Your Knee Is Innocent | Don’t Blame The Middle Man!

By Adam Smith PT,OCS | Contributing Author

Knee pain is a complaint of people of all ages
and all walks of life. In some cases people have arthritis and sometimes people have traumatic injuries to their knee. In these situations the knee is definitely the culprit to the individual’s pain. these incidences are NOT what this article will be addressing. This article will be addressing the vague knee pain that is often iagnosed as patellofemoral or illiotibial band (ITB) syndrome. The patellofemoral joint describes the relationship between the kneecap and your thigh bone. The illiotibial band is a fibrous band that runs from your hip down your lateral thigh to your knee. This pain is commonly seen more in women, runners, hikers, people who sit for prolonged periods during the day, and people who must use stairs on a daily basis.

This may sound hard to believe, but the knee pain that I have just described is not always CAUSED by the knee. I emphasize the word “caused” because I do want to confuse the cause of the pain with the actual area of irritation. Patellofemoral pain is due to a mechanical dysfunction at the knee, but this dysfunction is not always caused by the knee. THE KNEE IS OFTEN THE INNOCENT MIDDLE MAN. To find the source of this knee pain I often have to look up to the patient’s hip or down to the foot.

The knee and/or the patellofemoral joint are often held victim to forces created by the abnormal mechanics of the lumbar spine, hip and/or foot. When I watch individuals with vague knee pain, I look to see if the individual has excessively pronated feet (commonly thought of as flat feet) or if the angle created by their hip and knee (the Q angle) is greater than normal (see picture). This angle increases when the individual’s hip strength is not sufficient to maintain his/her body weight or when the individual has wide hips. Unfortunately ladies, this is why patellofemoral symptoms are more common with you than with males.

One important concept to understand is how hip strength can affect your Q angle and thereby create an abnormal force on your kneecap. When the hip muscles that allow your thigh to rotate outward (External Rotation) or the hip muscles that move your lower extremity away from midline (Abduction) are weak, your Q angle increases. If you can, visualize your knee diving inwards as you step down off of a stair. This inward motion is a result of your hips inability to hold your thigh in a neutral position and it is this motion that can cause an excessive pull on the knee cap.

This concept of treating the knee by increasing stability above and below the knee is relatively new. However, recent evidence has shown that interventions concentrated on improving hip strength and mechanics have been successful in improving knee and patellofemoral pain. This is reason I now incorporate hip stability exercises into most of the treatment I provide to the patients I see. Consequently, I am writing this article to staple one thought into your minds.  Strengthen Your Hips!! It will prevent abnormal forces around your knees and will help prevent many back problems as well. When people think of core stability, many often look to the abdominal muscles. Unfortunately, they miss the hips, which are the location of some of the strongest core muscles you have.

If you are suffering from unexplained knee pain and are not sure how to address your problem,  please contact a local physical therapist or your orthopaedic doctor. He/she will be able to point  you in the right direction, or initiate specific treatments if necessary. I have cited a number of research articles that were used in this newsletter.

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About the Author | Adam Smith PT,OCS graduated from the Medical University of South Carolina in 2003, where he received a Master of Rehabilitation Sciences-Physical Therapy. In 2003 Adam received the American Physical Therapy’s Association’s (APTA’s) Mary McMillan Award, the highest award given to a physical therapy student. In 2004 he participated in Kaiser Permenente’s Orthopaedic Physical Therapy Residency and in 2005 obtained Orthopaedic Clinical Specialist status.. Adam is presently acting as the Chair of the Membership Committee for the APTA’s Orthopaedic Section. Adam is a native of Long Island, NY and moved to Los Angeles in January 2004. (OCS).