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Ankle Pronation and Knee Osteoarthritis

8 Apr

Knee osteoarthritis (KOA) is a very common condition that is a significant cause of disability in older adults, often resulting in knee replacement surgery. There are several contributing factors to KOA, and perhaps one of the most important issues is excessive force exerted on the knee joint by improper biomechanics of the foot and ankle.

In the normal gait or walking cycle, there are two primary phases called the stance phase and the swing phase. As the names imply, the stance phase refers to the entire time the foot is in contact with the ground and the swing phase occurs when the foot is off the ground.

A 2019 systematic review and meta-analysis reported that the forces across the knee are not transmitted equally during walking, with the inside of the knee joint bearing greater loads than the outer knee joint in most individuals. This leads to breakdown of the cartilage faster on the medial side of the joint, which leads to KOA. One identified cause of this is called ankle pronation, which is an excessive rolling-inward of the ankle that occurs during the stance phase. This results in the knee knocking inward, which is technically called external knee adduction moment, or EKAM.

Fortunately, this can be addressed with the use of lateral wedge insoles or shoe inserts that try to minimize or eliminate the ankle pronation aspect that reduces the EKAM and associated excess loading of the medial knee joint.

When assessing a patient, doctors of chiropractic will expand their examination to regions of the body outside of the area of chief complaint as it’s common for dysfunction in one body part to affect another. In this case, we can see that abnormal motion of the ankle can place added stress on the knee, potentially leading to knee replacement. For the patient to achieve an optimal outcome, such issues need to be addressed.

Chiropractic treatment for the KOA patient can include manual therapies to restore proper motion to the affected joints, specific exercises to strengthen weakened muscles, and nutritional recommendations to reduce inflammation. If ankle pronation is suspected to contribute to the patient’s knee condition, then an orthotic insert may also be necessary. As with many musculoskeletal conditions, it’s better to seek care sooner rather than later. The earlier treatment can be provided, the faster and more likely there will be a satisfactory outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Running and the Knees

9 Jan

Running is one of the most popular forms of exercise, largely because it can be done almost anywhere at any time and it doesn’t require much in the way of equipment (other than a pair of running shoes). While there is a common belief that running always leads to osteoarthritis (OA) of the knee, the current research suggests that running may reduce the risk for knee OA and it can also improve pain and disability in patients who have developed the condition. Here are four tips for reducing the risk of experiencing a running-related injury so that you can reap all the benefits this activity has to offer…

Tip #1: Practice good form. Avoid running like you’re on a tight rope or balance beam (crossover gait). Practice walking, and then slowly run while keeping your feet apart (about the width of your pelvis). A crossover gait is bad because it increases foot/ankle pronation (rolling in), knee valgus stress (knock-knee affect), hip internal rotation (turns in), hip adduction stress (pulls on the outer thigh and impinges the hip), and low back extension (too much arching)—ALL of which can lead to injury in multiple body regions, including the knees!

Tip #2: Wear the “right” shoes for your foot. Dip your foot in water and look at your footprint on the floor. If your foot looks wide, you have a flat, pronated foot and a “motion control” shoe (designed for the low or no arched foot) is recommended. Avoid stiff soled shoes as they reduce the ability to feel the ground, leading to new or further injuries. If your footprint looks skinny, a “cushioned” shoe designed for the high arched foot is ideal as it absorbs the shock caused by the lack of pronation. If your footprint is between skinny and wide, a “stability” or “neutral” shoe designed for the normal arched foot is ideal. If you’re not sure, consult with a representative at your local running store. Many businesses that cater to runners have equipment on site to help identify the best shoe for you. Also, remember to replace your shoes every 250 miles REGARDLESS of your foot and shoe type!

Tip #3: Avoid progressing too fast. The tendency is to want to get into shape NOW! This can lead to overtraining and places too much stress on the body, which can result in injury.  Practice the 10% rule. If you ran ten miles in total last week and you want to increase your total distance, try adding 10% to each run so you achieve a total of eleven miles this week.

Tip #4: Strengthen your legs and hips with these exercises: 1) Posterior lunge – Stand and reach back with your left leg while squatting down as if to touch your left knee to the floor while bending your right knee (arms out front for balance). Go as far down as you COMFORTABLY can, keeping the right knee behind your toes. Repeat on the other side. Go slow, start with a half or quarter lunge to avoid injury!  2) Advanced Clam – Lie on your side, raise the upper leg and rotate the hip in and out slowly. 3) Side Plank Leg Raise – Lie on your side, legs straight (advanced) or bent (easier), and raise the pelvis off the floor (elbow under the shoulder), then raise the upper leg toward the ceiling.

If you feel as though running is causing pain or worsening existing pain, then consult with your doctor of chiropractic. He or she can examine your body and mechanics and provide conservative treatment to help make sure your next run is as pain free as possible.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Knee Pain and Foot Problems

11 Jul

Patellofemoral pain (PFP) is commonly associated with running, jumping, squatting, and walking up/down stairs. It’s thought that PFP is caused by excessive rubbing between the back of the patella and groove, or track, that it rides in. Besides overuse, additional causes for PFP pain include muscle imbalance or weakness or direct trauma. The condition is most common in adolescents and young adults, usually due to overuse and/or misalignment, the latter of which is often referred to as poor “patellofemoral tracking.” This can eventually lead to arthritis, which is more commonly seen in older adults with PF pain.

Past research has demonstrated that issues in the foot can increase the risk for musculoskeletal pain in other parts of the body, including the knees. In a 2018 study, researchers examined the effect of knee-targeted exercise vs. a combined approach that included knee- and foot-focused exercise with foot orthotics (shoe inserts to correct pronation or the rolling inwards of the ankle and foot) in patients with patellofemoral pain.

Participants were instructed to perform terminal extension quad exercises that emphasized COMPLETE extension (straightening) of the knee. This exercise can be done sitting or lying on the back with a rolled-up towel behind the knees (with or without an ankle weight) and fully flexing the quad muscles for three to five seconds and repeating the process ten to twenty times, as tolerated.

The results revealed a significantly greater improvement in the group that included foot care, supporting the conclusion that better outcomes are achieved by combining foot exercise and foot orthotics with knee exercises. The authors reported that the benefits were still present four months after the conclusion of care but not a year, suggesting the importance of continuing exercise and foot orthotic use.

Doctors of chiropractic routinely perform posture assessments when examining patients with knee pain in order to identify dysfunction in the hip or feet that may contribute to their chief complaint.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Hip Exercises to Help Knee Pain – Seriously?

14 Jun

The hip and knee are anatomically very close to one another. Functionally, there are several muscles that attach above the hip and below the knee joint. Hence, depending on the position and/or activity, the same muscle can move the hip and/or the knee. This close relationship crosses over in dysfunction as well, as patients with knee pain move differently, and the hip joint is ultimately affected. But which one is the real culprit, the chicken (hip) or the egg (knee)?

In a quest to answer that question, one study asked patients with patellofemoral pain (PFP) and without hip pain to perform either knee exercises or hip exercises. Each group consisted of nine men and nine women. The knee exercise group performed quadricep or knee strengthening exercises while the hip exercise group engaged in hip strengthening exercises. The specific hip exercises included hip abduction (outward resistance) and hip external rotation muscle strengthening exercises. Both groups performed their exercises three times per week for a total of eight weeks. All participants experienced improvements in pain and function; however, the patients in the hip exercise group reported greater improvements than those in the knee exercise group. These results persisted for the next six months.

Why did hip exercises help patients with PFP knee pain MORE than knee-specific exercises? Weight-bearing dynamic imaging studies (x-rays) have shown that patients with PFP knee pain frequently have a lateral or outward displacement of the knee cap as well as lateral tilt due to femur/hip internal rotation (IR) rather than just abnormal patella motion due to muscle imbalance (the “old” theory).

Other recently published biomechanical studies have reported that persons with PFP demonstrate excessive internal rotation and adduction (inwards positioning) of the hip that isn’t generally observed in pain-free subjects. Further, those with PFP tend to have weak hip abductors, extensors, and external rotator muscles than pain-free individuals.

Chiropractic care focuses on whole body care, and patients are often surprised that doctors of chiropractic frequently treat hip, knee, ankle, and foot conditions. Posture and gait assessments, which may be included in an initial patent examination, frequently reveal abnormal movement patterns, leg length discrepancy, pelvic rotation, and lower lumbar spine dysfunction that may contribute to a patient’s chief complaint. Often, treatment must address these issues for the patient to achieve a successful outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

What Can Be Done for Kneecap Pain?

19 Apr

Patellofemoral (PF) pain (or pain in the area of the knee cap) is a very common problem, especially in women because they naturally have a wider pelvis. A wider pelvis can cause a “knock-knee” effect, which can be exacerbated by flat feet and ankle pronation (rolling in at the ankles). The net result is that outward pressure increases on the patella, which can be quite disabling and interfere with weight bearing activities. So, what can be done for individuals with patellofemoral pain?

Because we cannot change the width of the pelvis, the focus must shift to the foot/ankle and hip/knee muscle balance. A 2014 study set out to prove (or disprove) that exercises that target BOTH the hip and knee vs. the knee only would yield better long-term outcomes.

Here, researchers randomly assigned 31 women with PF pain to one of two treatment groups: Group A participated in BOTH hip & knee exercises for eight weeks and Group B engaged in ONLY knee exercises for eight weeks. Following the completion of each eight-week exercise program, the researchers examined each participant, followed by a re-examination three months later. The investigators found that patients in Group A experienced greater improvements with regards to pain and function.

The authors of the study concluded, “An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.”

The “take-home” message here is that patients obtain the best results when treatment—in this case, exercise—is applied to more than just the area of complaint. Chiropractic care includes assessment of the whole person, not just a localized area where the patient feels pain. Perhaps this is why chiropractic almost always scores highest in “patient satisfaction” surveys when compared with other healthcare delivery systems.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Knee Pain and Jumping Injuries

15 Jan

The term “jumper’s knee” was first coined in 1973 to describe an injury to the tendon that attaches the lower (most common) to the prominence (tibial tuberosity) on the proximal shin bone (tibia) or the upper pole of the knee cap or “patella” to the quadriceps femoris muscle.

Jumper’s knee is one of the more common tendinopathies that affect up to 20% of all adult athletes in sports with frequent jumping, typically among adolescent basketball and volleyball players. Individuals who are obese or who are bow-legged or knock-kneed or whose lower limbs are unequal in length have a higher risk for jumper’s knee. Poor jumping technique can also increase the risk for this condition as can cause overtraining, especially on hard surfaces.

The disease process for jumper’s knee can be divided into four stages: 1) pain only after activity without disability; 2) pain during and after without disability; 3) prolonged pain during and after which affects function; 4) complete tendon tear that requires surgical repair.

Treatment for jumper’s knee can include: 1) reducing jumping activity;  2) icing the knee for 15-30 minutes, four to six times a day, especially after the activity; 3) a thorough exam of the hip, knee, ankle, and foot to assess joint function; 4) stretching the hamstrings, calf, quadriceps, hip flexors, gluteal (buttocks), iliotibial band, and tissues around the knee cap; 5) strengthening exercises focused on specific parts of the quadriceps (vastus medialis oblique especially) and other leg muscles; 6) ultrasound and other therapies that may help speed recovery; and 7) taping to help patellar tracking.

Doctors of chiropractic are trained to evaluate and treat the whole person and frequently treat athletic injuries. A successful treatment outcome for jumper’s knee requires both local knee care and the management of the entire lower “kinetic chain” which includes the foot, ankle, knee, hip, and pelvis.