The knee is always a very flexible joint, even when you think it’s stiff. The hip, on the other hand, is usually too stiff though you may not notice it. In the “Joint by Joint Approach”, by Mike Boyles, he quotes studies that have shown that joints alternate between being stiff and being loose. The knees are usually too loose and easily aggravated, while the joint above(hip) and the joint below(ankle), are usually too stiff and often cause the stress at the knee. The true long-term correction of the knee problem is to restore the mobility of the hip and/or ankle. Then, there is less strain on the knee joint and less pain. That is why we work on the hip to help the knee.
Let’s look at an example from my practice. Two months ago, a 55-year-old lady came in after twisting her knee walking the dog. She was unsure and exhausted even thinking about walking her dog but knew they both needed the physical activity. The ground was slippery, and she had walked for over 30 minutes. This patient hadn’t noticed knee pain before, only a slight swelling for a few months. She had some lower back pain the year before and on further questioning, her hip was a little sore then too. On examination I found her knee to be very sore, slightly swollen, and painfully restricted in flexion. When I moved the joint passively, non-weight bearing, it moved quite a bit in lateral/medial and anterior/posterior glide. This meant the knee was too flexible and easily strained on almost any movement; hence the swelling and tenderness.
One (or some) of the holding elements around the knee had suffered from a strain or overstretch. To help directly with the knee pain, we gently mobilized it, then applied ice, and encouraged rest. The real long-term fix was to assess her hip and her ankles and see where the tension was. A thorough Chiropractic exam included testing of the back to see if there were any vertebral nerves being irritated to further aggravate the knee and leg. We worked on the hip with some mobilization to increase flexibility, followed by releasing of any of the muscles that had become tense. We did adjustments to the restricted spinal joints and adjusted the foot and ankle as needed. Since the feet were quite flat, we prescribed custom-made orthotics to improve the alignment up the leg from heel strike to toe off.
Because the knee had been slightly inflamed for months, it took a little while before she felt well again. It was almost a month before she was walking pain-free and she has gradually increased her endurance and speed since. The dog no longer tires her out, so they both benefit from the walk: it’s a Win-Win. Spring is coming in 3 weeks. Let’s get active! Join the movement to be our best physical selves, and best mind, and soul. More on that next time!