A plan to avoid knee pain

Stretch and roll your lower legs in order to stay on your feet

Ask almost any responder who has done their time on the street, and a common complaint comes to light. After lower back pain, the knee is the second most injured joint in the body. A look at the literature from around the industry clearly shows that knee pain and injury are major disability drivers in our profession.

For the sake of this article, we are going to assume that there is no “diagnosed internal damage” to the knee, such as cartilage or ligament tears. The good news is that, even if you do have or have had a tear repaired, what I talk about here will still work fine. Just clear it with your doc first.

The knee is caught between two joints that can affect it: the hip and the calf/ankle . The simplest way to consider this biomechanical phenomenon is that the knee is the center of a moving tripod (your body). Any alteration in the function of the tripods foot or the tripods hip will cause alteration in the support joint, your knee. Since the knee gets most of its stability from soft tissue structures, any alteration of the mechanics below/above the knee will strain the soft tissue support structures.

Image EMS1 file photo

Runner’s knee

The first structure we need to address is the IT band. The iliotibial band is a thick band of fascia that is formed proximally by the confluence of fascia from hip flexors, extensors, and abductors. The band originates at the lateral iliac crest and extends distally to the patella, tibia and biceps femoris tendon. (1)

Iliotibial band syndrome is a common knee injury that usually presents as medial or anterior/lateral knee pain caused by inflammation of the distal portion of the iliotibial band; occasionally, however, the iliotibial band becomes inflamed at its proximal origin and causes referred hip pain. To all my runners out there, this is also called runner’s knee. When the ITB becomes tight, it pulls and causes a fulcrum-like effect. We feel pain on the medial to anterior medial aspect of the knee.

How do we fix it? First, roll it using a tennis ball, foam roller or massage stick. Next, strengthen the lateral hip muscle that is often the underlying cause of the knee pain.

Calf and ankle mobility

The calf and ankle are integral parts of the entire human movement chain. Everything we do in life and especially in our jobs is based on our interaction with the ground: Our footing, stances, balance and kinesthetic sense all originate with our bodies’ interpretation of the ground. When we lose mobility in the foot and or ankle, we often have knee pain due to the altered mechanics from below the knee joint.

Squatting, lunging and kneeling are all integral movements of our job. If you are no longer able to perform these tasks normally due to restricted movement in the foot or ankle, your knee takes a load it should not have.

The gastrocnemius and soleus are calf muscles. The gastrocnemius is the top calf muscle that originates above the knee on the femoral condyles. It crosses the knee joint and attaches on the calcaneus (heel). The soleus is a pure plantar flexor that, when tight, can cause the foot to “roll in.” Either way you look at it, both muscles must be mobile in order to do your job safely.

To ensure that the foot and ankle have proper mobility, you need to keep the muscles loose through stretching and foam rolling, and also keep the foot/ankle loose with some self-mobilizations such as ankle rolls and slow lunging motions with the foot propped up on a curb.

Foam roller — take it slow

For those of you who have used the foam roller, you will appreciate this word of caution. The first time you use the foam roller on your ITB, you will temporarily question your religion. The ITB is often very tender, but with time and consistency with the roller, it will hurt less. Your knee pain will dramatically lessen and in many cases go away.

The same holds true for the calf. Using the foam roller is uncomfortable, but you will be able to squat and lunge better almost immediately, and that translates into a big injury reduction risk.

As a rule, hold your stretches for 60 seconds and spend at least 90 seconds on each area when using the foam roller.

As I have said many times in this column: As a profession, we can no longer ignore our symptoms and our poor biomechanics; often that is how injury starts. If and when your knee starts to talk to you, be proactive — control the symptoms and take care of you so we can all keep doing what we got into this profession to do in the first place, taking care of others. A few minutes using a simple tool like a foam roller and doing a few stretches will go a long way toward helping you stay injury free!


1. Iliotibial Band Syndrome: A Common Source of Knee Pain
RAZIB KHAUND, M.D., Brown University School of Medicine, Providence, Rhode Island
SHARON H. FLYNN, M.D., Oregon Medical Group/Hospital Service, Eugene, Oregon
Am Fam Physician. 2005 Apr 15;71(8):1545-1550.

2. Muscles, Testing and Function
Kendall, F. McCreary. E.
p. 204-205, 56-59


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