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Author Topic: the hip-knee connection?  (Read 2116 times)

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Offline lodger

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the hip-knee connection?
« on: December 22, 2005, 05:27:38 PM »
I have PFP syndrome for the last 6 weeks, and have seen physio twice, and a podiatrist. The physio gave me exercises, which I've done twice daily. The podiatrist recommended special trainers, and orthotics - and I am wearing both. My knees have slowly been getting better. However I seem to be hovering over the same point - and not really progressing any more.

Something happened last night (not much point recounting it) which has made me wonder whether my hips might be contributing to these knee problems? Obviously this is something to mention to my physio, but I'm wondering what other people's feelings are re knees and hips? Oh, I am female, 39, don't have arthritis or anything like that, and was quite active.

I'm interested to hear what people think.

Offline KarenS

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Re: the hip-knee connection?
« Reply #1 on: December 22, 2005, 05:40:10 PM »
Oh, your hips can DEFINITELY throw your knees off. I don't know how to explain it in clinical terminology, but my PT has explained it to me because I have very weak hips and they are contributing to (if not the main cause) of the problems I'm having in my knees now. Hip weakness can throw off your entire leg and cause several different problems (as can back issues, foot issues, etc., etc.). Has the therapist given you a thorough exam, including watching you walk and evaluating your hip strength?

I also had reached a sort of plateau in my recovery a few months back where I felt about 95% better but still not quite right, and then started regressing quite a bit when I added too much activity at once, and my therapist feels strongly that it's because I wasn't doing anything to strengthen my hips (as well as my quads) to take the unnecessary load off my knees.
« Last Edit: December 22, 2005, 05:43:13 PM by KarenS »

Offline daisygirl2

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Re: the hip-knee connection?
« Reply #2 on: December 22, 2005, 07:12:28 PM »
ohh without a doubt! I was born with bilateral hip dysplesia and since my hips are still a "little out" its totally messed up my knees. My 2 bones (femure and tibia) go in different directions! since the Hip forces the femur to rotate in but my tibias rotate outward a little. I was told by my OS that the tibia is so slight it isn't much of an issue but the femur is looking to be bad. I went through 2 rounds of PT, taping, cortizone and orthotics (make my feet feel good but nothing else) and multile knee surgeries when my 5th knee OS told me to get the hips looked at. I am seeing hte Hip OS next month to find out what is going on.

My PT knew that the problem was coming from my hips so she gave me exercies that help both the knee and the hips. Swimming helped my hips get stronger and I also did some PT exercises in the water. My hips are stong I can balance on one leg but the pain is worse because my issue is not muscle related...

Offline lodger

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Re: the hip-knee connection?
« Reply #3 on: December 22, 2005, 08:56:10 PM »
Well, this is very helpful, thank you.

I am reluctant to spend more money to see physio again (and it'd be another 3 weeks before the clinic is open)... and I'd like to start now. If I search for hip exercises on the web could you give me an idea of what type of hip exercises I should look for? Are we looking for stability, or strength or fine movements? Are there specific muscles/muscle groups that I should focus on, avoid? Your thoughts please!

Offline Boydy

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Re: the hip-knee connection?
« Reply #4 on: December 22, 2005, 09:22:11 PM »
I second that request, I haven't heard of anything related to hip exercises, (just always concerntrating on quads and hamstrings), so I will be very interested in learning what to do to improve or work on those hips. (At this stage I am willing to try anything for further improvement, something that might just be that' missing link' in the recovery process !  ;)
Boydy
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Gosh I sure hope so !!

Offline blackbeltgirl

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Re: the hip-knee connection?
« Reply #5 on: December 22, 2005, 09:26:35 PM »
a lot of exercise syou do for your knee also help the hip.  Working the adductors and abductors.  The gluts.  The hamstrongs.  All those muscles connect the knee and the hip.  I do a variety of leg lifts - the standard 4 way SLRs for my knee.  But then I lay on my side, and do 3 different leg lifts that work the hip flexors and gluts more.  One is with the top leg just ahead of the bottom leg, foot turned down slightly, lift the leg all the way up.  One I set the top leg as close as I can get to 90 degrees straight in front of me, and lift until it's perpindicular to the ground.  One the top leg is just behind the bottom leg, foot turned to the floor, lift as high as you can go.  I've had a tight ITB lately, and I find when I keep the hip flexors strong the hip ITB doesn't bother me and the hip feels better.  But when the ITB is tight I feel it at both ends.

As a general rule, you shouldn't start new exercises without consulting a professional.  Some of the hip exercises may make your knee angry, and the goal is to feel better all around, not trade the pain from one joint to another.

Good luck.
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Offline lodger

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Re: the hip-knee connection?
« Reply #6 on: December 22, 2005, 09:34:38 PM »
Thanks BBG. I feel drawn towards the leg lifts, and I have a little collection of 3 exercises (one sounds like one of yours) which I could do. You answer is exactly what I was after - you are suggesting that it is for general strength/mobility - rather than targeting specific muscles. That gives me a lot to be getting started with.

Offline KarenS

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Re: the hip-knee connection?
« Reply #7 on: December 22, 2005, 09:35:35 PM »
This link has a good example of "the hike," which works the gluteus medius (as well as a good explanation of what the muscle does, and what happens when it's not strong): http://www.bodyresults.com/E2gluteusMedius.asp (Ignore the other exercises they show because they aren't what's recommended for people just starting out with hip exercises, particularly those who have knee issues!)

You can also do side leg raises. Lie on the floor on your side with bottom leg bent a bit. Flex toes up and raise top leg up, but not very high (hard to describe -- maybe about 45 degrees?). Hold for a second and lower. Do 2 sets of 10 to start (or if you're very sensitive to new exercise like me, 1 set of 5 to start!).

You can also do standing leg lifts. Turn your side to a table or counter and hold it. Flex toes up and raise leg to side, but not high (again, hard to explain). Do 2 sets of 10 to start.


Offline KarenS

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Re: the hip-knee connection?
« Reply #8 on: December 22, 2005, 09:37:27 PM »
And I just want to second what blackbeltgirl said about consulting a professional first. I've developed a new pain on the medial side of each knee, and the only hip exercise I seem to be able to tolerate at the moment is the hip hike. :(

Offline lodger

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Re: the hip-knee connection?
« Reply #9 on: December 22, 2005, 10:38:43 PM »
Karen - I've developed a medial knee pain too. It seems to be ITB, but possibly not. And yes, I will see the physio in 3 weeks - I think you and BBG are right. The hip hike looks good. Thanks for that one.

Offline KarenS

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Re: the hip-knee connection?
« Reply #10 on: December 22, 2005, 11:43:34 PM »
Is it really medial (inside)? ITB causes pain on the lateral side (outside) of the knee, and it often is felt in the outer thigh area, right up to the hip.

Offline trekker05

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Re: the hip-knee connection?
« Reply #11 on: December 23, 2005, 12:00:35 AM »
Lodger, I second the majority of what has already been said!  I also agree that it is important for a professional to give you an overall body assessment, or what is also known as a kinetic chain assessment.  Unfortunately there seem to be a lot of 'professionals' out there who don't seem to know or care to do this!  You can do a search on the site of hip issues, or you can check out some of my previous posts on this connection, and the exercises you may eventually have to do to correct the problem.  Heather M. can also probably direct you to some good articles on the issue.  You should know that the current research has shown that hip and core issues are extremely important in whether the knee functions properly or not, and in women may be the DOMINANT factor leading to problems with the knee.  If your therapist is unfamiliar with this link, I suggest you look for another one.

A tight IT band may refer pain to the medial side of the knee due to its ability to pull the patella laterally.  The most common reasons for this IT band dysfunction, other than overtraining (this is a common problem in runners) is dysfunction and/or weakness in the Glutes.

Offline lodger

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Re: the hip-knee connection?
« Reply #12 on: December 23, 2005, 12:23:38 AM »
Trekker05: "check out some of my previous posts on this connection, and the exercises you may eventually have to do to correct the problem"

I'd like to do that. Can you point me to the significant threads?

I'm taking your advice re kinetic chain assessment. I think my physio is pretty good - she works at the university's sport's injury clinic. But I'll check that she will do this assessment before I make another appointment.

Offline trekker05

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Re: the hip-knee connection?
« Reply #13 on: December 23, 2005, 01:14:27 AM »
You can click on my handle and it will bring up a page with a link to most recent posts by me; the ones you need are kind of scattered, but check you the 'Opinion needed re 13 year old..'.  Also, check out the section on "The Patello-femoral joint."  You can also do key work searches-a good one would be 'femoral anteversion' or, a little less specifically, 'maltracking'.

Offline KarenS

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Re: the hip-knee connection?
« Reply #14 on: December 23, 2005, 03:33:53 AM »
Quote
A tight IT band may refer pain to the medial side of the knee due to its ability to pull the patella laterally.

Thank you!!! This is what I've been thinking, logically, is happening with me! Whenever I do the ITB stretches, I would get this pain on the medial side of my knee, right next to the kneecap, and everyone would look at me like I had two heads when I suggested that maybe my chronically inflamed ITB is pulling my kneecap laterally and therefore straining it on the inner portion. It's finally gotten to the point where the pain is there all the time, and now it's really become an issue.

I don't understand why this is such a hard concept to understand -- seems pretty logical to me, especially since the therapist was taping my knees to make them "track better"! Anyway, I'm glad to see someone finally say that it's a possibility, so now I don't feel so crazy anymore. :)

(Sorry to change the subject of this thread for a moment here. Carry on! ;) )
« Last Edit: December 23, 2005, 03:37:31 AM by KarenS »