Knees and pelvises - what to do about them

Posted by Nell Mead at 15:13 on 14 Jul 2011

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.

Dem bones, dem bones... Knees and pelvises

Posted by Nell Mead at 14:00 on 20 Jun 2011

Dem bones, dem bones, dem dry bones

Dem bones, dem bones, dem dry bones

Dem bones, dem bones, dem dry bones

Hear the word of the Lord

Toe bone connected to your foot bone

Foot bone connected to your ankle bone

Ankle bone connected to your leg bone

Leg bone connected to your knee bone...

OK... you've probably heard a verson of James Weldon Johnson's spiritual somewhere before, and while it's not technically accurate in its anatomy, the concept (that everything in the body is linked and works together, rather than a body being a collection of separate joints) is one I reference a lot.

Today I'm going to talk about the link between knee pain and your pelvis - or, as JWJ might have put it, your knee bone's connected to your back bone.

The large muscles of the thigh - quadriceps at the front, and hamstrings at the back - are biarthroidal muscles.  This means they cover two joints, the hip and the knee.  The quadriceps work to flex (bend forward) the hip and extend (straighten) the knee.  The agonist (opposing) hamstrings work to extend the hip and flex the knee.  Both groups of muscles attach to the pelvis at the top, and to the shin (tibia and fibula) at the bottom.

When you walk, and more violently when you run, your quadriceps pull to swing your leg forward, as your hamstrings pay out at a controlled rate to prevent you from hyperextending and jarring your knee, facilitated by a slight backward rotation of the sacroiliac joint in your pelvis.  As your foot lands, both the quadriceps and the hamstrings contract to control your landing, and then the hamstrings begin to pull to provide the power to propel you forward over your landing foot.

So far, so good.  Everything is working normally; and normal functioning of joints with no structural deficits will cause no pain.  But what happens when there is a glitch somewhere in the system?

The sacroiliac joint of the pelvis (between the sacrum at the base of the spine and the iliac "wings" of the pelvis) is a pretty common source of problems.  There are many reasons why the sacroiliac joint can stop functioning properly - ranging from an impact injury such as a car crash or a fall, to a general poor posture which involves staying too still and not using the joint enough - but the effect generally is that it stops rotating effectively.  When this happens, it impacts on the hamstring's ability to pay out in the swinging leg, and the joint's ability to absorb shock when the foot lands.

When the hamstring doesn't pay out effectively, your body will respond by altering your gait so that it doesn't have to.  You'll take ever-shorter strides and your running gait will alter from a smooth glide forward to a jerky bob-up-and-down movement, which requires more shock absorption from the sacroiliac joints... and thus the cycle is perpetuated.  And if the sacroiliac joints can't absorb shock properly - well, the shock of impact has to be absorbed somewhere, and the knee (particularly the patellofemoral or kneecap joint) is often the victim.  In my experience, this is a very common cause of knee pain, especially in runners.

What can you do to break the cycle?  You need to reverse it: get your pelvis moving, and your hamstrings flexible.  I'll explain how in my next post, so watch this space!

If you are struggling with knee pain when you run, it may well be linked to a dysfunction at your pelvis.  Please contact me for assessment and treatment.