Nicole Parsons: Welcome to the Pain-Free Podcast with me, Nicole Parsons, and my guest Andy Ritchie. And today we’re going to be talking about the link between posture and knee pain, and what you can easily do to resolve your knee pain with simple exercises.
Andy Ritchie: Interesting.
Nicole Parsons: This week I had a fantastic result, or my client had a fantastic result with their knee pain, and it just made me think that it would be a great topic for the podcast. So, my client Morris came in to me with severe right knee pain, throughout his knee joint, and not being able to put a load on that right knee. Now, he had been to the doctor and had been given very strong painkillers, and the painkillers were not actually affecting his pain or improving his condition. And he was also really not keen on taking painkillers. That was the reason why he came to see me in the first place.
Morris didn’t really know that much about posture or what I did; he had been recommended by a friend. When he came into the clinic, what I did was, we took postural photos, and we looked at his alignment of his load bearing joints: his ankles, knees, hips, through his spine, his shoulders, and his head, and his vertical loading. And it was really obvious, to me and also to Morris, when we looked at his photos, and the alignment of his posture, the underlying cause of why he had knee pain.
Now if I can just describe Morris’s position in his lower body. He had all of his weight on his left leg. His right leg was out to the side, and with the foot turned out. Now, you would think, well of course his foot’s turned out, and he’s not putting weight on it, because he’s got pain there. But when we look at his posture, the alignment of that right leg was that the knee was knocking in. So it’s called “valgus stress,” but if you think of it as a knee that is knocking in towards the other knee … His foot was turned out to about 40 degrees, and his right knee was also turned out, to about 20 or 30 degrees. Morris was pulling up out of that right hip and putting all of his weight onto his left leg, and he could see that the position of that knee was not a good position to load. Which was actually the underlying issue of his knee pain.
Now, Morris said, “You know, I’ve got a skiing lesson booked next week; should I be going and taking that skiing lesson even though I’ve got pain?” And we looked at his postural photos and his postural assessment and said, my question to him was, “Well Morris, would you want to take that knee joint, in this position, into a situation where you’re going to put extra load on it?” And his obvious answer was, “No.” So what we did was, I gave him a program of corrective exercises to rebalance the muscles and re-establish the load-bearing position of his joint so that that joint could function correctly and do its job again.
He came back a week later, and he said he’d actually reduced down his pain medication because he didn’t feel he needed it. And the second week after he’d been doing his corrective exercises, we could see that the position of that knee and hip and ankle was actually much improved. He was putting weight on both of hips; his right leg had come back underneath him again, so it was taking load. The foot had turned so that it was pointing in a more equal position to the left foot. And the knee had started to rotate in to a position where it looked more equal to the left side. And in the second week he came to me, he said, “I’ve totally stopped my pain medication through choice because I’m not in pain anymore, and I felt that I didn’t need it.”
He was over the moon, that he had been given exercises that put him back in control of his health again. He was off his pain medication; he was walking pain-free. Now, we still had work to do to continue to correct the posture of his whole body and his alignment so that he was fully functional. But within two weeks he’d improved the balance of his muscles and the loading of his joints enough that that pain signal that the body was giving him to tell him, “Please don’t load this knee; it’s in a position that’s very compromised and is going to cause damage to the structure,” enough that he could then move pain-free, which made a huge difference to his life.
Andy Ritchie: It sounds amazing. Is there a link between, like, how you stand and how you move? To the actually pain that you get? So, what kind of caused that, how was he stood?
Nicole Parsons: Well, to answer that question Andy, it’s probably helpful to actually look at the structure of the knee, and what is the knee’s job. What role does the knee play within our body, within our postural alignment and within our load-bearing joints?
The knee is actually a joint that is translating the power between the hip and the ankle. If you look at the lower body chain, you’ve got the foot which is connected to the floor, and the foot and ankle are the joints that are taking the load from the ground, the impact from the ground, and transferring that up the body. The hip is above the knee, and it is part of the pelvis, which is a very important stabilizing part of our posture. The hip has very strong muscles, so if you think of the hip as having jet propulsion strength muscles, and the ankle has very small and fine control muscles, and if you think of them as having elastic band power muscles.
Now, to translate the load between the ankle and the hip is the knee’s job. It’s a translator joint. But it also does what the foot and ankle and the hip tell it to do. So when there is pain in the knee, I am always looking to the hip, and the foot and ankle, and the loading throughout the whole chain, but its closest relationships are the hip and the ankle. And that knee is a hinge joint. So if you imagine the joint being a very efficient joint, and it has a very small amount of rotation in it.
If the foot and the hip are changing the angle of the bones that make up the knee … So, the tibia, your shin bone, is the bone that is coming up from the ankle and it’s the bottom half of the knee. The femur, your thigh bone, is the bone that’s coming down from the hip and is controlled by the hip muscles; it is the top half of the knee. So, the knee is just the ankle’s translating bone, and the hip’s translating bone, coming together to make a nice hinge. Now, it can rotate slightly, but it’s not designed for a great degree of rotation.
Andy Ritchie: Right.
Nicole Parsons: If you imagine that the shin bone is twisting in one direction, so if you think the shin bone is twisting outwards or rotating outwards, and the thigh bone is also rotating outwards, but to a different degree. Now this is what was happening with Morris. His thigh bone and his shin bone were not lining up at the hinge joint of the knee, and what that was causing was excessive rotation through the knee joint.
Now that’s just in his standing position. We’ve got to think about what then happens when he starts to move. So as that nice, perfectly designed hinge joint starts to hinge backwards and forwards as you are walking and bending and flexing your knee, because of the excessive rotation and the position of the bones, it is then getting excessive rotation at the knee joint, which is causing friction, uneven loading, and wear and tear to the structures. The main structures that are going to be affected, are going to be your cartilage, the ligaments, the tendons, and the muscles.
Morris had been told that his cartilage was wearing away, and that the worn cartilage was, and the fact that the bones that make up his knee were closer together and therefore rubbing, was the cause of his pain.
Now from a postural point of view, we actually look at it from the other direction; we look at that it is the muscle balance around the joints, the hip, the knee, and the foot and ankle, that are causing the position of the bones to be in an uneven or an incorrect position for loading, and then through movement, that incorrect loading position causes the wear and tear to the cartilage and the pain.
We’re actually looking to correct the root cause of the problem, and to actually resolve the knee pain at the root cause we need to rebalance the muscles, reposition the joint back to its natural design, back to its perfectly designed natural position, so that it can function correctly in the way it was designed to function.
Andy Ritchie: So how do we go about doing that, if somebody’s listening to this episode right now and they’re thinking, “Man I suffer with knee pain,” and they’ve tried loads of things; they’ve been to the doctors, they’ve tried having injections in the knee, they’ve tried all different types of things and they seem to still have this common problem, what’s a couple of things they can do to look at their posture and decide whether this is something that might affecting them or not?
Nicole Parsons: Well something they can do to see what’s happening in their own posture, is actually just to, in shorts and a T-shirt or, if you’re at home on your own, your underwear, because then you get the best view of what’s happening with your body, just to stand in front of a mirror, and put your feet equally, and march on the spot, so you just move your feet around so that you’re not thinking about how you’re standing or posing. And then when you’ve moved your feet slightly, just stop and look into the mirror.
And what you’re looking at is, at the foot and ankle, are your feet pointing straight ahead, or is one turned out, or are both turned out and are they turned out to different degrees? Then look at your knees, and are your knees pointing straight ahead, and that’s if you imagine your kneecap had a light on it, like a headlight, is that headlight pointing straight ahead? Is it pointing outwards? Or is it pointing inwards? Or are they pointing at different rotations, one inwards and one outwards? Then have a look at your hips. Are your hips level and balanced? So if you look at, probably the line of your shorts or your pants, is one hip higher than the other? Or if you look down, can you see that one of your hips is forwards of the other hip? Have a look at your shoulders, and same again, are your shoulders level? And can you, looking down, see one of your shoulders in front of the other, and how is your head positioned sitting on top of your spine? Is it off to one side, are you looking straight ahead?
Now this is the easiest way that you can look at your load-bearing joints and see if your ankles, knees, hips, shoulders, and spine are aligned to their functional design with a nice right angle at the center of each of your joints. If they are not, in any of those areas, and you are experiencing knee pain, it’s looking at, where is that rotation coming in to your knee? Can you see that the position of your foot, the position of your hip, and/or the position of your shoulders, is affecting the rotation and the loading of that knee joint? So how is the position of your knee being affected by the position of all of the joints through your load-bearing design?
That’s one way that you can see what’s going on with your own body. So first of all, just to make that link as to actually what is the root cause of my knee pain? And then what can you do about that, there are some very simple exercises that are through the Egoscue Method of postural realignment, which I am an instructor in, that you can do simply at home with no equipment. And we’ll be putting a link to those at the end of this podcast.
One last thing I’d like to go through with you about how to assess which exercises are best for you, with your knee pain, is, when you are looking in the mirror and doing your postural assessment, and looking at your kneecaps, is to decide whether your kneecaps are rotating outwards, which is called external rotation, or rotating inwards. So, again, you’re looking at your kneecap, imagining that the kneecap has a light shining out of it, and if you were to take the direction of the light, if your knees are turning outwards, that is external rotation. If they are turning outwards, they’re pointing away from each other. And it doesn’t have to be equally; it can be at different degrees. If they are pointing inwards, or internally rotating, and pointing towards each other and again, it can be at different degrees, then they are internally rotated.
When you go to the link at the end of this podcast, you will be able to download a free PDF that will give you simple E-cises that you can do at home to help you to take control of your pain, resolve it at the root cause, and have something you can do right now to resolve knee pain. And you will be looking at either downloading the exercises for internal knee rotation, or external knee rotation.
So you will need to visit nicoleparsons.co.uk/knee to access and download this free PDF, which is my gift to you for listening to this podcast.
Andy Ritchie: Okay Nicole. Thank you very much for your time today.