Spring 2011

By Stretch Newsletter

The Back, Hip, and Knee Connection

By Debbie Rocket, PT

Did you ever think your hip could hurt because of your back or knee? In the human body, we are connected by muscles, ligaments, nerves, and bones acting as the building blocks. How these components work together determines how our joints feel. Ligament stability, muscle strength, joint mobility and the ability of the nerves to operate without irritation or blockage are key to normal function.

The Back

The lower back area, known as the lumbar spine, is made up of bones called vertebral bodies, discs that act as “shock absorbers” between the bones and ligaments that help, along with muscles, support these structures. Inside this “column” of structures is the spinal cord. At each vertebral level, spinal nerves exit from the spinal cord on either side. In the lumbar spine, these nerves supply both lower extremities. Back problems that involve nerve irritation or compression can lead to hip and knee pain depending on the levels involved. Certain muscles of the low back also attach to the hip. Issues with these muscles can lead to pain in the hip or restrictions that lead to problems of normal hip movement and pain is the manifesting result.

The Hip

Have you ever been diagnosed with bursitis of the hip? There are several diagnosis that involve pain on the outside of the hip, and these issues alter how you walk. Weakness of the muscles in the area reduces support to the pelvic area and resulting back pain can occur. In addition, increased internal rotation of the femur can lead to knee pain as changes in the movement of the knee cap can result. The iliotibial band is a structure that runs from the outside of the hip to the side of the knee. Tightness

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here can cause irritation of the bursa on the side of the hip and pain results. Restrictions in hip joint mobility can not only cause hip pain, but also affect the back and knee by changing the mechanics of how they move. Tightness of the hip flexors located at the front of the hip can affect the position of the low back and sacroiliac joints and how they function in relation to each other.

The Knee

In reference to the iliotibial band once more, this structure attaches to the fibular head. This is located on the side of the knee, just below the knee joint. Tightness of this band can not only manifest as hip problems, but cause pain also on the outside of the knee. This band also attaches to the outside of the patella (knee cap). Tightness can cause the patella to track to the outside of the knee and cause pain. The rectus femoris muscle is one of four muscles located at the front of the thigh. These muscles are responsible for straightening the knee. The rectus femoris starts above the hip at the front (the pelvic bone) and also crosses the knee to join the other three muscles as they attach below the knee. The patella movement and position are partly controlled by these muscles. Tightness here can cause both hip and knee problems.

A Physical Therapy evaluation is essential for your therapist to assess how all these factors interrelate and to address the problem effectively.

What’s Weighing You Down?

By Sonya Thigpen, ATC


As the fashion trends for purses and bags get more and more oversized so do the amount of items that we carry in them. For most of us, our bag is our home away from home. We have wallets, day planners, sunglasses, cell phones, MP3 Players, cameras, not to mention makeup, kids’ toys, lunch and other essentials. When carried on the same side all of the time, this heavy load can pull on your neck and shoulder leaving you in a very unnatural position. If you are continually pulling your neck to one side, you compromise the position of your shoulder which can place a strain on the muscles and nerves that run from the neck and into the shoulder. This can lead to headaches, poor posture, shoulder strains, neck spasms, and even difficulty sleeping due to pain. Carrying a heavy purse on one shoulder can also leave you unbalanced when you stand or are walking which might ultimately lead to falls, or lower extremity injuries.

If you don’t want to sacrifice fashion or convenience for health, don’t worry. Here are five simple tools you can use to prevent unnecessary injury or pain.

  • Step on the scale. Weigh your purse. You will probably be surprised to see how much it weighs. The average bag weighs 7-10 pounds. It is recommended that your purse (and its contents) weigh NO MORE than 10% of your body weight. If your purse weighs 5 pounds empty, you are already off to a bad start! Look for purses made of durable yet lightweight material.
  • Long and lean is out. Look for purses with shorter, sturdy handles. Long, skinny straps can cause you to lean to the side putting your body in a “C” shape. Long straps can also slip a lot which will make you more likely to shrug your shoulder to keep your purse from falling off.
  • Find your center. If you chose to wear a purse over one shoulder make sure it falls close to your center of gravity. This is typically close to your waist; if you are petite it will be higher.
  • Compartmentalize. Use the compartments inside your purse! Items that are kept stable inside a compartment won’t be able to shift inside your purse which will keep you more balanced. Also, the less you have to search for items in your purse, the less time you will spend distorting your upper body looking for them.
  • Prioritize. Clean out your wallet. Remove loose change, credit cards that you don’t use all the time and receipts. Carry only what you NEED with you. Use travel size make up, lotions, etc. Use a separate tote bag for extra items that you don’t need all the time like your lunch, water and kids toys and carry this on your opposite shoulder to balance yourself out.

    Golf and Shoulder Tendonitis

    Shoulder tendonitis or impingement can be a common occurrence with golfers. Tendonitis is usually caused by an imbalance of posturing or shoulder stabilizers within the shoulder. Golf can be a facilitator of poor posturing that can potentially lead to tendonitis. However, there are stretches and techniques to use in avoiding or aiding shoulder tendonitis.

    A forward flexed/ rounded shoulder posture is used frequently within the game of golf. From this posture, players can develop pectoral tightness. This pectoral tightness can lead to others things such as overstretched soreness that can result in tightness within the muscles that surround the shoulder blade and the back side of the shoulder. From these tightness patterns, poor shoulder mechanics can develop and place stress on the rotator cuff muscle. This is usually felt with pain and soreness on the side of the shoulder and can refer pain down the arm.

    Therefore, a few simple stretches before, during and even after a round of golf can be helpful to fight these patterns and may even loosen up the shoulder to provide a more fluid swing. As mentioned above pectoral tightness can be an issue and so a good stretch is recommended. To perform this stretch, place your hand on the door frame or rail of a golf cart and with your elbow bent at 90 degrees rotate the body away from the hand a until comfortable stretch is felt. Next, two different stretches you can do for the back side of the shoulder are a cat stretch and cross arm stretch. To perform the cat stretch, place your hands together in front of you with elbows straight and round your shoulder blades forward (keep your shoulders from rising up). You should feel a comfortable stretch between your shoulder blades and spine. The cross arm stretch is performed by gently pulling on the elbow of the tight arm with the arm across your chest. This stretch should be felt on the back side of the shoulder. Perform these three stretches for a 10 second count 10 times comfortably. In addition to performing these stretches, you may want to try shoulder blade squeezes or pinches to alleviate the forward flexed posture discussed above. This can be done in a set of 10 by squeezing the muscles between the shoulder blades together while keeping your shoulders from rising up.

    In addition to these stretches, your therapist can develop a more individualized program as needed consisting of stretches and stabilization techniques. This can facilitate better posture and shoulder mechanics to decrease pressure on the rotator cuff tendon and decrease your pain. Please ask your physician if this may be a good option for you.


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