Knee pain

The Number 1 Risk Factor For Developing Knee Arthritis

A new study has shown there is likely to be a 276 per cent rise in knee replacement procedures from 2013 to 2030 (based on data from Australia's joint replacement registry).

Pretty staggering ! 😱

The biggest risk factor for knee arthritis leading to a total knee replacement is being overweight, which overtime stresses the knee joints (70% of Aussies are overweight).

This article talks about your options, especially if you want to avoid surgery.

Main points πŸ’₯

βœ… Gradually increase your activity levels and incorporate targeted strengthening exercises to build the muscles around the knees.

βœ… This can make them stronger, help to maintain appropriate co-ordination and reduce pain.

βœ… Don't be fearful of exercise and movement, even if you do feel some pain. Pain doesn't equal damage.

βœ… Running πŸ’―% does not cause knee arthritis. On the contrary, runners have less chance of developing arthritis because they generally not overweight.

βœ… Consult with your GP and Physiotherapist who can develop a customised plan to get you moving well again.

βœ… Individual movement assessment can help you identify your weak links and help get you on the fast track.

βœ… For more info about how Physio can help with your knee pain and get you moving well again πŸ‘‡

http://www.kinfolkwellness.com.au/knee-pain-adelaide

Get To Know Your Muscles - TFL (Tensor Fasciae Latae)

Author: Daniel O'Grady is a Physiotherapist in Adelaide, Australia.

Most people know about their ITB (Ilio Tibial Band)  that runs on the outside of the thigh; but not as many are familiar with the strip of muscle that joins the upper part of the ITB to the pelvis. 

This small muscle is known as the TFL (Tensor Fasica Latae). 

If you’ve ever had problems with your knee, hip, lower back, calf or achilles, chances are you have some unresolved tightness in your TFL.

 

QUICK ANATOMY REVIEW:

As you can see in the picture, the ITB has upper attachments to both the gluteals and the TFL.  Any dysfucntion/weakness in the glutes means that the TFL needs to work proportionally harder.  Gluteal inhibition is common - especially if you spend a lot of time sitting.

 

PALPATE THE TFL ON YOURSELF:

To feel the TFL, place your finger on your front of your pelvic bone.  Slowly move down and to the outside of the thigh until you feel a ropey muscle that is the the width a finger.  It may be tender to touch.

 

FUNCTION:

The TFL is a hip flexor, abductor and internal rotator.  It works in conjunction with the gluteus medius and gluteus maximus to stabilise the leg during the stance phase of walking and running.  The TFL anteriorly rotates your pelvis.  Functionally, the TFL is part of the Lateral Line and the Spiral line, according to Thomas Myers in his book Anatomy Trains.

The Lateral Line

The Lateral Line

The Spiral Line

The Spiral Line

 

SYMPTOMS:

Overload of the TFL can lead to pain and tightness in the front of the hip.  Very common is also pain and tightness in the outer part of the knee and into the ITB.  This is most noticeable when walking or up and down stairs/hills. 

Other symptoms:

  • knee and hip pain (especially outside)

  • the lower back and SIJ

  • upper back

  • calf and achilles

As the TFL pulls the head of the femur bone forwards, chronic increased tone is one of the prime causes of hip osteoarthritis and degeneration. 

HOW THE TFL BECOMES OVERLOADED:

The TFL becomes overloaded with repeated use in the following situations:

  • excessive sitting, driving, kicking

  • walking and running (especially uphill and downhill)

  • cycling, swimming, kayak/canoe

  • meditating crossed legged in lotus position

  • sleeping in the fetal position

  • standing with a swayed back and wearing high heels too often

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your TFL issue.

Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building gluteal and core strength is critical to prevent a relapse.

 

TRIGGER POINT DRY NEEDLING:

Tightness and shortening of the TFL responds well to dry needling, which can de-activate the trigger points (knots in the muscle) that can form in chronic cases.  The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms.  Dry needling is certainly an unusual feeling, but definitely beats 15 minutes of deep painful massage in that area.

 

SELF-CARE TIPS:

  • apply heat to the front of your hip 10 minutes each day

  • avoid sitting cross legged

  • avoid walking and jogging uphills and on sloped surfaces in the short-term

  • ensure your shoes are not overly worn

  • sleep on stomach or side with pillow between knees

  • when running - avoid over-striding and endure proper warm up and cool down

  • use cruise control on long car trips to stretch the legs

 

GRADED EXERCISE PROGRAM TO ADDRESS TFL OVERLOAD:

PART 1 STRETCHES:

FOAM ROLLER ITB  Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER ITB

Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER QUADS  Go harder along the quads. Keep breathing!

FOAM ROLLER QUADS

Go harder along the quads. Keep breathing!

HIP FLEXOR STRETCH  Feel the stretch in the front of your hip as you tuck the pelvis under gently

HIP FLEXOR STRETCH

Feel the stretch in the front of your hip as you tuck the pelvis under gently

FOAM ROLLER TFL  Angle your body across the TFL and roll it with medium to light pressure

FOAM ROLLER TFL

Angle your body across the TFL and roll it with medium to light pressure

PRONE EXTENSION COBRA DECOMPRESSION  Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PRONE EXTENSION COBRA DECOMPRESSION

Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PART 2 STRENGTHENING:

The goal is to strengthen and support the muscles around the TFL

BRIDGE  Feel a stretch in the front of your hips while your glutes activate in the back of the hips

BRIDGE

Feel a stretch in the front of your hips while your glutes activate in the back of the hips

CLAM SHELL  Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

CLAM SHELL

Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

SINGLE-LEG BRIDGE  Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

SINGLE-LEG BRIDGE

Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

PUSH-UP TO SIDE-PLANK  Activate the obliques as you twist into side plank. Try x3 on each side.

PUSH-UP TO SIDE-PLANK

Activate the obliques as you twist into side plank. Try x3 on each side.

PLANK  Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

PLANK

Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

 

PART 3: POSTURE / NEW MOVEMENT PATTERNS

For many people, the TFL becomes the muscle that is always switched on and over-active.

Try these movements, focusing on keeping your core and gluteals engaged.
STANDING PELVIC-TILTS  Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING PELVIC-TILTS

Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING HAMSTRING CURLS  Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

STANDING HAMSTRING CURLS

Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

REVERSE LUNGE  Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

REVERSE LUNGE

Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

SIT TO STAND SQUATS  Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

SIT TO STAND SQUATS

Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10