Knee Pain

PFPS Cont. You want details?

~ Dr. Robert Speirs DC ~ Leave a comment

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The muscles of the hip provide not only local stability, but also play an important role in spinal and lower extremity functional alignment. (1-4) While weakness in some hip muscles (hip extensors and knee extensors) is well tolerated, weakness or imbalance in others can have a profound effect on gait and biomechanical function throughout the lower half of the body. (5) Weakness of the hip abductors, particularly those that assist with external rotation, has the most significant impact on hip and lower extremity stability. (5,6)

Hip Abduction.gif

The gluteus medius is the principal hip abductor. When the hip is flexed, the muscle also assists the six deep hip external rotators (piriformis, gemelli, obturators, and quadratus femoris). The gluteus medius originates on the ilium just inferior to the iliac crest and inserts on the lateral and superior aspects of the greater trochanter. While the principal declared action of the gluteus medius is hip abduction, clinicians will appreciate its more valuable contribution as a dynamic stabilizer of the hip and pelvis- particularly during single leg stance activities like walking, running, and squatting. The gluteus medius contributes approximately 70% of the abduction force required to maintain pelvic leveling during single leg stance. The remainder comes predominantly from 2 muscles that insert onto the iliotibial band: the tensor fascia lata and upper gluteus maximus.  Hip abductor strength is the single greatest contributor to lower extremity frontal plain alignment during activity. (6)

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Incompetent hip abductors and/or external rotators allows for excessive adduction and internal rotation of the thigh during single leg stance activities. This leads to a cascade of biomechanical problems, including pelvic drop, excessive hip adduction, excessive femoral internal rotation, valgus knee stress, and internal tibial rotation. (1,7-12)

 

References
1. Szu-Ping Lee, Powers C. Description of a Weight-Bearing Method to Assess Hip Abductor and External Rotator Muscle Performance. JOSPT. Volume 43, Issue 6
2. Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39:866-873.
3. Presswood L, Cronin J, Keogh JWL, Whatman C. Gluteus medius: applied anatomy, dysfunction, assessment, and progressive strengthening. Strength Cond J. 2008;30:41-53.
4. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor ex- ercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Phys Ther. 2010;90:895-904.
5. van der Krogt MM, Delp SL, Schwartz MH How robust is human gait to muscle weakness? Gait Posture. 2012 Feb 29.
6. Laurie Stickler, Margaret Finley, Heather Gulgin Relationship between hip and core strength and frontal plane alignment during a single leg squat Physical Therapy in Sport Available online 2 June 2014
7. Ireland ML, Willson JD, Ballantyne BT, Davis
IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33:671-676.
8. Noehren B, Davis I, Hamill J. ASB clinical biome- chanics award winner 2006: prospective study of the biomechanical factors associated with iliotib- ial band syndrome. Clin Biomech (Bristol, Avon). 2007;22:951-956.
9. Powers CM. The influence of abnormal hip me- chanics on knee injury: a biomechanical perspec- tive. J Orthop Sports Phys Ther. 2010;40:42-51.
10. Powers CM. The influence of altered lower- extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33:639-646.
11. Sigward SM, Powers CM. Loading characteristics of females exhibiting excessive valgus moments during cutting. Clin Biomech (Bristol, Avon). 2007;22:827-833
12. Souza RB, Powers CM. Differences in hip kine- matics, muscle strength, and muscle activation between subjects with and without patellofemo- ral pain. J Orthop Sports Phys Ther. 2009;39:12- 19.

Trigger points in the hamstrings.

~ bryancobb ~ Leave a comment

With all the sitting going on these days, tight hamstrings are becoming increasingly common. When your hamstrings are tight they almost certainly have trigger points. These contracted knots in the muscle are a common cause of pain felt in the back of the leg, knee and lower buttocks. Trigger points don’t go away with rest or stretching, they need a therapeutic intervention such as massage to be released.

Why trigger point therapy?

~ bryancobb ~ Leave a comment

People often think of a massage as a relaxing experience, something they might do occasionally, or give as a gift along with a trip to the spa. Trigger point massage therapy is another kind of massage used to treat pain and physical dysfunction. Trigger points can develop in people from all walks of life. They can affect people of all ages, office workers and labourers, elite and weekend athletes, post surgical patients, people with acute pain from injury and people with chronic pain. Trigger point massage therapy can treat a wide variety of physical conditions such as:

– Migraines

– back pain.

– sciatica

– Carple tunnel syndrome

– achy persistent pain

– pain from Fibromyalgia

– post surgical pain and scarring

– soft tissue injuries related to sports

– TMJ dysfunction

Trigger point massage

~ bryancobb ~ Leave a comment

Trigger points are contracted knots in muscles. They form from overload stress causing muscle fibers to become locked together in a self perpetuateing spasm. Trigger points will then produce pain, usually deep achy pain, as well as refered pain. Because of the contraction of the tissue trigger points will also produce stiffness and weakness. Trigger points are also known to mimick other symptoms such as Carple tunnel, and sciatica symptoms. Trigger points are one of, if not the most common cause of pain in the body. Regular massage therapy is not specific or deep enough to release trigger points, a specific technique of applying deep focused pressure to the heart of the knot is required for the point to release. This is called trigger point massage.

Trigger point massage.

~ bryancobb ~ Leave a comment

Myofascial trigger points are contracted knots in muscle tissue. They are one of the most common causes of pain in the body. Most people will experience pain from trigger points at some point in there lives. Trigger point pain is usually felt as a deep achey pain. This pain may be refered In a specific pattern to other areas of the body. For example, trigger points in your hip can refer pain all the way down the leg into the foot. Trigger points will also mimick joint pain leading to misdiagnosis of arthritis. Trigger point massage therapy targets the knots specifically with focused deep work to release the area and allow the muscle to heal. Visit http://www.triggerpointmassagetherapy.info or http://www.aberdeenchiropractic.com for more information.

What are trigger points.

~ bryancobb ~ Leave a comment

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce at some time in your life.

Trigger points in the rectus femoris muscle.

~ bryancobb ~ Leave a comment

The Rectus Femoris muscle is one of the muscles that makes up the quadriceps group. It works to extend the knee and flex the hip. Trigger points that form in the Rectus Femoris are an often overlooked source of knee pain. The pain is usually described as a achy pain felt deep in the joint.

Gluteus minimus trigger points and sciatica.

~ bryancobb ~ Leave a comment

The gluteus minimus muscle is located at the hip. It functions to abduct the hip and stabilize the pelvis. Trigger points commonly develop in this muscle from overload stress. The referral pattern of these trigger points will refer pain down the side of the leg, as well as into the glute and hamstring. These symptoms are often mistaken for irritation of the sciatic nerve called ” sciatica” which produces very similar symptoms.

~ bryancobb ~ Leave a comment

The Rectus Femoris muscle is a large muscle that makes up part of the quadriceps group. It functions to extend the knee and flex the hip. It originates on the anterior inferior iliac spine and part of the acetabulum. It’s insertion is the patella via the quadriceps tendon and tibial tuberosity via the patellar ligament. Trigger points in this muscle refer deep into the knee. This muscle is an often overlooked source of knee pain.

Myofascial pain syndrome

~ bryancobb ~ Leave a comment

Myofascial pain syndrome is caused by a stimulus, such as muscle tightness, that sets off trigger points in your muscles. Factors that may increase your risk of muscle

trigger points include:

  • Muscle injury. An acute muscle injury or continual muscle stress may lead to the development of trigger points. For example, a spot within or near a strained muscle may become a trigger point. Repetitive motions and poor posture also may increase your risk.
  • Stress and anxiety. People who frequently experience stress and anxiety may be more likely to develop trigger points in their muscles. One theory holds that these people may be more likely to clench their muscles, a form of repeated strain that leaves muscles susceptible to trigger point