Why your knee pain isn’t getting better.

Have knee pain but didn’t suffer some kind of injury?  You’ve probably tried the standard interventions Rest, Ice, Elevation, Compression, maybe even a brace or KT tape.  Airrosti anyone?  Chances are, this hasn’t done anything for your problem, the pain keeps coming back, or any time you try to go without the brace/kt tape the pain comes right back.

Right behind back and neck pain the most common area I seem to treat in the clinic is the Knee.  The above is how the story usually seems to go.  The aggravating factors?…Squats & Stairs.  So why isn’t your knee pain getting better or why does it always come back?  Because you’ve been treating the symptoms rather than the cause.  We can’t just ice the knee without asking WHY is it inflamed to begin with?  What caused the damage?

The answer: Poor Movement Patterns. 

When your tires are wearing weird on your car do you just replace the tires or do you check the alignment?

Why?  – Inward Rotation of the Knee
This can happen either because of hip weakness, foot weakness, or both.

from: https://goo.gl/images/cALrnH

1. Weak Hips
   • It is very common for people (even frequent gym goers) to have weakness in the hips, specifically the muscles that rotate the leg outward. When these muscles are weak the thigh will rotate inwards as the hip flexes, causing the knee to ‘turn in’ or move inward in relation to the foot and hip.  If these muscles are very weak, this will happen when a person is standing on a single leg.
     

     From: netter atlas of human anatomy

2. Weak Feet
   • If a person has weak foot muscles their arch will collapse when put under increased strain.  If the foot collapses, the knee will again move in relative to the foot and hip.
     

     From: Netter atlas of human anatomy

• Summary: The knee is the joint caught in the middle of two very problematic areas and when there is dysfunction, its often the knee that takes the brunt of it.

So the question is, when traditional methods fail what do you do?

1. Form Check – Try squatting in front of a mirror or film yourself performing a body weight squat. Does it look like the picture on the left?  If so we’re talking about a movement impairment problem.

http://www.aphysio.com.au/runners-knee/

2.  Strengthen

• Hips – 
  • Clam Shell

    Position: Laying on side, knees bent, feet together
    Heels, shoulders and hips aligned
    Tilt body slightly forward (pointing navel toward the floor)

    Action: Squeeze through your glutes (buttocks)
    Keep your heels together and lift top knee up.
    Hold 5 seconds, slowly lower to starting position. (In this photo I have a resistance band around my knees, this is a simple way to increase the challenge but is not necessary to benefit from this exercise)

    Form: Do not arch your back.
    Do not allow hips to rock back & forth.
    –You may want to perform with a wall or other straight surface behind you
    Keep glutes contracted the entire time.

    To increase the difficulty you can add a resistance band around the knees or hold for a longer period of time.

    

  • Glute Bridge

    Laying on back, knees bent about 100 deg,feet on floor & close to the buttocks. Squeezing your glutes and ab muscles, push through heels & raise hips off the floor until hips and knees are in a line. (if you feel your back working, don’t lift your hips quite as high)

    Hold position 2 seconds

    Slowly lower hips back towards the ground and repeat. (you can add difficulty by placing band around knees.)
    Feet – 

• Foot Muscle Energy Technique 
  • Sitting upright, curl toes passively, using hand.
  • Remove assistance of hand and continue holding toe curl with muscles in foot.
  • Hold for 10 seconds.

       Toe curl and point

• Sitting upright, leg extended out in front of you. Curl your toes around a small towel (dish cloth), you may need to bunch up the towel a little.
• Keeping toes curled/holding towel with toes, extend your foot as if pushing a gas pedal. Try not to drop towel. Hold for 1 second and return to starting position.

from: HEP2go public

Towel Curls

• While seated, place a towel on a smooth floor under the arch of the foot (heel is in contact with the floor). Curl your toes in pulling the towel back towards you.
• Be sure to keep your heel in contact with the floor the entire time.
• Place a small weight or bag of rice on the towel to increase difficulty

3.  Stretch

hep2go public

Standing calf stretch

• Start by standing in front of a wall about an arms reach away, feet about hip width apart.  Step one leg back about 3-4 feet, keeping the leg straight.  Point the toe of back foot slightly in, plant the back heel.
• Lean forward towards the wall as you allow your front knee to bend until a gentle stretch is felt along the back of your leg.
• Hold for 1 min each side, repeat 2x.

– Credit to: www.enhancephysiotherapy.net

Lunge Stretch: Start in a lunge position, with the hip you are stretching as the back leg. Move your hips and torso as far forward as you can and make sure your back knee doesn’t slide forwards. Keep your torso upright and chest forwards. You can add more of a stretch by incorporating an anterior pelvic tilt – by tucking your buttocks underneath you and moving your pelvic bone towards you.

TFL Stretch – kneeling

• Kneeling position, extend leg closer to the wall back and to the outside of the outer leg.
• Bend front knee and lean hip that is being stretched into wall.

The backfixer.com

5. Support

• If your feet are an involved component I highly recommend addressing your shoe-ware.  Unstable/soft shoes allow the arch to collapse if these are the shoes you wear when you lift, this compounds the problem.  Try buying a pair of “stability” shoes and using a pronation orthodic insert to help correct this.

The above interventions should get you on your way to correcting the ACTUAL problem rather than just treating the symptoms.  Fair warning: This is NOT a quick fix. Its not a magic pill.   It takes weeks for your body to build real strength and it takes many repetitions of doing something properly to make it habit.  The question is, is it worth it?  If the old methods aren’t working, isn’t it time to try something else?

Dr. Mims  PT, DPT.