 to physical therapy for a better life. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. I am hosting this show from my hometown in Ansonia, Connecticut, and I have a great show. We're going to talk about knee pain, why you all of a sudden have it, what to do if you have osteoarthritis, and what one critical muscle you can strengthen right now to make a huge difference. One of the most common complaints I have had as a physical therapist and even more so during the pandemic is people coming in with knee pain and saying, I don't know how I hurt my knee. I just noticed that it's hurting and now I can no longer take my daily walks. It hurts when I go up and downstairs. It hurts when I try to get up from a chair and sometimes even getting in out of the car is so painful. Help. And so one of the biggest problems, and this is why I titled it, the secret to healthy knees is a strong hip, is because the gluteus medius muscle attaches inside your pelvis to your hip bone. And that muscle lives right here inside this spasa and it runs down from your pelvis. That's if you put your hands right on your waist there. It runs down on those hip bones right out to this hip muscle. And so if it was going to contract, it would do this, like you're raising your leg out to the side when you're standing. And so that's all fine and dandy, except for the biggest action that the gluteus medius muscle has is to keep your pelvis level like this while you're standing on one leg. So while this leg is in the air and you're walking, are you going to put your leg up a stair? This gluteus medius on this side has to keep this whole pelvis and your torso level while this leg is in the air. If it doesn't, so if this gluteus medius doesn't while this leg is in the air, what happens is the pelvis will drop. I'll show you a video in a minute. The pelvis will drop here and then this femur bone will cave in and you see the twisting that happens at your knee. That's what happens. And so as you step for your daily walk up and down your stairs and this gluteus medius is weak and your pelvis is dropping, you are setting yourself up for meniscal damage and osteoarthritis. So the biggest solution for people when you come into the clinic and you have arthritis, a meniscal tear, a collateral ligament tear, and ACL tear is weak. Absolutely have to focus on strengthening the gluteus medius muscle right here to stabilize you. Aside from knee pain, this gluteus medius, as you could probably see, if your pelvis is dropping like this is hugely important in preventing people from getting back pain or lumbar instability when they're walking. That's another complaint for another show. So let's go to image number four because another contributor that people don't realize is that if you were to stand, like let's say her right foot is turned out, if you're going to stand like that because you had a bunion surgery or an old ankle sprain or you had your hip replaced or you've had an old knee injury, the position of having your foot turned out asymmetrically like that when you walk doesn't allow the gluteus medius muscle to get a signal from the brain to fire. So as you walk with your foot turned out, it doesn't set up the chain reaction that goes up your leg to the gluteus medius to stay fire and stabilize my leg. So let's look at video number five to see a little bit more of that. In this video, you can see how her foot is turned out on the right side, the side away from the cane. And you can also see how her knee is diving in. If we loop that, you can see the knee diving in as she's walking forward on that right side. There's a little bit of a crooked angle like she's holding it out. And how that happened is that happened over time. That was not one incident. Over time, that gluteus medius didn't fire, her knee caved in like I showed you on the skeleton, and now her foot is kind of just leading the path of getting severe osteoarthritis in the knee that could lead to a knee replacement in short course if she doesn't strengthen her gluteus medius. So now if we go to the next video, video number seven, you'll see this is her good side. And so there's a little bit of a pelvic drop, but not much. You see her knee diving a little bit, but we go to the other side where the foot's out. And you can see the wrinkles in her shirt, and you can see her hip dropping, and you can see her knee going out. So here's the good side. It's relatively straight. The foot is definitely straight. Here we go on the right side. The knee goes in, her hip drops, and then that's an unstable way to be going through life. And so she has right knee pain when she goes up and downstairs. She has right knee pain when she gets in and out of the car. She has right knee pain, just doing her everyday life. And the way to rescue your knees, even though there's already damage in the knee, is to strengthen the gluteus medius to support the knee. So now let's go to video number eight right now, where you're going to see a hiker. This is her good side. And so it's a little wobbly. The balance isn't there, but you can see it's relatively straight, relatively straight. Now if you go to video number nine, you'll see her troublesome side. And you can see how her pelvis on the opposite side is dropping. Her shoulders are even leaning over to the left, and her knee is wobbling in. So if we go back, we close the videos, I can explain a little bit more on the skeleton, where now that you've seen the videos, I can explain a little bit more how you can see some of in those videos, this tilt right here. And some of it looks like because like the shoulders will move over to the side. Those are things that I identify very quickly in the clinic when I see people walk. I can tell what muscle is not working when, just by if they kind of hitch over to one side, or if their shirt is wrinkling on one side, I can tell you which muscles in the body are not firing. And so I know what muscles to activate in their body, because our bodies are not perfect, but they are our bodies. And they're not symmetrical all over the place. But everything that we do in physical therapy, physical therapy for a better life, is to try to help activate the muscles in your body to help you be more symmetrical, and to help you be more aligned. So it ultimately leads to improved function and quality of life. So while you saw in the first video of the crooked knee, that knee is crooked. But if we strengthen the gluteus medius, get the foot going straighter. So it activates the gluteus medius pretty soon, you don't get this twisting at the knee anymore, that's going to continue to give osteoarthritis and pain while you just go about the daily routine. And to show the hip drop again on a skeleton, when this side drops down, when you're standing on this leg, that's what creates this angle, angulation, where the femur bone rotates in here. So like you're going in like this, that's the crooked knee that we saw on the video. So in strengthening the gluteus medius that attaches right here, the one that moves you out to the side but stabilizes you, you're stopping that excess aberrant motion from allowing the femur to move in and really twist your knee. So let's go right away to video 10, where it's going to tell you the exercises that you can do simply right now to rescue your knee. The secret to healthy knees is strong hips. And I'm going to explain to you why. You learned in the picture how the gluteus medius stabilizes your pelvis here on your leg. And you also saw in the previous video how when that is not happening, the knee can dive in and cause osteoarthritis or that crooked knee that gives you a lot of pain. But our bodies are not perfect or even all symmetrical. And so strengthening these muscles, even if you already have a crooked painful knee, every little modification and strengthening these muscles will help get you closer to symmetrical and closer to more aligned. So you don't have to have pain even if the leg is still crooked. So you want to strengthen the gluteus medius. And these are some of the simplest and best ways to get that muscle working. So first it's great to lie down to isolate it. So you can put a band around your ankles or if it hurts your knee to do this, you could put a band above your knees. So there's less strain. I'm going to put it on my ankles. You're going to lay on your back, you're going to pull your toes up, you're going to press your knees down and you're going to squeeze your glutes as if you're going to lift your buttock off the surface. And then you're going to slide apart and you're going to do 10 times. Then you're going to keep buns tight, press down, slide your right leg to the right for 10 times. Then you're going to repeat it with the left where people make a mistake as they lift and that is not your gluteus medius. That's your hip flexor. You want to squeeze your buns tight as if you're going to lift them off the ground, push down and slide apart. That's number one. Number two for gluteus medius, I'm going to put it above my knees because anybody that has painful knees knows that down here the exercise is harder. Up here it's a little bit easier. You're going to lay on your side, you're going to straighten your legs, you're not going to lift forward and up, you're going to lift a little bit back and up. So I am using my right hand to stabilize me. Keep your knees straight and you're going to lift up and down. So it's the same exact muscle we are getting. You don't want to lift here from your waist, you want to just lift up a little bit and down and get the gluteus medius. You can also help your hip rotators. It's called the clamshell. Clamshell, open up your knees, strengthen those hip rotators to straighten out this femur bone so your knee is not so twisted. But there's many hip rotators, so you want to work hip rotators when your hip is in the flex position and you also want to work them here like when you're standing, you're not in a flex position, you're in extended. So you want to do clamshells in both positions like that. You can also work your gluteus maximus and engage your hip abductors and rotators by sucking your stomach in, lifting your buns up and doing some hip rotation here. You can come down and pulse up, down, pulse up to really get the rotators, the abductors and your powerful gluteus maximus muscle. And then finally, to make it more into practice and more functional, you could put it around your ankles, keep your feet straight. If your knees are in, imagine lining them over your feet and then walk sideways. If you don't have a long hallway to walk sideways, you can do what I call an out, out, in, in. Just keep some tension on the band. Don't let your knees come in. Make sure they're over your toes. You can put your hands there as a guide. Out, out, in, in until you feel the burn and then switch out, out, in until you feel the burn. So you can strengthen your hips to save your knees. Aloha. I hope that all of you who have sore knees or you've noticed that you're standing with one foot turned out will take those exercises to heart and practice them. I mentioned in the video, you don't need a band. It just adds resistance. So if you add a band, you can do less repetitions. But the key is that you do some of these exercises to improve the function of your body. The largest thing I saw when the pandemic started was people coming in with this knee pain. And I would see them walking like I showed you in those videos, like the crooked knee, the foot turned out, the hip caving in. And these are people that had moderate to severe osteoarthritis on X-ray and you don't get it that fast. You don't get it in three months of starting a walking program because you can't go to the gym. And so the osteoarthritis had been there. It just became painful after doing lots of reps with the weak hip that you didn't know you had or a foot that was turned out that you weren't aware of. We all stand different ways. Sometimes I'm in an elevator and I look down and I'll see my foot's turned out and I know what to do. And that's why I'm sharing it with you. So I will turn myself straight because I know that my muscles will fire in an improved fashion when I do that. But these are the little things, the small little nuances that we're doing throughout the day that we are not aware of that are causing painful arthritis and painful injuries to our body parts. And one of the coolest things about being a physical therapist is that we can educate you about the fact that a joint up here and a muscle up here is hugely responsible for the happiness of a joint right here. So you've got those rotators as many of them that I mentioned in that last video. And you want to strengthen those rotators because when your foot lands on the ground, there's a thing called pronation where the arch rolls down. And when that arch rolls down, it takes this shin bone and it turns in a little bit. And when that shin bone turns in a little bit, this thigh bone turns in a little bit. And that's the message that turns on your gluteus medius and those rotators and abductors to slow down that motion and stabilize your pelvis right here and your spine on that one leg. But in that picture that I showed in the video where the foot was turned out, you're already more in a pronated position. So you don't go through that pronation where the arch is lowering. It's already kind of lowered because the foot's out and it's sending it. The message to the brain is in getting there for this rotation to happen because it's already landing more rotated. So you don't get the stretch reflex that turns this muscle on that stabilizes you. So I know it's kind of complicated mechanics, but I wanted really want to hammer home that to everyone who has knee pain, including myself. I've suffered from it. My mom, my patients, it's the biggest thing that I hear without even doing these exercises. When I have someone turn their foot straight when they're walking, the biggest thing I hear is, you know what, my knee feels so much better when I turn my foot straight, but I'll forget and it'll hurt and I'll turn it straight. I'll never forget actually, I was in Connecticut and there was a young gentleman in his fifties and he was carrying his daughter up and down his stairs. She would fall asleep in the car on the way back from school and his knee was killing him and I watched him walk and he had his foot turned out like I showed you in the previous picture. And so I said, gosh, you know, did you have knee surgery or foot surgery or hip surgery? And he goes, no, no, no. So I had him take his shoes off and he had the bunion. He had the surgery on his big toe and he had bunion surgery about 10 years before and anybody that's had a bunion surgery knows you can't really bear weight. They've got you in this hard shoe. You're walking with your foot turned out to the side because you just can't, you can't bend it when you first have surgery. So I had him turn his foot straight. He had terrible pain. He said it was like nine out of 10. I had him turn his foot straight to walk up downstairs and he had no more pain. And that's an extreme example of turning your foot straight, stopping the abnormal rotation at your knee that's causing you to have pain and osteoarthritis. But I want everyone to hear the message that it's very simple. If you look down and you have got one foot asymmetrically turned out like that, you need to turn it in. If both your feet are out like that, people have feet that are toeed out. I was born toeed in. You can just adjust it a little bit inward. You don't want to take your anatomy and completely change it to a different one. The key and the thing to be aware of is that if you have your feet like this and one foot is asymmetrically turned out and that's the side of the knee pain, you want to bring it in because you want to activate the right muscles to stabilize your body so that you can stop having knee pain. You can prevent osteoarthritis at your knee. You can stop having hip arthritis or back pain as well. So I hope that helps. I want everyone to rewatch these videos as much as they can. And I'm going to wrap it up. Thank you so much for joining me here in my hometown. Thanks to Think Tech Hawaii and all our sponsors and donors for allowing me to bring this to you today. As always, life is better when you listen to your physical therapist. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. 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