Functional training for knee pain: practical example of gonarthrosis

Functional training for knee pain: practical example of gonarthrosis

The principal aim of the Functional training is to enable one's own body to achieve the greatest possible efficiency in everyday life but also during sports activities. Pain is often a major limiting factor and the knee joint, as an important transfer joint for the communication of the foot with the hip (and vice versa), is significantly responsible for the efficiency of movement and is particularly often affected. 

This is also due to the lower three-dimensional joint mobility of the knee compared to the foot, ankle and hip joints, which results in a correspondingly high load on the knee joint structures during functional movements. Additional risk of increased wear and tear is especially prevalent when the active musculoskeletal system does not contribute optimally and with functional precision to the efficiency of knee joint function. The overall risk scenario of premature knee joint degeneration can be significantly mitigated, and in many cases even prevented, with proper understanding and professional use of measured training intervention. 

Functional training as the basis of training planning for gonarthrosis

With functional training, we set a training stimulus that it requires at that moment, with the appropriate dosage, for the right structure to successfully perform a particular movement. The concept of functional training is therefore neither new nor a trend. It is the optimal response, our body function, both in everyday life, in sports and in indications such as Gonarthrosis, to do justice.

Movement takes place in constant interaction with gravity as an omnipresent physical quantity. Gravity allows our muscles to store energy and helps you perform movements in all three planes, namely the sagittal, frontal and transverse planes, with the tension gained in the process. Functional training science refers to this as loading and unloading muscles.

Upright gait as a diagnostic and orientation function

Everyone wants to learn to stand upright and move around as early as possible. We never want to lose this ability. Therefore, the top priority for training is to base the selection of exercises on the main function of walking. In order for the knee joint and the Gonarthrosis to find those exercises that serve the relief, we must consider the following:

The classic model of the concentric, eccentric or static mode of operation of muscles is relativized when viewed from a functional perspective. Taking gravity into account, this leads our knee joint into flexion when walking, as soon as the foot hits the ground with its heel. The multi-joint "leg flexor" thereby experiences a shortening (concentric) in the sagittal plane at the knee joint, while it performs a stretching (eccentric) at the hip joint by tilting the pelvis forward. We call this combination of the working modes of the musculature eccentric.

This knowledge is particularly relevant in order to assess the situation of the knee joint with Gonarthrosis to be able to evaluate. Incorrect loading or compensation during daily movements can play a significant role in subjecting the knee joint to increased stress loads. Due to the lower mobility of this joint in the transverse plane, it has fewer options to compensate for incorrect loads.

The knee is highly dependent on the rest of the body in this context, especially on its immediate neighboring joints at the foot and hip. Insufficient hip mobility in transverse plane rotation causes the femur of the left leg, together with the pelvis, to rotate to the left and outward when stepping forward with the right foot. The lack of rotation is now compensated by one of the closest joint partners and results in this case in a strong internal rotation in the knee joint, provided that the left foot is still on the ground. If another stress variable such as overweight or explosive movement in sports is added, gonarthrosis and possible pain are unavoidable.

The knee and its helpers

Gonarthrose Kniegelenksarthrose |

From classical anatomy, we know that knee joint muscles originate above and below the knee and outshine it. Functional training science teaches us that muscles that do not have a direct attachment to a joint nevertheless exert an influence on it. An example is the soleus muscle, which neither originates at the knee nor passes over it. Nevertheless, in the functional movement of gait, it has a considerable part in knee extension because it decelerates the lower leg in its forward movement. In a chain reaction, this deceleration results in the extension of the knee joint. For this process to take place in the most knee-friendly way possible, the elasticity (loading and unloading capacity) of the muscular tissue is an indispensable prerequisite. Increasing incorrect loading due to pressure situation in the knee joint and accelerated degeneration with Gonarthrosis are the result.

A long-term healthy knee is therefore more likely the better its surrounding structures integrate into functional movements and efficiently support the knee in performing them.

Functional training with elastic bands

In order to counteract progressive degeneration and the loss of the associated movement competence, dosed and purposeful training intervention is required. Optimally, this intervention is ensured by well-trained personnel in therapy or training facilities. In reality, however, it requires a higher workload and more frequent training stimuli than the scheduling in the aforementioned facilities allows. The proverbial "5-minute movement breaks" can be life-saving for a knee with the appropriate exercise and training equipment.

Fitnessband PATband Trainingsband Widerstandsband
The "Swiss Army Knife" among training tapes - PATband Soft and Strong

Training with elastic bands has proven in practice to be the most effective and also the most versatile method. A resistance band offers a wide range of exercise possibilities. Therefore, different training bands have become established; special toe bands for training the toes and feet, smaller mini bands for activating the hip muscles or all-purpose bands with a large length and a variety of loops to adjust the training intensity.

Elastic bands have the property that as the band is stretched, the degree of resistance increases exponentially. This property is brought into line with the development of joint strength through the selection of the appropriate functional exercise. This is the clear advantage of functional band training compared to dumbbell or fitness training in the gym. In addition, training bands are inexpensive to purchase and the modern rubber-free versions made of textile are extremely resistant, durable, skin-friendly and easy to transport. With the right exercise, the proverbial "training to go" is the perfect complement in knee therapy and for Gonarthrosis.

Functional knee exercises

Elastic bands are rarely used functionally in practice. They are often used to mimic external resistance during a classic strength exercise or an isolated therapeutic intervention. They are often considered merely a substitute for a pulley apparatus or dumbbell. Unfortunately, their true utility, especially for knee therapy, often goes unnoticed in the process. Unlike the devices just mentioned, a strap can be worn close to the body. These "strappings" create resistance close to the body, which activates muscle loops during a functional movement. This strategy helps to better integrate weak points into a complex movement pattern to minimize compensation patterns.

Gonarthrose Kniegelenk PATband Strapping
Strapping with PATband for knee relief in gonarthrosis

In the following video exercise series, I have provided six exercise programs with three exercises each. These exercises prove to be very helpful in daily training practice.

We start with passive knee relief through fascial work and application of strappings. This is followed by techniques for hip and foot activation and thus active knee relief. Additional mobility exercises not only increase general mobility, but contribute to "de-stressing" the knee joint structures and are mainly necessary in terms of long-term effectiveness. The increase in stability is rounded off by exercises for functional trunk strength and full-body exercises from the aspect of hip activation.

Conclusion on gonarthrosis

The main cause of incipient and progressive degeneration of the knee joint is, in addition to obesity, incorrect or excessive stress due to sport, "gluteal amnesia", triggered by predominantly sitting or standing in everyday life. Static load of an "office athlete" favors the deactivation of important supporting muscles. As a result, body segments, such as the knee joint in our example, are integrated into movements more than intended and are thus systematically overloaded. A therapy of the knee joint at the joint itself therefore only provides a limited and very temporary remedy. A holistic view of all the structures involved is essential and promises a high degree of long-term success with a functional training intervention.
This article appeared in the Sportärztezeitung
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