What Are Your Knees Doing?

Research now shows that past lower limb injuries cause some of the gluteal muscles not to work correctly. This means the pelvis is not held in the correct position during weight-bearing activities and often causes the knee to point inwards relative to the foot. This is one of the major causes of knee pain in the active population.

An ideal position for the knee when it is bent is when the middle of the kneecap points over the middle of the second toe. When the kneecap points to the inside of the foot it causes abnormal stresses around the knee joint and many muscles are made to work in a way that are not optimal.

Conditions such as patellofemoral pain or ITB syndrome, characterised as pain on the outside of the knee, can then develop. This can be corrected with physiotherapy techniques such as mobilisations, massage, sometimes taping and always biomechanical assessments and rehabilitation exercises. Amongst other muscles the function of the gluteus medius muscle is assessed.

This muscle is one of the three gluteal muscles and is situated deep in the outside of the gluteal region. Its job is to rotate the thigh, take the thigh out to the side and ensure the pelvis stays level when load is on that leg.

The lack of the ability to hold the pelvis level when standing on one leg is often the most problematic. Physiotherapists not only look at the pure strength of this muscle but also the pattern at which it is recruited.

There are many exercises to which work your gluteus medius muscle. It is often a good idea to work on the strength of the muscles and also work on making sure it is working at the correct times.

Your trainer can go through with you the exercises to help you find this muscle and make sure you are working it correctly and not overusing other muscles to make it easier! Recruitment patterns are often learned in functional positions, as this is what you have to do during your daily activities.

One way to functionally work the muscles is to ensure that your pelvis is in a neutral position (not arched or tucked under) and that your knee is tracking straight ahead over your foot.

It is advisable to start working on the knee alignment with exercises in the gym that both legs such as squats and leg press. The progression is to then start working on one leg with exercises such as lunges and step-ups. Here, not only do you have to concentrate on the knee pointing over the second toe, but that the pelvis stays level throughout the whole exercise.

As your body learns what it should do you need to carry this good alignment of the knee and the pelvis to activities that you do during the day such as going up and down stairs. As the muscles learn the correct position, there is less load on previously overloaded structures and there will be less pain. The new alignment will become more natural and ‘normal’.

Identifying the dysfunction and correcting it early often prevents many potential knee problems occurring. Manual therapy and biomechanical analysis and correction are the optimal way of returning the active person back to their desired activity in the quickest and safest way.

Should you think you could be suffering with any of the problems above or have any knee pain come and make an appointment with one of us. We can correctly determine the exact cause of your problem and give you advice on exercises and training specific to you.