Hello, I'm Dr. Sarah Petrich, and I thought I'd talk about knee pain today. Now, a lot of people are stressed out about knee pain as if it's really, super complicated. Even other physical therapists talk about it. And sometimes it can be, but I find that the knee joint is actually a really simple joint: it's just a hinge joint. And so we get really scared about knee pain, but, a lot of times, general knee pain is really a victim of the pelvis and the feet. So if we can get good shoe wear, which I talked about in a different section, and if we can get the hip and the pelvis really in a good position and working correctly with good balance of glute muscles, and abdominal muscles, and inner thigh muscles, and quads, and hamstrings, if we can get that balance all nice and squared away, a lot of times, most of the time, knee pain is going to clear up. 

So, one of the reasons why I love this skeleton model is because we can see that reflected in the knee joint. So here's what we see in the most common pattern in the pelvis is that the left pelvis likes to tilt forward, so it goes like this. Now, if you were watching up here, now go down here and look at the knees. So if this hemipelvis rotates forward, you can see how that changes the angle of these femurs here . And if we change the angle of those femurs and they start to rotate a little bit, well this little knee actually doesn't go along with the with the thigh. Instead, a lot of times, it'll stay straight ahead. And so now this little guy is no longer tracking in the groove of the kneecap. So if we can get this pelvis in a better position, we can actually line that up better. And this hemipelvis coming forward can affect not just the left knee, but it'll affect the right knee too. So we're going to have problems in one or both knees with the same problem in the same position of the pelvis. Then, if we went from here all the way down to the feet and what you can't see because Boris has no feet, but if you looked in his feet he would bear more weight on one side of his foot, on the outside of his right foot and the inside of his left foot, and so that would be an issue. So if we can also affect the feet a little bit, we can take a lot of pressure off our knees. Which, again, it's just a simple hinge joint. But these joints right here, the hip and the foot, much more complicated and we’ve got to balance those out. 

Are people generally aware of their bodies?

Some people are really, really aware of their bodies and they come in and it makes my job super easy when I educate because they're already telling me, “I really feel like I'm always on the outside of my right foot and I know that's affecting my knee, I just don't know, you know, how to change it.” So that makes the conversation easy. But most people are walking around and if they're used to bearing more weight on the outside of one foot and the inside of another foot, or they're used to being a little bit twisted, that their brain thinks that's normal; their brain thinks that's straight ahead. And so they're thinking they're straight, and it's my job to help reeducate not only them on what's going on in their body, but also to re-educate their brain on how to move differently and feel their body differently. 

Will I have to constantly train my body with new techniques?

After a while that should become subconscious. So I'm going to reteach certain muscles to activate in certain ways, and then not only will we do some exercises laying down to find and feel those muscles and then I'll retest them and they're going to look much better in their pelvis, but that's one thing if you're laying down, but you've got to stand up and walk out to your car again, right? So we've got to make sure that we get you standing and also re-educate your muscles in standing and sensing your left foot just as much as your right and sensing it a little differently, and that's going to take some practice. But it should start to become more natural into your body as you do some exercises at home. So that's our goal. But, yeah, we need to make sure we don't just strengthen and try and correct a pelvis, much like some chiropractors do and that can be very helpful, but sometimes we get someone in a good position and then they walk out the door and they're still walking out with the same brain that they had before and the same habits and the same patterns, and so we've got to redo that motor planning in through their brain, so that they can walk out with a new motor plan. And they start walking differently and they have new habits that they can take with them and become more efficient movers. 

How long does neuromuscular reeducation take?

Everybody wants to know that answer, and it's such a hard answer. And the reason why is because everybody has different comorbidities that they’re walking into the clinic with. So, if you've got one thing going on, like knee pain, that's pretty simple and I can I can probably work on that in five sessions, and sometimes even less. If you're coming in and you're, maybe, more flexible or hypermobile, maybe you've got some pelvic floor issues going on, those things always take more time and it's really hard for me to answer that question. And it’ll be a little easier after I've seen you a couple visits because that'll give me a little idea because I'll see how you've changed and how you've carried forth what we worked on in our first session. But those two things make it a bit more challenging. So hypermobility, pelvic floor issues, a poor sense of where you are in space which might manifest itself in balance as well, that can be really much more challenging to correct. The other thing that's difficult is when you have a lot of things going on, and that's what I see a lot of times. So I'll see people with neck pain up here and knee pain and big toe pain on another foot and hip pain somewhere else, and if you've got a lot more areas to address, I always like to work on the whole body anyway, but we're going to have to be a lot more specific on getting all of those pieces working together in a balanced way, which is a bit tricky. Usually they come back in their second session and they do have some changes and improvements. Now if not, then I have to figure out what I didn't do or what I didn't instruct well enough the time before. And so then we remedy that issue. But, most of the time, if we can really get good breath and start engaging some muscles that help re-balance whatever asymmetry that that they might have, we can see pretty drastic changes really quickly. 

How does postural restoration, Pilates, and physical training come together? 

I love Pilates and especially equipment Pilates because it provides a lot of feedback for somebody to know where their body is in space. So there's a lot of people who love to work out, and I think part of it is that that it gives them some sense of the floor and just some feedback into their nervous system about where they are in space. And so we can get that through a Pilates Reformer with a little less compression and less heavy duty work and still get that feedback. So I love that aspect of Pilates. But the one thing about Pilates is that it kind of assumes that you're symmetrical, and that's a very dangerous assumption because most of us are a little bit crooked. And that's okay to an extent, but the more balanced we can be, the better. So I take my postural restoration skills, I'm trying to balance out symmetry, and I can apply that to my Pilates exercise or repertoire and we can tweak little things here and there, and I can get more of a left oblique on someone versus a right oblique which is going to help and impact their right back and lengthen that out, if that's their problem. So I can add those pieces to my Pilates repertoire and combine them to get the best thing for my patients and my clients.