Knee Pain
Stride Strong PT’s Formula
• Improve knee joint mechanics by increasing flexibility and strength of the quadriceps for squat, step, and loading ability.
• Strengthen gluteal muscles and ankle proprioception for limb and weight bearing stability.
• Decrease inflammation through use of modalities and taping methods.
Faulty Mechanics is a Common Side Effect and Cause
There are numerous diagnoses that explain for knee pain, e.g. patella tendonitis, chondromalacia patellae, IT Band syndrome, meniscus tear, ligamentous tears/laxity. Although differing in severity and presentation, they all result in one common thing: faulty biomechanics from weakened hip and quad muscles.
Non-traumatic knee pain tends to progress over time, and usually does not prompt the patient to seek immediate medical care for it. As a result of the pain, the body and brain shuts down usage of that limb and starts favoring the other stronger, healthier leg. The quads, glutes and peritibial muscles of the painful leg start to atrophy and surely enough, you start to see the biomechanical pattern above. A person with good mechanics and strength would look very neutral – there would be a direct vector line from foot contact on the ground through the hip join. A person with poor mechanics and poor hip and quad strength would demonstrate what us PT’s call “knee valgus” – the tendency for the knee to collapse inward because of weak hip abductor muscles, weak quads and excessive foot pronation. Faulty mechanics like these during daily activities will cause the knee pain to get worse regardless of its diagnosis. Knee pain begets more favoring of the leg … which begets more knee pain … and the cycle continues.
The same could also be said for “bow-legged” postures – where the knees seem to cave outward. Folks that present like this tend to have a larger probability of having meniscus thinning or tearing, and also higher probabilities of hip joint degeneration because of excessive forces translating up into it.
Those who are all too familiar with this may have tried the following interventions: rest; knee brace/strap; ice; IT Band foam rolling. Though this might help a bit in the short-term, the knee pain would most likely continue because you’re not stopping the cycle.
So How Can PT Help?
The following is a better recipe for getting rid of the pain: supportive shoes or sometimes even orthotics (over-the-counter or prescribed by a podiatrist), quadriceps strengthening, gluteus medius and maximus strengthening, peritibial muscle strengthening, biomechanics retraining, manual therapy on the IT Band.
For severe cases if osteoarthritis, sometimes hylouronic acid injections, also known as synvisc, may help lubricate and cushion the knee joint. It is recommended that the patient goes through adjunct physical therapy along with injections, so they can benefit from biomechanics counseling. Yes, some knee injuries are severe enough that they eventually do need surgical intervention. But oftentimes moderately severe knee pain can be helped by biomechanics retraining and strength training by a good physical therapist.
By Alice Holland, DPT.
Alice’s Google + page.
