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Treating hip, ITB, knee, ankle and foot pain

Treating hip, ITB, knee, ankle and foot pain

Knee pain and injury, hip pain, foot pain problems

Joint problems and soft tissue problems in the leg may inter relate or they can be just the one place.

Knees are a classic place to injure in falls, sports activity, and twists.  Structures that get damaged may be a ligament or the cartilage, or the cartilage rings called menisci. Knees often have aging wear and tear that effects the cartilage on the back side of the patella, the grooves on the femur that the patella tracks in, or on the weight bearing ends of the femur or tibia bones. This roughed up cartilage is called chondromalacia.

Patellar tracking, torn meniscus, knee sprains

Sometimes a fall may cause a small meniscus tear that isn’t too bad. Sometimes these small tears progress until you have a very sore knee.  The sprain might have been 3 years ago. Now the knee is a swollen and painful. PT may help, but if progress isn’t clearly being made I might send you for an MRI to see what’s going with more precision. Sometimes a surgery really is the best option.

Sprains and strains need help for a good recovery if they are bad enough.  Minor problems usually go away on their own.

It is a good idea to get PT help to regain full movement especially the component of knee straightening. Much of your strengthening can be done at home or at the gym.  I focus on the small details of rehab and let you do the basics in your preferred  place.

Sometimes knee problems develop over time from the way your bones line up.  Some people’s knee caps track nicely up the center groove in the femur. Other patellas  track off to the side, usually too much to the out side of their track.  Tracking issues can be improved by addressing all the links in the movement chain from the feet and ankles on up.  Some knee pain is made worse by how the hip muscles control the hip socket. The hip socket may feel normal and you only feel pain at the knee.  By stretching and retraining motion control and sometimes even the way you walk, strain can be reduced at the knees.

Arthritic  Toe Pain

Orthotics are routine adjuncts for many foot/leg issues.  I don’t make formal orthotics, but I do make some easily adapted foot padding that can be helpful.  Even if formal orthotics are being used, you still may not have good foot positioning and placement with walking.  I pay a lot of attention to how your foot positions on the ground, how you balance on your feet, and teach ways to increase your surface area of stable contact.  It’s a lot harder for your whole leg to balance on a pencil thin slice of your foot that works well versus being able to use all the surface area of your foot easily and with whole leg coordination.

Arthritic toes are really a hassle. I know because I’ve got them.  Sometimes surgery still leaves you with pain.  There is often a lot of improvement in walking ability and comfort that can come from helping the deep muscles of the feet spread back out and become better at balance, uneven surfaces, and direction changes.  Pain often causes the muscles to tense up and stay that way.  Walking patterns are very much unconscious and deeply programmed into your “hard wiring”.

This is a place that using Mind Body Physical Therapy really applies. Changing deeply ingrained and automatic ways of moving requires getting extra movement and control back and learned.

It’s possible to retrain how you use your feet and legs in walking to reduce the progression of strain and pain in your toes. You’ve probably already figured out that some shoes are okay and others make you worse. If your toes won’t bend well, are painful to bend, or simply hurt no matter what shoe you’re in, you can learn to substitute ankle motion for toe action.  Getting a stiff ankle to do this takes help.

Tight hips, arthritic hips

Hips can be painful from the joint wearing out.  Before this is bad enough to be a surgical issue, PT can help with gentle stretching for the joint and the muscles which get tight. I call it “hurt paw pattern”.  Like an injured 4 footer, the limb muscles will tend to tighten in a retracting pattern.  The muscles on the front side of the hip socket will typically get too tight. Also, a wide stance is an adaptation that promotes extra tight muscles on the outside of the hip.  It can be a big improvement in hip comfort to get these muscles, the hip abductors, lengthened and working well for ordinary activities like walking and standing.