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

 

 

 

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

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