Category Archives: Conditions

Treatment for knee pain when hiking downhill


 

 

Hi this is Dr. Kip Thompson with Catalyst Chiropractic and Rehabilitation, your chiropractor in Beaverton, OR. We have a lot of hikers here in Portland. One of the most common complaints I hear from our hiker patients is knee pain when hiking downhill. The reason for that is when you are walking downhill you have 3-4 times more force on your legs than when walking on an even surface. We take 2 approaches to combat knee pain when hiking downhill: First, reduce the amount of load going through the joint. Second, make yourself more resilient by increasing your capacity to bear the loads placed on the legs when hiking downhill (strengthen your legs). 

There are three ways to reduce load while walking downhill. The first way is to just slow down. As you can imagine, the faster you are traveling, the more impact you will have on your legs and knees as you are stepping downhill. The second way to reduce knee pain while hiking downhill is to bend your hips and knees more. The straighter your legs are and the more upright you are, the greater the impact on your joints, particularly the knees. Putting a slight bend in the hips and knees as you are walking downhill helps your muscles absorb more of the shock, taking stress off the knee joint. Lastly, you can use a hiking stick or trekking poles. These tools have been shown to reduce impact on your lower extremities by up to 25% while hiking, and that is why they’re important, especially for hikers with knee pain while going downhill.

Here are some examples of things we’ve done with some of our patients suffering from knee pain to help them become more strong and stable in the knees. Again, these are just examples of exercise techniques. To find out what is right for your situation, we would need to perform a thorough examination and come up with an individualized treatment and recovery plan. On your first visit at Catalyst Chiropractic and Rehabilitation, one of the first things I look at is your ability to stand on one leg while keeping your hips level and not losing balance. It’s surprising how often we find someone who can’t stand on one foot for longer than 10 seconds, yet never even realized they have a balance problem. If you are not able to adequately stabilize your hips while standing on one foot, this can translate into abnormal stress on your knees and result in knee pain. What I could have you do is practice one leg stands. Stand on one foot for as long as you can without losing balance or letting your pelvis tilt to one side. The goal is to be able to do that for 60 seconds. If you can’t do it, you could work up to it by performing 3 reps on each side for as long as you can before losing control. Then repeat that daily to gradually improve stability and balance.

The second exercise I’d like to demo is called quad sets. This exercise is commonly used early in knee rehabilitation to strengthen the quadriceps muscles and add stability to the knee. Lie flat on your back and rest a pillow or rolled up towel under your knee. Then contract your quads, which will straighten your knee and push downward into the pillow. Hold this for 10 seconds at a time, performing multiple repetitions of 10 seconds each.

Ultimately you will need to progress to more functional movements that mimic what you will actually encounter on the trail. A more progressive way to strengthen your quads is to start doing some squats. We mimic the downhill motion by elevating the heels by placing an object underneath your heels. From there, slowly lower into a squat position, then quickly return to standing posture. I like to use the cadence of 2 counts going down and 1 count coming up to emphasize that lowering motion that happens with every step while hiking downhill.

One last, more difficult progression is a 1 leg decline squat. This is set up the same was as the two leg decline squat that I just demoed, but it is performed with only one leg in the lowering phase of the exercise. Then use both legs to come back to starting position. The lowering portion of this exercise is called an eccentric muscle contraction of the quadriceps. Eccentric strengthening exercises are great for rehabbing tendon injuries, which is much of the time part of the cause with knee pain in hikers.

For any questions or to set an appointment to see me, call 503-526-8782 or visit our website at catalystchiroandrehab.com

Why your back pain diagnosis may be overrated

Low back pain x-ray diagnosis
Lumbar spine x-ray

In the most recent issue of “The Back Letter” the author summarizes findings of a task force employed by the National Institutes of Health (NIH) to set new research standards on low back pain. Their principle goal was to establish a classification system of chronic low back pain based on the anatomical causes of the pain. What was the result? They failed. The problem is that low back pain is too complex to just file it nicely into different categories. Here are some key points highlighted by the article:

  • It would seem easy to classify low back pain based off of diagnoses such as sciatica, disc herniations, and stenosis, but researchers and clinicians often have differing definitions of these conditions. This means that your stenosis may not look anything like the next guy’s stenosis, and they may not respond similarly to the same treatment.
  • Even with the amazing imaging technology available to us (MRI, CT scan, x-ray, ultrasound), the actual cause of your pain is not always clear. Numerous studies have shown that imaging findings do not correlate to symptoms as well as we think.

And the kicker…

  • “Tens of thousands of patients every year receive powerful medications and undergo physical treatments, injections, and surgery for spinal conditions that have never been proven to be primary causes of low back pain (The Back Letter, Vol. 29, No. 8, 2014. Lippincot, Williams & Wilkins).”

The bottom line is, don’t take your low back pain diagnosis at face value, and definitely don’t jump into anything that you are unsure of (injections, lumbar fusion, etc) without trying more conservative options first.

This is the fight that chiropractors have been fighting since the profession’s inception. Chiropractic is a safe, non-surgical, drug-free way to treat many of these common low back pain diagnoses that the medical world is having such a difficult time classifying and researching. I always tell my patients on their first visit that unless I really feel it is necessary, I probably won’t take x-rays.  We will proceed with a series of treatments to address the misalignments and joint restrictions I find in their physical exam and if their pain doesn’t improve, then we will take x-rays or order an MRI. More often than not, they will get better before we ever need any imaging. What a great model of spine care! This is why chiropractic has been shown in multiple studies to be so cost effective; the treatments are very affordable and fewer advanced tests and invasive procedures are needed when people see their chiropractor first.

Rant over. Have a healthy day!

-Dr. T

Are your glutes asleep?

I’ve recently begun implementing an evaluation tool called the Selective Functional Movement Assessment. This is a series of movement challenges that helps spot abnormal movement patterns that may be contributing to your pain. One common pattern that this assessment keeps revealing is that of weak gluteal (butt) muscles.
Unfortunately, most of us use our glutes more for cushions while we sit than for powerhouses while we move. Due to our sedentary lifestyles, the glutes become inhibited, or turned off, and other muscles have to pick up the slack.
Signs you might have a weak backside:
  • Most of the day is spent sitting
  • Frequent hamstring strains or cramps
  • Low back pain
  • Hip pain
  • Tight IT band (Iliotibial band syndrome)
  • Knee or ankle pain during activity
If these symptoms sound familiar, let’s do an assessment at your next visit and see if we need to whip your glutes back into shape.
In health,