165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Knee pain

When I have knee pain, does it mean I need a knee replacement?

knee-rolling-in-___-internal-femoral-rotation I developed right knee pain about 2 months ago. I didn’t fall or traumatize the knee. How did this happen? From what my physical therapist tells me, I have been using my hamstring too much for strength and stability in the right leg; not using the right gluteus maximus enough. It has become short and tight as well as my iliotibial band. My lower leg muscles have become tight as well, making full bend of the knee, especially in kneeling and squatting.

It is surprising to me how much less I want to use the knee due to pain. If I try to fully squat, or get up and down from the floor, my knee hurts, so I tend to avoid it. Being a physical therapist, I know the importance of staying active so I have been making sure I fully bend my knee, even if it hurts, but with no weight on the leg (laying down or sitting with my leg out straight). I have also been working on hamstring stretches, iliotibial band stretches, and strengthening the vastus medialus portion of my quadriceps, which has become weak. My calf muscles are also tight, so I have been stretching those, both the upper calf muscle (gastrocnemius) and the lower calf muscle (soleus). My front shin muscles are tender and tight and part of my treatment has been myofascial release from the physical therapist.

X-rays were completely negative for knee arthritis, and I am so excited! The last thing I want is a new knee as the rehabilitation process for that is very very painful!

I am about 50% better; I’ll let you know how this goes in the future

Right knee pain caused by left hip and pelvis! What???

knee image

knee pain image

This doesn’t really make sense, does it; right knee pain caused from the left hip? Until…you look at this video and see that the right knee tends to fold into a knock kneed position as the patient puts weight onto the right leg.

A concept called “crossover gait” has been around for a long time in running circles (at least since 1994, as noted in a medical article, “Relationship between foot placement and mediolateral ground reaction forces during running–Clinical Biomechanics March 9, 1994”. Here is the definition of crossover gait: The runner places the weight bearing foot under the center of the body or across the center to the opposite side. It happens with same sided hip weakness and opposite abdominal weakness.

The idea of crossover gait also happens with walking as well as running, but the consequences can be different. In the video shown above, the client’s left pelvis is higher than her right when she is, at the same time, putting weight through her left hip and leg as she lifts the right leg to place it onto the step. She SHOULD be contracting her left glut muscles and right abdominals at the same time to assist in lifting the right leg, (whether stepping up onto a step of taking a step forward) but she does not. Instead her left pelvis shifts to the left and the right side of the pelvis drops as she lifts her right leg. This causes her to have to fold her right knee into a knock knee position. THAT will cause knee pain.

If you watch the video, you can see she has been taught to lift her right pelvis and contract her left side glut muscles, which raises her right pelvis allowing the right knee to unfold to a straight position from a knock knee position!

Get your glut muscle workout with every day activity!

Gluteus Maximus

Gluteus maximus muscle-get your workout with everyday activity

Do you want to strengthen your gluteus maximus during day to day activities? Why is it even important? The gluteus maximus is important in preventing hip, knee and foot pain. It supports the thigh, knee and foot when you shift your weight onto your leg when you walk or run. It is absolutely essential for good balance. The gluteus maximus also supports the hip by keeping the ball and socket of the hip held closely tight, instead of allowing larger, longer muscles such as the hamstrings to pull ball towards the edge of the socket. At the image below, from “Diagnosis and Treatment of Movement Impairment Syndromes” by Shirley Sahrmann PT PhD FAPTA, it can be see on the top image, that the

Glut max versus hamstring

Gluteus maximus versus hamstring

that the gluteus maximus, the muscle on the top of the thigh, hugs the ball into the socket. In the lower image the hamstring can be seen pushing the ball forward in the socket, which can cause groin pain in the short run and hip arthritis in the long run.

To strengthening the glut with day to day activity do the following:
1) get in to a sitting position in a chair (or even on a toilet) and tuck your feet under you
2) reach around behind you to your buttocks
3) activate (tighten) your gluts
4) use your gluts to push you into standing
5) when moving from standing to sitting reverse this procedure

If you have in leg or back problems, be sure to check with your health care provider before attempting this exercise.

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

You’re kidding right?! Hip muscle strength helps bladder prolapse AND knee pain

Who knew?  The obtruator internus, a hip and pelvic floor muscle both, supports the bladder from below.  

When the bladder begins to slip down into the vagina that is called prolapse, and the obtruator internus, a HIP muscles can help support the bladder.

Ideally the pelvic floor muscles will lift the bladder…but another muscle supports the bladder, too. It is the obtruator internus which is a supporting pelvic floor muscles as well as a hip stability muscle. Look at the picture of a bladder to the right and below.

obtruator internus muscle next to bone

obtruator internus muscle next to bone

The bladder is the balloon looking object in the middle of the picture, and you can see the hip joints. The OI wings are the obtruator internus muscle underneath the bladder, helping to lift it. This particular picture is of a man, but the obtruator internus muscle lays the same way in a women. Look down and to the left to see the obtruator internus (in green) in the pelvis:
obtruator internus connection to pelvic floor

obtruator internus connection to pelvic floor

Interestingly, the obtruator internus muscle is very important for preventing knee pain as well as preventing plantarfascia. “Why?” See how the obtruator muscle wraps around the sit bone and attaches to the hip? It turns the hip and thigh out, which helps prevent the knee from rolling in (which causes kneecap pain).

obtruator internus posterior view attachment to hip

obtruator internus posterior view attachment to hip

The picture to the right is of the hip and thigh rolling in…the obtruator internus stops that movement AND helps the bladder.
knee cap pain due to hip weakness

knee cap pain due to hip weakness

If you have bladder prolapse, knee pain, or hip pain, or all 3, come to Comstock Physical Therapy to be evaluated by a therapist to get the help you need.