The snow season is fast approaching and it's time to get ready. We have about four weeks before the snow should be flying, and you will need your knees to be in tip-top shape to be able to do their job for you this season. Your knees are the shock absorbers of the system. They are the ones that get caught in the middle between the ground reaction forces from your feet up to the action of your hips. When you are downhill skiing, snow shoeing, cross-country skiing, or just walking your dogs in the snow, your knees have to be ready for all the action with their joint and muscle sensors revved up and ready to go. They need the appropriate muscles firing in the right motor control patterns to keep you safe, and your training needs to start now before the slippery stuff arrives.

Your knee is a simple hinge joint. There is cartilage called the menisci that sit between the ends of the femur, which is your thigh bone, and the tibia which is the weight bearing bone in your lower leg. Also a part of this joint is the patella, which we all know as the kneecap. The patella sits in the groove on top of the femur, and it is supposed to slide and glide easily in the groove as you bend and straighten the knee. The patella is attached to the joint through sets of soft tissue structures, and those structures often change as we age in their mobility. Suddenly, this simple hinge joint can easily become affected with a complex set of motions occurring there to provide you with the stability and mobility you need everyday.

Even though the knee joint is a simple joint, it does not mean it is not complex in the motions that occur there. The knee joint actually moves in multiple dimensions as we move dynamically, and often that is where the trouble comes in to the picture. The rotary motion is especially important in the joint, as we turn and pivot and walk up and down stairs and run and cut side to side. This rotation motion is where we really need the joint and muscle sensors to be in good working order. The joints and muscles have proprioceptors that tell the body where it is in space, and these sensors are what protect us from falling and assist us as we participate in our winter sports. These proprioceptors are easy to activate with fun balance activities and they respond quickly to training.

Furthermore, there are a few easy moves that can begin training the muscles that surrounding your knees, so they are ready to keep you safe this winter. These muscles, when activated in the right patterns, protect the knees and insure the best outcomes for your success.

Physical therapy can help you as you train your knees this season, whether you have an old nagging injury or creaky knee joints that drive you crazy. Here are a few exercises and tips to get you started.

Set the knee cap. Get a kick ball size ball and sit with your knees and hips bent at 90 degrees. Set the ball between your knees and then squeeze your buttocks together, squeeze the ball between your knees and push your foot to the floor. Hold for a six count and repeat 20 times. This move stimulates the muscles to fire in a pattern to help the kneecap and the knee joint in its strength.

Set the lower leg chain. Begin by standing up and align your hip, knee and second toe in a straight line on both legs. Don't let your foot turn in or out as you do this to start. When you begin training your best alignment to begin is this lineup. Then do a little mini squat. Not a deep squat because it should be done in pain-free ranges only, and hold onto the counter if you need to. This is the beginning training of the knee, hip and foot patterns.

Balance training. Stay in the standing position, holding onto the counter if you need to, and then stand on one leg. See if you can stand on one leg for 30 seconds without losing your balance, and with no real pressure on your hand. You should be able to do three minutes eventually, as you begin training with no problem.

Next you will further challenge the balance sensors. Stand on one leg again, and now with the opposite leg begin to do a little movement pattern with your leg. Gently lift the leg off the ground towards your nose, and hold six count without losing your balance. Then with the same leg kick it back behind you, and hold it again for a six count. Then, with your arms outstretched in front of you, turn your trunk and reach with your arms to the right and hold six count, and then to the left and hold a six count.

Do not do any of these exercises if you are in pain, please see your MD and physical therapist.

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy. She and her staff can be reached in their Coeur d'Alene office at (208) 667-1988, and in their Spokane Valley office at (509) 891-2623. Come in for a tune-up before winter is here.