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

A Hip Flexor stretch you’ll truly love

Whether you run long distance, sit in a chair all day, or find yourself somewhere in between, our challenging modern lifestyles guarantees you may find yourself with tight hip flexors or living your life with an anterior pelvic tilt.

When your hip flexors become overly tight, everything may seem out of sync.  You may feel like you walk funny, can’t run without knee pain, your lunges and squats are “off”, and your low back may ache or fatigue easily.  Sound familiar? You may have tight hip flexors.

Hip Flexor Anatomy and Biomechanics

The hip flexors are a group of muscles on the front of the body that crosses the hip.  These muscles include the iliopsoas group, and the quadriceps group (specifically the Rectus Femoris).  The hip flexors work in concert with your legs while walking or running and are responsible for flexing (bending) your hip, or drawing your thighs toward your torso. Sitting up, kicking a ball, marching, and lifting a leg to climb a ladder are all activities that involve your hip flexors.

Issues and Symptoms

You might imagine that your hip flexors get tight from overuse, while this is true, your hip flexors can actually get so tight from underuse that they stop or inhibit other muscles in your body from working.

You may have tight hip flexors if you feel discomfort in the front of the hip that feels worse when moving your leg toward your chest or if you have difficulty taking your leg behind your body and feel your low back working in order to do so.

Chronic sitting also leads to short and tight hip flexors. Tight hip flexor’s pull on the pelvis rotating it forward (anteriorly).This changes your posture by causing excessive curvature of the lower back (lumbar lordosis), a protruding belly (we all want that right?), knee dysfunction, and altered weight bearing through the spine.  Tight hip flexors can even inhibit your glutes from activating when you walk. If this happens, not only can your bottom become flat and flabby, but back pain and or discomfort generally follow.

A true stretch for those tight hip flexors

Hip flexor stretching has become very popular in the fitness and sports performance world, and rightly so.  However, this seems to be one of those stretches that either is performed incorrectly or too aggressively.

So here’s a stretch for those hip flexors that has increasingly become one of my favorites. IT is the half-kneeling hip flexor stretch. It is a true hip flexor stretch because when done correctly it truly stretches the hip flexor and doesn’t just torque your body into hip and lumbar extension.

Key Points to the Half-kneeling hip flexor stretch

  • There is a difference between a quadriceps stretch and a hip flexor stretch. When your rationale for performing the stretch is to work on stretching the hip flexor, focus on the psoas and not the rectus femoris muscle.
  • Keep it to a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates both the rectus and the psoas, but I find that there are far too many people who cannot perform this stretch appropriately. They compensate by usually stretching their anterior capsule too much or hyperextending their lumbar spine.
  • Stay tall. Resist the urge to lean into the stretch and really extend your hip.  Most people are too tight for this, trust me.  You will end up stretching out your anterior hip joint and abdominals more than the hip flexor.
  •  Incorporate a posterior pelvic tilt.  Contract your abdominals and your glutes to perform a posterior pelvic tilt.  This will give you the “true” stretch you are looking for. Most people won’t even need to lean in a little; they feel it immediately in the front of their hip.
  • If you don’t feel it, squeeze your glutes harder.  Many people have a hard time turning on their glutes while performing this stretch, but it’s key to this stretch.
  • Use your hands to guide your hips.  I will usually start this stretch with my hands on my hips so I can feel the posterior pelvic tilt.  Place your fingers in the front and your thumbs in the back and cue them to posteriorly tilt to make your thumbs move down.
  • Engage your core.  Once you can master the posterior pelvic tilt, progress to assist by cueing core engagement. Do this by placing both hands together on top of your front knee and push straight down, or hold a “massage” stick or dowel in front of you and push down “into the ground”. The key is to have your arms straight and to push down with your core, not your triceps.

So there you have it. The half-kneeling hip flexor stretch is a great stretch for those tight hip flexors and requires no equipment other than your own body. This works great for those with low back pain, hip pain, and postural or biomechanical issues related to having too much anterior pelvic tilt.  Give it a try and if you still need guidance, stop by and talk to one of the therapists atSynergy Manual Physical Therapy.

 – Albert Song Levingston, LPTA  

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