FOCUS ON HEALTH

Standing, walking, and running – Why does it hurt?

By Virginia Nsitem

Do you experience pain in the hips or knees when standing? Do you have difficulty walking or running because of hip and knee pain? This article will discuss how hip or knee problems can make these simple activities painful and challenging.

Hip Anatomy:

The hip joint is formed by the head of the femur (thigh bone), like a ball, connecting with the opening of the pelvis, shaped like a socket. That is why the hip joint is considered a “ball and socket” type joint. There are strong ligaments that surround the hip joint and form a capsule, and these ligaments provide stability to the hip joint.  The capsule contains fluids that lubricate the hip joint. The muscles of the hip help move the hip joint up, out, in, backwards, side-to-side, and around. Some of the important muscles include the quadriceps, gluteal muscles, hamstrings, and groin muscles. There are sacs called bursa that provide “cushioning” at the hip joint. Nerves from the low back supply the muscles of the hip and provide sensation to the hip, buttock, and thigh region. One of the most important nerves for the hip is the sciatic nerve. The hip joint functions to support the weight of the body during standing, walking, and running activities.

Knee Anatomy:

The main bones at the knee are the femur (thigh bone), patella (knee cap), tibia (shin bone), and fibula (small lower leg bone). The patella sits on top of the knee joint. There are ligaments at the sides, behind, and in front of the knee joint that help provide stability to the joint. The meniscus are the cartilage of the knee joint, and each knee has two menisci, one on the inside of the knee joint called medial meniscus, and one on the outside of the knee joint called lateral meniscus.  The meniscus helps the joint glide smoothly during movement, balances the weight at the knee, stabilizes the knee, and works as a “shock absorber”. There are fluid-filled sacs (bursa) that prevent the tendons from rubbing against the bone. The two main muscles that attach to the knee are the quadriceps (front thigh muscles) that straighten or extend the leg and provide stability, and the hamstrings (back thigh muscles) that bend or flex the leg at the knee. There are nerves and blood vessels around the knee joint. The knee joint supports the weight of the body during standing, walking, and running activities.

Common hip and knee problems:

Joint Osteoarthritis or wear and tear of the joint causing achy and stiff pain that is often worse after moderate activity and better after rest, pain that is worse in the morning, and eases after “warming up the joint”, and crackling noises in the joint.

Muscle, Ligament, and Tendon Injury causing difficulty standing, walking, running, jumping, and climbing stairs. Knee ligament injuries may make the knee feel weak and cause the knee to buckle or give way. Typical symptoms of tendonitis in the knee include pain felt at the bottom of the knee cap, especially after jumping and running, swelling at the bottom of the knee cap, and tightness of the quadriceps and hamstring muscles.  A groin pull is an example of a hip muscle injury.

Low Back Injuries such as muscle or disc injuries can refer pain to the hip joint and knee joint.

Nerve Injuries can cause pain or numbness around the hip. Injury can occur from trauma to the hip from a seatbelt injury, or trauma to the pelvis and low back.

Relieving Hip and Knee pain:

Before treatment and rehabilitation can begin, it is important to get an accurate diagnosis. In addition to a physical examination and a thorough understanding of your symptoms, you may be referred for additional tests such as x-rays, CT scans, or MRI studies. Chiropractors specialize in diagnosing, treating, and rehabilitating injuries of the spine, muscles, ligaments, tendons, joints, and nerves.  A correct diagnosis is important to rule out more serious conditions that may be causing your pain and symptoms. The focus of the treatment is to reduce pain, improve flexibility and strength, and increase function (standing, walking, and running).

Your treatment by a Chiropractor may include:

• An ergonomic assessment of how you stand, walk, and run, and tips to improve your posture.
• Chiropractic treatments for the hip and knee (and other related joints) to improve flexibility, balance, and strength of the muscles and ligaments, and restore proper movement to the joints.
• Specific Rehab Program. The type of injury you have will determine the specific rehabilitation program that you should receive. The program will target the injured parts of the joint to restore function and prevent re-injury.
• The addition of massage therapy and acupuncture to your rehab program may aid in pain relief.
• Monitoring your weight is also important as a few extra pounds can contribute to hip and knee joint pain.
• Proper footwear and proper foot mechanics can help reduce the intensity of hip and knee pain. Custom foot orthotics or over-the-counter foot supports can provide extra cushioning in your shoes which may reduce stress on the joints. If you have chronic hip pain or knee pain, and are limping, you may be advised to use a cane or walker, or other supportive devices to aid your mobility.

Stop the Pain … Before the Pain Stops You!

(Dr. Virginia Nsitem is a chiropractor specializing in laser therapy for spine, muscle, joint, and nerve injuries, and is a Fellow of the Royal College of Chiropractic Sports Sciences in Canada. She may be reached at (905) 275-4993, or by email at totalhealth@bellnet.ca )