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Knee pain - Are your hips, thighs or ankles to blame

When it comes to knee pain it reminds me the children's song "Dem Bones". The leg bone's connected to the knee bone, The knee bone's connected to the thigh bone, The thigh bone's connected to the hip bone, Now shake dem skeleton bones!

In 2016 I 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".

This means that perhaps you need to be taking a long hard look at your hips, thighs, ankles or feet for the cause of your pain. For the runners out there - think of your ITB (ilio tibial band) - what is often called runners knee - where you can get pain on the lateral aspect of the knee.

Its easy to blame the site of pain - but the tension in the ITB and the 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 for eg. until the cows come home but unless you address the issue with the Glutes - any pain relief will be temporary. Same goes for treating the Ankle, thighs and Hips

So what can be done?

In general, there is often a lot that can be done to reduce the stiffness of the joints and to improve the strength and activation of weak muscles.

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.

Myofascial release techniques of the calf muscles and thighs 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.

Earlier this year I attended a Sports Chiropractic conference at the Gold Coast, and another Functional Assessment Course (called the Selective Functional Movement Assessment or SFMA for short).

These types of assessments are typically used in sports and athletic populations - but anyone can benefit from what these type of assessments reveal.

What makes them different is the way that it makes you look at the big picture of how your body is working - what it does well and what it has to work around.

Often, as shown in the example above, the problem you are working around is what is creating issues - like pain or restriction - in other areas.

Unless it is addressed the problem is bound to continue.

I hope that this leads to you thinking just a little bit differently about how your body works and the role of often overlooked joints in the formation of injury, pain and restricted performance.

Next week I will show you some simple assessment techniques and the following week I will show you some strengthening exercises as well.

Until then keep moving.


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