The Body Vault

It’s a very large club.  Once the knee is compromised through injury or arthritis you realise how much you rely on your knees for everyday activities. The fact is that we have been taught to rely far too heavily on our knees. 

Have you been told to bend your knees to lift anything heavy or do lunge exercises to build your thighs? You, like many, have been misinformed.

The most you should be using your knees to do is to step over objects to avoid tripping over them.

The lower limb has three major joints yet so little is said about the hip and ankle. These two are in fact your primary driving joints. Learning how to gain your movement through these joints can save not only your knees, but your spine as well.

If you like the gym, take some time to watch the powerlifters. 

These guys (& girls) lift such enormous weights because they make it safe and efficient to do so.   If it were not, they would be weaker and suffer catastrophic injuries.

Posture and mechanics are everything when it comes to physical task completion.                 Whether it be your groceries, gardening, stairs, or an Olympic sprint. 

A lack of posture and/or correct mechanics only results in poor performance and pain. 

Many of us could delay the onset of osteoarthritis by improving our posture and learning some simple principles of biomechanics. 

Remember the powerlifter. They lift from the hip joint, not the back or the knees. 

The knees only flex enough to allow the hips to move back and down. All the load is therefore transferred through the hip joint. The knees are there to help the hip and ankle function to their potential.

When this principle is applied to other every day activities and combined by using the ankle and foot efficiently, life becomes easier, less painful, and more enjoyable.

Watch me working with a client to demonstrate the correct way to lift for knee protection.  Notice the posture corrections and how the hip and ankles become focus points.

One of the most common sources of knee pain is anterior (front) knee pain.

So many of us suffer pain in the knee caps without ever falling on them or getting struck in a sport or accident.Knee caps, or patellae, as we know them, are referred to as sesamoid bones. 

Their role is to keep the quadriceps muscle tendon from the front of your thigh in the groove on the end of your thigh bone (femur).  

This track that your patella follows is extremely sensitive and needs correct posture and muscle function to maintain this ideal alignment. 

Think of it in the same way as your cars wheel alignment. If your wheel alignment is askew your tyres will wear unevenly and prematurely as well as causing vibrations and poor performance.

In the previous post we spoke about protecting your whole knee joint with good posture and correct use of the other joints of the limb. This is vital as good posture and alignment is the foundation of function. 

When your pelvis and core are ‘neutral’ then your starting point for key muscles in the thigh can be both flexible and strong to maximise the patella’s efficacy and life. 

Remember, your patella has a life. At least the back of it that runs against your femur does. 

We call this your patello-femoral joint, and this joint when worn and painful robs many people of their independence and quality of life as years progress, especially if they have stairs in their home. 

Getting up, and worse still, down stairs can become quite painful when this joint on the front of the knee is worn and inflamed. 

Keep in mind that an unhappy cartilage (meniscus), as well as a host of other internal structures can give you pain on stairs. There are a few simple ways to prevent and often effectively manage with conservative exercise.

Stretching the quadriceps on the front of the thigh decreases the tensile loading through its tendon which houses and controls the patella. 

By doing simple physical therapy exercises to isolate and strengthen the muscle we call VMO we can pull the patella back toward a healthier alignment.

This VMO muscle is part of the four quadriceps muscle group that pull on the knee cap and ultimately on the shin bone to straighten your limb. It is yet again evidence of how clever nature truly is. 

The ‘O’ in VMO stands for Obliqus (or oblique). When it is activated it pulls the knee cap across into a safer, stronger alignment. 

It is activated primarily in the top half of the movement when you extend your knee to straighten your leg. 

When you do lots of these short range leg extension exercises, you build this muscle effectively giving your patella its own wheel alignment, just like the mechanic does for your car.

Watch this leg extension exercise video to view the correct way to perform this exercise and what it does for the patella and VMO track.

Keep in mind that correct shoes, foot orthoses, and even improving your overall gait (walking/running) patterns also have a profound effect on patella tracking and the earlier you address these issues the greater your chance of improving your function and pain relief. 

Dietary considerations which decrease systemic inflammation also have significant effects on any body part that suffers enough to suffer an inflammatory response.

Non steroidal anti-inflammatory drugs are always effective in the short term with what we call acute and sub acute stages of inflammation and there are surgical options with long term ‘crab eat’ patellae when the joint surface is degenerated beyond conservative management.

Once again, the earlier you address such issues, the less pain all round. 

Check out our Posture Correction Therapy on our Services page to get more ideas about releaving knee pain.

We spend a large proportion of the day on our feet, so it's little wonder that many people suffer foot problems and associated ankle problems. 

As you can see in the image to your left, there are many muscles, bones and tendons that comprise the foot and ankle structure. This image doesn't name them all but is intended to give you a good overview of the structure of your feet and ankles and to help you better understand what to fix when something goes wrong.

In this section of the body vault I am going to discuss a number of specific foot and ankle issues and how to recover from them, and more importantly, how to prevent them.

Let's start with Plantar Fasciitis.

One of the most common ailments affecting our feet is plantar fasciitis (pronounced - plan tar fash i tis).

It often presents as a feeling of a stone bruise under the heel and progresses to a sharp pain under the heel first out of bed in the morning or when you stand up and move after sitting for an extended time. 

Mid foot fasciitis results in dull recalcitrant arch pain, or that sense of fragility when walking or running.

It is one those problems that will indeed take your mobility and quality of life from you for years if not well managed. 

Depending on the length of time it progresses you may find a heel spur on X-Ray. This comes from calcification at the origin of the fascia under excessive load. 

The plantar fascia has an energy storage (windlass) role in the foot. 

It runs from the heel bone(calcaneus) to the toes. As your foot passes from heel contact to toe off in a walk/run stride and the joints to the toes extend, the plantar fascia stretches then releases this energy into the "toe off" phase to propel you forward. 

Many factors affect this process such as ankle joint range, calf muscle flexibility, and intrinsic foot mechanics and arch support.

The weight bearing walking/running limb is what we call a closed kinetic chain. The fascia becomes stressed and inflamed at its origin and midpoints because these are placed under excess loading when ideal limb, ankle and foot mechanics are inefficient.

Perhaps the most significant factor is ankle joint restriction, most often brought about by the short functioning of the calf muscles. 

Supportive footwear, padded heel raises, soft foot orthoses (inserts), and nocturnal ice compression all relieve symptoms.

Ultimately this is a functional pathology and needs to be addressed as such. Functional pathology means investigating the problem with a multi-pronged approach using functional, metabolic, biochemical, nutritional, and hormonal approaches.

More rigid foot orthoses may provide support for the foot but can lead to compensatory pain in the limb, hips and spine. 

If you do nothing to improve your own strength and function then orthoses can simply make you dependent on the device and vulnerable to further injury when not wearing the supports.

Stretching the calf muscles in neutral foot and limb position forces the gastrocnemius and soleus muscles to increase their range and facilitate maximum ankle joint range. 

This minimises the amount of pronation, (turn out) in the sub-talar joint of the foot required to complete the dorsi-flexion needed from the foot-limb interface. Let's untangle that mumbo-jumbo.

Put simply, if you cannot get full range in a straight line, you body will find it by using other joints that involve other directions, also making it inefficient and harmful.

Stabilisation exercises for the entire limb and basic postural correction exercises maximise limb and foot efficiency decreasing this overloading of the plantar fascia. 

By improving the mechanical efficiency of the foot and limb and decreasing the loading on the fascia, we allow the fascia a chance to recover. 

Once the icing and stretching decrease the swelling enough to begin a healing process, techniques such as hydrotherapy and gentle calf raises can be applied. 

The calf raises can be gradually allowed to be performed in a pronated (turned out) position allowing a graduated loading of the foot and fascia. The spur which can form never really resolves but the important thing is to regain pain free function. 

Once you have suffered a bout of plantar fasciitis, that structure will always be vulnerable. 

Never give up on your stretches and strength/stability exercises. They will keep you functioning optimally and help prevent further injury and pain.