Posts Tagged ‘knee pain’

From Dr

New research shows that a twice weekly hip strengthening regimen proved effective at reducing or eliminating the kind of knee pain referred to as patellofemoral pain (PFP) in female runners.  Stronger hips may correct running form errors that contribute to PFP.

The study used a pain scale of 0 to 10, with 3 representing the onset of pain and 7 representing very strong pain. The injured runners began the six-week trial registering pain of 7 when they ran on a treadmill, and finished the study period registering pain levels of 2 or lower.

According to Science Daily:

“PFP, one of the most common running injuries, is caused when the thigh bone rubs against the back of the knee cap. Runners with PFP typically do not feel pain when they begin running, but once the pain begins, it gets increasingly worse … PFP essentially wears away cartilage and can have the same effect as osteoarthritis.”

Vigorous physical activity in young children results in stronger hip bones.

More than 200 six-year olds participated in a study. Researchers measured bone mass and analyzed the structure of the hip and thigh bone. Physical activity was assessed for seven days.

According to Science Daily:

“The results showed that there was a relationship between time spent in vigorous activity and strength of the femoral neck, both in terms of shape and volumetric mineral density. This was independent of other factors such as diet, lifestyle and physical size.”

Poor form during exercise can end up frequently hurting your knees and cause you to develop problems like patellofemoral pain (PFP) which frequently occurs in female runners. PFP occurs when your thigh bone starts rubbing against the back of your knee cap while running.According to a pilot study, this type of pain can be reduced or even eliminated simply by strengthening your hips.Granted, this was a very small, preliminary study, but your body almost always has the innate ability to rebalance itself when something is out of alignment, so the theory is quite plausible.The key is to determine which area needs to be strengthened to correct the imbalance.In this case, the theory that strengthening your hips to improve your gait, which in turn might correct the form error that contributes to PFP, makes sense, as stronger hips will help reduce the severity of the “q” angle on your leg alignment. The q angle is more severe on women because the distance between a woman’s femur bones is greater for child-bearing reasons.  This ends up putting more pressure on women’s knee joints. The hip-strengthening exercises prescribed during this study involved single-leg squats and resistance band exercises, twice a week for 30-45 minutes, for six weeks. The results were surprisingly positive as the majority of the runners no longer experienced onset of pain when running at the end of the trial.

So, if knee pain is bothering seek out a “qualified ” professional who can evaluate you to find your imbalances and prescribe an appropriate exercise program for you.  Hint – if your laying on a table or the floor doing various leg lifts you are in the WRONG place!

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In the previous hip flexor post we talked about how the tight hip flexor inhibits the gluteus maximus and increased lumbar extension and hamstring activity to compensate.  There are also several other compensatory problems that occur from the tight hip flexor.  Remember that most people have tight hip flexors due to sitting, driving, sleeping in the fetal position, inactivity and repetitive patterns.  So, if the hip flexor is tight it could lead to patellar tendon/knee pain, and plantar fasciitis.

Lets look at jumping.  Jumping requires an eccentric load (hip/knee/ankle flexion and internal rotation) followed by a concentric contraction (hip/knee/ankle extension and external rotation).  In the take off phase if the hip flexor is tight it inhibits the gluteus thereby decreasing its ability to generate force.  This leads to poor jumping ability.  It also limits the amount of hip extension that can occur therefore the knees will hyperextend as a compensation for the lack of extension at the hip.  The hyperextension and the increased quad force cause the patella to be compressed and inferiorly tilt more irritating the tendon and fat pad leading to knee pain and tendonitis.  

Upon landing the gluteus cant control the forces and the femur excessively internally rotates and adducts causing increased stress to the med knee. ( The gluteus maximus eccentrically controls femoral internal rotation during loading).  This can be one of the causes of poor jumping mechanics which has been seen especially in females and correlated too increased ACL injury risk.

If the hip flexor is tight it will decrease extension of the hip and therefore decrease stride length.  This can lead to increased extension of the low back which over time can cause low back pain or as a result cause the heel to come off the ground early in the trail leg of gait.  This results in the trail leg diminishing its eccentric loading and therefore decreasing its ability to push off efficiently.  This ultimately creates more stress on the front leg as the muscles have to work harder to re – supinate the foot.  The lead leg in gait relys on the push off and successive swing of the rear leg to re-supinate and unload.   With the trail leg heel coming off the ground early an a-propopulsive gait results.  While this is a mild stress that wont cause problems in one step, the microtrauma and/or fatigue over time (thousands of steps in a day, 7 days a week and 4 weeks in a month etc.) eventually leads to the tissue unable to tolerate the stress and bang, pain occurs in this case plantar fasciitis.  So, a tight hip flexor on one side can lead to plantar fasciitis on the opposite side.  The beauty and challenge on understanding function, it never gets old!

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Many suffer from knee pain.  It can range from intermittent aching to severe debilitating pain. The symptoms may include pain, stiffness, swelling, popping, difficulty climbing stairs, squatting and sitting for long periods. X-rays often reveal varying degrees of arthritis, but sometimes are normal.  Barring traumatic injury many of the symptoms of knee pain can be attributed to muscle imbalances and faulty biomechanics.  This leads to increased wear and tear and tendonitis from overuse.  Through advanced study and greater understanding of biomechanics and functional anatomy we realize that most knee pain has nothing to do with the knee.  The knee pain is a symptom, but the cause is usually elsewhere.  Many times we have found the foot and/or the hip to be the weak link. The foot and hip are  both very mobile joints, while the knee is primarily limited to flexing and extending.  The phrase “it’s all connected” is the central theme to human movement. For example, if the foot flattens out more than normal (overprontes) it will cause the knee to collapse more than normal towards the midline.  This will put stress on the medial knee joint, compress the lateral knee joint, cause the knee cap to track off center and subject the muscles to work harderto try to control and stabilize through a greater range of motion.  Another example would be tightness of the hip flexors and weakness of the gluteal muscles which are present in most people due to the fact that we sit a lot and sleep in the fetal position.  We refer to this as “dormant butt syndrome”. When the hip flexors are tight they cause weakness in the gluteus maximus (the butt, tooshee, cannon or powerhouse) through a phenomenon called reciprocal inhibition (when one muscle is tight it causes weakness in the opposite muscle).  The butt is a strong stabilizer/ motion controller of the lower extremity. When it is weak it also allows the knee to collapse into the midline placing more stress on the joint and soft tissues.  Over time the knee is subject to more wear and tear and many of the symptoms of knee pain begin to creep up. So if your knee pain persists it is a good idea to seek out a knowledgeable professional to help you. Knee pain doesn’t have to put an end to your fun, if the right approach is taken.

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