The Knee Bone Is Connected to The… Well a lot!!!
Question: Did you know that stiffness in your upper to mid back could be the cause of your knee pain?
Truth: Pain is very misleading, but if we can learn to understand it’s true origin, then we can also learn how to treat it to live a more productive life.
The Story: A middle-aged man that also happens to be a tri-athlete came to me with complaints of knee pain while cycling and running. If you have every watched professional cycling, the typical posture is one that includes being hunched over with the arms tight to the body, very focused on the road ahead.
The Problem: If there were even a minor restriction in the mid back (causing a rotational shift to one side), that restriction could cause a compensatory rotation in the hip or the knee, especially when clipped in.
For example, if you are sitting in a little bit of rotation to the right, due to perhaps a fall onto the rib cage or maybe even because you sit to the right while working, in order for you to keep your gaze directed forward while cycling, you must rotate somewhere else to achieve this. And that could happen anywhere in the kinetic chain, even the knee.
In this case, it was the knee. In someone else it could be the neck. Everyone is different.
The initial evaluation included screening tests such as a standing forward bend and a squat, which simulated the movement of his lower back while cycling. This revealed a twist in his thorax to one side, which limited mobility to his opposite side. We also performed a sitting slump-like test, and it revealed the same twist.
What also happened was a significant rotation in the knee. Knees are not really meant to rotate, they are so called “hinge joints”, because they bend and straighten like a hinge (not like a ball and socket). When we corrected the twist in the thorax, the rotation in the knee went away and the experience was better for the patient.
Primary Treatment: Releasing the tightness in the muscles of the thorax, increasing movement in the joints of the upper/mid back and taping to maintain his thoracic control. We also did a movement re-education series to include straight squats and squats with rotation, as well as a sitting practice task with cues to keep the control in his thorax.
Secondary Treatment: We also did some Pilates exercises on the Cadillac that included pushdowns with the bar with a rotational bias. The patient did some yoga, so we incorporated postures such as a sustained forward bend with a rotational bias to help to maintain his new movement pattern.
The Positive Results:
- A return to cycling – pain-free!
- The incorporation of corrective exercises into a regular training routine
- Consciousness of how the body is connected
- New mantra: “the knee bone is connected to the spine!”
BONUS: He also helped his fellow triathletes understand the importance of finding someone that will look at the body as a whole, and not just at the part that hurts – a very important lesson to a thriving and active life!
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