Knee Pain: Look Above and Below

“My knees never bother me”—said no one ever. Everyone has experienced either a complex knee injury or a simple tweak that is now haunting. “Oh great, my knee doesn’t hurt anymore”…<perform max squat clean>…”Never mind.” Here’s another scenario—”I’ve never had knee pain”…<gain 10 pounds>…”Why do my knees hurt all the time?!” The knees and low back are the middle ground, Switzerland, neutral territory. With neutrality comes comprise. Our knees and back compromise when the feet, hips, and upper body battle.

Look above and look below. What does this mean? It’s important to look at the joint or structure above the knee pain and below it to fully treat the problem manifesting in the knee.

In the foot, we’re looking for over-pronation (flat feet, knock knees) or under-pronation (rigid feet, bow legged). A simple correction to a neutral foot position may remedy knee pain. This may mean changing shoe type, getting new shoes, or getting a running/walking shoe evaluation (done at many running stores on a treadmill for free).

In the hip, we are looking for a neutral pelvis, leg length, muscular weakness (typically the gluteals in adults), and muscular tightness (quadriceps, hamstrings, gluteals, piriformis), which may be affecting knee position and function. Correcting leg length in athletes may greatly reduce knee and back pain.

Here’re a couple of tips to deal with knee pain:

1)  Stretch—seriously, at least 1-2 times a week spend some quality time stretching. Stretches specific to the knee include: hamstrings, quadriceps, gluteus, piriformis, gastrocnemius, and soleus.

2)  Joint mobilization—Try a gentle knee mobilization with a towel roll hold 30 sec to 2 minutes and repeat as feels comfortable.

3)  Strengthen—Target the gluteus medius, gluteus maximus, and hamstrings.

4)  Good shoes—don’t wait until the tread wears off or until your pinky toe is sticking out to get new shoes. Generally, for those exercising daily, this means zapatos nuevos every 6 months.

5)  Correcting leg length—this may be as simple as adding an insert or heel lift in the shoe of the short leg. For significant discrepancies (greater than 1cm) the use of a shoe cobbler may be beneficial to build the shoe up from the outside.  Many times shoes can be altered (even cute sandals) with no apparent, aesthetic, difference.

heel lift

6)  Knee sleeves—I know I know…I hate to rely on supportive devices but my left knee has converted me. For those of us squatting (especially below parallel), lunging, and lifting regularly, a knee sleeve can alleviate pain during these tasks. DO NOT wear the sleeve 24/7 unless recommended to do so by a PT or physician.

knee sleeves

7)  Allow time to heal—for a solid 10 WHOLE days after the initial injury, avoid movements that exacerbate the pain. In this time, you are stretching, strengthening, and mobilizing pain limited or pain-free. You may implement knee sleeves if returning to the activity continues to cause some pain.

8)  Maintain a healthy weight—fast every now and then. From my observation, the leading cause of knee pain is carrying around too much weight. The quantity of food I can consume in one sitting has changed drastically since fasting (I’m a small lady but I can eat!). Over one year, I worked my way up to tolerating a liquid only fast for 24 hours about once a week. If I have a crazy hard workout planned on a fasting day, I definitely throw some protein powder in the mix. I also allow myself to fail if it’s getting too hard and I need dinner—I just pick it back up again next week. This practice and regular exercise keep me in check.

**all of these recommendations are in the absence of a severe injury that requires medical attention such as a fracture, or ligamentous tear. You’ll know its severe if the pain intensity stays the same and function continues to be inhibited or impossible.

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