Now, with knee injuries in rock
climbing, there are no specific injuries that climbers get due to our
sport – we get “normal” knee injuries, such as meniscus
problems and ACL ruptures. The only thing that differs is the
mechanism of injury, such as falls from doing an “Egyptian” or
heel hooks, phrases your standard doctor or sports physiotherapist
may not understand!
But first, as always, to discuss the
anatomy of the knee, to aid your understanding of what's going on in
your joint:
Knee anatomy
Now, the knee is a lot simpler to
understand compared to those joints with more movement such as the
shoulder, as it predominantly is a hinge joint, so moves forwards and
backwards only.
However, there is a slight degree of
rotation and translation (moving forwards and backwards of the bones
without gross movement of the leg), and it's mainly these movements
that cause damage to the structures of the knee.
Bones
Ligaments
Within the knee, there are 4 main
ligaments, two on the outside edge of the knee called the collateral
ligaments, and two on the inside of the knee called the cruciates;
and two sections of cartilage called the menisci.
Muscles
The
muscles of the knee provide the gross flexion / extension movements,
which is provided by the hamstrings for flexion, and the quadriceps to
extend the knee.
Movements
As
previously discussed, the gross movement of the knee is flexion and
extension of the knee, however there is a degree of lateral translation
of the knee and some rotation.
Cause for injuries
Eqyptian / Drop Knee
These
moves tend to stress the hamstrings and therefore can cause muscle
strains or tears. They also put pressure on menisci and ACL/MCL which,
in conjuction with a fall from these moves, can cause rupture and injury
due to the unusual orientation of the knee.
This is caused by passively
‘sitting’ on the medial collateral ligament (MCL) that runs down the
inner side of the knee.
Heel hooks
Falls
Especially when bouldering, falls onto an uneven surface can cuase damage and rupture to ligaments and muscles around the knee. This can even cause a cascade effect when one ligament fails, it shock loads the next and causes multiple injuries.
Common injuries
Common climbing injuries related to the above movements, as already mentioned, are:
Meniscal tears
Anterior Cruciate Ligament / Medial Collateral Ligament
Patella Dislocation
Hamstring and other muscular tears
I
could go into much more detail, but then this post would turn into an
essay and you'd be asleep by about....now! Further information on any
specific injury can be provided, or as future posts.
Symptoms
Symptoms
of a knee injury will depend on the degree of damage and the structure
damaged, however, you will tend to find one or more of the following
symptoms:
- Locking of the knee
- Localised swelling/tenderness/pain
- Inability or difficulty in weightbearing
- Clicking/grinding
Symptoms of an injured muscle will be the following:
- Tightness
- Swelling/Bruising/Redness
- Weakness
- Pain
- Inability to fully stretch
Treatment
The treatment
to a specific knee injury depends on the injury, the extent of it, and
whether a surgical intervention is required. However, much of the rehab
will focus on training those muscles around the knee, so below are some
sample exercises discussed.
Exercises: open and closed exercises
 |
Simulated loading cases: A, closed kinetic chain
or squatting (WB, body weight). B, open kinetic chain leg
extension (WT, tibia weight). C, open kinetic chain loaded
(WT, tibial weight; M, external moment on tibia) |
In
a closed chain the end of the chain farthest from the body is fixed,
such as a squat where your feet are fixed and the rest of the leg chain
moves. In open chains the end is free, such as in a seated leg extension
- See more at:
http://www.afpafitness.com/research-articles/closed-chain-exercise-for-legs-and-knees/#sthash.pEvSRn4h.dpuf
In
a closed chain the end of the chain farthest from the body is fixed,
such as a squat where your feet are fixed and the rest of the leg chain
moves. In open chains the end is free, such as in a seated leg extension
Closed chain exercises are
better, as they provide more stability to the joint, less shearing forces
therefore less chance of injury, increase stability, engages more
muscles, and are more functional.
Some evidence says closed improve strength, however open chain exercises maybe nessecary if you are unable to weight bear on the injured knee.
To increase difficulty of these exercises, fix proximal point on unstable surface e.g. stand on a gym ball to increase stability and control
See some more sample exercises listed below.
Swimming and/or cycling are good later stage activities - non-weight bearing strengthening
Prevention
Again,
much of the prevention work for knee injuries is strengthening of the
muscles around the knee, and below is a sample of exercises from
Climbing.com. Much of the other preventative work is repetitive
information, but again is listed!
1. Strengthening work
Three Exercises That Protect Your Knees
Note: Ramp up gradually — building connective tissue can take two years.
1. Hamstring Curl on a Physioball
How: Lie
on your back with heels on the ball, knees straight. Tighten your
abdominals and bridge your hips up, and then bend your knees to roll the
ball toward you. Try two sets of eight reps with good form; work up to
three sets of 15. Advanced challenge: single leg atop the ball!
Why: The
ACL prevents forward movement of the tibia. Your hamstrings assist in
preventing that motion (particularly in this exercise).
2. Floor Touches
How: Stand
on one foot with your knee slightly bent. With the opposite hand, touch
the ground outside your standing foot. Keep your back straight. Repeat
on the other leg. If tight hamstrings restrict your reach (and your
lower back rounds), bend your knee more and reach only halfway. Begin
with two sets of 12 slow, controlled reps, and work up to holding a
three-to-10-pound weight in the hand reaching the fl oor. Advanced
options: reach to the front, then inside your standing foot.
Why: Multi-joint
proprioception and eccentric hip control. This exercise enhances the
body’s positional awareness, to improve protective reflexes, and
strengthens the hip muscles that maintain knee alignment.
3. Sidestepping with a Theraband
How: Place
both feet atop a Theraband and hold opposite handles, with your arms
crossed. Slightly bend your hips and knees, and then step left with your
left foot, stretching the band. Lift (don’t drag) the right foot, and
then step it left to narrow your stance slightly, keeping your feet
greater than hip width apart — use core muscles to steady your
shoulders, with your feet forward. Begin with 15 to 30 steps in each
direction (depending on the band’s tension) and work up to 100.
Why: ACL
injury can also occur when the knee is forced into a valgus
(knock-kneed) position; your hip abductors and external rotators can
minimize this vulnerability. Traditional exercises and day-to-day
activities don’t strengthen these muscles, making the ACL injury-prone
in certain climbing positions.
Also, performing the moves will help train and strengthen the ligaments and joint in question, however start easy and simple and build up with repetition.
2. Correct any muscular imbalances
Personally,
I know my hamstrings are quite strong, however this means my quads may
not be as strong, therefore I perform cross-training, I run to ensure
equal training of my lower limb muscles.
3. As always, improve technique to avoid falls and stressing your knee in strange positions because you have rubbish technique!
4. Down climbing to prevent falls / look at stable landings
Including using bouldering mats to protect landings.
5. Ensure good lower limb mobility
Make sure you have good range of movement at the ankle, knee and hip to limit damaging specific structures.
6. Stretching
Ensure muscles are correctly stretched, not overstretched, to aid performance at their optimal range
7. Listen to feedback from your knee
If it starts to hurt, or ache, or twinge, stop doing the move that's aggravating, or else something may well go pop!
8. Warm up!
Tendons and ligaments are stiff when cold, more elastic and better proprioception when warm.
Sample warm up for knees
Try
the following before climbing: •10 lunges on each leg, to open your
hips and warm up your legs •10 floor touches (exercise No. 2 above)
•Single-leg balance on the ground for 20 seconds — close your eyes •Two
30-second quad stretches (hold your foot in your hand and bend your
knee, with your heel touching your behind)
COMING SOON: a post on lower limb amputations, as I'm currently treating a gentleman and learning lots in the process!
References
http://www.afpafitness.com/research-articles/closed-chain-exercise-for-legs-and-knees/#sthash.pEvSRn4h.dpuf
Jewell DV. Guide to evidence - based physical therapy practice: Jones & Bartlett Learning; 2008
Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med 2004;32:1122-30
Bakhtiary AH, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. British Journal of Sports Medicine 2008;42:99-102
http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Open%20versus%20Closed%20Kinetic%20Chain%20Exercises%20for%20Patellofemoral%20Pain%20Syndrome_Tsai.pdf
Cohen, Hrvoje Roglic, Grelsamer, Henry, Levine, Mow, Ateshia 2001 Patellofemoral Stresses during Open and Closed Kinetic Chain Exercises An Analysis Using Computer Simulation Am J Sports Med
July 2001
vol. 29
no. 4
480-487
Dave Macleod; Injury case study, knee ligament tear
