 Christine Linders, physical therapist and board certified orthopedic clinical specialist. Today I have an excellent show for you to help resolve your knee pain. In 10 short videos I'll explain how to use proper knee mechanics to rescue your knee as well as self-treatments to decrease pain immediately. But first I want to share something with you about myself. I don't know for those of you watching who know much about me I don't think I talk about it very much but I am one of the most injured people that I know and I think over the years it was a little bit of a curse because I love sport so much and it has stopped me from doing the things I loved over and over again in high school in college when I was playing college volleyball and then I ran track at the end of my college year when I couldn't play volleyball anymore and then into my post college years where I was doing triathlons playing gaelic football, surfing and all the other sports that I loved I kept getting sidelined from one injury another so I've had five shoulder surgeries I grew really fast as a young girl I had my first one at 18 I had my fifth one two years ago and as you can see I'm a little bit injured now from working because of the damage I've had to my arm I've had a knee surgery I've sprained ankles I had two car accidents where I have a a shift in my neck and I also hernia two discs in my back from helping a patient probably about five or six years ago who was having trouble up in a chair so I assisted him the request of the nurse to get back to bed and and hurt myself in the process so I am very familiar with injuries and I think what used to be a curse to me of all these injuries and stopping me from doing what I love the most became a blessing and I'm in a blessing in that by treating myself and experiencing all these injuries plantar fasciitis posterior tendonitis foot pain I have learned and have this internal knowledge of biomechanics that's beyond what I learned in physical therapy school beyond what I learned in all my further education that I paid for to get my orthopedic certified specialist and my manual therapy certification so this show I bring to you with my 24 years experience as a physical therapist my x number of years experience as an injured person to inspire you to try these things and do these things because they work not only on myself and my friends and my family and my patients but they're going to work for you too and so if I can do it and I can work on my body the way I do with all my different parts that are injured and not perfect to get myself to play beach volleyball and still love it to go surfing and still love it just still take a sunrise sand jog once or twice a week and still love it then you can do it too so let's talk about the knee I want to start by helping you learn what can cause wear and tear to your knee that would lead any of us down to an insidious injury to our knee which means you wake up one day and you have knee pain and you can't really relate it to something you did oftentimes that wear and tear is caused by something silly that you don't realize like you're walking with one foot turned out just a little bit because of an old ankle sprain or hip pain that you had five years ago or an old surgery or bunion surgery that you had so it also could be because your hip is weak like mine was after I herniated those discs and I'm walking around New York City not realizing I have a weak leg until I tried to stand and balance to show a patient exercise and I was all over the place and I thought oh my gosh wow I'm going to hurt myself and I did I hurt my foot actually from that so let's go to video one and two where you can learn more about some of the things that can lead you to wear and tear in your knee wear and tear from abnormal movement at your knee that happens when say your foot is out or your foot is proning too much or the hip muscle isn't strong enough to control the rotational movement at your thigh bone your femur is a very common way that you can get degenerative conditions of the knee degenerative degenerative arthritis and meniscal wear and tears that happen in these structures right here these are the meniscus this is your patella tendon a lot of people get pain in the patella tendon if their foot is turned out or if they don't have the hip stability when they're landing from a jump say playing beach volleyball playing basketball even running or hiking if we take this off you see this is the front of your knee your knee cap sits right here these are the meniscal structures right here called menisci and so if your leg is rotating down here because your foot is out or your hip isn't stabilizing your femur and this is twisting you get a lot of wear and tear on these and you get degenerative changes of the structures inside your knee you can also tear these ligaments which is like the ACL and the PCL they run in a cross between your leg and that is when something happens like this and the force or the momentum is too much for that ligament to handle and so it tears mechanics of your lower leg are so critical to the health and the well-being of your knee your pelvis needs to stay level and stable while you're moving on your femur and if your hip is weak if this is your pelvis and this is your leg if your hip is weak and your pelvis is dropping too much it acts as your femur going in which causes the bending at your knee like a sideways bending I don't know if you've ever seen people walking with a crooked knee it kind of looks like this as they're walking it's so important to make sure you have the stability of your hip and of your pelvis so that your knee doesn't get a little bit more of abnormal wear and tear with each step you take even if you're just walking around your block not including running jumping or repetitive activities like that also the position of the foot that I mentioned is really important because if your foot and the arc if your foot or the arch is dropping down or your foot is turned out causing the arch to be dropping down your lower leg bone the tibia will roll in as well and that takes your knee with so let's go to video number three which will give you a better picture of what I'm talking about the hip and the foot play a critical role in keeping the knee healthy because this is the femur bone and so if you get too much rotation in the femur here because your hip muscle isn't strong enough it will cause a rotational movement like this at your knee a twisting and that's what leads to wear and tear same thing happens in your foot if your foot is turned out or you're over pronating your arch is collapsing too much that causes a rotational movement at this bone below so where this one was moving before now this one is moving and ultimately it causes a twisting at your knee leads to wear and tear meniscal damage and arthritis so this weekend I went up with my Friday night search club to go to Chun's Beach for a little Chun day fun day and so my friend Laura is I played beach volleyball with her but we also surf with her she is going to be having knee surgery in a few weeks and I wanted to take a quick video of her before she had surgery to see if she had any nuance motions that we needed to take care of before she went into surgery because she's got something needs to be repaired in her knee and I wanted to know she didn't remember an injury so I wanted to know what led her to that was her foot unstable was her hip unstable what movement patterns that she have that that she needs to change that caused that wear and tear at her knee so I was able to take a video of Laura so let's look at video number four this is her on her good leg I don't know if you could play that one more time and you could see how her her trunk she's a little wobbly because we were on the dirt but her trunk is pretty straight in line over her knee let's play that same video again now let's go to video five where you can see that her trunk is shifting over to the outside of her knee as she squats see it right away how her shoulder just kind of drifts a little bit to the right over that leg and she's more wobbly and there's a strained movement let's play that one more time so you can see how her shoulders shift over that hip important to see because that's not that much of a motion change that's not that big of a deal to notice you would think however when your trunk leans over your leg like that it shuts down your gluteus medius and that's the muscle that I'm going to show you how to strengthen towards the end of the show today that muscle helps to stabilize your femur your thigh bone on your pelvis when you're standing when you're squatting and if you don't have the control of all of your hip rotators but most importantly the gluteus medius you'll start getting other problems you can get um it band syndrome which is either a pain at your outside of your hip or a pain at the outside of your knee or down your leg you can get patella tendonitis you can get meniscal wear and tear you can get back pain on that side you can get hip pain out of that side there's so many things that can go wrong if your gluteus medius is not stabilizing you there and also you can get sciatica or the piriformis syndrome that people talk about which is when your gluteus medius doesn't do its job to stabilize your leg on your pelvis the piriformis muscle which is also an abductor mostly a rotator though it has to work harder to stabilize you so runners often have it band syndrome and they get that piriformis syndrome from running because their gluteus medius isn't strong enough to stabilize them and their rotator the piriformis muscle is working harder so let's look at image number six which is an image of my mom who i always joke with her about her crooked knee but what happened with her knee she did injure her knee when she was young she fell on i think some glass or a pile of rocks but also the thing that i've been harping on her for 15 years probably is that she walks with her right foot turned out always i take videos of her every time i see her turn your foot straight mom turn your foot straight mom turn your foot straight when you go up and down the stair and she mentions that every time she does turn her foot straight her knee doesn't hurt when she goes up and down the stairs and why that happens is like i explained before if your foot is out it takes your tibia and puts it in a different position and it twists at your knee because you're going forward it's a complicated biomechanics but the important thing to take home is you can even see her foot's turned out just ever so slightly but look at that bending in her knee that's that sideways angle i was telling you about the crooked knee and she has terrible knee arthritis and knee pain and of course she does because she's been having abnormal wear and tear that rotational twisting every every step she takes as she goes forward about her day as she does her gardening as she walks around an uneven yard and now let me point out the pelvis if you can see up at her pelvis she's got that wrinkle and her shoulders are completely angled down to the leg that she's not standing on and that is because her gluteus medius on that right side is not stabilizing her pelvis so not only is her foot out but her hip is dropping causing her femur to rotate inward so her knee is literally getting twisted every step that she takes over and over and over again leading to that collapse at her knee so that twisting is just the lower bone going this way and then the upper bone going this way and so over and over and over again you're wearing away those meniscal structures that i explained in the first video you're wearing away at your cartilage and it ends up with osteoarthritis or wear and tear or degenerative joint disease all those different names that's what happens abnormal movement over time leads to arthritis and wear and tear and damage to your knee so what do you do you need to correct those mechanics you need to work on turning your foot straight you need to work on strengthening your hip muscle you need to work on strengthening your knee so i want to go to video number seven where we could talk a little bit more about alignment that faulty alignment that we just saw in those two videos where the knee is caving in or the trunk is deviating over indicates that you don't have the proper stability of your leg on your pelvis and that's what those exercises those hip exercise will help you with so to break it down even further if you're standing here you have the alignment right here and when you bend there should be a relatively straight line right down your body your hip curves a little bit straight down your knee what you saw in one video was the knee going in a little bit like that so this femur bone is rotating and that's where sometimes the knee gets a screwing mechanism on it you can get minuscule wear and tear degenerative joint disease arthritis also the other thing that was happening in the younger girls video where she was doing this so she was compensating for her hip not working to try to help straighten her knee she's going to be getting knee surgery in two weeks i just saw her at the beach after surfing and said let me look at your leg for this video but what i had her do was to shift her hips so that she's straight and you're trying to use her hip and all of a sudden she was unstable so her body was compensating by doing that to get stability and it was one thing that i wanted to work on with her before surgery because it's important the movement patterns that you have that are altered that you fix them as soon as you can that's a major point that i want to hammer home is how important it is to have normal mechanics turn your foot straight so that it matches your other foot if you're toeed out normally that's okay but look down to make sure they're symmetrical if you have knee pain and you're really toeed out normally turn them both in a little bit to get your glute to fire some more now let's go to a question i have a question from a viewer thank you so much for sending this what's three things i should always keep in mind when i walk to prevent knee pain and does keeping my back straight when i walk help so three things you should keep in mind when you walk to prevent knee pain or stretch your calves first because most people that i see that have knee pain foot pain hip pain back pain have tight calves so gives your calves a little bit of a stretch i don't have a video for that but i do in several other of my shows so you can go through some of those and also it's important when you walk to keep your foot straight look down and see what's happening when you keep your foot straight don't walk on angles so if the road has a tilt don't walk on the tilt find the sidewalk that's more even that's another thing that can strain your knee if you're going up and down hills actually down hills land with soft knees don't land with your knees locked sit back a little i call that a hip strategy it's like if somebody punched you in the stomach you would stick your butt back right to bend at your hip so bend at your hip to stick your rear back when you're going down a hill it's like going down a conveyor belt i used to say so that you use your muscles to absorb the shock and not your knee joint and the second part of the question is do keeping my does keeping my back straight when i walk help absolutely i mean i'm not sure if straight is a good word but having proper posture when you walk is excellent i had a patient of mine who had terrible neck pain wear a posture strap when she walked because she was hunching so much her neck would bother her all the time and i thought well you take these nice long walks how about you wear this posture strap to take some of the tension off your neck and encourage upright posture while you're walking and that day she sent me a text message and said her pain was m i a missing in action that day so i hope that answers your question let me go back to a little bit more of the importance of alignment and subtle nuances i'm talking about turning your foot straight let's go to video number eight to learn a little bit more about that if one of your feet is more abnormally towed out than the other from a foot surgery ankle sprain previous hip injury or other type of surgery bunion surgery there's one great way to fix that so you don't continue to injure your knee if you're walking like this on one foot it's so easy to fix turn it straight i know that sounds silly but you turn it straight but now what has to happen is your brain needs to learn how to work with that so you may have been walking like this and now your knee is hurting because your knee is getting this twisting with every step that you take and now you turn it straight you might see that your knee wants to look in like that and that's because walking this way has shut down the hip muscle as soon as you turn this in it gives a rotational stimulus that fires to your brain to tell this muscle to work but your body doesn't know how to do that anymore because you haven't walked that way in a while so you turn your foot straight you focus on doing that when you walk then you start focusing on balancing in that one leg and don't let your knee cave in imagine like you're pushing your knee just out towards the finger to keep it alignment and you work on holding it there and then you do all those great hip exercises to support your knee by using your hip i realize i'm throwing very highly detailed information your way but the reason i want to do it is because whatever you take home from these videos is going to help your knee and i think it's something that i go through with my patients all the time in the mirror about look at your kneecap look at the line of your pelvis to make sure it's here look at your shirt wrinkles above to see is it wrinkled on one side of the video of my mom like you could see indicating that your pelvis is not being stable look at your kneecaps are they both facing forward in the mirror or is one turning in like you just saw in me on the previous video are your feet symmetrically pointed forward or is one turning out is one arch collapsing and you feel like your ankle is unstable all those things are important to pay attention to in our own bodies and it's something that i've done in my own body to help correct all the problems that i've had from being a teenager up until this point so that is why i throw all this information at you so let's look at video number nine video number nine i'm going to show you how to strengthen your hip so that you can stop having these problems at your knee the best exercise is to help restore the alignment that is needed at the knee joint from having proper hip function are these they're very simple these are great ones to get you started so all you need is an exercise band number one put the exercise band around your ankles straighten your legs out you pull your toes up you squeeze your buns and you slide your legs apart you want to press your knee down to tighten your quad muscle to make this muscle bulge out right here press down slide you don't want to lift because i use your hip flexor when you push down you're going to get your gluteus medius which is the muscle that's going to stabilize your leg on your pelvis when you're on one leg walking then you do one leg 10 to 15 times then you repeat with the other leg 10 to 15 times you can also do it on your side but when you do it on your side you need to go up and back not up and forward because gluteus medius extends and moves to the side so you want to go up and back you should feel it not on your hip bone but just behind your hip bone you can also do what physical therapist and other professionals call clam shells but here you're going to be in your hip is going to be bent so you want to do clam shells here but you can also do them here to work your hip and extension also clam shells on your side are great because you can use gravity so you bend your hips and knees first do a clam shell do it till it burns then you straighten your legs so now you're in a straight line with your knees bent behind you and you clam shell clam shell clam shell all those are a great great way to start getting your hip to help stabilizing your femur and then the last one is more functional you put your feet together and you walk sideways and your knees are a little bit bent and that starts teaching you you can you can go a step out step out you could step out this way everything to work your hip muscles so that you can save your knee aloha okay excellent so those are many exercises that will help your knee there's so many different ones i can do five shows on it but i wanted to get you started because these are the things that when i do it with my patients on their initial visit in addition to me working on their knee which i'll show you later in the last video they always come back and say wow i feel so much better i i don't even know what to do and another one that i showed them in the in the first video that i didn't show here because i showed it in a previous uh show i did um was to just press the back of your knee down into the surface so you're laying flat with your leg straight and you just press the back of your knee down to tighten your thigh that one is a fantastic one and first course of action to get your to get your knee going when you have pain now i've got a question when my sister does squats her knees start to hurt a lot the next day do you know any alternative to squats there's many alternatives to squats to get your glutes firing to get your hamstrings firing to get your quads firing and i think the important thing to know is how is she doing squats is she doing a squat standing where she's um letting her knees go in front of her feet if her low back is rounding when she does squats that sends the femur bone forward and causes a lot of compression and tension on the front of the knee joint in addition to the patellar tendon so to strengthen your quads your hamstrings and your glutes there's many exercises i just showed you a few for your glutes but a leg press is a great alternative to squats where you're laying on the back if you're going to use the machine i'm not sure if she's doing these workouts at home or if she's at a gym if you're at a gym doing the leg press is a great alternative to squats because it's taking your body weight off gravity i like lunges as an alternative to squats but again the way i do my lung is very specific and when i put myself in a long lunge and i drop the back knee down i don't lunge forward so my front knee goes over my foot i'm not sure if this is if this is making sense but there are many alternatives to squats i know it's hard to explain them without without showing a video so i hope that helps a little bit um in the next video i'll show what you can do if her knee is hurting after squats she should really modify her mechanics and how she does the squats make sure she's sitting back make sure she's not dropping below 90 degrees as well if you go too low there's a lot of compression and a lot of stress on the anterior knee joints so maybe that's part of her problem is she's squatting too low and putting too much stress on her knee or holding too much weight or she's letting her knees dive in together it's important to have your feet right under your hip joint your hip joint is right in your groin it's not the outside of your hip it's right in your groin so a common mistake is some people put their feet too wide for squats and they squat down and their knees dive in so have her look in a mirror to make sure she has the proper alignment i hope that helps so let's go to video 10 where i show you how to do direct self-treatment massage your knee the number one way to make it feel better right away i get a lot of questions about what to do when you have this crunching when you bend down when you squat down get up and down from a chair or just move your leg back and forth and the reason why that is is that you can have an uneven surface or a roughened surface behind your kneecap articulating with your femur bone and one of a great ways to help improve that articulation is to work out the muscle so you have good muscle control left to right so the it band often gets tight so i like sport screen but you can use whatever you want this has a nice glide you want to massage this part of your leg out really loosen up this band this band gets often tight when you have a mount alignment of your leg when your hip is not aligned over your knee and over your foot and i'll explain that a little bit more later but then you want to massage the outsides of your knee in and out massage under your patella tendon here underneath your kneecap you don't want to push down on this kneecap part this can move in and out but you kind of take your hand and you cup around it and massage over that area and pull up massage over that area and pull up because you want to have the normal tissue tension from the outside to the inside of your quads as well as the front quad and oftentimes that just gets overworked and you get an imbalance there so that should help you with the crunching it'll also help you if you have tendonitis pain pain in the front of your knee pain on the sides massage it here massage where your calf muscles come up and they cross your knee joint massage rear hamstrings come down and cross your knee joint stretch your calf all of that can help you with the pain that you're feeling in your knee enjoy i just did this with my mom this weekend she was having terrible hip pain go up and down the stairs and i said mom sit down we got on the video we rub down her it band and her leg and then she was able to go up and down the stairs much easier so let's go straight to the last video which is about what you can do and you can do it to help yourself even if you have end stage knee arthritis and you're waiting for a knee replacement let's watch this video to learn what you can do even if you have severe end stage knee arthritis you can still help decrease the pain in her knee and improve its function so one way is to massage get some lotion or sports cream as i like and you massage your leg massage the outside of your thigh massage your quad muscle massage behind your knee massage the tendon under your knee and then take your hand and this kind of a horseshoe put it around your knee cap and move it side to side like wiggle in and out like this it's a great thing now i have someone this one's for you melton who came in for the other knee he was having pain with swimming and doing his activities but i measured the the knee that he didn't have trouble with and he barely could bend it so i was trying to stretch it this way just to have him do some heel slides like this to get the knee range of motion when you have arthritis you need to flush the fluid through your joint spaces that's why motion is lotion move your knee before you get up to walk if you have a sniff knee and also you can stretch your quad so i had him lay face down and i had i helped him to bend his knee this way now he could only get about this far but he didn't have knee pain he just had thigh pain so in stretching out his thigh the muscle that you massage he gained so much range of motion and he came in last week and said thank you so much both my knees are feeling better so i want you to know that you can still help your knee even if you have severe knee arthritis you can still turn your foot straight going up and downstairs you can still strengthen your hip to support the femur that thigh bone so it's not twisting at your knee enjoy all right so let's wrap it up use these techniques try them massage your knee press the back of your knee down strengthen your hip and improve your mechanics i hope this helps thank you so much for joining me i'm christine lenders this is movement matters aloha everyone