The knee cap (patella) glides in a track in the thigh bone (femur) as the knee straightens and bends. The movement of the patella is generated by the four quadricep muscles on the front of the thigh. If these muscles are weak or unbalanced, a sudden or repetitive twisting of the leg (especially on uneven surfaces) can result in the patella coming out of its track causing inflammation, pain, and in the worst scenario, a dislocation.

LIGAMENT SPRAIN

Ligaments are non-elastic tissue that connect bone to bone. In the knee, there are ligaments connecting the inside, outside, and the internal aspects of the knee. Each ligament has a specific function for keeping the knee stable with movement. Ligament injury most often occurs when the foot is planted and a twist (change of direction) or blow occurs at the knee. Ligament sprains are graded 1-3 which indicates the severity of the tear. Although in most cases the tear will heal, a stretched ligament will never shrink back to its original size. Therefore prevention is really important.

CARTILAGE TEAR

The knee has two cartilages a medial and a lateral. They are made of a tough shock absorbing material called collagen. Their function is to absorb shock through the knee and resist excessive twisting. Cartilage tears most often occur with a sudden or repetitive load and twist on the knee.

ILIOTIBIAL BAND (ITB) SYNDROME

The IT Band is a long band of connective tissue(fascia) and muscle spanning from the pelvis to the outside of the knee. When the IT Band is tight, its attachment on the outside of the knee will rub against the femur and cause inflammation and pain. There are three main causes of tightness in the ITB;
-Over-pronation (when your foot rolls in excessively) or over-supination (when your foot rolls out) will result in the muscles connecting into the ITB to tighten up to compensate.
-Lack of flexibility of the muscles connecting into the ITB such as the Gluteus Maximus and the Tensor Fasciae Latae.
-A muscle imbalance of strength and or flexibility between the muscles of the inner thigh and the outer thigh. The most common culprit is weakness of the inner quadricep muscle called the Vastus Medialis. If it is weak, the outer thigh will try to do a job it was not designed for to compensate.

PREVENTION IS BETTER THAN CURE!

1. Here are five things that you can do preseason to prevent an injury to the knee that may take you out for part or all of the season.

2. Regular stretching of the calves, hamstrings, quads, and glutes. Hold for a minimum of 30 seconds 3x when trying to increase flexibility and a minimum of 20 seconds in your warm-up. Always do a little cardio warm up before stretching.

3. Adequate strength base of the quadriceps, hamstrings, glutes, and calves. Lunges and ¼ squats are simple but effective strengthening exercises that can be done at home.
4. Getting some guidance from a sports Physiotherapist or Athletic Therapist on specifics can be helpful if you have had a lower extremity injury in the past.

5. Fresh shoes (maximum 450-500 miles per pair) specific to your foot type +/- orthotics for some.

6. If you are doing some pre-season running, a gradual increase in mileage (10% for beginners or those who had injuries last season) with at least two rest days/week.

7. Seek medical care within 7 days of onset of any ache or pain not resolving with reduction or activity, ice , stretching, and anti-inflammatories.