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Physio: If knee pain addressed early, you will soon be active again
It’s a chain reaction—knee pain coming from hip muscle weakness.
With the warm weather finally making its way to the Okanagan, many of us are getting back outside pounding the pavement, beating our opponent to the soccer ball or climbing up that mountain. Did you know that every step puts at least half of your body weight through your knees?
And if you are climbing the stairs, that number increases up to seven or eight times your body weight.
Many people, both young and old, experience knee pain that develops without a specific incident. One of the most common types of knee pain occurs in the front of the knee or around/under the kneecap. These pains are often the result of abnormal biomechanical stress on the knee, known as patellofemoral pain syndrome (PFPS).
The knee, or patellofemoral joint, is at the mercy of both internal factors, such as muscles, ligaments and fascia and external factors such as body mass, speed of walking or running, surface and footwear.
In a normal knee, all of the forces should be balanced side to side. However, in those with patellofemoral pain syndrome, the kneecap is usually misaligned relative to the femur (long bone of the thigh), placing more stress through the knee joint.
This can result in pain and inflammation.
If you tried to squat or sit down in a chair right now, how would your knees look? Do they buckle to the middle?
If your knees are buckling in, it is likely that the muscles controlling your hips aren’t able to prevent the legs and knees from driving to the middle.
Gluteus medius is an important muscle on the side of the hips that often gets weak. Weakness in this muscle can be the result of poor standing posture, inactivity or from a previous history of an injury to the hips or back.
Even though the muscles in your hips may be tight, that doesn’t mean that they are strong.
As this is just one potential cause of patellofemoral pain syndrome, a thorough examination from a physiotherapist can diagnose the underlying cause(s) and rule out any other potentially serious knee injuries.
From this information they can advise you on which exercises are most appropriate to your specific case.
You can begin to manage your patellofemoral pain by minimizing activities that place large amounts of stress through the knee joint, such as squatting, jumping, running and going up and down stairs.
You can give your knees a bit of a break from these high compressive loads by trying water running, swimming or cycling to maintain your fitness.
You can also ice your knees to help start the healing process. It is recommended that you ice for 15 to 20 minutes approximately two to three times per day for optimum recovery.
Also, if you have weakness in your gluteus medius, you can start to strengthen these muscles by performing an exercise called the clam shell. The clam shell involves lying on your side with your hips and knees bent as if you were sitting on a chair. Keeping your ankles together, slowly move your knees apart, with the top knee moving away from the bottom knee as if your top knee is a door being opened. Then return to the starting position.
During this movement, make sure that your top hip stays facing the ceiling and doesn’t roll either forward or backward.
If you put your hand on the side of your gluteal muscles, you should feel them activating.
You can start with three sets of 10 repetitions on both sides to keep the hips strong overall.
The earlier you can start managing patellofemoral pain syndrome, the better. We want to keep you as active as possible and nipping this early can get you back on the mountain, field or pavement with pain-free knees faster.
Teryn Buna is a registered physiotherapist and associate at Sun City Physiotherapy, St. Paul Street location.