Glutes and Knee Pain

Greetings. I just got off the phone with a happy client this AM. (always a good thing:) He ran a 10k race this past weekend with his girlfriend and didn't have any right knee pain. This was pretty significant since his right patellofemoral knee pain was keeping him from doing the things that he loves (competitive cycling and running) for the past year or so.

I have seen him about 4x with a focus on getting his glutes to fire. Nothing fancy...some soft tissue work to the ilitibial band, manual stretching to the same area and activation work for the glutes in non weight bearing and weight bearing positions. Next up on the menu will be single leg stability and strengthening exercises.

The glutes play such a large role in the stability of the knee and yet endurance athletes have a hard time using them functionally. The muscles of the hip assist in stearing the knee relative to the position of the foot. Imagine the energy leak that occurs in this area if it is weak to begin with and your training volume increases? You are setting yourself up for injury or a loss of performance.

In the past I would have done quad sets up the whazoo to make sure the patients VMO was firing so that the patella would track properly. I may have even used ultrasound on the painful area of the knee...aka boo boo therapy. Boo boo therapy is when you use various modalities over the painful area to make it feel better. Remember when you were a little kid and you fell, scraping your knee or elbow. You ran to your Mommie so that she would kiss the wounded area and make it feel all better. Boo boo therapy is akin to "painting over the wet spot on the ceiling instead of fixing the hole in the roof".

It has taken me a while to stop treating the symptoms and to focus on finding the dysfunction that is driving the pain. There is a saying from noted physical therapist Gary Gray.."the knee is stuck in the middle of the hip and ankle with nowhere to go". Pretty profound eh?