Hip to be square...

Patellofemoral syndrome, also known as "runner's knee," is a fairly common knee condition that is treated in chiropractic offices. Treatments can consist of many different therapies from taping, mobilization, active stretching, or strengthening programs. Too many times, the treatment focuses mainly on the knee area, but in order to treat this condition most effectively, we have to consider the rest of the body as well. Instead of only focusing on local areas, you must look distal (away) from the site of injury... particularly the hips. That is where the focus of this article will be...

There are so many different causes of patellofemoral syndrome, the most common one being weakness in the leg muscles (i.e. hamstring, quadriceps, or TFL [Tensor Fascia Latae]). Recently, there has been a general shift in focus toward looking at hip muscles and joints, specifically the TFL. By adding strengthening of these muscles, we can not only decrease the pain associated with "runner's knee", but also increase mobility in the body during day-to-day tasks. "Hey Cassie! Tell me how!" Gladly... :)

Initial treatments should consist of mild to moderate stretching of these tight muscles as well as regular adjustments to the lumbar spine (low back). To the patient's tolerance, light exercises can be added into the treatment. Side-lying clam exercises should be initiated to address the TFL and gluteus muscles. The patient should be positioned in a side-lying position with their feet together and knees at 45 degree flexion. Then instruct them to lift the top thigh up and back.

Next, you can progress to weight-bearing exercises involving both limbs, such as squats. Throughout the duration of treatment, hamstring flexibility should be watched. If the length of the hamstring is reduced it can increase pain during these exercises.

The next phase of rehab can include single-leg weight-bearing exercises. These can be in the form of single-limb sit to stand, step-downs, squats, deadlifts, and eventually lunges. Lunges should be done with a long stride instead of a short step. Why? Short step produces more compression on the knee joint. The longer lunge puts more emphasis on the glutes.
*** Side note: When doing treadmill exercise, remember to lengthen your stride in relation to the above mentioned information. ALSO, make sure that the treadmill is not bringing your foot back on the stride. You should be pushing the foot backwards as if you were walking on a stationary surface. Why? Allowing the treadmill to do the work for you will cause over strengthening of the frontal leg muscles, but an overall weakening of the glutes and backs of the legs.

SO! LOOOOONG story short, though the hip joint is one of the most over-looked areas in the treatment and rehabilitation of "runner's knee", by addressing the TFL and hip joint with appropriate stretching, exercises, and adjustments, we can provide a much more effective rehab program.

Stay hip... and stay loose... :)