BULLETPROOF KNEES Mike Robertson, M.S., C.S.C.S., U.S.A.W.Copyright © 2007 by Mike Robertson All rights reserved. No portion of this manual may be used, reproduced or transmitted in any form or by any means, electronic or mechanical, including fax, photocopy, recording or any information storage and retrieval system by anyone but the purchaser for their own personal use. This manual may not be reproduced in any form without the express written permission of Mike Robertson, except in the case of a reviewer who wishes to quote brief passages for the sake of a review written for inclusion in a magazine, newspaper, or journal — and these cases require written approval from Mike Robertson pri r to publication. For more information, please contact: E-mail: Mike@RobertsonTrainingSystems.com Websites: www.RobertsonTrainingSystems.com www.BuildingTheEfficientAthlete.com www.MagnificentMobility.com www.Inside-Out-Warm-up.com www.CFitLLC.comDisclaimer The information in book is offered for educational purposes only; the reader should be cautioned that there is an inherent risk assumed by the participant with any form of physical activity. With that in mind, those wishing to participate in strength and conditioning programs should check with their physician prior to initiating such activities. Anyone wishing to participate in these activities should understand that such training initiatives may be dangerous if performed incorrectly. The author assumes no liability for injury; this is purely an educational manual to guide those already proficient with the demands of such programming.Contents Preface... SECTION |: UNDERSTANDING THE KNEE Chapter I: Anatomy of the Knee. Bones and Articulating Surfaces. Passive Stabilizing Structures. Active Stabilizing Structures Sc, aceon ae Chapter 2: Common Causes of Knee Injuries: Biomechanical Alignment... Suboptimal Muscle Function and Strength Poor Mobility at Adjacent Joints. Poor Strength in Surrounding Musculature Excessive Tension in Surrounding Muscle an Flat-Out Overuse Types of Knee Injuries The BIG Question ‘Common Misconceptions about Chapter 3: The Bulletproof Knee Program Overview Ten Things You MUST Do to Keep Your Knees Healthy SECTION 2: STRENGTH TRAINING AND THE HEALTHY KNEE Chapter 4: The Gluteals. Functional Anatomy. Assessment. Training Summary. p Chapter 5: The Posterior Chain . Funetional Anatomy. os Chapter 6: The Quadi Functional Anatomy . Training.Summary Chapter 7: Single-Leg Training, Quad-Dominant Exercises.. Hip-Dominant Exercises SUMMAFY sve SECTION 3: MOBILITY AND THE HEALTHY KNEE Chapter 8: Hip Mobility Definitions of Flexibility and Mobility... Mobility vs. Stability. The Joint-by-joint Approach t0 Mobility Sitcing’s Effects on Hip Mobility ron. Strategies to Improve Hip Mobility Weight Troting for Improved Mobi? Summary. Chapter 9: Ankle Mobility. ‘Ankle Mobility. Ankle Mobility Drills Summary. SECTION 4: SOFT TISSUE AND THE HEALTHY KNEE Chapter 10: Soft-Tissue Length 109 Dynamic Flexibility : —_ Static Stretching .... Eccentric Quasi-Isometries (EQI's) SuMMAPY nnn Chapter II: Soft-Tissue Quality. Soft-Tissue Quality to the Rescue! Foam Rolling os Active Release Technique. Deep Tissue Massage.. Settnsrumant Mesa Summary . SECTION 5: OTHER FACTORS THAT IMPACT KNEE HEALTH Chapter 12: Improving Athletic Ab Ballistic Training. How to Incorporate Ballistic Drills into Your Program Bie yometrc Del ‘Summary .. Chapter 13: Diet and Supplementation. Improve Acid-Base Status Decrease Inflammation...‘Supplementation... Summary SECTION 6: THE NO-MORE-KNEE-PAIN PROGRAM Chapter 14: The No-More-Knee-Pain Program. Core Training Phase |: Bad > Ok... Phase Il: Ok > Good Phase Ill: Good > Great Add True Force Absorption Work... Chapter 15: Optimizing the No-More-Knee-Pain Program Heat Pre-Workout. Knee Sleeves vs. Knee Wraps SIM Pre-Workout. Proper Warm-up. Ice Post: Workout Bank Cards for Fluid Drainage Summary . Chapter 16: Closing Thoughts .. BONUS SECTION: STATIC STRETCHING EXERCISES.. BONUS SECTION: FOAM ROLLING EXERCISES. BONUS SECTION: SINGLE-LEG EXERCISES About the Author References ...Preface First and foremost, I'd like to thank you for purchasing this manual. In the week or so it will probably take you to read it, I'm going to give you every single drop of information | have on knees and how to keep them healthy for a lifetime. You see, two years ago | was at my powerlifting peak — | was training all out and readily approaching a squat in the mid-500's. By powerlifting standards that may not be all that great, but | really enjoyed the consistency and discipline it took to drive my powerlifting numbers up. Beyond that, | was doing everything in my power to stay healthy — solid strength training, stretching and mobility work, getting regular soft-tissue work done, and even following an extremely healthy diet. | was as strong and healthy as | had ever been, Then it happened. | decided to go downhill skiing with a buddy, and let's just say | was a little less than proficient. | spent the entire morning on the bunny hills and then felt compelled to try some bigger runs before heading home. | can’t even tell you how many times | fell; by the end of the day, I'd actually mastered the art of falling so it wouldn't hurt as badly!Over the next few days, my knees became stiff and sore; the mobility and strength that I'd spent years developing started to wither away before me. But | had a powerlifting meet in less than three months, so | had no choice but to continue pushing forward. Long story short, | got to the meet and set personal records in both the squat and deadlift. | figured after the meet I'd take a full two weeks off to let myself heal up and get back to normal. Little did | know this was just the beginning of my journey. When I returned to training, my knee still wasn't right. | saw an orthopedic surgeon, had an MRI taken, and got the bad new: I'd torn the meniscus in my left knee and it would require surgery. ‘Almost one-and-a-half years to that day, here | am writing a manual on how to keep people's knees healthy. You see, when your body and training are your life and all of a sudden they are compromised, you'll do anything in your power to make them right. So beyond the “in-the-trenches” experience, I've done a ridiculous amount of reading and researching to figure out the most efficacious ways to develop and maintain long-term knee health. And that’s where you come YOU are the one who gets to benefit from my experiences. Have you ever had knee pain? Or worse yet, knee surgery? xii Prefaceam going to reveal how to build the healthiest knees possible. This information is applicable no matter what your current condition. | would argue that this manual is even more important if your knees are healthy because, as the saying goes, “You don’t know what you got "til it’s gone.” This product is geared toward fitness professionals, and | will tell you up front this isn’t your average fitness info product. Throughout this manual, I'm not only going to give you specific programming to use and follow, but I'm going to explain every step along the way so you'll understand EXACTLY why you're doing everything. Not only it expand your knowledge base, but you'll achieve greater success with your clients, along with opening yourself up to training different demographics. Some of you may not be in the industry and therefore may not care about how it works; you just want to use it and get results! I'm totally cool with that. If it gets a little science-heavy at times, bare with me — the results you'll achieve will be well worth it. Read the manual. Apply the steps and program I’ve included, and then relish in the fact that your knees, and those of your clients, will stay healthy for as long as you are alive. After all, we only get one body — you might as well take amazing care of it so you run out of time before it does. Mike Robertson Preface xiiiSECTION |: UNDERSTANDING THE KNEEChapter I: Anatomy of the Knee Could you imagine a doctor prescribing a drug without knowing the patient's condition? It sounds ludicrous, right? Instead, the doctor would not only have a working knowledge of the patient, but their condition as well. At that point, a treatment program would be outlined to help resolve or treat that patient. The same can be said for knees — if you want to fix knees, you need to understand knees. Many of you who purchased this manual may have no desire whatsoever to read this chapter. Will it help you better understand the manual and how it all ties together? Sure! But it's not essential, Instead, I've included this chapter for the fitness professionals or those who just want to satisfy their “inner geek.” If you have no interest in the finer points of knee anatomy, go ahead and skip this chapter. | won't be offended!Bones and Articulating Surfaces While | choose to use the general term of knee joint throughout this text, the knee joint is, in fact, comprised of multiple bones and joints. The following bony structures make up the “knee” joint: * Femur The femur (thigh bone) sits above the knee and is the largest, longest, and heaviest bone in the body. = Tibia The tibia (shin bone) sits below the knee and is the second longest bone in the body. = Patella The patella (knee cap) sits between the patellar ligament and quadriceps tendon. 4. Bulletproof KneesAnterior view of the right knee joint These bones form two joints, the patello-femoral and tibio-femoral joints. The tibia and femur, where they articulate, are actually wider than the areas above and below them. This allows for better stability and weight-bearing ability. Anatomy of the Knee 5The ends of the femur and tibia and the back of the patella are made up of a softer bony tissue known as articular cartilage. Some may consider the fibula (posterior shin bone) and its joint with the tibia (tibio-fibular joint) as a portion of the knee, but we won't be discussing it at length in this manual, The patella is a sesamoid bone. It sits within the quadriceps tendon and allows the quadriceps to have a greater mechanical advantage and produce greater force. The patella sits between two condyles on the femur in a space called the trochlear groove. 6 Bulletproof Kneesas Lateral view of the right knee joint Passive Stabilizing Structures Your knee is held together by active and passive structures. Passive structures include the ligaments, capsule and menisici, while the active structures Anatomy of the Knee 7are the muscles that surround your knee. Let’s discuss the passive stabilizers first. The joint capsule attaches outside all three of the major bones involved in the knee (patella, femur and ti ia), and helps circulate synovial fluid to the articulating surfaces. Synovial fluid is found in all synovial joints (shoulder, hip, wrist, knee, etc.), and reduces friction between the cartilage and other structures to lubricate and cushion them during movement. Capsule of right knee joint: lateral (left) and posterior (right) views 8 Bulletproof KneesThere are four primary ligaments that prevent movement and provide stability at the knee. The cruciate ligaments are large and cross each other in the middle of the knee; this X-shaped design helps provide anterior and posterior stability within your knee joint. The anterior cruciate ligament (ACL) runs [Pega 9 from the anteromedial portion of your ti and travels up, connecting on the posterolateral portion of your femur. The posterior cruciate ligament (PCL) does the opposite; it runs from the anterolateral portion of your femur and connects on the posteromedial portion of your tibia. The ACL provides anterior stability to the knee joint (preventing the tibia from moving forward) while the PCL provides posterior stability to the knee joint (preventing the tibia from moving backward). The anterior cruciate ligament Anatomy of the Knee 9Higament of Weisberg Medial meniaras —Bibiul ctlatceat Tigament Lateral meniven: Fier collateral The posterior cruciate ligament ‘On either side of the knee, are the collateral ligaments. The tibial and fibular collateral ligaments provide medial and lateral stability to the knee joint, respectively. The tibial collateral ligament helps prevent excessive medial (inward) movement of the knee joint, while the fibular collateral ligament prevents excessive lateral (outward) movement of the knee joint. Due to the natural valgus (knock-knee) alignment of the knee, and the fact that the lateral aspect of the knee is most readily exposed, tibial collateral ligament injuries are 10 Bulletproof Kneesmuch more prevalent. Due to the need for increased stability on the medial side, the tibial collateral ligament is much thicker than its counterpart. ‘The tibial (left) and fibular (right) collateral ligaments Between the femur and tibia, you have two crescent shaped rings of fibrocartilage known as menisci. The menisci of the knee provide stability to the joint, spread synovial fluid, give proprioceptive feedback to the nervous system, and increase surface or contact area of the knee. Their primary role, however, is promoting shock absorption at the knee joint. You have a meniscus on the inner and outer portion of your knees, called the medial and lateral meniscus, respectively. Anatomy of the Knee 11Anterior eraciate ligament Pransverse Ligament | Ligament of Weisberg Posterior cruciate Vgament ‘Top view of the menisici of the right knee joint Active Stabilizing Structures Several muscles surround your knee and thus provide dynamic stability. On the anterior portion of your thigh, the quadriceps muscles are your primary stabilizers. Posteriorly, the hamstrings, gastrocnemius, and popliteus all cross the knee joint and thus provide varying levels of stabilization. We'll cover the muscles more in depth in their respective chapters. The knee joint is classified as a hinge joint. Much like a door opens and shuts via its hinge, the knee has two primary movements: flexion and extension, From the standing position, knee flexion occurs when your calf and hamstrings draw closer to one another. Knee flexion is caused by active contraction of the hamstrings, with the gastrocnemius and popliteus also playing small roles. 12. Bulletproof KneesKnee extension Knee flexion Many would assume that the femur merely sits on the tibia and rotates into flexion or extension, but it’s a little more complicated than that. In the beginning stages of knee flexion, the femur rotates around its axis; however, as knee flexion continues, there is a combination of both rolling and gliding forward on the ia. This is important to note because often we only examine compressive forces (due to gravity and weight-bearing) at the knee. However, both compressive and shear forces must be examined if the end-goal is optimal knee function. Knee extension is the opposite movement, when the posterior thigh and calf are moving away from each other. An example would be when someone is kicking a ball. The quadriceps are your primary knee extensors. It should be noted that there is minimal internal and external rotational movement at the knee joint (via the tibia) in the extended position, due in large Anatomy of the Knee 13part to tension in the cruciate and collateral ligaments. However, in the bent knee position, these passive stabilizing structures aren’t as efficient, and thus more rotation is possible. Tibial internal rotation Tibial external rotation Summary Even if it's not your goal to earn a Ph.D. in biomechanics or anatomy, this section lays the groundwork for moving forward. Once you have a basic idea of the structures that comprise your knee, you'll have a much better idea of why the concepts we get into later on work so well 14. Bulletproof KneesChapter 2: Common Causes of Knee Injuries You may have thought this section would cover specific injuries like patellar tendinosis, ACL tears, and a myriad of other knee maladies that people suffer from. Instead, I'm not going to discuss specific injuries at all ~ I'm going to discuss WHY these injuries happen in the first place. Recent research evaluated the frequency of knee injuries in an athletic population. Would you believe that one in three sporting related injuries occurred at the knee? It’s true! In this study, out of 17,397 patients, 6434 had a knee related issue.’ That's 37% of the sample! Why is the knee one of the most frequently injured joints in the body? There are many reasons, but here's a short list of problem areas we * Biomechanical alignment * Suboptimal muscle function and strength * Poor mobility at adjacent joints * Poor strength in surrounding musculature * Excessive tension in surrounding muscle and fascia * Flat-out overuse!