# The main reasons for knee, back, hip, etc pain are......



## bikerbert (Aug 28, 2004)

*******TIGHT AND WEAK MUSCLES*******

Here is what they can cause:

Calves: Achilles tendonitis, plantar fascitis, low back pain

Hamstrings: Alters hip stability, leads to anterior knee pain, chronic hamstring strains due to them being overactive to compensate for weak/tight glutes, leg length descrepancies

Piriformis: Low back pain from lumbar spine dysfunction, IT Band tendonitis, becomes dominant hip stabilizer if glutes/outer hamstrings/outer calves are weak

PSOAS: Inhibits glutes from firing, can lead to patellar tendonitis, causes overactivity of the hamstrings leading to repetitive strains, piriformis syndrome, inhibition of the lower abdomen, increases compressive forces on lumbar spine

Quads: Increases load on patellar tendon, inhibits glutes from firing

Glutes: BIGGEST ENEMY OF CYCLISTS EVERYWHERE!
Patellar tendonitis, shin splints, overloads quads causing them to slow knee down when it flexes instead of the hamstrings doing this, plantar fascitis from decreased hip flexion shortening calf muscles, Achilles tendonitis due to the calves having to constantly be under tension, repetitive micro-trauma to the Achilles tendon.

Obliques: Rib cage dysfunction causing more shear forces on the lumbar spine leading to dominant hip flexors in hip extension.

Lower Abdomen: Decreased neural drive, leads to low back pain due to resulting spinal column and pelvic instability. A dysfunctional lower abdomen will also lead to tight Psoas, weakened/tight glutes……

LATS: Tightens psoas causing increased lumbar curvature, leads to weakened glutes, decreases deep abdominal wall function, will cause shoulder impingements

Chest/Shoulder Muscles: Decreases respiratory muscle function, forward rounded shoulders, tenderness behind eyes and base of neck, leads to tissue overload of the rotator cuff, can cause tingling/cold fingers. 

I hope this helps everyone out!

Al


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## sanmusa (Jun 25, 2004)

Al, great information here! Thank you! I hope you don't mind me bringing up my problem and getting your opinion: my doctor diagnosed me with Patellofemoral Pain Syndrome, it hurts mostly when I walk, run (doctor told me not to run for a while), stand, sit with my leg extended all the way or bent all the way. Having the legs partially bent does not hurt much. Cycling doesn't hurt at all, in fact after I ride my bike the legs will feel good for a while. After walking for 15 minutes they start to hurt. last Friday my knees hurt so bad that I couldn't walk more than 5 minutes without having to sit down. Sometimes it feels like some nerve is being pinched somewhere in my knees. Should I continue cycling or should I stop? If I continue riding, should I avoid heavy gears? I must ride to work everyday as I cannot own a car where I live and there are no buses. I either walk or ride... What cycling specific excercises can I do to heal this? I begin Physical therapy at a local clinic on October 30, and I might be heading in to the heospital for an MRI to make sure everything is ok in there. Any guidance on how to avoid this is appreciated!


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## bbanker (May 21, 2006)

*Gettum' checked out*

Hey Sanmusa, I would highly reccomend seeing a PT. Ok, so I am biased because I am one, but... 
Patellofemoral issues can be a complicated and multi faceted matter, and "just resting for a while" and taking some NSAID's may temporarilly alleviate the sypmtoms, but do not change the biomechanical and/or training factors that got you there in the first place. 
Most of the issues that Al listed above can be contributing factors to anterior knee pain or patellofemoral pain syndrome as well, and you may do best with a specific treatment regimen based on the evaluation of a licensed professional. 
That being said, do your knees hurt more when you try to straighten them all the way, or more when you bend them? You could have irritation of the fat pad in your knee. It may be the most pain sensitive structure in the knee.
Brad Banker, PT, DPT


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## bikerbert (Aug 28, 2004)

Definitely need to do a corrective exercise program. If there isn't structural damage in the knees, an exercise program based on removing muscle imbalances would be a great place to start. 

Without being able to evaluate you in person, I'd suggest strengthening: the glutes, lower abdomen, and working on lower body flexibility. It sounds like there could be some impingement issues if you are feeling like there is a nerve issue. A tight piriformis could be contributing to this.

There could be several factors that have contributed to your condition, so again without being able to see you, a more general butt strengthening program is a safe place to start.

I'd suggest bridges on the floor with your feet on a stability ball. Make sure you feel your lower butt/abdomen as the primary muscle sensations. If the hamstrings/quads are the primary, then just reduce it to pelvic tilts with your feet on the floor. Get a foam roller, and "Active Isolated Stretching: The Mattes Method" to address your flexibility issues. 

What do you think Brad?


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## bbanker (May 21, 2006)

For Sam, 
Without an examination of course, I would agree with what Al said. I would also recommend lying on your side with your knees bent and lifting the top knee up (like a clamshell) without letting your hips roll back. Repeat on both sides. When that gets easy you could add some elastic band or tubing. Also try getting on all fours with special attention to keep your back flat and lift your knee back and out to the side. You should feel this in the back of your hip in your butt muscles, not in your back. The hard part of both of these exercises is not letting your back arch, twist or hips roll. 

For Al,
I agree. Some recent research seems to suggest that much of the biomechanical forces that cause increased patellofemoral forces may be due to passive IR of the femur during closed chain activities implicating not only the hip extensors, but ER's as well. If you haven't seen any of Chris Powers' recent research using dynamic MRI in closed and open chain situations check it out. Interesting stuff. I think he has some more new stuff coming out soon as well. Jenny McConnell also has some new research on unloading the fat pad and it's clinical implications for AKP. Good stuff. She just published a study with hemiparetic CVA pt's and gluteal taping that demo. increased hip extension and EMG data for glutes, and I believe is working on some other stuff with non-neuro patients.


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## sanmusa (Jun 25, 2004)

Thanks for all the replies! That is some usefull stuff, going along the lines of what my PT told me this morning: strengthen the glutes, abdomen and flexibility! S small background on me: I am in the Army and I run a lot, this knee pain has been going on for over a year but it's been getting progressively worse and more frequent. I've been to the doctors numerous times, and they always give me Motrin, which we call "Army candy" because the docs will give it for any kind of pain... Army medicine sucks. Only after I could barely walk one day that the doctor took me seriously. I've been doing a lot of the "dirty dog" excercise, where you lay on all fours with the back straight and extend one leg to the side and rear. That really burn my butt, which I think it's the goal here. How would you recommend the flutter kick excercise? We do a lot of those here, besides puch ups and all. The doctor also gave me a medical profile which says I cannot run for three weeks, and also gave me more 800 mg Motrin. He told me I can still bike, but I should stay away from heavy gears and should take it slow on the uphills. I'll be following this excercise regimen (PT, dirty dogs, flutter kicks, Motrin, profile) for the next couple of weeks and then go see the doctor for a follow up in a month. Once again, thanks both Al and Brad for the replies!!


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## deoreo (Aug 26, 2005)

Hey bikerbert - can you give some suggestions on stretching/exercise, for Chest/Shoulder Muscles?

What you said here: 
"Chest/Shoulder Muscles: Decreases respiratory muscle function, forward rounded shoulders, tenderness behind eyes and base of neck, leads to tissue overload of the rotator cuff, can cause tingling/cold fingers."

Really describes some aches and pains I have been feeling to a tee!

Some background on me: 5'6.5" 137 LBS. slight build, lots of bike riding, and some walking for exercise, and stretching when I rember to do it, but no strict regiment.


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## bikerbert (Aug 28, 2004)

Deoreo,

The best thing I can suggest to you is to get "Active Isolative Stretching: the Mattes Method."

Awesome book on stretching, and you can get it on Amazon. I definitely recommend it.

As far as exercises go, upper back work are light weight dumbbell/cable flies are two of the better ways to go.


Please let me know if you've got any more questions, I'll be more than happy to answer them.

Al


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## Bob_Element50 (Jun 16, 2006)

*Another reason*

Don't forget the other common reason for joint pain... a lifetime doing all those things your brain said you could and now your body regrets. Weightlifting for football turned into drug free powerlifting. A quick jog to get in shape became 5 miles a night. A fun bike ride became a three hour tour. Three pullups turned into "come on, you can get 25". It is true about the weak and tight muscles. My body is compensating for so much lost cartilage and disk space that there are times when my feet are pointing in every direction but straight ahead when I stand. The ironic thing is now I work out to reduce pain and increase flexibility. If I miss a workout, I feel horrible. It's a constant battle trying to stay balanced. The biggest problem I have is the OA in my left knee. It creates an imbalance in my core that ultimately leads to back pain. Stability ball work and other core exercises help, but I need to do the routines daily to keep centered. Looking back, I wouldn't have done anything different. Toby Keith's song says it all, "I ain't as good as I once was, but I'm as good once as I ever was"! :thumbsup:


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## POG (May 20, 2004)

*What do you experts think...*

about knee straps/braces such as the cho-pat?


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## bikerbert (Aug 28, 2004)

for TEMPORARY relief of pain, not bad. But long term, not a good idea. Their is pain in the body for a reason, and a brace won't fix what's wrong. Plus, if you wear it long enough, the muscles in the body that are supposed to do the work the brace is, will shut down.


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