KNEE PAIN AND HIP STRENGTH

KNEE PAIN AND HIP STRENGTH

I work with many patients with knee pain associated with different diagnoses: osteoarthritis, patella misalignment, tendonitis, and meniscal tears, among others.  Although diagnoses are different, these patients have one thing in common: weak hip muscles. These muscles not only move our legs as in the picture below, but also play an important role in stabilizing the pelvis when we walk.

First thing that is noticeable in many patients with knee problems is weakness of the quadriceps muscle (commonly referred to as the “Quads”) – large muscle of the front thigh that straightens the leg and also helps to bring the whole leg up. Usually, the bulk of the strengthening protocol consists of working the quadriceps. While it is certainly very important to strengthen this muscle, the strengthening of the hip abductors (muscles at the side of the buttock), hip extensors (muscles of the buttock and back of the thigh that bring the leg backwards) and hip adductors (muscles on the inside of the thigh that bring legs together) often gets overlooked.

           

In the research article “Hip Muscle Weakness in Individuals With Medial Knee Osteoarthritis” published in “Arthritis Care & Research”  (Vol. 62, No. 8, August 2010, pp. 1190 –1193) the authors found following differences in strength of the hip muscles between people with knee arthritis and the control group.

Hip flexion: 26% weaker

Hip extension: 16% weaker

Hip medial rotation: 20% weaker

Hip lateral rotation: 27% weaker

Hip abduction: 24% weaker

Hip adduction: 26% weaker

The authors also note “… it is possible that hip muscle weakness may precede disease onset”.

All of these muscles participate in our walking. When one or more of these muscles are weak it can cause us to alter our gait which, in turn, can lead to abnormal strain on the knee, pain and, eventually, arthritis.

Following exercises will help you to strengthen your hip muscles.

Hip Abduction

 Bridging

Hip Adduction

Hip Extension with bent knee (This one specifically targets the glutes, for those “Buns of Steel”!)

Hip Extension

Straight Leg Raise

Perform all exercises in sets of 10 for 2 or 3 sets two or three times a week. As you get stronger, you can add light ankle weights or start doing the exercises in standing with rubber bands providing the resistance. In one of my future posts I will cover advanced hip strengthening exercises. For now… stay healthy, do your exercises and write a comment for this post. If you have questions, don’t hesitate to email me.

Yours in health

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center

Blood Clots: What to look for and what to do

BLOOD CLOTS: WHAT TO LOOK FOR AND WHAT TO DO

The topic of this article is Deep Vein Thrombosis.

Deep Vein Thrombosis (DVT) is a blood clot in a deep vein. It can be caused by variety of reasons; one of them is a recent surgery, such as a knee replacement.  It can also be caused by prolonged immobility, especially during long flights or driving. Sometimes it’s symptomless. More often there is redness, swelling, and pain. Frequently, it occurs in the lower leg. DVT can go away naturally, but the most serious complication is when a thrombosis dislodges (embolizes) and travels to the lungs to become a life-threatening pulmonary embolism.

During my career as a physical therapist I have seen quite a few cases of DVT. Most frequently it happened to patients after an orthopedic surgery, such as knee replacement or hip replacement.  First time I saw it was when I just started to work at Columbia Presbyterian Hospital. I went to a room to see a patient who had had total knee replacement several days before. The patient complained that her calf was hurting. The calf muscle was hard and the lower leg appeared swollen and was much warmer and darker in color than the other leg. 

I performed a special test, which came out positive and confirmed my initial impression.  I immediately notified the patient’s doctor who ordered the ultrasound test. The test confirmed the diagnosis and the patient was saved.

Since then I don’t hesitate when I see symptoms that could indicate DVT. At Free Motion we have sent about 10 patients to the emergency room or to their doctor with symptoms that we found suspicious. Out of 10, five were found positive for DVT and thanked us for saving their lives. Five were negative and that was fine by us! We would rather be safe then sorry.

How can DVT be prevented? One way is to take blood-thinning medications and that’s what being done after surgeries. Another important measure is to make sure that there is good circulation in the legs. Exercises like “ankle pumps” (moving the ankles up and down) and starting walking soon after the surgery will help to minimize the risk of blood clots. 

Being checked regularly by your doctor and physical therapist and being alert to the symptoms will go a long way to ensure fast recovery and greatly reduce the risk of life-threatening complications.

When traveling on a plane or sitting for a long time it’s very important to take frequent walks and move your feet and ankles while sitting.

Have you had an experience with DVT? Do you know someone who has? Share your thoughts with me and let me know what other topics you’d like to see me write about.

Stay healthy!

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center