Studies find a decrease in knee pain by increasing hip flexor and glute max strength

Studies find a decrease in knee pain by increasing hip flexor and glute max strength 

by: Karen Gilbert-Tyssen 

Registered Physiotherapist

Many runners suffer from knee pain at some point in their running career. Knee injuries can be difficult to settle down and are often accompanied by swelling, weakness, and altered running form. For runners this can be a huge problem and mean the end of their racing season. Many Runners are told their knee pain is arthritis and their options are limited, including medication, surgery, bracing or use of a cane. An end to their running career at this point seems inevitable and we begin to catastrophise. Will we ever run again?!!! For a runner these option are unacceptable and they often continue to run with pain, only making the problem worse.

Fear not my running friends! There is great news for knee pain sufferers in the world of science! A research study published in the July 2013 Journal of Orthopaedic & Sport Physical Therapy is reporting that increasing strength of the hip flexor muscles (specifically the Tensor Fascia Latae), the IT band, and the gluteus maximus has been shown to decrease load on the inside of the knee joint by transfering load to the outside knee joint. The theory behind unloading is that this will slow disease progression of medial joint line Osteoarthritis sufferers, decrease pain, and improve function. The study was done using knee cadavers hooked up to a robotic testing system where load of the inside and outside joint surface was measured with 0N, 50N and 100N of Force applied to the ITB in 0-30 degrees of knee bend. J Ortho Sport Phys Ther 2013;43(7);478-485. Epub 18 March 2012. 

This graph depicts the decreasing load in the medial (inside) joint line of the knee as the amount of load on the ITB increases. 

So what's the lesson here? Strengthen those hips and glutes! Runners are notorious for weakness in both these areas! Helpful exercises include bridges, theraband hip flexion (forward), abduction (sideways), and extension (backward) exercises. 

Of course we all hope to never get to this point in our season...so why not decrease the load before deterioration begins. As always, prevention is key!

The best course of action if you are having knee pain is to seek medical advice from a regulated health care practitioner like a physiotherapist. 

As always i can be reached at my clinic at 519-858-2931 for assessment including regular injury treatment, acupuncture, or running gait assessment.

Thanks for reading!

-Karen

running form

A great visual breakdown of good running form!

Run on.

So it has been over a month since starting at my new location at Body Mechanics on Waterloo street in the YMCA. Things here are going great, loving the new location, the access to the gym and working with great co-workers and mentors! My case load is building up nicely and I am loving seeing and treating lots of runners! I am doing Functional Movement Screens as well as gait assessments and regular treatments including cupping, acupuncture and manual therapy.

Running had been a bit of a challenge for me over the past 2 months however. I have taken a step back in terms of training to help with the issues I have been having with my heel since national cross country championships in November and my marathon build up in October. I was running higher mileage and did an extra month of training and suffered from plantar fasciitis, which settled down quickly with some treatment on one side, and then flared up on the other side, without the same response to treatment. I have backed off a few times in training since then for both short and extended periods of time without really being able to get it pain free. Now the plantar fasciitis has settled but I am super stiff in the ankle and heel joint and have to do frequent treatment on it to loosen it up. Things have been better over the last few weeks and I am building back up in mileage and hoping to focus on the fall and winter for some quality racing.

I have been so inspired by all the racing over the last few months, including some great racing in London and Moncton by fellow London Runners Leslie Sexton, Aaron Hendrikx, and Ben Proctor, and Road racing by Lanni Marchant, Krista DuChene, and Natasha Fraser (on the track and the road), and Rob Watson. It is so great to see runners pushing the barriers and continuing to improve post collegiately as well as while in University.

With all the summer training programs winding into full swing I am looking forward to getting out and doing some injury prevention talks for some of the running groups around london, and would urge anyone interested to contact me either on facebook, or by email.

I am hoping to see most of you out on the trails as I ramp back up my mileage and get back into racing shape!

Until then, Happy Running!
-Karen

New beginnings

So i am finally done my exam and back to days without studying all night! And I have some exciting news to share! I have been offered a position working at Body Mechanics Physiotherapy and will be starting may 13th. I will be at the location on Waterloo street 3 days per week, and will be doing some hours on tuesday, thursday at the Bob Hayward and Sunningdale YMCA locations!

I am very excited to be returning to this fantastic company after a few years, made of very talented therapists and incredible mentors.

To book an appointment call 519-858-2931 or come on in to check it out at 382 Waterloo street.

Exercises every runner should do

It has been a few weeks since my last blog post as I have busy studying for my intermediate exam (an advanced certification in physiotherapy that leads you more than half way to becoming a Fellow of the Canadian Academy of Physiotherapists of Ontario). I have been continuing to increase my running mileage after a set back I had in November after my build up to running the Scotiabank marathon in October and then the Canadian Cross Country Championships in late November. I had my first week back up to more than 80km which felt great and I am excited to be back racing tomorrow at the Downtown 5km London Honda Race series. I will be running for London Runner Distance Club a distance club I joined after completing the Boston Marathon last April.

Okay well enough about me back to the exercises!

In my physiotherapy practice I treat a large number of runners who typically suffer from conditions including 1. Runners knee 2. Iliotibial pain syndrome 3. Plantar fasciitis 4. Shin splints and 5. Achilles Tendinopathy. Typically injuries are caused by either excessive load (like speed work), or repetition (caused by excessive mileage) or a range of motion injury (like pulling a muscle).

Despite the specific diagnosis the majority of runners I assess share common weaknesses including
Weak glute (bum) muscles, weak core muscles, and tight over- active hamstrings. So to head off these common weaknesses before they can lead to some of the common injuries suffered by runners i recommend several exercises be performed daily.
1. Clam shells: this exercise strengthens the glutes and is performed by laying on your side, hips and feet stacked one on top of the other. Without letting your top hip roll back slowly lift the knee in the top leg toward the celing while still keeping your feet together , only lifting the knee as high as you can before your hip starts to move, then slowly lower it can down keeping the mivement slow and controlled. You should feel this work the back and side part of your bum. I would suggest performing 3 sets of 10-15 repetitions.

2. Bridges: this exercise helps strengthen the bum musle that helps with push off during your run or "gait" cycle. It is performed by laying on your back, tilting your pelvis back as if to flatten your back and then slowly lifting your hips towards the ceiling by using the muscles in your bum (glute max) and the backs of the legs (hamstrings). Try to keep your hips level as you push up and slowly lower down. Reps should be 3x 10-15. Arms can be kept at your side or crossed over your chest.

3. 4-point leg and opposite arm extension. This works on your core, and the posterior "slings". In a table top position with your arms under your shoulders and your knees under your hips, contract your inner core unit, keeping your hips level, slowly slide your knee straight behind you and lift your opposite arm in front (while keeping it in line with your ear). Slowly and in a controlled manner lower your arm and leg back down and switch arm and legs. Ensure your are not letting your hips drop or hike or your back arch. Perform 10-12 reps per side 2-3 sets.

I will try to post some pictures to help get you started. Performing these daily will help ward off injury and keep you running fast and efficient!

- Karen

Post-Run Recovery Modalities

If you are trying to find ways to stay injury- free during the training season here are a few great ways to do just that!
1. Foam roller work- rolling out tight muscles pre and/or post run is an excellent way to perform self massage between boughts of training. Foam rolling muscles such as the quads, hamstrings, calves, IT bands and shin muscles for a total of 5-10 minutes a day helps decrease muscle tone and break down  scar tissue within or between layers of muscle tissue.

2. Active isolated stretching (AI)- this should be performed 1 to 4 times daily for a total of 15-20 minutes. AI can be used in conjunction with foam rollering to reduce tone and tension in tight lower limb muscle and muscle around the hips. The key for AI is to actively contract the opposing muscle group to one you are looking to lengthen while you move the muscle tissue actively through its available range of motion. AI should be performed x 10 repetitions with a 2 secound hold for each muscle and done on both right and left sides.

3. The Stick: The stick (which is similar to a rolling pin) can be used to roll over tight and sore muscles and can be performed for 5 minutes or more daily.

3. Ice Bath: According to an article in Sweat Science and the British Journal of Sports Medicine, standing or kneeling in a bath or bucket of 14 degrees celcius cold water for 5-15 minutes has been found to reduce inflammation and soreness between training bouts. It is recommended ice baths be performed during the racing season only, and avoided during the training phase to optimize on the benefits of training during the build up to racing season.

4. Ice. An ice pack can be used to reduce pain, swelling and muscle soreness. Icing should be performed for 10 minutes on and 10 minutes off. Ice should never be placed directly on the skin. Try soaking a wash cloth and place it between the ice and the skin to improve conductivity of cold to the tissue.

5. Heat. Heat can be used to reduce tension and muscle spasm and is recommended 48 hours or more post injury for 10-15 minutes.

6. Pool Running- running in a deep pool with or without a foam running belt to maintain fitness and reduce load on the legs between  training sessions is a great way to get to the end of a season injury free! Try to keep your body upright and maintain your form to best simulate the demands placed on the body during running.

Active Isolated Stretching

Jim and Phil Wharton are a father and son duo who pioneered and finely tuned "kinesiotherapy" into what is now known as "Active-Isolated Stretching".  Active-Isolated Stretching (or AI) was initially created out of necessity- when the potentially career ending diagnosis of scoliosis was given to Phil, a competitive long-distance runner. As Phil transitioned from high school to the collegiate level he increased his weekly mileage to over 90 miles per week, ultimately leading to numerous injuries and the recommendation for surgical intervention to reverse his scoliosis. Jim (an exercise physiologist) and  his son Phil stumbled upon "Kinesiotherapy" and over time, adapted it to create AI, a form of dynamic stretching that uses muscles natural reflex loops to create maximal relaxation of the tight tissue. This works by using what is called "reciprocal inhibition" of the muscle. Because your body can't straighten and bend your knee at the same time, when you tell your body to straighten your knee and contract your front thigh muscle (or Quadricep), your brain sends a message back down to the muscle on the back of the thigh (your Hamstring) to turn off , or "inhibit" so the movement can occur. By taping into this feedback loop, active isolated stretching can create length in the goal tissue without any resistance from the muscle that is originally tight. The AI system helped Phil get back to the sport he loves and now Jim and Phil teach the AI system to elites and novices around the world.

AI states that 10 repetitions with 2 secound holds performed one to four times daily is recommended to significantly increased mobility in restricted muscle tissue, thereby increasing mobility, flexibility, and performance.

I have recently begun using the AI system daily as well as teaching it to my patients and fellow runners with great success. I have attached a link to the Wharton health website and would highly recommend you take a look and give it a try!

http://www.whartonhealth.com/portfolio/nike-boulder-running-camp