When you experience knee pain and see a physician, you are given a diagnosis. Commonly, it is something along the lines of IT band syndrome, patellofemoral pain, Runner’s knee, patellar tendinitis, or meniscus issues.
Your research online leads you to doing all the ‘stuff’ for it – foam rolling, stretching, icing, resting. You start strengthening the hip and glutes as well because you heard that was good for knee issues. And months later, no change! Same pain, same limitations, still not training like you want to.
You finally choose to see a physical therapist. You get all the ‘feel good stuff’ to the knee – ultrasound, e-stim, ice, etc. The tightness gets worked out in all the flared–up tissues that surround the knee. And you are given stretches to do for all the tight muscles as well as other ‘cookie cutter’ exercises that are typically given for knee pain. This all results in 3-4 months of therapy and a return to training only to have the pain return as you build your distance and intensity back up.
This is a very common, and unfortunate, scenario I see with athletes. And it may parallel your story as well. So why, when it seems like you are doing everything right, does the injury continue to return?
Simple answer: you have only been addressing the symptoms, not the cause.
Now for the longer answer. Knee pain is rarely due to an issue at the knee itself. Because of the anatomy of the knee, unless you have a traumatic injury in which the knee took an impact, knee injuries are normally due to another area in your body not working or moving right. Many times, this comes down to something at the foot and ankle, something in the hip, and/or habitual movement patterns you have. Often times, it is all of the above.
Foot and ankle
Several things can go on at the foot and ankle to create improper tracking and movement at the knee – lacking foot and ankle control, lacking ankle mobility, and lacking big toe mobility are three big ones.
When you lack foot and ankle control, you are often unable to control the pronation of the foot, resulting in overpronation. This creates increased forces at the knee each and every step you take and even greater forces with more dynamic activities such as running or jumping.
When you lack mobility in the ankle and/or big toe, two things can happen: 1) you turn your foot/leg outward to compensate for the lack of mobility, or 2) you shorten your stride or create a slight vaulting to bypass the lack of mobility. Either way, the knee has repetitive increased stresses and forces on it.
Similar to the foot, you can have both strength deficits at the hip as well as mobility deficits.
With strength or stability issues, the knee will collapse inward when you walk, run, or jump – the more dynamic the activity is, the greater the inward collapse. This creates increased torque, rotational forces, and sheering at the knee that over time add up to an injury.
One thing important to point out here is our hip and foot are highly connected. If the foot does not activate well, the hip won’t either. Another great reason to start working on the foot!
Because of muscles crossing both the hip and the knee as well as the movement the hip needs to be able to do on a regular basis, any time there are mobility deficits in the hip, the knee can be impacted.
There is not necessarily one ‘perfect’ way to move, but there are ways that are more ideal for your specific body, there are ways that are more ideal based on the stability and control your body has in this moment, and there are ways that are ideal based on the task at hand.
Let’s use me as an example. When in the gym and moving quickly and/or under heavy load, my feet are flat (normally barefoot), with both my heel and ball of the foot in equal contact with the ground and toes pressing into the ground. All of that helps to engage the glutes and core properly to maintain good stability and control throughout the movement. But I can also stand on my toes, keeping my heels fully elevated, and then do a squat to full depth and stand back up without any issues to my knees because I have built up the stability and control throughout my body to do that. Would I attempt to do that under heavy load or quickly? Absolutely not! Could I do that years ago prior to working on the foot control and body control? Nope!
It comes down to training your body to move in a way that activates the necessary muscles to create the power from the proper areas for the task at hand. Once your body learns how to do that, it will stop placing increased and inappropriate forces on your knees.
Not sure what to do next with all this information? Let’s chat! Schedule a FREE Discovery Call with Dr. Brianne Showman to figure out the next steps to resolving your knee pain.
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