Ask A Physio: If My Knee Hurts, Why Are You Looking At My Hip?

As physios, we see bodies differently than most people. This is a good thing - you want your body specialist to see beyond the obvious! But what is often obvious to us is a mystery to others.

You may have heard one of us talking about the “kinetic chain”, a concept borrowed from the engineering world and repackaged for health care. The basic idea is the movement in one joint will create and affect the movement of the next joint, and so on. If your pain is in your elbow, we would be doing you a disservice if we didn’t also look at your wrist, shoulder, neck and upper back as well.

The kinetic chain is a big reason why one-size-fits-all approaches don’t work.

We don’t tell you to simply Google your symptoms and treat yourself. One person’s treatment approach for sciatica will be completely different than the next. My grandma’s elbow pain often has a completely different cause than my daughter’s elbow pain, even if they are in the same spot. Looking at the body as a whole is imperative to proper treatment.

A Case Study in Kinetic Chains: Runner’s Knee

A great example of this is someone with runner’s knee, also known as patellofemoral syndrome (PFPS). To understand how PFPS develops, an understanding of knee biomechanics is crucial.

The patella (aka the kneecap) rides in a groove on the femur at the front of the knee and is critical for proper knee movement. The patella acts as the attachment point for ALL your quads - think of how much muscle that is! To stretch out your leg, your quads first contract and pull on the patella. The force is transmitted through the patellar tendon (or ligament, depending on who you read) and pulls on the tibia, the main bone of your lower leg. Without the patella, the amount of force required for the quads to unbend the knee is simply too great. The patella acts as a fulcrum, giving the quads a mechanical advantage.

Need a visual? Check out this fantastic video:

Muscle imbalance is one of the main causes of PFPS. The patella is held in its position by a fine balance of muscle and connective tissue. Muscles that attach to the patella directly - we’re talking about the quads here - are obviously a main focus. But there’s many more muscles to consider. Consider these two examples:

1. One cause of PFPS is tight calf muscles. The gastrocnemius, one of the calf muscles, attaches at the back of the leg above the knee and can have a great effect on knee function. When these muscles are too tight, people tend to walk more in a pronated foot position (see photo on the right), increasing the forces at the back of the knee and adding to the compression and irritation of tissues around the patella.

2. The IT band runs the length of the thigh on the outside of the leg and attaches to the outside of the patella. The gluteus maximus, the large muscle in your buttock that controls hip extension, attaches into the top of the IT band. If the glutes aren’t doing their job, you can experience knee pain even if it isn’t the source of the problem.

We don’t expect you to know the ins and outs of this - that’s our job! When you come in for a little rehab, don’t be surprised when we start checking out your other joints - you may be surprised by what we find.

If you need to see a physiotherapist, give us a call at (778) 630-8800, email us or book online. We would love to work with you!

Hip Pain in Dancers

Anh Duong grew up in Prince Rupert and was a competitive dancer for years, training in ballet, jazz, tap, contemporary, modern, hip hop and acrobatics. She is a member of the Dance Health Alliance in Canada and she now works with dancers at all levels. Whether it’s dealing with an injury, preparing the feet for pointe or improving performance, Anh has the experience and expertise to help you reach your goal. Read Anh’s latest blog on hip pain and overstretched hip flexors.

Dancers, do you really have tight hip flexors?

For years, I suffered from hip pain, especially with movements involving kicks (i.e. grand battement, developé, rond de jambe en l’aire, etc). I always thought it was because I had tight hip flexors. So naturally, I would get down into a deep lunge and stretch and stretch and stretch... but nothing changed.

Little did I know that it wasn’t a hip tightness issue. The opposite, actually - my hip flexors were long and weak likely from years of being overstretched.

Think of that hair elastic that you have been using for 3 months, the one that has kind of lost its shape, doesn’t really hold your bun up. Similarly, my hip flexor muscle was overstretched and was not strong enough to hold my leg up.

The hip flexors are a group of muscles that are responsible for lifting your hip and leg up in front of you. They also play a role in bringing your trunk towards your legs (i.e. doing a full sit up). When these muscles are long and weak, they often have to work harder and strain to do their job resulting in that pinching or gripping feeling in the front of the hip. When this happens your body will often recruit different muscles to compensate for the weak hip flexors, often causing even more problems.

For many dancers with hip pain, the solution is often not stretching but strengthening the hip flexors through the whole range of the muscle. 

So what do you do?

1. Settle it down and avoid painful movements. This may include marking exercises for a period of time. 

2. Strengthen the hip flexors. Start with small ranges and slowly work towards larger ranges. Do floor exercises and floor barre before progressing to standing. Use weights and therabands to further build strength.

3. Core core core! Avoiding compensation movements through the pelvis and spine is key to long term success with overstretched hip flexors. A strong core is the best way to achieve this goal.

Should you stop stretching your hip flexors?

No! Flexible hips are required for many dance movements BUT you need to ensure that you are doing the proper stretches and combining stretching with strengthening. The goal is a strong muscle at any range!

Overstretched hip flexors are one of the many causes for hip pain but certainly not the only cause. Make sure you are assessed by a professional before getting back into the studio. Treating any injury correctly the first time saves you a lot of time and pain in the long run.

If you are a dancer experiencing hip pain, book with Anh online or give us a call at (778) 630-8800. You can either visit us at our Ladner location or book a virtual appointment.