One of the most common aches and pains that I hear about is
knee pain. Most of the time, I speak
with people who have injured their knees due to overuse. Overuse can be a result of over exercise; however,
it can also be due to an imbalance somewhere else within the body.
Because I am seeing an increased occurrence of these knee issues,
I have decided to address some of the imbalances that can cause knee pain and
how they can be addressed. If not
attended to, these imbalances can lead to injuries of the ligaments and
tendons, and ultimately require surgery to be fixed.
Gluteus Medius (Gluet Mead) Tightness and Weakness
The pelvis is comprised of three bones that come together to
form the hips, and the femurs are the large bones that attach to the pelvic
area to form the parts of the hips that move the legs.
In order to move the hips, the muscles surrounding these
bones must contract and release to facilitate that movement. The glute mead attaches to the ilium section
of the pelvic bone and the greater trochanter of the femur. This
muscle acts to abduct as well as medially and laterally rotate the hip
joint. All of these functions are
necessary for walking and running and rely on healthy functioning of the glute
mead to remain optimal.
Glute mead issues affect the knee joint in two major
ways. Imbalance in glute mead strength
and tightness will cause the pelvic to tilt laterally. The pelvis will raise too high on the side of
the weakness and drop low on the side of the tightness. When a hip joint constantly flexes and
extends with a glute mead imbalance, the femur rotates internally and cause
uneven pressure and strain on the knee joint.
A properly trained exercise professional should be able to
test the integrity of the glute mead muscle.
If I am assessing a prospective client with knee pain, I will undoubtedly assess the strength capabilities of the glute mead muscles before
assuming that there is a structural issue with the ligaments or tendons. If glute mead weakness exists, I will
incorporate specific exercises to strengthen this muscle within the exercise
program.
This is an important imbalance to detect, because it can
also become the cause of low back issues and eventually shoulder injuries. This is a concept that will likely be
addressed in a later post.
Iliotibial Band (IT Band) Tightness
The Iliotibial band (IT Band) is an extremely strong fascia
running down the outside of the leg. IT
band tightness is a common ailment that I see contributing to knee pain. Although IT band tightness is often detected,
it is rare for the root cause of this issue to be addressed in the proper way.
Techniques such as foam rolling and direct stretching of the
IT band are frequently utilized methods attempting to loosen the fascial
tension. Although this might help a
little, it is unlikely that these tactics will be a long-term solution to the
problem.
IT band tightness is caused by an imbalance in the muscles
that connect the fascia. By targeting
the imbalances and fixing them with proper exercise, it is much more likely
that the problem will be solved rather than temporarily relieved. Let me explain what this imbalance looks
like:
The tensor fasciae latae (TFL) is a muscle that works with
the glutes to abduct (move away from the body) and medially rotate (turn in)
the femur. This muscle is connected from
the hip to the femur through the iliotibial band. Conversely, the Glue max muscle is absolutely
the strongest hip extensor (pushing the leg back) and lateral rotator (turn
out) of the hip. The glute max attaches
to the back portion of both the hip bone and the lateral (side) portion of the
femur, where it also connects with the IT band.
Paired with the TFL and glute max, the lateral quadricep muscle also connect
with the IT band. This muscle is a
powerful extender of the knee joint.
I regularly see an imbalance in these specific muscles,
resulting in the tightness of the IT band.
Most commonly, I assess prospective clients with tightness in the TFL
and lateral quadriceps that is paired with a weakness in the glute max. This imbalance literally causes a train wreck
for the knee joint by rotating the femur in a position that offsets the patella
(knee cap). OUCH!
So, why isn’t foam rolling the number one solution? Because rolling a large foam structure
between the ground and body weight against a piece of fascia that can withstand
a thousand pounds is NOT balancing the muscle tissue. Each muscle that innervates the IT band needs
to be addressed separately, some with stretching and others with strength
training.
The rolling and stretching needs to happen on a smaller
scale to directly target the tight muscles that connect to the IT band. It is the muscles that cause the tightness,
not the fascia itself. Often, smaller structures
such as a tennis or lacrosse balls are more effective at reaching the tight muscle fibers and releasing the tension. It is
much more productive to stretch the muscles causing the tightness rather than
the fascia that will not respond.
Paired with stretching techniques, strength training needs
to be implemented for the areas of weakness.
I often assess this weakness in the glute max muscle, which is most effectively
activated by moving the hip joint against resistance through full flexion to
extension movements.
Ultimately, there can be many causes of knee pain, but these
issues seem to be the causes that I see most often. As always, it is important to speak with a
trained medical professional before partaking in any exercise program. It is also important to seek the advice and
guidance of a trained exercise professional to help manage these imbalances and
help you reach your goals of pain-free positive health.
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