Approximately 10% to 25% of adults experience some sort of knee pain while walking, with general knee pain effecting 25% to 60% of adults at some stage in their life. It’s one of the most common issues we see in Functional Patterns Dublin, and in this blog we will shed some light on why this is and dispel some myths around what causes it. While the culprits are usually said to be weak or tight muscles, there is a lot more to the story.
Walking repeatedly loads the knee, but knee pain does not always mean that there is an issue with the knee itself. While poor long term loading can eventually cause structural issues in the knee like cartilage, ligament or meniscus damage, most times the pain felt is just a signal from the body letting you know that something isn’t right. When you learn to improve how you co ordinate and load the patterns of walking itself, the alarm bells often disappear.
Is Knee Pain Caused By Weak Glutes or a Tight IT Band?
When it comes to any type of joint pain, the culprits are often said to be either weak or tight muscles. With knee pain, people are often simply told they have weak glutes and to strengthen them. How you might ask? Well it generally is said not to really matter. Just strengthen them in any way shape or form and all of a sudden these plump glutes will know how to do the job carry you along as you move.
If you have tried countless amounts of banded crab walks, glute brides or squats with no improvements you can relate to the frustration of this supposedly simple solution not working. The IT band (a big strap of tendinous tissue running from the outside of your hip to your knee) is also often brought up in conversation when it comes to knee pain with some clinicians saying that it needs to be released and stretched, while others saying it has no impact on the knee at all.
One thing that our experience in FP Dublin has taught us over the last 10 years is that while things like the the glutes and ITB are often involved, they are not necessarily the cause. Poor coordination when we move can lead to poor load distribution, and it seems more likely that the coordination issue causes the muscle issues not the other way around.
How Poor Coordination Can Increase Pressure on the Knee
When we move, our body has to coordinate joint movements in a way that distributes load and force throughout the body. Joints like the hip and ankle play a big role in conjunction with the knee when we do an activity like walking. As well as this, the whole trunk and spine need to find themselves in positions that allow proper stacking in order to have this force transmission be something that happens fluidly and smoothly.
In order to coordinate these movements, the body must have access to certain key functions. If these functions are not present, the body will compensate by defaulting to another type of movement. All of a sudden a hip extension can very quickly become a pelvic shift or a knee valgus, and this misdistribution of force can then be something that concentrates too much load on particular areas of the body like the knee. If this happens more and more over time then pain becomes the natural by product.
As mentioned above, it is important to distinguish between the mechanism causing the issue, and the structures and areas of the body effected. Unfortunately, too often we look to the structures effected for answers regarding the mechanisms that are causing the problems. When you dig deeper, you will find that how the body coordinates movement and distributes force is often the mechanism that is the root cause.
The Role of Instability and Load Distribution
Poor coordination of movements as explained above can often lead to instability in a certain joint at a certain point on the gait cycle. Poor coordination can lead to instability, this instability can cause excessive load through a joint, which can cause muscles around the joint to become problematic as a way of trying to compensate for the instability.
Instability doesn’t necessarily mean the knee is visible giving way, although it can. It can mean that the body lacks control at particular moments in the walking cycle, making it harder to spread load efficiently across the wider structure. As you can gather, issues like knee pain when walking are a little bit more complex than simply strengthening a weak muscle or loosening a tight one.
What Should We Assess?
It might seem very obvious to say, but if pain is present when walking then walking itself should be the first priority during assessment. At FP Dublin we routinely assess gait an posture as standard during our initial assessment. While isolated joint and muscle tests can give us some information, they do not help us understand the coordination issues that may be leading to instability, and as a result pain.
Often times, clinicians can get lost in the weeds trying to diagnose the exact structures that have become painful based on these ways of testing. It can seem easier to treat when we put the issue into a neat little box in order to follow whatever treatment protocol is allocated to it, but it is often not going deep enough.
When these coordination issues are present they can put pressure on a number of different areas of the knee. Sometimes people will feel more pain on the inside of their knee, others on the outside. Some may have most of their pain around the ITB, others around the hamstring. The exact structure that has started to act up is the result of these issue not the cause, and we can often get lost trying to understand these signals.
Conclusion
Many people experience knee pain while walking, and while weak muscles or a lack of flexibility in a certain area of the body are often seen as the cause we need to look deeper. Global coordination issues during movement can create poor distribution of forces and instability that will lead to pain if not addressed. Good assessment looks at gait mechanics and the whole body as one system rather than focusing on isolated strength and flexibility. If you are struggling to get a handle on your knee pain, get in touch and start to build full body coordination that will address the issue at its core.
