Knee pain

July 29, 2011

A quick review: the thigh bone is connected to the hip bone.

It is not uncommon for runners, especially those that have not run before, to experience knee pain. There are a few things that can cause pain in the knee. To offer a disclaimer, I am not diagnosing you and cannot do as well at evaluating your pain as your personal orthopedic.

One cause is related to the main topic that I am going to address. Iliotibial band tightness and friction. The band on the outside of your thigh can become irritated where it runs over a bony projection at the knee. There are a variety of reasons even for this (some we will cover), but that is a topic for another day.

The most popular knee pain is what is known as patellofemoral pain. Often associated with runners. Here are a few of the causes: iliotibial band tightness, calf muscle tightness, irregular boney alignment, quadriceps weakness/tightness, and more commonly hip weakness/tightness.

Hip weakness is difficult to understand without knowing the anatomy of the hip and knee. Bottom line: As you land on the leg your body weight is supported by that leg (hip, knee, and ankle). If there is weakness along that leg then the weight is not supported properly. When the hip is weak the thigh bone (femur) will rotate over a fixed shin bone (tibia). The knee cap (patella) isn’t going anywhere. It is in the tendon at your knee and so when the femur rotates it runs into the back of the patella.

Why is this important? The femur has a groove which the patella rides in. Think of a boat in a canal. In our example the boat isn’t moving, but the canal is. The bottom of the boat is very sensitive. When the canal runs into the boat it is painful. Now do that over 1, 2, 3, or 5 miles. That’s a lot of damage to the boat.

To fix this it is necessary to strengthen the hip. Several exercises that I like are below:

Sidelying hip abduction: Lay on your side and slightly extend your hip, keeping your knee straight. Lift your leg up and hold. Slowly lower back to the floor.

Quadraped hip abduction: On hands and knees, raise leg out to the side and hold. Slowly lower back to the ground.

Band walking: With a resistance band tied in a loop so that it fits around both ankles, walk sideways down a hallway. Step with lead foot and then control (slowly) step with the trail leg. Walk the length of the hallway and then walk back.

Balance rotation: Tie a resistance band to something securely about 3-4 feet from ground. Stand sideways grasping the band with both hands so that there is no slack in the band. Stand on the leg that is closest to where the band is tied. Rotate only the trunk without rotating the unsupported leg. You are only rotating from the hips up. Control the movement back to where you started.

This is a starting point for exercises and is by no means exhaustive. If you are having knee pain, take a break and get the pain under control. Use these exercises and then gradually resume running. Remember, don’t try to start out with a long run. Begin short and slowly work up. Continue using the exercises to strengthen your hips.

Last point to be made: Your hips can never be too strong. And no one has strong enough hips.


One Response to “Knee pain”

  1. Carey Says:

    Very helpful! I never thought about my hips affecting my knees, but now that you mention it, they get kind of achey too. Thanks!

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