Thursday, January 29, 2009

Patellar Pain: Part 2 - The Solution Step 1 - Posture

It wasn't until I began to study for my National Academy of Sports Medicine (NASM) Performance Enhancement Specialist certification that I learned about muscle imbalances that existed within the joints above and below the knee, which in turn caused the knee and foot to be out of alignment with activities, which then developed into knee pain/PFPS or worse. Then I attended Gray Cook and Lee Burton's Functional Movement Screen Seminar that I learned about faulty movement patterns and how to retrain them.
In regards to imbalances and faulty movement patterns, I tend to see this dysfunction a lot in runners. Some runners will ignore the pain or try to work around it, putting "fitness on top of dysfunction" (as Gray Cook would state). The problem there is subconsciously the body will try to adapt and find a way to run pain free, which is usually with a foot turned out appearance. This causes imbalances to exist and then the knee wobbles in.

In turn, that runner can keep wearing down the patellofemoral joint unt
il irreversible damage is already done. Whether they are age 10 or 50 at some point or another they come see me for rehabilitation on that knee.

Hopefully they see me early, which I tell the younger runners that their knee pain may be a good sign that something is not working correctly. Their pain and dysfunction can be corrected so that they do not have irreversible damage from them continually running on that particular knee with bad mechanics due to muscle imbalance.

So now I begin the process towards a healthy and pain free knee:

You would not believe how many times when I see a patient for the very first time that I can usually tell which knee is the one they are having pain with. The patients/clients that I see with knee pain all seem to stand particular way, they have one or both feet turned out.
In my mind, the foot turned outward posture could have been the beginning of the problem or the end result. Overall that does not matter to me about how the imbalance began, but the importance is in the method of how to fix it. The first thing I have to educate people who suffer from any type of dysfunction or pain is to improve their posture. Their poor posture is just reinforcing those muscle imbalances and movement dysfunctions which in turn leads to pain.

Think of it this way, you come into therapy you usually get 30 minutes. For example, they may perform ultrasound or electronic stimulation to help with the inflammation, if you are lucky they will introduce you to the foam roller and the art of myofascial release, you perform some mobility/flexibility exercises, then you perform some stability exercises, then you grab a bag of ice and are on your way home. What is the first thing you do then when you get home? You go right back to that foot turned out posture while seated and standing, which just defeated everything you did in therapy.

If you perform 30-60 minutes per day of exercises to improve your dysfunction patterns, then spend the rest of the day having poor posture and reinforcing the dysfunction, how are you improving? 60 minutes of right will not cure the 10-12 hours of the wrong you did the rest of the day.

This is why one of the first things I try to educate my clients/patients is the importance of good posture. Standing with feet straight ahead, shoulder width apart, butt cheeks tightened together. It will take some practice but it is well worth it. Might feel very weird in the beginning, but over time you will become more comfortable with this good habit. You will have to look down and check to make sure you are not going back to your old way of standing and sitting. Catch yourself and then correct it. It will pay off in the long run.

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