So today I would like to start a serie on knee pain. I will approach several common reasons for having knee pain with common movements and tasks. I will also demonstrate what you can do about it and what you can change with specific exercises that will help you correct what you are doing wrong.
We have many patients that come to see us with complaints of knee pain stating that they have had increasing difficulty with knee pain when they ascend or descend stairs, going over curbs or stepping off a high platform, and even walking or hiking on hills.
Using stairs is a required and normal part of life to participate in society but it is far from easy for many.
A lot of people that have knee pain think or have the conception that the problem is coming from inside the knee joint, that a structure is likely injured or not doing what it is supposed to do. I am here to tell you that it is rarely the case. I think that the knee joint generally deteriorates only from direct trauma, or much more often from problem occurring at the hip and ankle joints instead.
There exists a multitude of knee problem and diagnosis that can create pain with stairs use. You might know how limiting or unsettling this can be. With conditions such as osteoarthritis, IT Band syndrome, chondromalacia/ knee cap problems, and ligament problems , it is not uncommon to experience pain with stairs use. That pain can be located on the outside, the inside, the front, the back and any combination of these.
If for a big part of your life, you develop a different movement pattern when you use stairs, it can take its toll on the structure of your knee and create pain and inflammatory process, and make you lack confidence when standing on that leg, challenges your stability and give you the feeling your knee might collapse.
Although, it can seem complicated, the mechanic of the movement is actually not. It is physics.
What happens at your knee depends on what happened above and below your knee, meaning your hip and ankle joints respectively.
In the problem that I will describe today, the problem tends to come from weakness at the hip, leading to poor positioning of your thigh bone a.k.a. your femur. This led to an increase angle at the knee, angle that we called valgus or valgum... You might have heard of this as knocked knees.
What happen is that the femur is driven inward towards the midline and this changes the mechanic at your knee, placing extra stress over cartilage inside your knee, the joint surface between the femur and the tibia. It also lead to poor tracking of your knee cap/ patella over your femur. This irritates the cartilage underneath. Overtime, this mechanism can be responsible for the wearing of the cartilage in your knee joints. We call that osteoarthritis.
And so, it is very important to have the proper mechanic to prevent this problem.
Today, I want to show you a way to learn to place your knee correctly when you step down from a step, in stairs, or on a curb. And that can also be applied to walking/ hiking down a hill as well.
In order to move your knee properly, you need to look at where your knee falls over your foot as you lead with the opposite foot when descending stairs.
The way you can do this is by visualizing the line that bisect your foot and goes through your second toe, the one right next to the big toe.
As you are bending your knee, you want to center your knee to fall right over that line. This will prevent either valgus stressed as we discussed when your knee falls inward, or prevent varus stress, the opposite, as when your knee falls outward.
This is a very functional exercise as it will re-train your body to move correctly and will help build muscle memory so every time you use the stairs you will more naturally keep correct alignment of your knee over your foot. It might seem like a small thing but in life, it's often the small changes we make that lead to big changes.
This exercise require a certain amount of hip strength, particularly in your gluteus muscles. And practicing this will help built their strength as well. I will show you some specific exercises to strengthen your glut medius in a future post. stay tuned.
So if you have knee pain when you are going downstairs, please try this. Let us know how it goes in the comments.
We have helps hundreds of people in Burien, WA and Seattle, WA avoid knee surgeries by helping them change their movements. Call, text or email us with your questions!
Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.