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

 

 

 

Training Through Pain

You’re in great physical shape, you’ve been spending the last couple months ramping up your training for the next big race….. and then it happens. It can start off as a small twinge of pain in your knee or as a soreness in your hips which you blow it off and keep running. Then a month goes by and it’s a little more nagging, and your frustration is growing. Now you are even closer to the race and become worried that it will affect your time. What do you do, keep training or stop?

Jogging injuryIf you have been competing for any length of time you have likely heard this scenario from fellow competitors or even have gone through this in the past yourself. So what do you do now? An injury whether big or small can not only cause physical stress but also mental stress as it may cause you to stop or slow your training for that next race or event that you have worked so hard towards. But if you push through an injury you may be doing yourself more long-term harm than good as pushing through an injury will often lead your mechanics to change and cause a breakdown of other structures. Deep down you know you should see a doctor or physical therapist to help you, but like many you may be in denial that it is a problem, you don’t want to be told to stop training, and you have high hopes that you can just “run it off.” But in reality you are just putting off the problem and likely growing it into a bigger problem in the long run.

In some scenarios it may be a simple fix like running on a different surface or the other side of the road temporarily, changing your footwear, or improving your flexibility or strength in your hips. Runner’s World posted an article in 2011 titled “The Big 7 Body Breakdowns” that reviewed the top 7 running injuries and how you should approach them. As this article points out in most cases where the pain stops you during a run or the pain is progressively getting worse, you need to seek the advice and treatment of a physical therapist before it turns into something serious.

It is better to get it taken care of as a small injury and possible only having to decrease your training a couple weeks early on than pushing through it and it potentially ruining your racing season. At Synergy Manual Physical Therapy in Colorado Springs, we focus not only on your pain but also on finding out what is the movement or mechanical fault is that began the breakdown in the first place. Call or stop in today to set up an appointment and create a new, pain-free, beginning to your training. We look forward to meeting 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

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