Perhaps it’s not your knee at all

As the season of fun runs draws near, many of us will begin running programs that result in knee pain. Whether you’re hoping to complete Sydney’s City to Surf, or to run a personal best time in a marathon, it is important to understand the possible origin of your knee pain as it may have nothing to do with your knee at all.

The pain that this article refers to is that which you get in the front of your knee joint (patella). You may recognise this as patella femoral dysfunction, patella tendonitis or patella chondromalacia just to name a few. However, the activity that is occurring at your patella is often just a symptom of the real problem that lies elsewhere.

It is no secret that the knee is located in between your shin bone (tibia) and your upper thigh bone (femur). The tibia is greatly affected by the ankle joint, while the femur is greatly affected by the hip joint, meaning that any instability at either joint will affect your knee.

The more common instabilities include weak arches, or flat feet that act on your ankle joint, and weak gluteal muscles at your hips. As the arch in your foot collapses due to this weakness, it causes your foot and ankle to roll in or over pronate. Following this inward rotation, your tibia then proceeds to rotate towards the centre of your body, creating incorrect alignment at your knee.

Knee problems caused by lack of activation from your gluteal muscles revolve around weak gluteus medius. Gluteus medius is the muscle that acts to keep your femur from rotating inwards (much the same as the ankle and tibia due to flat feet). Gluteus medius has the job of ensuring that your knee travels in a straight line while you run, minimising harm on the rest of your body and being much more energy efficient through a long run. Inactive gluteus medius means that your knee joint will rotate inwards. Combine this with your weak arches, as most of us do, and you will find that your tibia, patella and femur are all rotating towards the middle of your body. It is the way in which your body attempts to compensate for this that may be causing your knee pain.

So how does the body do this? Enter the Iliotibial Band (ITB)! Your ITB begins at your hip, runs down the outside of your upper leg and inserts at the front of your knee (where you’re feeling that pain). The result of your incorrect biomechanics is that your ITB has been forced to become overactive in its attempt to minimise the angle between your hip and knee. The excessive load on your knee is mirrored by the strain in your ITB as it pulls your knee cap in the direction away from the middle of your body to correct the instabilities at your ankle and hips.

To correct these, you will need to strengthen your arches, or even seek professional advice on footwear that can assist your body with such dysfunctions. Your ITB will need to increase its flexibility while you improve the strength and efficiency of your gluteus medius muscles. Try single leg exercises like lunges, and perform them while ensuring that your knee travels in the direction of your second toe. The benefits of correcting these will not only decrease your knee pain, but these issues can also instigate back pain, and will definitely be inhibiting your running times and ability. An efficient body means efficiency in performance, lifestyle and achieving your goals!

Hi Blake,

I’m under the impression that I have Crohns disease and was wondering if you had some more information on this issue? I am having a really hard time. I am doing heaps of research on the topic and was just wondering if you had any good information I could get hold?

Thankyou
Carleana A

Hi Carleana,

By Blake Worrall-Thompson

First we need to know exactly what Crohn’s disease is. Wikipedia states that Crohn’s is: an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody), vomiting, or weight loss, but may also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.

Crohn’s disease is an autoimmune disease, in which the body’s immune system attacks the gastrointestinal tract, causing inflammation; it is classified as a type of inflammatory bowel disease. There has been evidence of a genetic link to Crohn’s disease, putting individuals with siblings afflicted with the disease at higher risk. It is understood to have a large environmental component as evidenced by the higher number of cases in western industrialized nations. Males and females are equally affected. Smokers are three times more likely to develop Crohn’s disease.

For Carleana to fight off Crohn’s there are 4 principle rules that need to be followed:

Unfortunately this isn’t a quick process, so take your time and do it properly!

Good luck!

As we come out of summer, our training motives may shift slightly from aesthetic towards those of health and vitality. Through winter, it is a good idea to begin preparing for your summer fun by combating the very effects that modern civilization is having on your energy levels. Modern civilization, in all of its glory, has had a detrimental effect on our posture, and is therefore having a big impact on our energy levels. The lynch pin of posture is, of course, the spine, and your lack of energy at the end of each day may be directly related to how well your body can stabilize this hub of movement.

Correct posture can be understood as a balance between strength and flexibility of both large and small muscles, which limit the stress placed on our joints and allow optimal efficiency from our body as a whole, resulting in minimal energy expenditure for any required movement.

Unfortunately, the posture of your spine is constantly affected by outside stressors, such as hunching at your computer, limited physical activity and incorrect recruitment of our muscles to perform any given task. The body’s will to compensate leads us to the internal tug of war between opposite muscles that we know as incorrect spinal alignment, or poor posture.

This attempt from the skeletal system to correct itself, contributes to faulty movement patterns at your limbs, and simple movements are usually performed by a much bigger muscle than is required, increasing the risk of injury and draining the body of more energy than it should. Such compensatory mechanisms within the body are known as energy leaks.

The deep muscles of your trunk and core are known as your inner unit. They are responsible for making the spine rigid enough to provide your outer unit (the muscles that generate large movements) with an energy efficient, strong platform.

The inner unit is made up of transverse abdominis (TVA), a belt like muscle that should anticipate movement and act like a corset to add rigidity to your spine and allow maximum strength from your limbs; your diaphragm, which should drop down to the top of TVA as you breathe and your pelvic floor that should engage from underneath your pelvis at the bottom of TVA. All three should come together to provide a solid cylinder that stabilizes your torso and spine. Supplementary to these is multifidus, a muscle that sits within the cylinder, and attaches to the spine to hold your vertebrae in their best position for function.

If you want your body to perform, it is essential that your inner core activates efficiently, as it is much less taxing for these small muscles to stabilize your spine, rather than requiring much bigger energy sapping muscles to over power it and take away from your base of movement. A strong spine, in combination with good posture is a true natural remedy to beating ‘three-thirty-itis’, and it will provide you with more gusto to perform well both at work and in the gym!

Hopped on the scales recently? Are you thinking because you had a huge week of exercise last week that there will be a massive LOSE IN WEIGHT? Amazed that your weight hasn’t changed or might have even gone up? It’s because your body is under too much stress.

The hectic pace of 21st century lifestyles has led to a combination of high stress and anxiety. There are numerous sources of stress, from physical (over exertion, trauma, infection), environmental (heat, cold and noise) and chemical (pollution, drugs, cosmetics), to emotional (relationship stress, worry, fear) and nutritional (nutritional deficiencies, processed and packaged foods). It is said that we are 100 times more stressed than our grandparents. We are working longer hours, have higher targets to meet and have less time for ourselves and the people we care most about.  To add to that we have the global financial crisis, the rising cost of living and a higher exposure to chemicals and toxins further fuelling the downward spiral into stress.

And guess what? These stressors are one of the primary factors as to why you aren’t get those results you want!

Your body releases hormones and cortisol regularly, which help regulate your blood pressure, blood sugar levels and help to fight stress/inflammation. Over an extended period of time, if we don’t come back to homeostasis (the balance between good stress and bad stress) because of lack of adaption to the constant stressors we experience on a daily basis, the adrenal glands have to work over time. This slows down our metabolism which means we don’t burn those calories. We become catabolic (so don’t build muscle) and we end up with a hormones imbalance which is a growing problem especially amongst females.  To workout what type of exercises you need to be doing put yourself into one of the following categories!

• Low Stress

  The individuals that fall into the low stress category are generally those that take extreme care in their health and wellbeing. For example someone that trains 5-6 days a week, sleeps between 10pm-6am each night, doesn’t drink, eats organic and non processed foods, has minimal work or relationship stress and has regular massage or attends pilates amongst other things would be deemed low stress load. Yep, I know what you’re saying; ‘There aren’t many people out there like that’ guess what? Your right! Those of low stress concern should have very few restrictions and be able to workout at a high level of intensity if required. Still address any forms of stress that they are placing on their bodies.
  Those that fall into this catregory are likely to be:

  1. Healthy uni students
  2. Professional athletes
  3. Those that have a brilliant understanding of their own health
  4. Those that implement relaxation techniques on a daily basis.

• Moderate StressA large percentage of our society would fall into either the moderate or high levels of stress. As the average gym user you’re not expected to be able to evaluate the large number of stresses in your life but an experienced health professional/personal trainer would be the perfect inclusion here. The intensity of your workouts should be monitored and at this level of stress extremely high levels of intensity would be detrimental to your health and fitness. There are a number of things that you can do to reduce the stress placed on your body including relaxing techniques such as Pilates, yoga or meditation. Lighter weights with a longer recovery (potentially 2-3 mins) will be beneficial. With all forms of stress you need to actually be aware of what is stressing you to address it, so start to take note of those days that you get home and feel absolutely wreaked. What is happening on those days that make them worse than the others.
  Those that fall into a moderate level of stress are:
  1. Poor sleepers
  2. Corporate
  3. Regular drinkers
  4. Consumers of convenience meals
  5. Irregular exercises
  6. Parents
• High Stress In the past decade this group has grown so quickly that stress is now a MAJOR KILLER!!! More and more people are taking stress leave from work and are losing all control over their life and wellbeing. These people are on the brink of burning out and are causing severe damage to their bodies on a daily basis. Regular low intensity exercise is the key here. The individuals in this category should be working at 40% of their maximum effort with plenty of recovery (2-3 mins). Their exercise regime should be made up of a blend of pilates/meditation/ yoga along with low intensity weight training and cardio (no more than 20 minutes). These individuals need to address all aspect of their life, from the detrimental lifestyle habits they live, their eating patterns and quality of their food, sleep, work and relationship stress, their exercise; or more likely their lack of exercise and much, much more.
  Those that fall into this category are:
  1. Individuals that NEVER exercise
  2. Heavy smokers
  3. Heavy drinkers
  4. Individuals with extreme stresses at work
  5. Individuals with high levels of stress due to kids, relationships
  6. Certain immune diseases such as auto immune

So get started on addressing your stresses and in turn see the results you want start to happen!