Got Knee Pain; Get Pilates

We often have clients that come to us complaining of knee pain. Sometimes the pain is exercise induced, and the client is looking for a form of exercise that is forgiving to the knees. Sometimes the pain is chronic and results in limited activities of daily living. These clients are looking for functional improvement and possible pain relief. Pilates can be beneficial in both of these situations.

A common finding in exercise-induced pain is crepitus around the kneecap. Knee crepitus or patello-femoral crepitus results from abnormal movement of the kneecap (patella) on the end of the thighbone (femur).

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Crepitus can be an isolated finding without pain. If there is no pain, ensure good functional alignment of the hip, knee and ankle to prevent future problems, especially if “flat arches” are present. Pilates is an ideal form of exercise for strengthening, lengthening and balancing opposing muscle groups to allow for proper functional alignment.

The quadriceps muscles play a key role in allowing the patella (kneecap) to slide smoothly in the groove of the femur (thighbone). If the lateral quadriceps muscle on the outside of the thigh is stronger than the medial quadriceps muscle on the inside of the leg, the patella will be pulled laterally and rub or bang against the femur as the knee is bent. Performing Pilates side-lying work with feet in straps helps to balance these muscles and keep the patella well aligned in the femoral groove.

Crepitus with pain is often associated with wear & tear of the cartilage behind the kneecap. Chondromalacia Patella is an irritation of the cartilage behind the patella that results in patellofemoral pain or pain around the kneecap. It is frequently described as a dull ache with occasional sharp twinges or stabs. Walking up and down the stairs exacerbates pain. Walking down the stairs may cause more pain than going up. Kneeling is difficult, as is prolonged sitting. Both can result in pain and discomfort.

The Reformer is a piece of Pilates Equipment excellent for clients with exercised-induced knee pain. Leg exercises are performed lying supine against spring-loaded resistance. Lying on the back takes pressure off the kneecap since the client is no longer weight-bearing. The spring resistance can be adjusted to the client’s level of fitness. Limiting the range of movement of the reformer can control the degree of knee flexion. This is helpful to clients with knee replacements or limitation in knee flexion for other reasons.

The modified Cadillac and Spring Walls allow exercises to be performed in a standing rather than kneeling position. Kneeling for even short period of time can be painful and nonproductive for many people with knee problems. Modifying exercises by having clients sit on the reformer box rather than kneeling may be helpful.

Clients with osteoarthritis of the knees frequently benefit from Pilates. Osteoarthritis results from excessive wear and tear of the cartilage on the surface of articulating bone. Simply said, the end of the bone becomes rough and ragged and no longer freely glides along the meniscus surface of the knee joint.

This is a common finding in athletes with prior injury to the meniscus or ligaments of the knee joint. Muscular imbalances combined with prolonged repetitive activities (running, biking, racquet sports) can wear down the cartilage in the knee. Footwork on the Reformer or Stability Chair can allow clients to maintain balanced strength in the legs without further irritation to the knee. Feet in Straps on the Reformer or Leg Presses on the Cadillac can help lengthen hamstrings.

Other culprits of knee pain include excessive weight, genetic tendencies toward early degenerative changes or just the wear and tear of daily activities over years of use. Pilates can help to reduce the biomechanical stresses on the knee by strengthening and stretching opposing muscle groups without causing additional stress on the knees.

If you have knee pain and have had little luck in finding an exercise regimen you like, give us a call and give Pilates a try. Be sure to be as specific as possible with your medical history. If you have radiology reports, we’d like to see them (just the reports-we can’t read images!). Exercises should not hurt! Feeling a hard working muscle is fine but pain is not gain. Be sure to tell us when you feel discomfort and we will modify the exercise for you.

With the proper modifications, Pilates is good for Every Body!

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