A 3D approach to Knee Health – at any level

I can’t help but get excited and appreciate the World Cup.  Yes, I am a bandwagon soccer fan, but what’s not to appreciate; the fan fare, the passion, and the sheer athleticism and endurance of these athletes is astounding.  As a physical therapist and overall movement nerd, I also can’t help but be impressed with the durability of the knees of world class soccer players.  The truth is, their knees are able to withstand cutting, turning, landing from a header and quickly transitioning to a sprint, planting on one leg to shoot with the other; the whole time testing and challenging their knees’ integrity.  This world class sporting event has inspired me to share some components of a “healthy knee” workout and provide a few exercises that can be added to your routine and progressed to maintain healthy knees throughout your active lives.

Multiple studies have shown that ACL injuries are more common (2-8 times) in female athletes, especially teens and adolescents, than their male counterparts playing at their same level.  This alone, necessitates education on injury screening and designing a conditioning program for female athletes at every level.

At Catalyst PT and Wellness, we are firm believers in injury prevention sport-specific training and PT check-ups before a season starts and throughout a healthy athlete’s career.  We pride ourselves in taking a 3-dimensional approach to movement analysis and conditioning; watching how a knee responds in all directions. This 3D approach is supported by research to successfully reduce primary-injury risk and incidence in ACL injuries.

The essential components necessary to re-educate your neuromuscular system and  strengthen your leg muscles properly to prevent knee injury are:

    1. exercises promoting greater knee flexion and symmetrical knee flexion during landing
    2. single-leg exercises incorporating postural control
    3. exercises promoting lateral hip/gluteal muscles strength and control
    4. exercises that facilitate greater hamstring to quadricep utilization ratio

All of these components will help control the knee’s position while landing, or the ability to change direction over a planted leg without injury.



This exercise promotes the use of lateral hip musculature while in knee flexion.  This exercise is best utilized at the beginning of a workout to promote use of these muscles before moving onto more integrated or functional tasks.  The focus of the athlete should be on sitting low in the squat throughout the walk and not allowing their knee to “dive-in” towards the middle.  A good cue is to keep her knee in line with her second toe.  When adding the rotation, this should not allow their knee to migrate laterally, only feeling more tension on the lateral hip muscles with each turn.  This exercise also promotes functional hip internal rotation, side-to side control of the knee and co-contraction of hamstrings/gluts and quadriceps.


By transitioning to a single-leg, the athlete is immediately testing and training her core and postural stability which is another key component of knee health. This single-leg activity specifically targets the hamstring and gluts (back of the thigh), which is necessary to take control away from dominance in the quadricep (front of the thigh). This movement should be a hinging at the hips for the athlete without rounding their back to reach greater depth. If an athlete has excessive extension in her knees it is important to keep a slight bend to prevent the knee locking out.


This exercise promotes the functional mechanics of walking,while promoting greater hip and knee flexion and extension angles. By adding the reach, the athlete is promoting functional hip rotation and emphasizing strengthening of the lateral gluteal muscles. The walking lunge can be modified an infinite number of ways, with this being a great starting point.


The athlete starts in an athletic stance and is encouraged to load further into a squat before exploding out of the jump. The client then will to attempt to land as softly as possible by bending the hips and knees to accept their body weight, she should’t hear a loud “thud” when landing. When transitioning to a one footed landing, the athlete should be able to control the knee to prevent it from diving inward. If the athlete is unable to land with control, she is not yet ready for single-leg landing. This exercises is a progression of two-legged landing to one-legged landing to practice landing and taking off with proper form. This exercise can be progressed to greater speeds or greater depth or by changing the direction of the jump to a more lateral movement.

Muscular and biomechanical factors are only a few predictors of knee injury. There are a multitude of external factors and other biological factors, such as, hormonal and nutritional needs that all combine to keeping an athlete’s knees healthy. If you are having knee pain while enjoying your favorite activity, check in with a physical therapist for an evaluation. Every person’s body’s needs are different and the above list of exercises is by no means comprehensive. Take advantage of conditioning programs at physical therapy clinics or sports medicine facilities to get a program personalized for you and your sport.

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