I’ve written a bit about how the predominant issue for people with knee pain is their knee(s) cave inward too much.
I wrote extensively about how the TFL (and IT band) is one of the main muscles causing this issue. You can find that on The best damn it band stretch.
One element I haven’t touched on much is what movements cause the knee to cave inward, or what movements cause the TFL and IT band to tighten up. Because in actuality, the tight TFL is a symptom of excessive movements (that use the TFL) throughtout the day.
In other words, what common activities do most people partake in causing them to move in a way that elicits a tight TFL/ITB, and subsequently causes knee issues.
In some ways this is pretty straightforward. Pay attention to yourself during the day, when is your knee caving inward? Boom, there’s a movement that’s causing your knee pain.
The most common time I see this mentioned is when people try to correct squat form.
Again though, is this really the cause of the issue? Put another way, is squatting an activity you regularly perform? Something you perform everyday, tons of times per day? I doubt it. Therefore, crappy squat form is more often a symptom rather than a cause.
Here is a cause I’m not sure I’ve ever seen cited: Driving.
We often get caught up looking at the knee and it’s valgus (caving inward) movement. Back to the squat example, I always see people talking about “Knees out!” but I never see them talk about where the feet should be. It’s equally important to look at the feet and each tibia. Movement here affects the knee as well.
For instance, you could have your knees be out but still have the feet turned too. Which means there is still rotation going on at the knee, which the knee does not like. (Too much rotation is often what causes knee injuries.)
So, valgus and internal rotation of the femur is important, but so is LATERAL/EXTERNAL rotation of the tibia.
You may have the knee in good alignment, but have the tibia in crappy alignment. Like when you are….driving.
Knee pointing straight, but foot / tibia pointing out.
And what pulls the tibia into external rotation? Among other things, the IT Band.
Credit to Anatomy Trains and Tom Myers
Therefore, however long it is you spend in a car each day is how long (at least) your IT band is sitting in a tightened position.
Furthermore, because you get so used to sitting in this position it’s likely you sit with your foot / tibia in this fashion even when you’re not driving. Like while typing at your desk:
The left knee isn’t caving, but the left foot is still turned excessively outward.
And then when you go to get up, you start from this position. So what do you do? You perform a crappy squat pattern.
That’s a lot of time to have your knee in a twisted position. No wonder it doesn’t feel well.
Get rid of it. Get your foot straight, get your knee straight, and make sure the foot and knee are facing the same direction.
Mariam Tripp
August 15, 2012
Thank you so much for taking the time and giving good advice :))
Please let us know how to help heal an ankle injury.
reddyb
August 17, 2012
Thank you Mariam.
What kind of ankle injury are you referring to? There is some stuff on the site I’ve already written that I may be able to point you to
Teresa
September 4, 2012
This is an excellent description and oh have you put a finger on one of my problems! I have very, extremely, outrageously, tight lower quads. I’m the person who can not sit all the way back on my heals, not even close. There is no stretch there at all. It has been that way since I was a child, much as I would try to sit like the other kids. Eventually I realized if I kept pushing it I would hurt myself.
Currently I do advanced Pilates including mat and machines. I know my limits and make sure I don’t exceed certain bends in my knee so I have never injured myself. Very luckily I have found wonderful teachers who listen when I tell them I can’t do certain things and they modify accordingly. However, I do tend, on some of the exercises, to see my right knee bowing inward. Much as I try not to let it do that, I can’t seem to stop it. It’s very frustrating!
I also walk, a lot. By sheerest accident I found that the running shoes I was wearing while walking were causing extra knee pain. It’s that big flat heel on the shoe, I bought them for the padding and extra arch support. When walking on a road surface, it’s generally crowned so it slopes. The big flat heel was making my knees bend just a little bit wrong all the time. One day I ended up wearing a pair of K-Swiss Blade Light Recover shoes (meant for after running use) they have a rounded heel but enough cushion that my super high arched feet were okay walking in them for 4+ miles. Lo and behold, no extra lower quad pain after that walk! I’ve been wearing them ever since.
I love your excellent quad stretch, I shall have to work on that one carefully so I get the body position right, it is much better than the other stretch of standing on one leg and holding the other pulling it. Sometimes my knee doesn’t want to bend enough for me to grab it from that position. The knee on the floor with the foot up on a sofa gives me the ability to change the range of motion much easier so I shall be able to work into that stretch.
What I can’t figure out is how I might be able to do the “best damned IT stretch” without the use of a bench. I don’t have access to one. I’m sure my bed, while high enough off the ground, might be too soft. I have the ab strength to make it work, I worry about keeping hip alignment and tilting to the side on a soft surface. I would appreciate any thoughts on how one might do it at home without extra equipment. Maybe it’s not possible? Anyhow, thanks for the great site!
reddyb
September 5, 2012
Hey Teresa,
Thanks for the comment.
Footwear is definitely an important part of looking at knee pain. Typically, the higher the heel the worse the shoe is for the knees. As you and every woman knows, women don’t wear heels because they make their joints feel good…
Being on a very soft surface can definitely make the stretch harder to do. Have you seen the standing version I wrote about? http://b-reddy.org/2012/06/01/standing-version-of-the-best-damn-it-band-stretch/
That’s often easier to do around the house. All you need is something to put your foot up on like a chair, bed, arm rest, etc.
Hope that helps.
Teresa
September 5, 2012
Thanks so much! I shall give it a try and see what I can do with the standing stretch. Awesome!
Legend33
April 13, 2013
Interesting article, thanks! I’ve always been curious about this – I have had 10 right knee surgeries, including a patellar realignment, and my right foot bows outward. I always thought it was from the realignment but it seems lately it might be more from weak/tight hips/glutes. I also had an osteochondral allograft on my trochlea/patella – returning full cartilage thickness back (2 years ago). I still have severe knee pain with loading, even though structurally my knee looks great. I’ve been trying to find the root cause of the pain since my surgeon and practically no other medical professional knows what to do with me anymore. I have a sharp pain with any kind of loading past 30 degrees. It’s the classic Patellofemoral Pain Syndrome.
I admittedly have weak/tight hips/glutes and only in the last few months have I been trying to focus on that. Of course with all the surgeries and limited aerobic activity, I now have a decent amount of lower back pain. I’ve considered going to a chiropractor but to me it seems like the hip/glute/IT band connection may be the biggest issue. This is now off topic a bit – but where would you recommend I start with such troubleshooting? I saw your article just now about the Best Damn IT Band stretch and am going to look into it further. Any suggestions you have would be greatly appreciated!
reddyb
April 15, 2013
Hey Legend,
Give these a read. I think you’ll find some poignant information, especially regarding the foot turning out:
b-reddy.org/2012/09/03/my-visit-to-the-washington-university-in-st-louis-physical-therapy-program/
b-reddy.org/2013/02/06/example-of-a-postural-assessment-2/
http://b-reddy.org/2013/02/20/another-example-of-a-postural-evaluation/
Mike
August 16, 2013
Hi! Have you another great article about about how to address this crappy tibia alignment?
reddyb
August 20, 2013
Hey Mike,
This is a much more comprehensive look: http://b-reddy.org/2012/09/03/my-visit-to-the-washington-university-in-st-louis-physical-therapy-program/
And I just published this today: http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/