It has been mentioned before in this Comox Valley Chiropractor Blog that improper activation of the gluteal muscle can lead to many lower limb issues such as knee pain (patello-femoral syndrome) or IT Band problems. A research study was recently published which sought to establish a group of exercises that were the most effective at activating the gluteal muscles.

The study, published in the Journal of Orthopaedic & Sports Physical Therapy, measured the EMG (muscle electrical activation) of the gluteus maximus and medius during various exercises. They came up with a group of 5 exercises which are the most effective.

1. Side lying hip abductions – abducting the top leg to 30 degrees.
2. Single leg squats – ensuring the knee stays above the second toe, and start with knee and hip at 30 degrees of flexion.
3. Single leg dead lifts – keep knee bent at 30 degrees to maximize hip and trunk flexion.
4. Lateral band walk – side-stepping against the resistance of a band tied around the ankles.
5. Side-hops – hopping sideways off the non-dominant leg to land on the dominant leg.

These exercises may not be appropriate for all patients and all conditions. Consult a professional in order to determine your diagnosis and any other issues you may have. A good home program lets you achieve the results you desire in terms of stability, with exercises that are easy to do and won’t result in further injury.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Anytime someone comes into my Comox Valley Chiropractic office with knee pain, I always will look at their hips and pelvis for dysfunction. It is a logical step that most chiropractors will take.

Now, new research is emerging which is showing that a measurable relationship does exist between patellofemoral joint (kneecap) pain and altered hip mechanics.

This study published in the Journal of Orthopaedic & Sports Physical Therapy found a link between women with kneecap pain, increased internal hip rotation and weakness with hip extension. These subjects consistently showed weaker single leg squatting and jumping abilities, and had improper hip mechanics when running.

A comprehensive treatment strategy would involve normalizing the hip and pelvic function with chiropractic adjustments, working on the muscular tension with soft tissue therapy, and addressing the hip weakness with a gluteus medius and maximus rehab program.

The incidence of knee pain is very high in our society, especially in younger women. There are ways to help this condition, and it is not necessarily something you have to live with!

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

An article in the Journal of Manipulative and Physiological Therapeutics reviewed all the research concerning chiropractic treatment of lower extremity conditions. What they found is that chiropractors have a big bag of tricks to deal with lower limb conditions – including manipulation, soft tissue therapy, exercise therapy and modalities such as laser and ultrasound.

While there was not a huge number of studies done on this subject, the authors did find enough good evidence to state that chiropractors can be confident in using these methods to effectively treat lower limb conditions.

What that means for the patient is that chiropractic care is another effective way of dealing with any lower extremity condition you may have, whether its achilles tendonitis, plantar fasciitis, knee osteoarthritis or IT band issues. Often time my patients will start an office visit with “You probably can’t do anything, but my <insert lower limb part here> is giving me problems”. They usually leave very satisfied with the results of treatment.

What this means for chiropractors is that we need to do a better job of educating our patients about our wide range of skills, and all the different ways we can help them.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

At the beginning of the study, there were no differences between the 2 groups of participants. One group performed only strength training exercises, while the other group performed a combination of strength and balance exercises. Based on various outcome measures such as pain, disability, stiffness, depression and physical function; the balance group performed significantly better after one year.

This study suggests that it is important to ensure that any rehabilitation program for knee arthritis should include simple balance exercises. Some of the exercises used in the study are as follows:

• 25 m backwards walk
• 25 m heel walk
• 25 m toe walk
• 25 m eyes closed walk
• 30-second one-legged stand (with leaning in all directions with eyes open and closed)

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Ever since I started using kinesiotape in my office, I seem to be using it more and more for knee conditions. There are so many different ways to apply the tape, but I find sometimes that the most simple applications make the most difference. Here are some quick and easy applications of kinesiotape for knee pain. They are modifications of the listed technique that can be found in the kinesiotaping manual:

1. ACL instability

2. MCL strain (inner knee strain)

3. Patello-femoral syndrome (kneecap pain)

Its best to seek out an accurate diagnosis first for your knee pain. If you find that kinesiotape works, it is a safe and effective way to control your symptoms and allow you to ultimately rehabilitate the knee.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

A research study published this week in the New England Journal of Medicine states that “Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”

Researchers followed two groups of patients with knee arthritis randomly assigned to receive either knee surgery or physical therapy plus over the counter medication. A follow up at two years showed no difference in pain level and quality of life between the two groups.

This study is not the first to demonstrate the ineffectiveness of knee surgery for osteoarthritis. A study in the July 2002 edition of the New England Journal of Medicine demonstrated that the outcome after knee surgery was no different than that of placebo treatment (incisions but no surgery).

Knee surgery is a common procedure recommended for arthritis sufferers for the simple reason that it has always been done. Now, there is mounting evidence that conservative care is just as effective as the surgery, never mind being less invasive, safer and less of a cost on the health care system.

It is my opinion that as responsible health care consumers, we must make smart informed choices on treatment options. Practically speaking, for most conditions it is wise to choose the most conservative form of therapy first and save the most invasive (surgery) for later. The worst thing that will happen with most conservative therapies is that you don’t improve. Conversely, the worst consequences for surgery include infection, sepsis and death (especially with all the drug resistant bacteria in hospitals such as c. difficile).

The effectiveness of many common surgical procedures (including those for low back pain) is starting to be questioned. If you would like to learn more about what your options are for conservative therapy, please contact your Comox Valley Chiropractor.

Iliotibial Band

Iliotibial band syndrome (ITBS) can be described as outside (lateral) knee pain that is made worse by any lower limb activities, most notably running and cycling.  The incidence of this injury is on the rise in my practice, but research also shows that ITBS is the most common running injury in the lateral knee, with an incidence of 1.6-12%. In cycling, ITBS may account for up to 15-24% of all overuse injuries.

It is thought that ITBS is an overuse injury in which the portion of the iliotibial band which runs over the outside knee rubs over the femoral bone with repetitive knee bending and straightening. This results accumulated tissue damage and irritation of the ITB. Specifically with running, as each leg comes forward before heel strike, the tensor fascia latae (TFL) and gluteus maximus/medius are contracting to slow down the leg, which can result in a large amount of tissue tension generated in the ITB.

A study published in Manual Therapy systematically reviewed all studies on ITB treatment in order to determine which was the most successful method. What they found is that there is a marked lack of good evidence to support any one given treatment for ITBS. All forms reviewed – ultrasound, friction massage, medication or ice all had very little benefit on the condition.

Part of the reason for this is that different treatments could work for different subsets of people (i.e. older cyclists respond better to one thing, while runners with chronic ITBS respond better to another). This Comox Valley Chiropractor will often see good results with ART (active release therapy) and other such soft tissue therapies, kinesiotaping,  and chiropractic adjustments to restore proper function of the pelvis, hips and back. Of course, one must always look above the problem (pelvis) as well as below the problem (feet) for a source of dysfunction.

So the bottom line of this post? So far, the evidence doesn’t point to one therapy being better than another. So when seeking out treatment, be sure to set an appropriate treatment plan that includes regular re-evaluation with your therapist. If something isn’t working, don’t be afraid to move on and try another modality once you’ve given the first one a good shot.

If you have any questions about ITBS, feel free to contact your Comox Valley Chiropractor for more information.

This article was originally written for Wings of Steel – a blog created and maintained by Karley Cunningham, a cycling woman of steel!

Did you know that knee pain (or patello-femoral pain) accounts for one quarter of all cycling problems?

While cycling can provide an amazing workout without the repetitive high-impact forces (like those associated with running), it is in fact associated with a great number of overuse injuries. Patello-femoral syndrome, which is the most common cycling injury, accounts for around 25% of all cycling related complaints.

Biomechanical irregularity of the knee joint, along with demanding training, are believed to be responsible for most cases of chronic knee pain in cyclists. These irregularities are believed to put excessive pressure on the cartilage within the knee during the constant knee flexion and extension associated with cycling.

This produces degeneration of the knee cartilage and other structures. As the cartilage degenerates, more stress is put on the bones as they compress, producing pain and inflammation.

Why do people develop biomechanical problems with their knees? Explanations abound, including weak quadriceps (most notably the vastus medialis oblique), over-pronating arches, poor flexibility, genetic structural problems, improper bike set-up or poor equipment.

Training aspects that could aggravate the knees include excessive hill training, riding slowly in high gear and a sudden increase in training volume. Interestingly, research has shown that most cyclists with knee pain have too much side-to-side swinging of their knees during the down-stroke of their pedal cycle.

Usually, people will feel pain in the front and inside of the knee, which is hard to pinpoint. Often people will say it is inside the knee, or under the kneecap. Activities that can worsen the pain include walking up and down stairs, sitting for prolonged periods of time, squatting and of course riding.

If you’re a cyclist who develops knee pain, your first line of defense should be the familiar RICE – rest, ice, compression and elevation. Most cyclists with knee pain will find that this relieves the symptoms quite quickly.

It is important to note that this self-therapy will only serve to reduce the symptoms, but will not resolve the biomechanical problem that is causing the pain. Therefore, the pain will return when you go back to your regular training.

Your ultimate goal is to improve your joint motion, flexibility and strength. The quadriceps muscles need to be strengthened, abnormal biomechanics of the lower limb need to be identified and corrected, and training errors need to be rectified.

When introducing hill training or when increasing your training volume, be sure to do so in a gradual and measured manner. You may also add in some spinning, or cycling at low gears in order to maintain volume while minimizing stress on the knees.

If you are unsure of the source of your knee pain, or are unable to manage the condition on your own, consult your Comox Valley Chiropractor. A chiropractic doctor can diagnose a specific cause of your pain, provide treatment to manage the condition, and prescribe sport specific and injury specific rehabilitation exercises.