Foot Drop: The causes and anatomy

Do you or someone you know suffer from foot drop? Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to afoot drop nerve, or paralysis of the muscle/s in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself.

The most common cause of foot drop is injury to the peroneal nerve as it passes around the outside of the knee. The peroneal nerve is a branch of the sciatic nerve that wraps from the back of the knee to the front of the shin and travels down into your foot. Because it sits very close to the surface near your knee, it may be damaged easily. This can be caused by prolonged compression of the nerve while sitting cross-legged or having your leg leaning against something, a sports or impact injury to the knee or lower leg, knee or hip replacement surgery.

Nerves are part of the “electrical wiring” system that carries messages between the brain and the rest of the body. Motor nerves carry messages between the brain and muscles to make the body move. Sensory nerves carry messages between the brain and different parts of the body to signal pain, pressure, and temperature. And most nerves, such as your peroneal, have both sensory and motor components.

Pressure or stretching injuries can cause fibers within the nerve to break. This may interfere with the nerve’s ability to send or receive signals, without damaging the insulating cover, similar to a wire you find in your home or electronic devices. However, nerves can heal, and with time, this injury is likely to fully heal and you can likely make a complete recovery.

When a nerve is cut, both the nerve and the insulation are severed. The end of the fiber farthest from the brain dies., but the end that is closest to the brain does not die and after some time, may begin to heal by developing finger-like sprouts that begins to look for its partner end. If those sprouts reach the other end, your function and/or sensation will be restored. If not, surgery may or may not work to repair the damaged nerve.

a1Compression of the peroneal nerve can lead to pain, numbness, and/or weakness to the foot, ankle, or outer portion of your lower leg. Once a nerve is injured the symptoms will typically occur below the site of injury and can last minutes or hours, or with a more severe injury, it can cause months or a lifetime of disability.

The common personal also has multiple branches that vary in function. Some branches just innervate our skin and so compression or injury to this portion may only cause numbness or a tingling sensation to our lower leg or foot. And then other branches support our muscles of the lower leg and foot, most notable being the anterior tibialis muscle that controls your ability to lift your foot off the ground.

The tibialis anterior muscle runs along the front to outside portion of your lower leg. It begins just below the outside of your knee, and inserts into your foot, just below the front of the ankle. The most important function of this muscle is to lift the foot during gait so you do not drag your toes on the ground, which can be a fall hazard. It also controls your foot as you strike the ground with your heal during walking, allowing your foot to slowly lower to the ground giving you more stability, and preventing the notorious foot slap that is associated with foot drop. When this happens, likely an AFO will be prescribed to improve that ankle stability and prevent tripping over your toes.

So there you have it. That is the basic anatomy and physiology of foot drop. If you think you may suffer from this condition, or just want to learn more about it. Stop by and see me or another one of our physical therapists today!

Michael Phillip, PT

Physical Therapist – South Office

Knee pain: It may be all in your hips

You’re trying to get yourself back into shape, eating healthy, hitting the stair master, lifting or jogging… everything you’re supposed to do right. BUT, after a couple weeks your knees start to bug you. You wonder: “Am I doing too much? Am I too old for this? What am I doing wrong?” Someone suggests shoe inserts, someone says don’t buy inserts. What next?

Knee pain can be a tricky and is also one of the most common issues we see. The knee is the center point of what us PTs (or to-be PT in my case) call the “kinetic chain” of the lower limb. This kinetic chain involves the lower back, hip, knee, ankle and foot. Dysfunction at any part of this chain can be the underlying cause of knee pain. Determining where and why this dysfunction is occurring is the key to solving most knee issues.

One of the first things we try to determine is if your legs are resting in similar alignment, if leg-length-discrepancy-not we call this a leg length discrepancy. Leg length discrepancies generally fall into two broad categories: structural or functional.

Structural discrepancies account for a very small percentage of what we see and stem from anatomical differences in the length or shape of the bones of the leg. This usually results from previous injury, illness or can be present from birth. Structural discrepancies are a little more challenging to treat dalton01__1_1_5760and sometimes require orthotics, inserts or other devices to help your body compensate for the anatomical differences.

With functional discrepancies, all the bones are the right size and shape but aligned incorrectly. This can be caused by a variety factors like posture, muscle imbalances, restricted joints or training errors. Functional discrepancies are usually correctible with manual therapy to realign the bones and exercise techniques to help the correction to stick. Shoe inserts are typically not useful for functional discrepancies because they don’t correct the underlying alignment issue and can actually lead to more problems.

It’s impossible to create a single solution that will fix every individual person’s pain and discomfort. Interventions must be tailored to each patient’s unique profile. Before investing in a pricey pair of orthotics it’s important to determine if you are actually likely to benefit from their use or if you would be better off with corrections and therapeutic exercise

Kit Durban, SPT

Physical Therapy Student, Boston University

Synergy North Clinic

 

 

 

Pesky Plantar Fasciitis

      You have stretched, braced, iced, rolled, rested, strengthened, changed shoes and prayed to the plantar fascia gods but nothing is helping your chronic plantar fasciitis. You are not alone, it occurs in 10% of the population. Don’t worry your problem is correctable but may be related to more than your foot. Plantar fasciitis causes heel pain in active as well as sedentary adults of all ages. There are many causes that can include overuse, improper foot wear, obesity, sudden increase in duration and frequency of activities. Plantar fasciitis is defined as inflammation of the plantar fascia. With any inflammation, the stress causing the inflammation must be removed to completely treat the problem. In most cases, plantar fasciitis doesn’t resolve or keeps returning because the cause of the problem is not corrected. Common symptoms include, pain in the heel with the first steps in the morning, sharp, localized pain in the heel or arch, and slow decrease in pain with activity. With chronic plantar fasciitis, one must look past the foot and ankle.

The foot has 33 joints and 20 muscles, with the muscles and fascia attaching to the bones that make up the joints. The plantar fascia has many attachments throughout the foot. A lot can go wrong in such a small space. A joint that doesn’t move properly can cause a host of compensatory reactions in other joints and soft tissues in and around the foot. Joint restrictions can lead to changes in the way your walk, asymmetry in flexibility or limitations in your nerve mobility all the up the kinetic chain. These problems will turn an acute situation, into a chronic problem quickly if not corrected. So it is important to treat all systems to effectively heal the plantar fascia. The biggest problem may actually be in your lower back. The nerves that exit your lower back area are the ones that control the foot and ankle. A joint restriction in your lower back may be the actual cause of your plantar fascia. Restrictions in the lower back cause biomechanical alterations to the joints down the kinetic chain and can limit normal nerve mobility. All this can create abnormal stress to the foot and ankle, especially if combined with an activity like running.

Manual physical therapists will assess strength, flexibility, joint and soft tissue mobility, and nerve mobility of the entire lower quadrant to include lower back, pelvis, hips, knees and feet. We will correct for any joint restrictions throughout the kinetic chain to ensure a quick return to pain free living. Modalities may be appropriate to treat swelling, pain or inflammation. These can include ultrasound, iontophoresis, electrical stimulation, infrared and/or cold therapy. Exercises will be prescribed to normalize mobility and prevent further issues. Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required. So, if you are still dealing with plantar fasciitis, it is time to see a manual physical therapist at Synergy Manual Physical Therapy. In the meantime, be sure to rest as much as possible, perform stretching of the hips, plantar fascia and calf, massage the bottom of the foot and ice multiple times throughout the day. Hang in there; it will improve with the right care.

Kelly Haddock PT, COMT, ATC
Owner
Synergy Manual Physical Therapy – South Office

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Herniated Discs (Part 2): Symptoms and Treatment

This blog is the second part of a two-part blog on herniated discs. In the first post we covered the anatomy of your spinal discs and the common injuries to these discs. You can visit that post by clicking this link. Today we will discuss the symptoms and treatment of a herniated disc and what you should expect when you see a physical therapist.

SYMPTOMS OF A DISC

Just as no two people are the same, neither are our injuries. So this is a list of all possible symptoms but even just having one or two could indicate a disc injury, or you could even have a herniated disc without any symptoms. But on the flip side you could have two or more and actually not have a disc injury. (Are you thoroughly confused yet?) An evaluation from a physical therapist or medical doctor would be required to properly diagnose or rule out a herniated disc.  These are the most common symptoms of a disc injury:

  • Forward flexed posture
  • Increased pain in the morning or late at night
  • You don’t love sitting (standing might also not be that great due to more pressure on the disc)
  • Symptoms radiating down your leg or arm such as numbness, tingling, and/or pain
  • Weakness in arms or leg
  • Muscle cramping or tightness in your neck or back

HOW CAN PHYSICAL THERAPY HELP?

Physical therapists can design treatment programs that help the discs heal and address any other associated issues the back and lower body have from compensating. The back will try to protect itself as you still try to function and it can result in muscle tightness and guarding, sacroiliac joint dysfunction, tension in the nervous system, core weakness, and injury to other structures in the spine (ligaments, joints, nerves) as the disc fails to do its job. Treatment of these related issues can help your pain and provide good stimulus for the disc to heal.  Additionally we can design exercise programs so you don’t risk re-injury.  You don’t have to become completely immobile while waiting to heal. For example walking 15-30 min can help pump nutrients to the disc to allow itself to repair.

Therapy can also involve “passive modalities” like traction, ultrasound, electric stimulation, heat and ice. These can help you feel better and promote healing, but you aren’t the type of person who lives your life laying down on a table. You need to lift, reach upwards, pick things off the ground, hike up 14,000ft while carrying a 20 lbs backpack.

Therapy will also include exercises to re-activate the small stabilizers (called the multifidus) of the vertebrae that “shut off” with low back pain. When these don’t work, the large muscles of the back to take over which leads to fatigue and spasm (aka more back pain and tightness). There is a large variety of simple to advanced exercises to work the muscles you need to and these aren’t your weight lifter grandma’s intense sit ups.

You might also be put through exercises to restore motion of the spine, improve the hydration of the disc and to improve flexibility of the lower limbs.  These help combat the stiff and “stuck” feeling of your low back.

Finally, PTs can teach you positions to ease your pain. Remember how I said sitting tends to be a painful position? Try a rolled up towel placed in the low back to maintain the natural curve. Don’t rely on the “lumbar support” from your desk chair or automobile seat. Don’t rely on a “one size fits all” for your specific back anatomy.

Low back bothering you through the day or at home? Try lying on the floor on your back with your hips and knees flexed to 90 degrees such as when you lay on the floor with your legs up on the sofa or a chair.

CONCLUSION

If after reading this you have further questions or suspect you may be suffering from a herniated disc, feel free to call us or stop by one of our offices to schedule an appointment with me or another therapist. One of the keys to a quick recover is to not only beginning to receive treatment right away, but also knowing what to do and what not to do. This is where we take each patient as an individual and create a specific program that matches your symptoms and abilities. So don’t waste any more time, come by and see us to get your back in shape and allow us to help you recover quickly and effectively.

Kacie Rognlie, PT

Clinic Manager – South Office

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Herniated Discs (Part 1 of 2): Anatomy and Injury

For many people, injury to one of the discs in the lumbar spine (lower back) evokes thoughts of costly MRIs, large needles for injections, and stories of friends who have had bad backs their whole life. An injury to the low back doesn’t have to be a career or recreation ending injury and can be safely treated with conservative measures, so before you start thinking surgery I want to do some educating on discs and disc injuries to ease any fears of the unknown.

Anatomy of your Disc

The discs of the low back are like other structures in the body (bones, skin, tendons, muscles, etc) that can heal. To give you a better understanding, let’s start with some basic anatomy

  • A healthy, normal disc sits between 2 of the bones (vertebrae) in the spine to cushion shock forces, control movement of those 2 bones, and give us some extra height to tower over the competition. (well, for some)
  • The disc consists of outer and inner fibrous layers oriented like the skin of an onion. These are attached to the vertebrae above and below, which helps control the motion of the bones from moving too much on one another. Due to this connection, you can’t technically “slip” your disc out. I’m telling you this so you sound smarter when talking to medical professionals. (on a related  note , don’t tell your therapist you “twerked” your back. That is definitely not the term you think it is. You might have “tweaked” your back, which can happen, but I don’t want to know if you were trying a Miley Cyrus dance move)
  • Inside of the fibrous layers of the disc is an inner nucleus that is more gelatinous. Think about a jelly donut (you know you want one now!). This nucleus gives you the cushion of the spine.  Overall the nucleus and fibrous layers work together with your muscles and joints to provide the stability that allows you to do what you need to with your back.

Disc Injuries

A disc can become weakened due to the normal degenerative process of aging, prior injury from the glory days of high school sports, current or past overuse that is often due to lifting during work or sports, or a multitude of other injuries from falls or accidents. These past injuries often predispose the disc to future injury and limit its normal functions of support and cushion. The disc is most prone to injury with combined flexion and twisting motions. Throw on a weighted load such as during shoveling snow or yard work and you are setting yourself up back pain.

Injury can happen to inner or outer layers of the disc, the internal nucleus or a combination of those, which can cause a herniated (bulging) disc.  In some cases a bulging disc can impinge on a spinal nerve and cause pain, numbness, and/or tingling down the leg. However, depending on the extent of the bulge and where the injury is, the back may or may not even hurt and there are not always symptoms down the leg. For this reason, we can’t say that all discs herniations benefit from traction (aka “decompression therapy”), injections or surgery. This is where detailed evaluation from a skilled physical therapist can help you. Put us on your list of things to try if you think you might have injured your back at some point.

Conclusion

This post has covered the basics of the anatomy and what happens during an injury. In our next post we will go into more details of the symptoms of a herniated disc and what treatment approaches physical therapists can use to eliminate your symptoms and get you back to a normal life without surgery. If you have any questions, please give us a call or comment on this post. If you know you do have, or suspect you have, a herniated disc, give us a call to set up an initial consultation. We can often have you feeling better in just a few treatments.

Make sure to look out for Part 2 of this post, “Herniated Discs: Treatment“.

– Kacie Rognlie, DPT

Clinic Manager

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Knee Pain and Your Kinetic Chain

The knee joint needs to be trained and strengthened properly to avoid excess wear and tear (arthritis) on the joint that can eventually lead to knee pain. Running, hiking, agility training, yoga, and even strength training improperly can create or increase improper knee mechanics leading to pain or even arthritic conditions. On the flip side, performing proper balanced exercise routines can help reduce knee pain and slow down the production of arthritis in the knees. Decreasing knee pain or joint break down can also help regulate energy expenditure, increase overall performance, and slow down the production of arthritis.

Stretching and strengthening are always good to increase joint performance and improve joint mechanics. Closed chain exercises (squats, lunges, and leg presses) are more functional for lower extremity joint strengthening. However, these exercises done improperly can create increased pain.  Ideally you should be performing these exercises with your weight in the heel and the base of the big toe to engage gluteus maximus which helps support knee function while decreasing forces being distributed in the knee joint. Two additional open chain exercises (exercises done without your feet planted on the ground) that can increase glute strength are the clamshell and side lying hip abduction (see pictures). Lastly, hip flexor and calf stretches held for 30 seconds or longer can complete a great routine for the biomechanics of the knee.

Mechanically the knees, feet, ankles, hips, and spine all coordinate to provide the linear motion and disperse the impact during walking or running so individual joints do not take all of the gravitational forces. Structurally, if all these joints are coordinating their movement and muscle firing patterns, then in theory no pain should exist and arthritic production will decrease.  If there is stiffness or tightness in spine or other lower extremity joints, it can lead to excessstress and impact on the knee joint during running, walking, or even standing. This is why when assessing a runners form, we typically begin in the hip and lower spine and move down the kinetic to the foot, then reverse this and assess the ankle/foot on up ensure the runner is able to maintain the proper lower extremity mechanics. To read more on the kinetic chain during running check out this article on RunningMechanics,com, “Running Injuries and Kinetic Chain Disruptions.

Decreasing knee pain can simply take a few extra steps to improve function and lower extremity mechanics. With these additions to a training regimen the lower extremity joints will perform better, improve knee pain and reduce the breakdown of the knee joint. So if you are suffering from knee pain, rather than just “running through it”, try a few of the tips I suggested above. If this doesn’t help within a few weeks stop by one of our clinics for a thorough assessment by one of our physical therapists trained in running and gait mechanics. We look forward to helping you!

- Brett Barnes, PTA

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Rehabilitation following a meniscus tear

So your doc said you have a meniscus tear? Ouch! And now you are wondering what rehabilitation will be like. This is going to depend on whether or not you had surgery and how bad the tear is. Small tears are common and can even heal on their own if in the right place, which is the outside one-third of the meniscus. This is due to the rich blood supply in that area. So if you are lucky enough to have chosen this place to tear it you are in better shape. Other tears, even small tears, that occur in regions without such a blood supply will not heal or may take extensive time to heal if they do. This is when your doctor may tell you surgery is your best option.

What is rehabilitation like following a meniscus tear?

As with everything about our bodies, it is difficult to compare one person to another due to our composition and genetic makeup. If you are a fit athlete who is in great shape chances are you will have a much faster recovery time than the couch potato. Rehabilitation following a meniscus tear begins with a baseline assessment of how much you are limited. Can you squat? Descend stairs without pain? Walk or stand for > 10 minutes? The answers to these will allow us to establish where in the rehabilitation plan you will begin.

Baseline rehabilitation will start with improving your strength and range of motion (ROM), typically in a non-weight-bearing manner. For strengthening we will have you do isometrics (a fancy way of saying contracting your muscle without movement), seated knee extensions to improve quad strength, and hip exercises that will improve the stability of your knee. To improve your ROM we may have you start on a stationary bike, lay down and then pull your foot toward you using a strap, ball, or slide it along the table.

Patients who are farther along may begin with light-weight bearing options such as small squats, stepping up and/or down on a small step, balance activities, leg presses and resistance exercises for the hip and knee. This will include the greater use of weights, elastic bands, and machines. We typically won’t be pushing you through any painful activities that are in the moderate to severe levels, especially if you have not had the knee surgery. And at this phase we will also be more aggressive with our ROM activities. In order to walk properly you will need 60-70 degrees of knee flexion, but for descending stairs (which is the most common complaint with a meniscus tear) you will knee 110-120 degrees. Note: between 130-145 degrees is a normal ROM for the average person.

Advanced stages of recovery will focus on function, function, function. Doing the things you need to be able to do to perform your activities of daily living or return to your sport. Of course, if you are returning to a sport it may take longer and be more intense than an individual just looking to return to walking and a desk job. Activities at this stage will be things such as walking on the treadmill, advanced stability exercises, running or jumping activities, stair or ladder climbing, squatting and lifting items off of the floor. This is when we try to make sure you are ready for any of the challenges you may face after you are discharged.

Meniscal tears are extremely common knee injuries, and with proper diagnosis, treatment, and rehabilitation patients often return to their pre-injury abilities. Even if you elect to try physical therapy first and your meniscus does not heal, you will be in a better position following your surgery. Recovery also depends on the motivation of the patient, so listen to your physical therapist and do your homework….. yes, you WILL have homework!

We wish you a great recovery and remember, at Synergy Manual Physical Therapy here in Colorado Springs we are always here to provide excellent rehab and answer any questions you may have. Call us today for an evaluation or you may also leave any questions in the comments section. We look forward to hearing from you!
- Synergy Physical Therapy Team

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Piriformis Syndrome: A real pain in the butt!

SciaticNerve It may be there when you first wake up, after a run, or it can even haunt you as you are sitting at your desk. And whether it is called sciatica or piriformis syndrome, it can literally be a pain in the butt. Piriformis syndrome is a condition in which a small muscle (piriformis) in your posterior hip irritates the long sciatic nerve that runs down your posterior leg. The sciatic nerve commonly runs under your piriformis, but if you’re one of the lucky few (approx 17% of the population) it can also run directly through it which has thought to increased your odds of developing this condition. It can cause a variety of symptoms ranging from a simple annoyance or pain in the butt or posterior hip, to pain, numbness, or tingling down the back of your leg.

What causes it?

There can be a variety of reasons that the piriformis muscle can decide to tighten up on you. Commonly in non-athletic populations it occurs as a direct injury to the lower back or tailbone, causing the piriformis to tighten up in response to the injury as it tries to brace and protect your back from further damage. In athletes or those that workout regularly it can be from weakness in their gluteus muscles of the posterior hip, or from faulty mechanics while lifting, running, or working out. Externally rotated hips for extended periods of time can also lead to piriformis syndrome and allow for a shortening of this muscle to occur. If you tend to walk or run with your toes turned outward, this can indicate a possible source of the problem. Misalignment of the bones of the pelvis may also be involved.

To properly diagnosis piriformis syndrome is not the difficult part, but finding out the cause behind it can be. And to treat it without knowing the cause is likely to assure that this pain in your butt is not going anywhere anytime soon. This is why it is important to see your physical therapist so we can evaluate you and find the culprit as soon as possible.

What to do about it?

Fixing piriformis syndrome on your own can be challenging if you do not know the exact cause. I can tell you how to “plug the leak” for now, but if you don’t know why the piriformis muscle is squeezing the life out of the sciatic nerve, then it will come back. The most basic way to decrease the tension of a tight muscle is to stretch it. You can do this piriformisstretchby laying on your back with your feet flat on the ground, place one ankle on the opposite knee, and pull the thigh with the foot still on the floor to your chest (see picture). A deep pressure to the muscle can also help to release the tension in it. We sometimes will do this manually, almost like a deep tissue massage directly to the piriformis, or we advise our patients to sit on a tennis ball to perform a self massage. However, to do this effectively you will need some guidance on exactly where the piriformis is, or you could actually inflame it. Our clinics also use trigger point dry needling to help decrease the tension on the piriformis and other muscles that may be contributing to your symptoms. But when you come to Synergy Manual Physical Therapy we will likely find the cause and address the specific issues that are causing this in the first place. Sometimes it can be as simple as doing some simple stretching and exercises to improve glute activation which will decrease the need for the piriformis to fire during your runs or workouts.

As you read, there can be a ton of reasons for this pain in your butt and even more ways of how to correct it. This is why a little guidance from a musculoskeletal expert such as a physical therapist can help you get to the cause quickly and set you on the right track to making a full recovery without all the guess work you may be doing on your own. If you have any questions or want to know more, stop by one of our 2 physical therapy clinics in the Colorado Springs area today!

– Synergy Physical Therapy Team

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

 

Runner’s Knee: What it is and how to treat it

What is Runner’s Knee?

If you have been running for a long enough time you are bound to hear the term “runner’s knee.” Hopefully it is another runner complaining they have it rather than hearing it from your doctor’s mouth, but either way you should know what it is and what to do about it. Runner’s knee is medically known as Patellofemoral Pain Syndrome, or PFPS. It is a condition where the undersurface of your patella (knee cap) rubs against your femur causing irritation. The pain can either be a sharp occasional twinge of pain or a constant dull ache that typically progresses the more your run, but has also been known to come and go as you run.

What is the cause of runner’s knee?

As you walk or run your patella glides up and down in a groove in your femur as your thigh muscles contract and relax. Where the problem lies is when it does not track correctly in the middle of this groove. This can occur due to several reasons which needs to be found and addressed to eliminate the symptoms and prevent further wearing. Some of the most common reasons are:

  1. Weakness in your quadriceps muscle, specifically your VMO (vastus medialis oblique). This muscle helps to balance your knee in the center of the groove in your femur. If weak, it can allow the opposing muscle to pull the kneecap towards the outside of the knee which can cause increased wear on the cartilage of the kneecap.
  2. Weakness in your gluteus medius. This is a muscle in your buttocks that controls the stability of the hip and knee. It is located more on the back and side of your hip and is a common weak muscle in runners and cyclists due to commonly only training in one direction, forwards. It activates each time you are weight bearing through your only one of your legs to keep you upright. Without it your hips will drop each time you raise your knee and you will compensate at the ankle and knee joints. This can become weak during long runs and cause subtle changes you may not be aware of that can eventually lead to a breakdown or inflammation in your knee joint.
  3. Biomechanical faults in your hip, knee, or ankle. Your foot and ankle have a lot of control in what forces are placed at the knee joint. For example, if you have flat feet that pronate your knee will tend to have greater stresses placed on the inside. If your patella has bone spurs, is tilted, or is sitting too high in your femoral groove you can get excessive wearing of the kneecap. Your hip joint angles can also affect your knee. If your knee is rotated in or outward it can affect the placement of the kneecap in the femoral groove.
  4. Past Injuries and current structure of the knee. If you have damaged the cartilage of your knee or kneecap in the past you may likely be suffering from it now. You have a certain level of cartilage to cushion and protect your knee. If this has worn out over the years than you may be developing early arthritis which can lead to patellofemoral pain.
  5. Tightness in quadriceps, hamstrings, or calf muscles. Those muscles all effect the knee joint and an imbalance in flexibility overtime can cause increased pressures on the knee and cause the kneecap to track more laterally or medially.

What can you do to prevent runner’s knee?

Staying strong and flexible can be key to keeping this painful condition at bay. Your body loves to be symmetrical and balanced, and when one side is weaker or less flexible than the other it will eventually throw the whole chain off which can affect you anywhere from your spine to your feet. You need to perform strengthening and stretching exercises that not only improves the muscles you think will help you but also those that you may not even be aware of. For example, when running most people think training your calves, quads, hamstrings and your large glute maximus muscles are the only ones you really need and use. But this can lead to weaknesses in your other muscles that can help stabilize your joints during a run.  The best way to do this, cross-training. Cross-training is doing other exercises that are outside of your typical training regime can help boost the strength of your stabilizers and reduce fatigue in the primary muscles you use during your event. This can not only prevent injuries, but also help improve your speed or time! (I will be writing a blog on cross-training in the near future)

If you want to know more about Runner’s knee, various exercises or stretching to prevent it, or if you need physical therapy to treat it, please call or stop in one of our clinics today. We will provide a complete assessment of your entire kinetic chain from your back to your feet to truly find what has caused your runners knee and guide you through a treatment program to not only get you back to running pain free, but also make sure when you are pain-free you do not continue the mechanics that lead you do develop this debilitating condition in the first place.

We look forward to hearing from you!

- Synergy Physical Therapy Team

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112