Knee Pain, It's Not the Knee's Fault
The Bad Knee
Are you having knee pain when you go up or down stairs, squat, run, walk, or other daily activities? You’re not alone and the good news is that it can be fixed. As physical therapists we see a lot of people with various ailments and injuries, and one of the most common problems people deal with is knee pain.
Many of our patients come to our clinic with knee pain and tell us “I have a bad knee, the doc took x-rays and said the cartilage is degenerating and I have arthritis in my knee.” Sound familiar? This is extremely common and many of the degenerative changes are completely normal once we get past the age of 30. In fact, these same degenerative changes can be found in “healthy populations” without knee pain. Arthritis is extremely common in America, but is often not the reason people experience knee pain. The knee is a relatively simple joint in terms of motion as the primary motion of the knee is bending and straightening. Usually knee pain is a result of biomechanical dysfunction and muscle weakness.
The Hip Controls the Knee
One of our catch phrases at the clinic is “Weak hips lead to bad knees. Strong hips lead to healthy knees.” When we move around throughout the day we often take thousands of steps, but don’t ever think about how we do it. Every time a step is taken our body has to combine a series of motions to complete the task which includes hip, knee, and ankle motions. When the foot is in contact with the floor it creates a closed kinetic chain between the ground and the body, and as a result the knee becomes a sort of middle man. With the foot in contact with the ground it is unable to move freely, and thus motion must come from further up the chain (either the knee or hip). We’ve already pointed out that the knee is very simplistic in its motion (bending/straightening) thus has little do with actual motion control in the knee. We then progress further up the chain to the hip. The hip joint is a simple joint, but provides a wide range of motions including: flexion, extension, internal rotation, external rotation, abduction, adduction, and when we combine various motions it creates circumduction. These motions at the hip determine the position of the knee during most daily activities like walking, squatting, stairs, running, etc.
How Does This Work?
The majority of knee problems stem directly from hip muscle weakness. Think about it, when you go to the gym what specific exercises do you do for the hip? Squats? Deadlifts? Bridges? These exercises are great for the posterior gluteal muscles, but do not work the lateral gluteal muscles (hip abductors). The hip abductors are the main muscles we use to control knee positioning during activity. There is a direct correlation between hip abductor weakness and knee injuries like ACL and MCL tears. Why does this happen? The knee is great at controlling sagittal motions (bending/straightening) with the quadriceps and hamstrings muscles, but it doesn’t have any muscles that stabilize it on the sides. Instead that control comes from the hips and hip abductors. Test it out and try this! Stand in front of a full-length mirror and squat down and watch your knees. Does your knee dive inward when squatting down or coming up? If the knee dives inward it’s likely the lack of muscular control at the hip and weakness of the hip abductors. It is also possible that the ankle is responsible, but that is a discussion for another time.
Result
When weakness of the hip abductors is present “wear and tear” of the knee is accelerated. Often X-Rays might find an “unusual” wear pattern of the cartilage where one side of the knee joint has less cartilage than the other. When people begin to experience knee pain, very few people actually seek treatment because they think “it’ll just go away.” The reality is that most knee pain can be successfully treated with physical therapy. Most knee pain can be managed with conservative treatment and does not require surgery (save for the traumatic events when surgery is indicated). The key to knee pain management is to determine the underlying cause of the knee pain.
At Spokane Sports & Physical Therapy we will perform a thorough assessment of movement patterns, strength, biomechanics, and other aspects of function that can be contributing to your knee pain. If you’ve been noticing increasing knee pain in the past few weeks, months, or even years, do yourself a favor and come see us. It’s never too late to do something healthy for your body. Our goal is to get you back to living your active, healthy, pain-free lifestyle whether that’s getting back into running marathons, or just keeping up with the grandkids.