Do You Have Knee Pain? Genu Valgum May Be the Culprit

A friend of minewent on a bicycle ride with me, and after about an hour started to experience severe knee pain. After checking her lower extremity I found she had "knock knees". The clinical term for "knock knees" is Genu Valgum. The opposite would be "bowlegged" or Genu Varum. Since Genu Varum isn't normally associated with pain or problems, we'll concentrate on my friend with Genu Valgum. However, both of these conditions are the resultant of the Q-angle.
 
The Q-angle is determined in the frontal plane by drawing a line from the anterior superior spine of the ilium to the middle of the patella, and a second line from the middle of the patella down to the tibial tuberosity. A normal Q-angle for quadriceps femoris function is usually 10 -14 degrees for males and 15 -17 degrees for females.
 
 Anyway, back to my friend... 
 
When assessing the lower extremity you have to "get out of the box" sort of speak, says Ruben Salinas PT, OCS. Ruben is the clinical director of the Fortansce and Associates Physical Therapy clinic in Arcadia, CA. "Don't just focus where the pain lies look at the whole picture. Remember, the lower extremity is a closed chain, especially in cycling."
 
Normally associated with Genu Valgum you'll find pronation or flat feet, tight gastrocnemius and in some cases trochanteric bursitis.
 
Let's look at one at a time:
At the ankle, the body will try and compensate for the valgus stress at the knee (tensile forces on the medial side of the knee; compressive forces on the lateral side) by pronating. In gait you have to dorsiflex one ankle in order to swing through with the other leg.
 
If your clients gastroc is tight, they won't be able to dorsiflex, which will cause the foot to cave in. This will indeed affect the knee and then the hip. To lengthen the gastroc, have your client stretch. Be careful to insure their foot doesn't cave in while stretching. If needed, support the inside of their foot with a wooden block so their foot won't pronate.
 
For the tibialis posterior (which is an inverter and crosses the ankle) have your client perform "windshield wipers." By strengthening the inverters, (see diagram) you'll cause the foot to supinate which is the opposite of pronation.
 
Here's how:
Lie a light weight on a towel. With their feet flat on the floor have the person slide the weighted towel inwards towards their other foot. There are other ways of helping the foot out, but that's a whole other article.
 
My friend wasn't complaining about her feet though, the pain was on the lateral or outside part of her knee.
 
So let's examine the knee:
Because of the excessive Q-angle there will be more compressive forces on the lateral side and more tensile or distraction forces on the medial side of the knee. So how do you fix that?
 
"This is topic a large grey area in the physical therapy world," says Ruben Salinas. He is an expert on knees. VMO weakness or the inability to fire has been suggested as the culprit for patella - femoral dysfunction. The experts still can't agree. It's definitely worth trying though. To increase VMO activity, try quad sets in all directions or have your client put a small ball or rolled up towel between their legs when the perform leg extensions. Have them squeeze tightly or adduct at the top of the extension.

Another method Ruben suggests is Bio-feedback. Have the client put their hands on both the Vastus lateralis and Vastus Medialis, then have them contract their leg. Through their fingers they should be able to feel which side contracts first. Try and get them to "fire" the inside (vastus medialis) first. It would be nice if you had some surface EMG's, but hey, we're just trainers!
 
At the hip, you'll often find weak external rotators. It's almost as if the head of the femur has rolled forward and inward. When this happens, the greater trochanter starts to smash up against a bursa which eventually could lead to bursitis.
 
The external rotators of your hip are the key here. Concentrate on the gluteus maxims and not the gluteus medius. Remember, the medius is an internal rotator. Don't forget the deep external rotators either. By performing external rotation with a cable or tubing attached around the ankle, you will strengthen the piriformis, superior and inferior gemellus, obturator externus and internus as well as the quadratus femoris. This will help stabilize the hip so that smashing of bone against bone doesn't occur.
 
Be aware, some clients may have an aversion. This is the angle of the femoral neck in the frontal plane. (see diagram). Anteversion will turn the toe turn inwards, increase mechanical advantage of the gluteus maxims as an external rotator, increase the Q-angle and cause more pronation at the foot. Anteversion is structural, so you can't repair that without a scalpel and a chain saw.
 
In conclusion, I hope you can see that in the case of the lower extremity you must take a holistic approach. Ask a lot of questions. How did they get this way? Is the condition acute or chronic? Is it congenital? Is it structural or muscular? Examine their gait. 
 
If there is pain when performing these exercises, refer them out and get a medical release.
 
I hope this will help you and your clients, and I sincerely hope you'll assess their posture before you load anyone with a weight.
 
By the way, after a little RICE, (rest, ice, compression, elevation) my friend was able to walk again. Now she just needs one of you to train her.

Don't Ignore Early Warning Signs Of Arthritis Symptoms

When you get an ache in your knee, it's very easy to just assume it's arthritis. But what are the symptoms of arthritis? Your body can ache for lots of different reasons, so it's sensible to get any ongoing pain checked out. Arthritis symptoms are many and varied, so it's not always obvious that something is being caused by arthritis, if you have one or more less common symptoms.

The first step is to visit your doctor. It's important to let your doctor know if there's a history of arthritis in your family. Make sure you keep track of where and when the arthritis symptoms are occurring. It's also good to note what type of pain you are feeling - is it general stiffness in a joint? Or are you actually experiencing pain when you move the joint? Keep track of any obvious patterns to your arthritis symptoms, such as whether the pain gradually improves through the day, or whether it's worse right before wet weather. If your arthritis symptoms only last a day then disappear for weeks before returning, then tell your doctor that.

Initially, your arthritis symptoms may be so mild that there will be some doubt about whether it's actually arthritis at all. That's okay, and not unusual. You should still get it checked out by your doctor, just in case the problem is being caused by something entirely different. A whole range of problems can cause pain in various parts of your body, and it's important to make sure the cause is pinpointed, so that it can be dealt with more effectively.

If you find that you're getting arthritis symptoms in one particular joint, think back and try to remember whether that particular joint has recently suffered a knock or blow. Perhaps you've been undertaking a new activity, which could have caused those particular muscles to be feeling a bit sore and tender? The thing with arthritis symptoms is that over time, they recur. So if it's possible that your current pain has been caused by a recent event, it's quite possible you don't have arthritis at all. Again, visit your doctor so that you can discuss the situation and determine what the most likely cause could be.

Excess Body Fat Has Huge Consequences

There's no escaping the fact that the more body fat you have and the longer you carry it, the more you increase your risk of developing debilitating and, possibly, fatal diseases. Many of the diseases are very serious. Being obese or overweight is the second leading cause of preventable death in America today. It's a national epidemic!

Excess body fat has huge consequences to your health by increasing the risk of the following conditions and diseases:

Cardiovascular Diseases: High Blood Pressure, High Cholesterol, Elevated Triglycerides (blood fats), Atherosclerosis/Coronary Artery Disease, Stroke, Angina,
Myocardial Infarction/Heart Attack

Metabolic Diseases: Elevated Blood Sugar, High Insulin Levels (Hyperinsulinemia), Insulin Resistance Syndrome (also called Syndrome X), Type 2 Diabetes, Gall Bladder Disease/Gallstones

Cancers: Breast Cancer, Uterine Cancer, Ovarian Cancer, Cervical Cancer, Colon Cancer, Prostate Cancer

Orthopedic Conditions and Diseases: Osteoarthritis of knees and hips, Lower Back Pain, Disc Degeneration in Lumbar Spine region, Foot and ankle pain

Other Conditions and Diseases: Sleep Apnea, Gout, Impaired mobility, stability and flexibility

One of the most common diseases is Insulin Resistance Syndrome (Syndrome X). Approximately 60-75 million Americans have Insulin Resistance Syndrome. Insulin Resistance Syndrome is a precursor to Coronary Heart Disease and Type 2 Diabetes.

When you have Insulin Resistance Syndrome, your insulin has difficulty shuttling glucose (blood sugar) into the glycogen (stored glucose) storage sites in your liver and muscles. When this happens, the pancreas secretes more insulin to help the process. The excess insulin in the bloodstream damages the arteries, eventually leading to Coronary Heart Disease and heart failure.

About 5-10% of people who have Insulin Resistance Syndrome eventually develop Type 2 Diabetes. This happens because the body becomes so insulin resistant that the pancreas cannot supply enough insulin to reduce the high levels of glucose in the blood stream.

Type 2 Diabetes is a degenerative disease because it causes further damage to the blood vessels. In some cases, this blood vessel damage results in blocked capillaries resulting in the amputation of parts of your arms and legs. And, of course, Type 2 Diabetes also increases the probability of Coronary Heart Disease.

Also, Type 2 Diabetes will cause similar problems in the blood vessels in the retinas in your eyes. If untreated by an ophthalmologist, then this blood vessel damage can lead to impaired vision or blindness. Most people that are being treated for this condition still experience impaired vision.

Excess belly fat in men and women increases the risk of cancer. Visceral fat around the stomach organs and subcutaneous fat over the abdominal muscles promotes an inflammatory response in the body which is believed to increase the risk of developing such cancers as: breast cancer, colon cancer, uterine and cervical cancer, and prostate cancer.

Being overweight or obese for long periods of time greatly deteriorates the hip and knee joints. Increased body fat levels and higher bodyweights contribute to the development of osteoarthritis - a degenerative disease of the joint. Eventually, hip and/or knee replacements become necessary if a person wants to be mobile and pain free.

Research done at the Robert Stempel School of Public Health at Florida International University found that hip replacements have increased 71% from 1997 to 2004 and knee replacements have increased 83% for the same time period. When you compare this data with the fact that adults have been getting increasingly heavier in the last several decades, it's no surprise.

Clearly, excess body fat ages and deteriorates your body at an accelerated rate. With excess body fat, you become "old before your time" and this eventually results in a greatly diminished quality of life. If you want to be active and healthy, then you must do everything possible to reduce the body fat or prevent any accumulation of body fat. If you don't, then you risk the dire consequences discussed above.

To lose body fat and reduce your risk of the diseases mentioned above, you must employ three key strategies: resistance training, cardio exercise and a sensible diet. These strategies are the foundation of a successful fat loss program. If you're overweight or obese - you don't have to be. There is a solution.

My Arthritis Story - First Time Pain Free In Over Fifteen Years

Earlier this year, I decided it was time to schedule the knee replacement surgery that I had been putting off for over 15 years. Originally they said I was too young at age 37, they told me that if I could live with the pain until I was 50, the replacement would be more feasible.

So I began taking the Chondroitin and Glucosamine supplements and they seemed to help... for a while. Then the pain got worse and I began taking prescription Naproxen as an anti-inflammatory and pain reliever. After reading all the side effects of prolonged use, I tried to take them as little as necessary. First it was once every three days, then every two, etc. until it was twice daily.

That brings us to earlier this year. Now the pain was continual and causing me to lose sleep every night. I decided it was time to schedule the appointment and arrange for the replacement. The orthopedic surgeon that was recommended by my doctor as the best had about a six month waiting period just to get in and then another six months before you actually had the replacement. But I was ready.

A Friend Recommends An Alternative:

After hearing about my pain and decision to have the surgery, a friend of mine suggested that I try this all natural supplement that she was using for back pain. She was trained as a nurse and worked as a therapist, so I listened to what she had to say. She told me that this supplement was helping her and others to live a better life with less pain. She provided the details and web information about it and I read everything available.

It was not cheap (90 servings for $69.95 plus shipping), but based on her recommendation, I decided to give it a try. I figured that I had about twelve months before the replacement could be scheduled anyway... so trying it for a couple months couldn't hurt while I was waiting.

My Skepticism Abounds:

I am a fairly skeptical person by nature, so I really didn't have a lot of hope that it would work. But in all fairness, I was going to give it a try for 45 days. Why 45 days? Because that was how long it would take to use the 90 servings according to how she instructed me to take the supplement.

I was instructed to take one capful in the morning on an empty stomach, then another a couple hours before bed, also on an empty stomach. Of course, I didn't feel any relief immediately and now I was about three weeks into the bottle. While I didn't feel much better, I definitely didn't feel any worse. It did seem like I had more energy and was sleeping a little better, which were both positive.

Pain Relief And Surprise:

Somewhere around the beginning of the next week, I started to notice a significant change. My knee pain was beginning to subside and my range of motion also seemed to be improving. Now I began improving on a daily basis. This is starting to get my attention.

So I begin trying to explain it in other ways. Am I doing something different? What have I been eating, or not eating? Have I been doing more exercise this week. I have lost a few pounds recently...

As the weeks progress, my pain is getting better and better. I am now getting more exercise because it doesn't hurt to walk anymore. I am starting to lose weight because of my increased activity.

The Next Step:

Over the next month or so I start feeling really good. I am mobile and feeling a lot of energy. So I decide to stop taking my Naproxen. I start by dropping to one a day, then every other day and finally after just a few months, I stop taking them entirely.

Much to my surprise, I am still feeling good. I actually feel "Pain Free" for the first time in a very long time. At age 53, my knee that was injured when I was 16 is not bothering me. I know the injury and multiple surgeries have taken place, but I am feeling really good.

After several months of feeling better and increased activity, I decide to cancel my appointment with the orthopedic surgeon. So far it has been great and while I have had a few incidents where I "over did it" and had some soreness, the recovery time from these incidents has been very quick.

I can't guarantee it will last forever, but for now I am enjoying the new found youth and vitality. As a side benefit, this supplement is also good for your skin, allergies and I have seen a noticeable improvement in my night vision due. She tells me that is because of an ingredient called "Billberry Extract". OK!

Spreading The Word:

For months now I have been telling friends, family and others about my story and many have tried it with similar results. So I decided to write an article here to share my personal story. I can't guarantee everyone will experience the same success that I have, or as quickly, but if you are in pain, as I was, it sure is worth a try.

Conclusion And Summary:

If you have suffered with arthritis pain, joint pain or any other issue related to inflammation, what is it worth to you to have the opportunity to potentially be "Pain Free"? For me it was a lot more than the $75 it cost to give it a try. You might just feel better and gain some of your youthful energy and mobility back.

For detailed information click this link: Isotonix OPC-3 Supplement, and scroll down the page. It can only be purchased online, but they usually deliver it within 5 days. You will have to "sign in" and set up a free account with your email, name and address. I hope your results are as good.. or better... than mine!

Knee Strengthening Tips to Avoid ACL Tears

When attempting to avoid a knee injury, incorporate three types of exercises: flexibility exercises, strengthening exercises and cardio exercises. We've compiled a list of important tips and exercises to help you strengthen your knees against ACL tears.

• Tip #1: Stretch and warm up: No matter the intensity level of the exercise, begin every physical activity with a brief and gentle warm up. Jog in place, do a few jumping jacks and get the blood flowing to your muscles. Having warm muscles can help reduce injuries and keep you out of an ACL brace.


• Tip #2: Exercise regularly. Many knee injuries occur the first time getting back into the sport and exerting oneself too hard. Certainly not all injuries occur from a lack of pre-sport conditioning, but in many cases, you can prevent knee injuries by consistently practicing the sport. Note: remember to utilize your medical knee braces when exercising if you're prone to knee problems or have previously suffered a knee injury.


• Tip #3: Listen to your body. Pain is your body's way of speaking to you and warning you. Get to know your body's warning signs and the difference bet. The New York Times' article "That Little Voice Inside Your Twinge" reminds us that there is a distinct difference between pain and discomfort.


• Tip #4: Begin a plyometric exercise program. Plyometric training is used to develop faster reacting muscles while strengthening tissues which can help improve performance and helps prevent injuries. The basics of any plyometric program are a series of exercises, or drills, which involve heavy muscle loading and muscle contractions like hops or jumps.


• Tip #5: Ball squat. Place a fairly large ball between your knees and squeeze to hold it in place. Lower into a wall squat position with your knees bent at a 90 degree angle. Do 3 - 5 sets of 10 -20 ball squats to strengthen your knees.


• Tip #6: Flamingo (single leg) dip. Stand between two chairs for balance. Lift one leg, keeping it either straightened or loosely bent while the other is firmly on the ground. Slowly lower down to a 90 degree angle, keeping your hands on each chair for balance. Slowly use your leg muscles to push back up to standing and switch legs.


• Tip #7: Step Ups. Channel your inner Richard Simmons and get out at least a 6 inch high step or stepping stool. Start by stepping onto the step with your left foot. Place it solidly on the step and place the majority of your weight on that side. Next, raise your right foot off the ground and bring it to the step, without placing it fully on the step - almost like a tap to the step. Then, lower your right foot back to the ground (without having placed it on the step) and then your left foot. Switch sides.


• Tip #8: Big Tire Jumps. Imagine there is a large truck tire on the ground that you have to jump over. Stand on your right leg and hop high and wide "over" the tire, landing on your left leg. Pause and hold your right leg in the air as you balance on your left leg. Then push off your left leg back "over" the tire to the right and land on your right leg. Repeat 15 times.

While keeping yourself out of an ACL brace isn't always avoidable, there are certain measures you can take to best prevent a knee injury. Remember to include flexibility exercises, strengthening exercises and cardio exercises, especially a plyometric program, to best condition your body and combat ACL tears.

Please note that this article is for informational purposes only and is not intended to diagnose or treat any medical condition, or be taken as medical advice. For more information related to your unique situation, please speak with your personal physician.

Total Knee Replacement - Heal Faster

After any major surgery such as total knee replacement (total knee arthroplasty), one of the patient's prime concerns is regaining function and mobility. Exercise has been found to be beneficial for wound healing and also for more complete and quicker recovery of mobility and function. Exercise achieves these outcomes through several different methods. Some recent studies, written up in medical journals, provide pointers for anyone wishing to have a positive effect on their own rehabilitation after surgery.

One of the immediate results of almost all major surgery is reduced function and mobility. Reduced function and mobility immediately raises the stress level of the patient who is now confined an unable to provide complete care for themselves. This has the direct effect of increasing stress.

It has been demonstrated in numerous studies that stress slows the healing process. In Neuroimmunomodulation, Vol 13, 2006, Glaser and Christian write that "...stress can significantly slow wound healing: stressors ... impair healing in humans and animals. For example, in humans...the relatively brief stress of academic examinations impedes healing." They go on further to state "Recent evidence suggests that interventions designed to reduce stress and its concomitants (e.g., exercise, social support) can prevent stress-induced impairments in healing."

A 2005 report in the Journals of Gerontology describe a study on exercise and healing among older adults that was completed with some surprising findings. The study followed the results of 28 adults, with an average age of 61, who had not exercised in the previous 6 months. Half the group was started on a program of 75 minutes of exercise activity for three times a week. The other half did nothing other than their normal routine. After four weeks of exercise, all the adults received small puncture wounds on their upper arms and were then monitored for rate of healing. They also performed stress tests twice, at the beginning and at the end of the study. Their cortisol levels were measured before and after each stress test.

When they did the stress test before the study, the researchers found that neither group showed any increase in cortisol levels after the stress test. Exercise normally increases cortisol levels. The ability to produce cortisol diminishes with age. This is significant because cortisol increases the efficiency of immune system function. This is a factor in the commonly observed increased time for wounds to heal in older adults.

The results of the study were that the exercisers healed faster, typically within 29 days instead of 39 days for the non-exercisers. The researchers expected this. They reasoned that exercise increases circulation, and that fact alone would improve the flow of nutrients to the wound site and the flow of wastes away from it. What surprised the researchers was that when they administered stress tests at the end of the study, the exercisers showed increased cortisol levels typical of younger adults. This increase in cortisol levels was a second mechanism that promoted improved healing.

Exercise also plays a role beyond improvement in healing rates. Patients that undergo total knee arthroplasty or hip replacements will be dependent on walkers and canes for mobility during the early stages of their recovery. It is not uncommon for the increased exercise load on the upper body to lead to soreness, pain, and decreased energy levels in those unaccustomed to doing this type of activity.

In the 2007, May issue of Journal of Strength and Conditioning Research an article reported on the results of a case study involving two TKA patients. One underwent 4 weeks of pre-habilitation exercises. (Pre-habilitation is physical therapy delivered before any surgical intervention). There were significant differences in both function and self-reported pain perception in the exercising case than in the non-exercising case.

This supports the findings of a study reported in the February 2002 issue of Applied Nursing Research that compared preoperative exercise, anesthesia, or analgesia on the ability to walk after surgery. It was found that anesthesia, or analgesia had no effect. Subjects who exercised before surgery were able to walk significantly greater distances afterwards.

What does all this mean for people looking forward to surgery, whether total knee replacement or some other major intervention? It's simple. Exercise can help you in four ways.

1. It will actually help speed healing of the wound site through improved circulation and the attendant improved flow of nutrients to your wound.

2. It will help stimulate the proper regulation of cortisol levels in your body, which will improve your immune system function.

3. It will help strengthen your body, leading to improved mobility, especially if you must use an assistive device such as a walker or can after your operation.

4. And finally improved mobility will mean less stress on the recovering patient. In addition, exercise is a proven stress reducer in its own right. By reducing stress, you remove the ability of stress to slow healing.

The studies seem to be quite clear. If you know you are going to go for surgery, start exercising, even if it is a limited program. Any exercise, done regularly, is better than no exercise. And remember, discuss your exercise program with your doctor.

Good luck.

Running With Knee Pain

Fact: forty-two percent of all injuries from overuse affect the knee joint, and runner's knee (a.k.a. patellofemoral pain syndrome or PFPS), is the most common injury among runners.

PFPS can effect both knees, though more commonly it is more painful in one knee. According to the British Journal of Sports Medicine PFPS hinders more young and active people, and twice as many women as men. This is most likely because women tend to have wider hips, resulting in a greater angling of the thighbone to the knee, which puts the knee cap under more stress. The symptoms of PFPS are caused by the irregular tracking of the patella (kneecap) in the femoral groove.

What are the common symptoms of PFPS?

The most common complaint of those suffering with PFPS is tenderness behind and around the knee. Some also experience pain on the posterior side of the knee capsule as well. Instability and cracking could also be signs of PFPS. Although symptoms will be different in each case, running on hills and uneven surfaces often aggravates PFPS symptoms.

What are possible causes of PFPS?

Determining a single cause of your knee pain can be quite difficult. A good approach to eliminating your pain is having your knee assessed by a physical therapist. Anterior knee pain could be a biomechanical problem. Biomechanical issues that may be causing your pain include: excessive internal rotation of your hip, your knee cap may sit too high or too low in its groove, worn cartilage in the knee joint which reduces shock absorption, high arches of the feet providing less cushioning and flat feet, or knees that turn in or out excessively can pull the patella sideways. There could also be muscular issues contributing to your PFPS. Tight hamstrings and calf muscles, in particular, can put excessive pressures on the knee. Weak quadriceps muscles can also cause the patella to track out of alignment, creating painful friction and rubbing.

What can I do to help with PFPS?

A good physical therapist can perform a thorough assessment and determine what factors could be contributing to your knee pain. They would also evaluate your running stride while running on a treadmill to determine if there are any problems with your running technique and gait which may be the culprit of your pain. Treatment will likely consist of exercises to focus on correcting existing muscle imbalances and improving strength in weak muscles. You will also perform a flexibility program for the hamstrings, calves and hip flexors, and education on proper footwear and referral for orthotics to correct your foot positioning, if necessary. The rule is if your feet have good form, your knees will follow.

Some smart ways to prevent PFPS is to try running on softer surfaces like grass or trails. Also, don't do too much. Increasing your weekly mileage more than ten percent each week is too much. And lastly, running on hills can be good for your heart but hard on your knees; make sure to introduce a hill routine slowly! For the best advice contact a good physical therapist who can analyze your running gait and provide strengthening exercises to prevent future pain in your knees.