Knees and pelvises - what to do about them
In my last post, I explained how having a stiff and unyielding pelvis can be a real pain in the knee. But it's not fair to leave you hanging, so here's the solution.
The first step is to release the tightness in the low back and pelvis joints. To do that, you need to release the surrounding muscle spasm and then stretch out the muscles and ligaments that are holding the joints so stiffly. This will help to flush out the joints, encouraging the synovial fluid inside them to become more liquid and less viscous, allowing more nutrients in and more waste products out.
At Victory, I release the low back and pelvis joints using my feet, in line with the Sarah Key Method. This is quick, effective and quite gentle, and it gives a "kick-start" to the exercises, which allow you to maintain and improve on the changes we achieve in the treatment session. However, in many cases it is also possible to make significant gains with just the exercises.
Therefore, for home treatment, the two exercises I really recommend to release the low back and pelvis are the appeasing exercise and a variation on the back block exercise. Alternate them, doing three sets of each exercise for 30 seconds each, 2-3 times per day, and your pelvis should soon start to free up.
The variation on the back block exercise is that instead of placing the block horizontally under your pelvis, this time I'd like you to place it vertically - so that it points down towards your feet. The upper end should still be under your pelvis though, not under your low back. Then, once you've lowered your bottom onto the block, instead of sliding your feet away from you, just drop your knees apart, something like this picture from the Egoscue website. If your adductors (inner thigh muscles) are tight, you may well feel a stretch there; if they're loose, you'll feel a stretch at the back of your pelvis as the "wings" stretch apart. Hold the position for 30 seconds before drawing your knees back together, removing the block from under your pelvis, and resuming the appeasing exercise.
The second step is to stretch your hamstrings, with particular emphasis on the distal (knee) end. Traditional hamstring stretches, where you bend forward with knees straight, focus on the proximal (hip) end of the muscle; but people with knee pain tend to be tighter near the knee.
To emphasise the distal end of the hamstring, you need to start with your hip fully flexed, and then gradually extend the knee. So, as demonstrated here by the lovely Graeme, stand in front of a chair (preferably one without wheels!) and place one foot on the seat. Bend forward at the torso and get your chest right onto your thigh. Hug your thigh tightly with both arms, so that your chest stays attached to it throughout the stretch.
Gradually lean your bodyweight backwards so that your raised knee starts to straighten out. Go as far as you can, until you feel as though your chest wants to lift, then hold the position for 10 seconds. Release slightly and then lean back into the stretch for a further 2 x 10 seconds, then repeat with the other leg.
Another really useful treatment is massage. You may well find that you have tight, sore trigger points in your buttocks, hamstrings, adductors and/or iliotibial bands (fascia that covers the outer thighs). Stretching can be significantly aided by massage to get rid of these small localised areas of muscle spasm. You can either get someone to help you with this (if your helper is not a trained therapist, ask them to start gently and work their way in: kinder and more effective than an aggressive pounding!) or you can self-treat using a foam roller. I really like this comprehensive YouTube video from Alex Poole that shows some effective foam roller techniques.
If you would like to get rid of your knee pain (whether due to the pelvis or not!) please e-mail me to arrange a session and see how I can help you.
Rewards for Forces
An interesting conversation on Twitter the other day led me to contact Peter Raith at Rewards for Forces, a benefit website for serving and veteran members of the Armed Forces.
As you know, I used to be a Physiotherapy Officer in the Army. It was a period of my life that I really enjoyed, and I'd recommend it to any young physiotherapist with a strong interest in sports and training injuries, as they offer superb opportunities for both in-house and external training with unrivalled access to physically fit and motivated patients to practise on!
Although I've obviously now left the Army and moved into private practice, I still have strong links with the military. Many of my friends are still serving, and as I blogged recently, I'm still involved in getting the Mobiliser into standard usage in military physiotherapy departments. As this post goes to press, I'm even in Aldershot myself, partnering former Papua New Guinea international Lawrence Tere in the mixed doubles section of the Army Tennis Championships! Perhaps, to bastardise a common phrase, "you can take the girl out of the Army..." etc.
At any rate, I'm still very sympathetic to the needs of the military patient - and conscious that nobody joins the Forces to earn a mint. And as far as I'm aware, there aren't any physiotherapists working with the Armed Forces who practice the Sarah Key Method, which I believe is one of the most effective and patient-centred systems available. So I'm delighted to announce that I'm now able to offer a discount to self-funding serving and veteran members of the Armed Forces of 20% off all physiotherapy assessment and treatment sessions. All you have to do is to sign up to the scheme and present your Rewards for Forces card at your first session.
Membership of the Rewards for Forces scheme costs £12 per year, and at current Victory prices, our discount will give you £30 off your assessment and £20 off each subsequent treatment session... surely a no brainer?
I look forward to seeing you; please e-mail me to arrange a session.
Congratulations to Lillie and James
My gorgeous sister Lillie is getting married today, to her fiance James, in the tiny church in the village of Kettlebaston. It's the smallest church I've ever seen: I doubt you could fit two abreast down the aisle, and cramming 100 guests inside will be one heck of a squeeze. Perhaps that's why Lillie and James' is only the third wedding there that the vicar can remember in the last fifteen years!
My bridesmaid dress is sorted, and I have a slinkier number for the evening - when I fully intend to dance the night away to the smooth vocals provided by Black Hat.
I *think* it's going to be a lovely occasion for friends but even more for family. Our grandmother, the fabulous potter Janet Allan, is growing confetti in her back garden. Our aunt and uncle, Lis and Steve Henderson, have offered to host a "first day" lunch at their lovely home at Landermere - where various other members of our family intend to set up camp for the weekend! Lillie and James: congratulations - and, James: welcome to the family!
xxx
Blog for Victory
Hi, I'm Nell Mead. I'm a former Army physiotherapist and I specialise in sports medicine and back pain. This is my blog, where I write about issues that are on my mind. Some of these are about issues that are specific to particular injuries or medical conditions but I will also be updating you on events occurring inside Victory and in the wider world of medical rehabilitation. I also publish guest posts by Victory's other therapists whenever I can persuade them to sit still for long enough to write something!
When we're not writing, we're offering appointments at The Foundry in Liverpool Street. We'd love to see your comments on our posts - and we'd love to meet you even more, so do pop by and meet the team.