By Christi Williams, DPT, OCS, Cert. MDT
Let’s face it, if there is one GOOD thing for many people during this strange time of social distancing, it is that many of us have had more time to go for a run or be active because since so many of us are working from home, we have no excuse (like getting stuck in traffic or having to work late) to skip our work-out 😊. Even though many of us are not able to hit the gym like we might prefer, or participate in our group exercise classes or even share our misery of training for that next big race with our fellow runners in our running groups, one thing is for sure… nothing is keeping us from getting outside and enjoying a casual run or walking through the neighborhood with our families. Unless, of course, your knee pain is getting to the point of holding you back.
There are many different causes of knee pain, however one cause that we see a lot in the clinic with our runners and our group exercisers is patellofemoral knee pain. Basically, patellofemoral knee pain is pain that develops behind your kneecap and is caused by abnormal tracking of the kneecap on the femur (thigh bone) underneath it.
During this period of social distancing, you’re probably wondering what you can do about your knee pain if you’re not able to get in for an appointment with your doctor. Well, at Nashville Physical Therapy & Performance, we can help you out and we can do it at a social distance!
Often times knee pain is caused by either muscle strength imbalances, joint mobility limitations or even tight muscles in your lower extremities. Sometimes it is a result of some combination of all of these issues and sometimes it is only due to one of these issues. In other words, the exact cause is unique to everybody.
How can we test for these issues from a distance? At Nashville Physical Therapy & Performance, we can do a telehealth visit or a “virtual visit” using our software program (HIPAA compliant) which allows us to see you and you to see us. This use of technology allows us to watch your movement patterns while you are performing specific movements or tests that we demonstrate for you. Based on your movement testing, we can evaluate where your limitations are coming from so we can ultimately provide you with a customized program to help resolve your issue!
One example of a test we can perform at a distance is a single-leg squat (pictured above). The runner featured here is suffering from knee pain while running long distances. As you can see, when she does a single-leg squat on her right leg, you’ll notice that her pelvis drops on her left side nearly 7 degrees and her right knee moves inward (medial collapse). Ideally, we would like to see her pelvis stay level and her hip-knee-foot to be in a straight line (which would measure 180 degrees in this picture).
When we see someone’s pelvis drop when in a single-leg support position, we refer to this as a Trendelenburg sign, and it is due to weakness of the gluteus medius muscle on the stance leg. When we see someone shift their upper body toward the side of the stance leg (as demonstrated above), we refer to this as a compensated Trendelenburg. The runner pictured here is compensating for some of her strength deficits by shifting her center of mass over the support limb. In this case, if she didn’t lean her upper body to her right, she would likely demonstrate a greater pelvic drop or worse yet, even more medial collapse of her knee.
As you can see, this runner’s right knee deviates inward about 16 degrees (when it shouldn’t deviate inward at all) which places significant stress through the joint and often leads to patellofemoral knee pain.
What causes the knee to deviate medially (inward)? Most often this specific movement pattern is caused by weakness in her gluteus maximus muscle on her right side. Medial collapse of the knee is a combination of hip adduction and internal rotation (those are the fancy terms describing the position of this runner’s thigh when she performs a single-leg squat). When the gluteus maximus muscle contracts, it does the exact opposite movement pattern. This is how we can begin to develop clues about what muscles are weak simply by watching someone’s movement patterns. Further movement testing and questioning also allowed us to determine that this runner also presents with some limitations in her right ankle mobility which further accentuates this patterning.
The treatment? We start her on a customized strengthening program for her hips and a stretching program specifically targeted at her limited ankle mobility. When we follow-up, we progress these exercises to challenge her more and more until she is ready to move into a dynamic program consisting of more and more difficult movements while specifically focusing on form and control. Basically, we train the muscles first, then we train the brain to use these newly strengthened muscles to develop new patterns of movement.
When a runner demonstrates this movement pattern over and over again when running, or when someone participates in their exercise program that involves a lot of squatting, lunging and/or jumping, the repeated movements eventually lead to more and more discomfort until finally you get to the point in which it stops you from being able to exercise or run altogether. It also starts to cause aching and discomfort with prolonged sitting or when doing your everyday activities around the house.
The key is to break this cycle before your knee pain gets out of control and stops you from doing the activities you love! Throughout this period of time in which we all need to social distance, remember that there is no better time than the present to key-in on some of these movement patterns and work to resolve them so when you get back to your group exercise classes and running groups, you can go back pain-free!
Contact us today to schedule a telehealth session or “virtual visit” so we can help get you started on the right path to success! Every person is unique and presents with their own unique movement patterns. Let us watch you move so we can customize your program to specifically meet your individual needs. Need help determining what equipment you need at home? We can help with that too! Just visit our store on our website to get started with some featured products that we commonly recommend to our patients and that we use with our patients in the clinic.
(Photo used with permission)