s really, really bad. That would be like a totally unstable knee joint.

But the way I can take the stress off my knees is by working on my hip internal rotation. You know if I can get my hips so that I can rotate my femurs in, that’s what gets my feet wider. I’m not bending my knee out to get a wider butterfly flair, not at all. Your knees are pointing straight down. It’s the hip internal rotation that give you that flair. And we’re nothing if we ain’t got flair!

Okay, let’s talk about some injuries. Two injuries that sound really, really bad but they’re just kind of like, “Yeah, you know, that happens.” Patella femoral pain syndrome. (How awful is that? Like a syndrome. A pain syndrome for goodness sakes!)

Here’s what it means. It means that some of the structures across your knee, so maybe your rectus femoris and your other quadricep muscles, they might be tight or your vastus medialis might not be strong enough or smart enough so that your kneecap is either getting pulled a little laterally, a little bit out of its groove, and the cartilage is getting squished, and then that gets achy and sore.

Or it could mean that just the muscles are so tight that they’re really driving the kneecap, the patella, back onto the knuckles of the thigh bone, and that irritates it as well. Inside our joints we don’t actually have a blood supply. We have what’s called synovial fluid. There’s a joint capsule that’s like a fibrous sock that goes around the joint, and inside that the synovial fluid, and synovial fluid bathes the cartilage and the meniscus and that’s sort of its life blood.

So if we’re squishing the cartilage and it’s not sort of getting that movement, even like if you’ve ever been sitting in the car or sitting in a movie for a long time, and you get up and your knees are kind of creaky, but then you get going and then they’re totally fine, it’s because that cartilage has been squished. It’s been denied its nutrients, so it’s sore. But then once we get it bathing again and it’s all happy, all the nice synovial fluid. We don’t want to squish parts of it.

Really, patella femoral pain just means, you know, I have pain between my patella and my femur and usually feels like an achy sore feeling underneath. It’s still uncomfortable. It’s not nice at all. You would still go see your sport physiotherapist and figure out why are you getting that pain. Because there are some general reasons that I’ll sort of share with you at the end, but you want to make sure there isn’t something else going on.

The other one that sounds really bad that isn’t so bad is Osgood-Schlatter’s disease. It’s like, “Oh now I’ve got a disease in my knee.” It’s in adolescent teenage athletes. The good news is you outgrow it, so the cure is finish your growing. Your growth plates close. You don’t have that pain anymore.

But what it is … and it can be sore. (I had it when I was a kid). If we look at all the structures coming down and attaching right under the kneecap, well if you’re an active kid like a lot of you are, you know and you’re jumping and you’re ramming around, well that’s yank, yank, yank, yanking on that spot.

The problem is when you’re a kid, that spot is still sort of spongy bone. It hasn’t solidified yet. It’s not cortical bone until we stop growing and our growth plates close. As these muscles getting yank, yank, yank, yank, yanking that bone gets irritated and it even gets sort of, not pulled off, but it gets pulled on and it adapts by sort of making like a bigger bump. It almost gets elongated like that. And it is sore.

When I was a kid and had it, they said, “Well, you need to stop playing sports for a year.” So I did and then I went back to playing sports and it was sore anyway. So now what they say is, “Yeah it sucks. It’s going to be sore. Don’t kneel on it, that’s going to hurt more. Ice it before and after. If it gets too sore you know take a day off or a couple days off to get it back under control.”

The take home message is it isn’t permanent damage to your knee joint. It’s not something that’s going to, “Oh well now I’ve ruined my knees because I played sports with that.”

The other thing, ACL tears. Usually for a hockey goalie, I mean it can happen. You can just get in an awkward position or almost fall on yourself in an awkward position. A lot of times somebody falls on you or into you and pushes you into an awkward position, so usually it’s more of like a something weird trauma, like a soccer player.

A soccer player might just be running for the ball and plant and pivot and then they tear their ACL because those hamstrings that you attaching, the quadriceps and the hamstrings aren’t working together. The quadriceps pull and they pull that tibia forward and that tears the ACL.

If you tear your ACL you typically will hear and feel a pop. That’s what people describe, “I felt a pop in my knee.” Then it will swell quite a bit and quite rapidly. I can’t remember the exact number but my mentor, a guy named Dr. Peter Fowler, he said … I think it’s like 80 to 90% of knees that have an acute hemarthrosis, which is like acute swelling after an injury, are ACL tears.

That one, like anything, just like we talked about the ankle. You can have Grade I, II, or III sprains, because there are ligaments involved, so it’s a sprain not a strain. Grade I is basically like, “Yeah, I tweaked something but it’s okay.” Grade II is you’ve actually torn some fibers. There may be some instability, but it’s not completely torn. Grade III is it’s completely torn. If you have a completely torn ACL, and you’re going to continue playing hockey or multidirectional sport, seriously, you’re probably going to have that reconstructed.

MCLs! Again, usually it’s somebody falling into you and driving your knee. In football and things like that it’s a guy who has a planted knee and then somebody hits them and tears it.

For you guys it’s often, you know if your knee’s out stretched and then somebody falls into it, (and that’s another way you can tear your ACL too). Often in those mechanisms you’ll go through your MCL first, then you’ll tear your ACL, and then you’ll come over on the outside and pinch your lateral meniscus and often give it a little tear too.

I mean there are … there’s strengths, thankfully that MCL is quite a strong ligament, but that’s a bad injury for a goalie to have because there’s so much force on that with any kind of movement.

With a meniscus injury it’ll often feel, the physio I worked with described it really well, like a hangnail. If I catch it going one way, it’s fine. But if I catch it, you know, going against the grain, it will give me a start. Menisci sometimes it’ll be like, “Oh yeah, I think it’s fine.” Then you might just walk around a corner or something and it grabs you. Again, sometimes those settle down. Physio can sometimes help. It depends where in the meniscus the tear is, because the outer portion has a little bit of a blood supply, so sometimes it actually can heal. The inner portion not so much.

Sometimes that thing will keep flipping up or sometimes a piece will get flipped, and that’ll be your knee gets stuck like you can’t straighten it all the way or if you tried to it just, you know, excruciatingly painful. Sometimes that requires some surgery to either just scope it and clean it out, or if it’s a serious tear, and you’re going to continue as an athlete, they can sometimes suture it back together, which is a much longer rehab. But it saves you your meniscus, which is really important element of your knee for maintaining your knee health over time.

In the olden days they used to just, “Oh, just take it out.” Then lots of people getting really early onset osteoarthritis, so they’re like, “I guess we should have left that in there.”

The secret to sparing your knees is in your hips. Keep your hips mobile. It’s going to take wear and tear off your knees. Again, you’re playing a sport that’s hard on your knees and hips and ankles and back and everything. Let’s do what we can to minimize it. (You’re not normal. What you do is not normal.)

Here are sort of my key three.

Work your hip internal rotation. We have lots of ways that we can do that. One of the ways is just lying on our back with our feet like hip width or a little wider and bringing our knees into together. Not forcing them in together, just bringing them in to get a nice little stretch.

The other is, and this will help with the patella femoral pain, it’s always good to stretch your hip … or for you guys, typically you have tight hip flexors, so we want to stretch those hip flexors. To really help the knee, what you want to do is make sure you’re getting that two joint hip flexor. That rectus femoris that crosses your hip and your knee, so you do that by getting in a hip flexor stretch position and then bringing your heel toward your bum.

Then the last thing really is working on your mechanics. When you’re in the gym, make sure when you’re squatting you’re not pinching your knees in. When you’re jumping you’re not letting your knees pinch in. Make sure that you’re building strong gluts that can work with your quads so that again, squatting comes as much from your hips as your knees.

If I kind of was zeroing in just on stuff to help your knees, those are my key three. Then I still would be working like my rotator cuff strength in my hip, even though I know rotator cuff’s in your shoulder, but I just call it the hip. Work those stabilizers. Transitioning from double leg strength to single leg strength in the gym so that you’re making those muscles smart and strong and stable.

Oh I’ve got to go! I’ll see you next time. Cheers.