Squat, Press, Extend or Flex for Strong Legs & Healthy Knees, Pt. 2

While being the largest and most complex joint in the human body, the knee is also the most delicate. Receiving a pounding from the time we are born all the way through life, it is no wonder that a large percent of the world’s population has or will have a knee problem.


As a fitness trainer or coach, you will undoubtedly have to create an exercise prescription around aching knees for many of your clients. In part one of this series, we took an in-depth look at the structures of the knee. Moving into part two, we will examine some of the most common injuries that affect the majority of the population; whether stemming from lack of conditioning, overtraining or simply a bad move.

Torn Meniscus

A torn meniscus is generally caused by one of two things; acute trauma or degeneration of the knee joint. Acute trauma is the type of injury caused by physical activity in which the knee is subjected to constant forceful blows. This is common in activities such as football, rugby, baseball, soccer, basketball and racquet sports.

Other types of acute trauma injuries are also common in activities of daily living. For example, if the knee is rotated forcefully while the foot is firmly planted on the floor while bearing weight, the meniscus can become injured.

Other causes for a meniscus tear are Hyperflexion or Hyperextension, which can happen during a car accident or other low impact activities if the knee is unstable. The most common mechanism of injury is non-contact stress from deceleration or acceleration coupled with a change in direction (cutting maneuver).

Joint Degeneration (Osteoarthritis), or wear and tear, is the most common form of arthritis, affecting at least 20 million people worldwide. Sparing no race, age or gender, Osteoarthritis sets in when the cartilage that covers the ends of the femur, tibia, fibula, and patella deteriorates over time. Eventually, when the cartilage breaks down you are left with bone rubbing on bone, which is usually accompanied by an overgrowth of bone (osteophytes). This in turn narrows the joint space and places even higher compressive forces on the meniscus, leading to a tear.

Types of Meniscus Tears

Meniscus tears are classified by how they look as well as where the tear occurs.

Longitudinal Tears are the most common variety usually occurring at the back or the inner cartilage and are common in young adults during sports activities. The injured person can generally pinpoint the incident with three factors being present. The knee was flexed while bearing weight and then twisted.

Bucket Handle Tears are tears around the rim of the meniscus causing the central portion to displace into the joint. It is commonly referred to as an exaggerated form of a longitudinal tear where a portion of the meniscus detaches from the tibia, forming a flap that looks like a bucket handle.

Flap Tears have a loose medial flap along a horizontal plane that tends to flick over from time to time causing symptoms. They can occur as an acute tear or as a progression from longitudinal tears.

Transverse Tears, also referred to as radial tears can be small where only a portion of the meniscus is torn generally radiating from the inside to the outer menisci or large where the tear reaches almost to the outer portion.

Torn Horn Tears, also referred to as Parrot Tears, are commonly found in the posterior horn (tip) of the meniscus, specifically the posterior inner aspect that’s more toward the center of the knee joint. A forceful blow or twist such as pivoting during physical activity is the most common cause for a Horn Tear.


1. Collado H., Fredericson M., Patellofemoral pain syndrome. Clin Sports Med. 2010:29:379-398

2. De Cardo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010:29:81-106

3. Steiner T., Parker RD., Patella subluxation and dislocation. DeLee and Dree’s Orthopaedic Sports Medicine 3rd ed.

4. Clark, J. M. (1990). “The organization of collagen fibrils in the superficial zones of articular cartilage.” J Anat 171: 117-30.

5. Mechanics of human joints” Physiology, Pathophysiology, and treatment. Unsworth, A. 1993

6. Basic Orthopaedic Biomechanics, Second Edition, Van C. Mow, Wilson C. Haynes, 1997

7. Medial Collateral Ligament Tears, Cedars-Sinai, 2012, a 501(c)(3)

8. Arthroscopic repair of traumatic longitudinal meniscal tears, K Roeddecker, G.D. Giebel, C. Lohscheidt and M. Nagelschmidt, 1993, Vol 7 Num 1

9. Meniscus tear recovery time, Benjamin Wedro, MD, FACEP, FAAEM, 2012 10. Bursitis, The Basics, What you should know about bursitis, 2012 Carol Eustice, ASCP, ARHP

About the Author

Felix Doval is the founder and owner of Pro-Active Wellness, a leading South Florida Health and Fitness education provider whose curriculums are taught using the private training facilities of Active Bodyz Fitness Training located in Davie Fl.Felix holds a Master Certification with the NFPT, and is NSCA and NAHF certified. He is a graduate of a two year Natural Health Consultant program at Stratford Career Institute in Washington DC, and from the Professional Career Development Institutes’ Professional Fitness and Nutrition program in Atlanta, GA. His advanced knowledge includes multiple specialty studies in the fields of diabetes, heart disease, arthritis, lung disease, and osteoporosis. He has directed and developed wellness programs around the nation and is currently responsible for developing, staffing and coordinating the NFPTs’ worldwide workshop division.


These resources are for the purpose of personal trainer growth and development through Continuing Education which advances the knowledge of fitness professionals. This article is written for NFPT Certified Personal Trainers to receive Continuing Education Credit (CEC). Please contact NFPT at 800.729.6378 or [email protected] with questions or for more information.
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