Knee pain is a common complaint - but is it really your knees fault?
Could it be your stiff ankles or hips?
I recently attended a seminar which was about lower limb biomechanics and low back pain. The speaker (Jon Mulholland) made an interesting observation. From his many years working with high performance runners and athletes (including the Kiwis Olympic track cycling teams) he has often found that
"unless direct trauma is involved - eg a blow to the knee, the most common cause of knee pain is from problems stemming from the joint above or below".
(see the previous blog on the Joint by Joint approach)
This means that perhaps you need to be taking a long hard look at your Hips or Ankles for the cause of your pain.
Now before you think this is a crazy - perhaps you need to consider what happens at these joints that cause your knee to struggle.
Lets consider the ankle first.
Coming up with normal ranges for the human body is sometimes difficult - but a well accepted test is the weight bearing lunge test for ankle dorsiflexion.
You can do this test yourself by planting your foot firmly on the ground (with your big toe about 10cm away from a wall).
You want to try to let the knee travel out over the toes until it touches the wall. You cant let your heel come off the ground, your knee drop inwards or let your arch drop.
If you can keep good form and touch the wall easily - move your foot backwards until you can find your max distance and then compare the other side. If you cant touch the wall at 10cm then move your foot closer until you can.
Most people agree that you should aim for 10-12.5cm distance from the wall to not be thought restricted.
This depends a little on the length of your shins though - so if you are a shorty don't get to caught up in the exact figures.
Another measure of this commonly used in research is the angle of your shin against a vertical line. It should be about 35- 38 degrees.
Now keep in mind that for you to walk or run normally on a flat surface you need at least 10 to 15 degrees of dorsiflexion, and to run or walk uphill normally you will need almost all of the 35 degrees.
And for those who love Squats - one research article suggested that to squat to a thighs parallel with the ground position you need at least 22 degrees of ankle dorsiflexion.
So what do you think happens if your ankle wont bend far enough?
Something has to compensate.
Your foot turns out, you pronate the foot to make up for the lack of ankle movement and your knee angles in and gets stressed out. This leaves your overworked knee giving you pain - but it isnt the cause. (it also starts to create increased pressure on the big toe - hello bunions and arthritic changes!)
In the case of the squat example the hips have to flex even more and your torso is forced to lean forward. This compounds the pressure in your hips and low back - and in case you are wondering, that's no good at all.
The Hip joint can create a similar problem for the knee.
If you have weak glutes that don't activate and support your femur as you load it ( for example when you put your foot on the ground when walking or running, or when you try to squat) the knee buckles slightly every time.
This constant pressure and dysfunction adds up - and will often cause pain as muscles of the thigh that attach to the knee try to compensate.
For you runners out there - think the ITB (ilio tibial band). The tension in the ITB and pain where it inserts near the knee may just be caused by weak or under active muscles higher up.
Why is this important to know?
Well, you can work on the ITB until the cows come home but unless you address the issue with the Glutes - any pain relief will be temporary. Same goes for the Ankle.
So what can be done?
In general, there is often a lot that can be done to reduce the stiffness of the ankle joint and to improve the strength and activation of weak muscles.
A quick search for mobilisation techniques for the ankle will bring up many good options. The mulligan technique for ankle mobility is particularly popular.
Myofascial release techniques of the calf muscles are also used to good effect - think foam rollers and massage balls. This makes my eyes water a bit just thinking about - but it can be very effective.
As for muscles - the weakness is not always caused by poor muscle size. Often it is more to do with when and how the muscle is recruited.
Its a bit like an uncoordinated newly born giraffe trying to stand for the first time. It has all the muscles it needs - it just doesn't know when or how to use them.
This can be corrected with practice. Often a few well aimed exercises and some smart cues can make a world of difference - both to aches and pains - and to performance.
And then there is the option of professional help.
Studies have shown how certain restrictions of the pelvis and lumbar spine for instance will drastically reduce both the strength of contraction and the timing of firing of certain muscles like the glutes and the multifidus muscles of the spine. This is where Chiropractic care can play a role.
For now i think that will do. I hope that this leads to you thinking just a little differently about how your body works and the role of often overlooked joints in the formation of injury, pain and restricted performance.
There is just so much to know - and small things can make a big difference. (perhaps next time we can discuss how your big toe might just be causing you a similar issue....... bet you cant wait!)
If you would like to know more or to book an initial evaluation give us a call - Body and Spine Solutions 301 Anson Street Orange Ph: 5310 6259 or send us an email and we will get in touch.
Thanks for reading
Chiropractor and writer of longer then expected Blog articles!
Body and Spine Solutions
Orange NSW 2800
Andrew Blyth studied Chiropractic at Macquarie University and has a Bachelor of Medical Science Degree from the Sydney University. He has been in practice as a Chiropractor since 1999 and has been working in Orange since 2009. Body and Spine Solutions is an Allied Health Centre based in Orange NSW providing Chiropractic, Acupuncture, Remedial massage and Myotherapy services. All practitioners are dedicated to continuing education, maintain excellence in standards of care and providing relevant advice and information to help clients improve and achieve results from their care.