- 9 Tips for Traveling With Knee Pain
- Proper Positioning While Driving in Frederick
- Anterior Knee Pain
- Coleman Physical Therapy
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- Do Your Knees Hurt During or After Driving?
- Common Knee Issues Associated With Long-Distance Driving
- Knee Joint Strain
- Chondromalacia Patellae
9 Tips for Traveling With Knee Pain
Sitting still for an extended period of time while traveling can be tough when you have knee pain. “Sitting for long periods in a car or a plane can often worsen stiffness and pain for people suffering from conditions affecting the kneecap, such as arthritis and runner’s knee,” says Steven Stuchin, MD, director of orthopedic surgery at NYU School of Medicine in New York City. Fortunately, there are ways to lessen the discomfort. Try these tips for traveling with knee pain.
Reducing Knee Pain During Travel
- Get out of your seat. Periodically getting up and walking around an airplane cabin or train compartment will help ease stiffness and knee pain from being cramped in a seat while you travel. “This is especially helpful for people with arthritis,” says Dr. Stuchin.
- Stretch out. Move your seat back and stretch out your legs, using the area underneath the seat in front of you. “You probably won’t be able to completely straighten your legs, but you may get some relief,” says Stuchin.
- Pick an aisle seat. Sitting on the aisle will make it easier to get up from your seat. Plus, you may be able to straighten at least one leg by stretching it out in the aisle. Even better, try to get the aisle bulkhead seat in an airplane, recommends Stuchin. Bulkhead seats have the most legroom.
- Take shorter flights. Booking connecting flights rather than a non-stop transcontinental flight may be worth the extra time if you suffer severe knee pain when flying. Your knees will be scrunched up for a shorter period of time, which may translate to less knee pain.
- Consider a car trip. If you have a choice, opt for driving to your destination. “Driving tends to be easier on the knees than flying because you can change your seat position in more ways,” notes Stuchin. Move your seat back, lower it, and tip it back to avoid bending your knee at a 90-degree angle. If possible, let someone else drive so you can sit in the front passenger seat, where it will be easier to scoot your seat all the way back.
- Use cruise control. If driving, use the cruise control option. Keeping your foot on the accelerator requires bending your knee. Staying in the cruise mode on interstates may allow you to stretch your leg out.
- Wear a brace. Dr. Stuchin recommends using an elastic kneecap donut brace for long trips. “The brace will help compensate for weak or damaged ligaments and cartilage by stabilizing the kneecap,” says Stuchin. A stable kneecap will result in less pain.
- Exercise regularly. Building up your quadriceps muscles with leg lifts or strength training via weight machines can also help compensate for a bum knee. “Strength training stabilizes the knee the same way a knee brace does,” says Stuchin. It’s best to start your exercise program several months before your trip.
- Make frequent stops. When driving, take breaks at rest stops every few hours to stretch your legs and give your knees a break from being bent up. It may take longer to arrive at your destination, but you’ll feel better when you get there.
These simple measures should help make your trip less painful and more pleasurable. Your knees will thank you when you get to your destination.
Proper Positioning While Driving in Frederick
With the summer months approaching, Americans will be hitting the road for vacation travel. For many people with back pain or neck pain, the prospect of a long trip can be daunting. Many drivers do not position themselves correctly increasing the strain on their back, neck and arms. A lot of the discomfort of driving comes from improper seat placement. Along with improving driving comfort, correct seat positioning can actually help improve control of the vehicle, prevent accidents and reduce injuries sustained from collisions. To adjust to the seat to proper positioning, use the following steps.
- Position yourself in the seat and ensure that you are sitting as far back in the seat as possible. It may feel as though your buttocks are wedged between the seat and back.
- Next you want to adjust the distance between the seat and the steering wheel. Move the seat forward enough so that you can fully depress the brake (and in some vehicles the clutch also), while still maintaining a slight bend in the knees. Your leg should ideally maintain an angle of approximately 120 degrees. A fully extended leg results in the knee locking-up which reduces the leverage and feel of the pedals, increases effort, and puts you in risk of injuries in a collision. When driving try keep the knees in line with your body, and avoid it dropping to the side while you drive. This can cause some aggravation to the pelvis, which can also lead to pain in the low back, hip, knee and foot.
- If possible, adjust the tilt of the seat by tilting the seat forwards or backwards until there is full support of the leg from hip to knee. While having your foot on the gas pedal, make certain that the seat is not pressing uncomfortably into the back of the leg. If too much pressure is placed on the, decreased circulation in the lower leg can occur.
- Adjust the back of the seat to an angle that fully supports the length of your back. When the seat is reclined too far, strain on the neck occurs because you to have to bend your head and neck forward at an angle in order to see the road. Some cars have a lumbar support feature which helps maintain a lumbar curvature in the spine while in the seated position. Adjust it so it supports the lumbar area without pressing into your back and causing pain. Placing a rolled towel behind the lower back can achieve the same position.
- The steering wheel should be positioned close enough for your hands to reach the 10 and 2 position, while maintaining a slight bend in the elbows. Having it too close to your chest can be dangerous in an accident, but you also do not want it so far away that you are straining to reach it. Tilt the steering wheel an angle so your hands are just a little lower than your shoulders. Keep both hands on the wheel when driving. Steering with one hand makes the weight of the hand work on the wheel, for which the shoulder musculature must be used to keep the wheel steady. Driving with one hand also results in a twist of the spine, especially if you get into the habit of holding the wheel from its top
- Finally adjust the head restraint by having the bottom of the head restraint level with the base of your skull. The headrest should be about an inch from your head, in order to avoid whiplash in the case of an accident.
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Anterior Knee Pain
What is Anterior Knee Pain?
Pain around the knee cap (patella) is also known as Anterior Knee Pain or Patellofemoral Pain Syndrome and may have many causes. It is frequently caused by altered alignment of the knee cap due to a combination of muscle weakness and tightness of soft tissue resulting in pain or discomfort.
How does it happen?
This can be caused by repeated bending of the knee in activities where there is a lot of pressure put on the knee cap such as sport, climbing stairs and hill walking; especially on uneven ground. Usually there is no history of injury, but it can follow an accident such as falling directly and heavily onto your kneecap. It is sometimes a type of wear and tear on the cartilage on the underneath surface of the patella, which becomes soft and occasionally inflamed.
Who gets Anterior Knee Pain?
It is a very common condition. It may affect people at any age.
What are the symptoms?
The main symptom is pain or an ache over the front of your knee. The pain may come on for no apparent reason and can gradually gets worse with activity. The pain can be especially worse with the following:
- Walking up or down stairs
- Running (especially downhill)
- Walking on rough ground
- Prolonged sitting or driving
What is the long term future?
Your outlook is very good and a steady recovery can be expected with attention to very simple guidelines. X-rays of the knee are normally not necessary.
How do I manage it?
The application of ice packs can help to relieve your pain. Wrap an icepack (a bag of frozen peas or ice cubes can be used) in a damp towel. Place on your knee for up to 20 minutes. You can repeat this every 2 to 4 waking hours. The key approach is for you to modify or rest from the activities which make the pain worse and to retrain your muscles, especially the quadriceps (on the front of your thigh). Referral to a Chartered Physiotherapist may be necessary to supervise rehabilitation. Sometimes a short course of pain medication may help. Please see your GP or pharmacist for advice on this.
Repeat each exercise 10 times 3 times a day. If you get pain with the exercises reduce the number of repetitions, but stop if the pain persists and ask for advice.
Lying on your back with legs straight. Bend your ankles and push your knees down firmly against the bed. Hold for 5 to 10 seconds and relax. Repeat at least 10 times.
Lying on your back with one leg straight and the other leg bent. (You can vary the exercise by having your foot outwards). Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20cm of the bend. Hold approximately for 5 to 10 seconds then slowly relax. Repeat at least 10 times. The exercise can also be altered by sitting up with legs out in front.
Reproduced with kind permission of NHS Fife Physiotherapy services.
A middle aged male adventure racer who had been struggling with right knee pain for six months sought my assistance. Adventure racing involves competing over multiple days, ultra-distance walk/running combined with other activities such as mountain biking, swimming, kayaking, and rock climbing. His knee pain was focused to the anterior lateral aspect of the right knee. He denied experiencing previous traumatic injury to his back or lower extremities; he denied having to wear corrective shoes or braces on his feet as a child.
His training included long trail walk/runs on the weekends of 6 hours duration. The knee was painful when walking and running longer distances and would eventually result in walking with a limp.
The significant findings of the clinical examination were in standing his right foot pointed outward more than the left. In relaxed sitting with his knee flexed 90 degrees and feet dangling the right foot and lower leg pointed outward (laterally) more than the left foot and lower leg. Active and passive range of motion of the hips, knees, ankles, and feet was with in normal limits and symptom free except for passive medial or internal rotation of the right lower leg and tibia. Active and passive medial rotation of the right lower leg was stiff and limited compared to the same movement of the left lower leg.
After the initial interview and examination it was apparent that he was suffering with a repetitive use injury to the right knee possible IT band syndrome. What was not clear was why the injury was only on the right side of the body.
Running/walking on trails for 6 hours is a symmetrical activity; involving both the right and left legs equally. Why was on the right knee experiencing abnormal and excessive amounts of stress and injury? There was no history of traumatic injury, congenital defect in the lower extremities which would correlated with his right knee pain. The observed asymmetrical lower extremity alignment of the right foot pointing laterally made me suspicious that he may use the right foot to operate a pedal. Nine months ago, his job changed and his commute to work was 2 hours one way, 4 hours of driving a day. His right foot was pointing outward on the gas pedal 20 hours per week. He was doing more driving than walking/running, and biking. This problem was gas pedal knee not runners knee. The pain occurred when walking/running, but the asymmetrical alignment was related to too much driving with too much lateral tibial rotation, foot on gas pedal.
Interestingly, he reported he tried to use cruise control often, but when his right foot was not on the gas pedal it was still positioned in a laterally rotated position on the floor board of the car.
He was instructed to modify his foot position on the gas pedal when driving to avoid lateral rotation of the lower leg. He was instructed to position his heel towards the middle of the car so that when his foot was on the gas pedal it was aligned straight due north and not pointed east or to the right relative to body.
He was instructed in remedial exercise to increase flexibility of right lower leg (tibia) to medially/inwardly rotate. The goal was to have passive and active medial tibial rotation on the right which equaled the range of motion of the left tibia relative to the knee.
The exercise is done sitting, positioning the right ankle resting on the left thigh.
With both hands grasping the right lower leg (tibia) the lower leg is pulled/stretched in a medial direction with both hands. In this position the foot will point towards the ceiling.
Once the maximum amount of passive medial tibial rotation is achieved use the muscles in the leg to hold this position of maximum medial tibial rotation and let go with the hands while holding the position with active contraction of leg muscles. It is important to strive to avoid sag of the lower leg, but to engage the muscles responsible for medial tibial rotation to sustain the position of maximum medial tibial rotation.
Finally he was instructed to consciously turn his right lower leg inward/medially when walking and running.
This client was able to eliminate his chronic right knee pain that he had been suffering for 6 months and run walk/run 6 hours pain free with in one week’s time.
This is an example of managing a repetitive use injury by identifying the excessive amount of asymmetrical repetitive activity which correlated with the injury. Once the offending alignment/movement was identified strategies were developed to modify the repetitive asymmetrical activity. Remedial exercises were developed to restore normal alignment and movement, and conscious modification of walking/running form was used. Gas pedal knee was alleviated in a very short time period.
Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits [email protected]
Coleman Physical Therapy
I learned how to drive stick shift at the age of 16 and I was absolutely horrible. However, 3 out of 4 family vehicles at the time were manual transmission so I had to learn fast. I now own a 5-speed manual Toyota Rav4. Over the years of driving and thousands of clutch presses, I have experienced my fair share of knee pain and found ways to avoid it.
What & How:
There are a few muscles that are mainly used when depressing the clutch. The glutes, which extend the upper leg, the quadriceps and hamstring, which are for lower leg extension and curling, and the gastrocnemius, soleus, and anterior tibialis, all of which work together to act on the ankle and allow the pumping motion of the foot. The main way the clutch is usually pressed is by knee extension.
The knee is extended, or straightened out, by way of the quad tendon pulling on the tibia through the patella, or knee cap. The knee cap give the quadriceps a mechanical advantage and helps use to perform knee extension much more efficiently.
Compression and overuse. The knee joint has a thin cushion that sits between the femur and the tibia, called the meniscus, which absorbs the compressive force from the knee. Compared to the shock force during a standing and walking position, the shock force is not evenly distributed in a seated position–most of the force stays at the knee. During leg movement, the kneecap glides in a groove at the end of the femur, called the patellofemoral groove. Irritation between the patella and femur may occur from high repetitions of rubbing between the two surfaces. In some people, the patella does not track perfectly in the groove, causing quicker and more painful irritation.
Knee sleeves are a good way to distribute compression and congruently guide the patella in the patellofemoral groove to reduce pain. Another source of pain may begin when an enormous amount of force is put through the quad tendon during extension against a resistant force, like a clutch. Highly repetitive tension put through a small tendon over an hour commute in stop-and-go traffic is of concern for pain and fatigue.
Reasons & Fixes:
1.Stop and Go Traffic – Traffic is where most damage is done from driving manual. Reduce the use of the clutch by properly gauging the distance between yourself and the car ahead of you. Slowly crawl in 1st or 2nd gear during traffic to decrease the number of times you use the clutch.
2. Seat Distance – The more the knee is bent, the more force is put through it. When the leg is bent, the quad tendon is stretched and pressed into the patellofemoral groove. Set your knee distance so that you knee is slightly bent and relaxed.
3. Leg Weakness – If your lower extremities are stronger, it will require less energy to perform the action and experience less fatigue.
4. Butt Weakness – The butt muscles, called the glutes, are a group of muscles that extend the thigh bone, called the femur, and can assist with straightening out the knee when seated. If the glute muscles are weak, the quads are will be overworked when depressing the clutch, causing knee pain.
5. Use your Foot – If possible, press the pedal by only using your calves and by pressing down the clutch with your foot to give your knee a break.
*Bonus* – Don’t forget about your right knee! Move it around to allow the natural fluid of the knee to lubricate the joint and avoid stiffness.
Without a doubt, seeing a Physical Therapist is the best way to prevent and END knee pain. Having a hands-on experience with a Physical Therapist means dedicated attention and care to relax tight muscles, lubricate stiff joints, and strengthen your body so you can get back to doing what you love.
- Give the manual vehicle a rest when possible.
- Ice , compress, & elevate the knee if severely irritated
- have a stiff or tight clutch fixed
- Keep the knee joint moving. Hours of driving stick shift keeps the joint in limited positions. joint motion restores nutrients and reduces swelling and pain
- A knee compression sleeve may also help the reduce pain by helping the kneecap glide in the femoral groove correctly.
Combine this knowledge with a visit to a physical therapist and you will see a dramatic drop in your pain and a dynamic increase in the activities you love to do.
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Do Your Knees Hurt During or After Driving?
Experiencing knee pain during and immediately following driving is a common problem especially on long trips or in stop-and-go traffic. If that pain is located at the front of your knee under your kneecaps, you may be suffering from chondromalacia patellae (also known as CMP). This condition is characterized by the degradation of the protective cartilage that sits under your kneecaps and can be attributed to injury, aging, muscular imbalance or an anatomical misalignment of the kneecap.
Often, this type of knee pain occurs in drivers with long legs who keep their knees bent while in the car. To get relief from your knee pain, try adjusting the position of your seat. Sliding your seat back until your legs are almost totally straight will force you to only bend your ankles when operating the pedals. In this extended position, your kneecaps sit on top of your knee joint, relieving pressure and pain. If your knee pain persists, be sure to contact your physician to further evaluate your condition.
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Barbara K. Hecht, PhD
Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic knee pain. The condition develops due to softening of the cartilage beneath the knee cap (the patella), resulting in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. The changes can range from mild to complete erosion of the cartilage. This process is sometimes referred to as the patellofemoral syndrome.
Chondromalacia commonly occurs in females. Girls in their teens are at elevated risk because the cartilage of the knee is subjected to excessive and uneven pressure due to the structural changes that accompany rapid growth. Chondromalacia may also occur in adults over age 40 as part of the wear-and-tear process that eventually leads to osteoarthritis of the knee joint. Other factors that may precipitate chondromalacia include trauma, overuse, or abnormal forces on the knee joint. It can develop in skiers, runners, cyclists, and soccer players, especially if someone is knock-kneed or flat-footed.
The pain of chondromalacia occurs in the front or inside of the knee. The pain is generally worse with activities such as running, jumping, using stairs, or kneeling. The pain is also typically worse after prolonged sitting with the knees bent. This pain is called the “theater sign” of chondromalacia.
There may be tenderness of the knee along with a grating or grinding sensation when the knee is extended. X-rays of the knee are generally normal in chondromalacia but may show a slight displacement of the knee cap. (Even if you have symptoms consistent with chondromalacia, your doctor may still order an X-ray to rule out other reasons for your knee pain.)
Nonsteroidal antiinflammatory drugs medications such as ibuprofen (Advil/Motrin) or naproxen (Aleve) are often prescribed both to alleviate pain and reduce the chronic inflammatory processes that increase the structural damage. Icing the knee can also help.
Chondromalacia is usually treated conservatively with exercises designed to strengthen the muscles around the knee and restore normal alignment of the knee cap. These exercises should be carefully designed to selectively strengthen the thigh muscles (the quads) and realign the patella.
About 85% of patients with chondromalacia improve with conservative treatment alone and require no further therapy. In about 15% of cases, the pain persists or worsens to the extent that surgical correction of the knee joint may be needed. While it is not always possible to prevent chondromalacia, avoiding trauma and abnormal stresses on the knee and keeping the leg muscles strong and flexible may be able to help to prevent its development in many cases.
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Common Knee Issues Associated With Long-Distance Driving
Many people spend a lot of their life on the road. Whether you’re a truck driver driving through multiple states, you work at a job at least an hour away, or you deliver goods to your nearby area, you may constantly find yourself in the driver’s seat.
Many drivers put a lot of wear and tear on their knees while driving. The bend of the leg, the stop and go functions, and the limited mobility of driving positions are just a few of the factors that contribute to extended knee pain. Learn about some of the more common knee issues you may experience while driving and some of the treatment options so that you are more comfortable on the road.
Driving in the same position repeatedly can put a lot of wear and pain on your kneecaps. Over time, the cartilage may wear down and result in a type of arthritis known as osteoarthritis. For long-distance drivers, osteoarthritis may occur over time due to the natural stop and go of traffic stops.
For example, when you do a lot of city driving, you are constantly putting wear and tear on your knee as you switch back and forth between the brake and the gas.
Once osteoarthritis has begun to form, you will want to seek treatment as soon as possible. While physical therapy may help reduce the overall pain, you may need to seek out some type of knee surgery or treatment option to increase flexibility and movements in the legs.
To continue driving, you may need to wear various support products like a knee brace. The use of a knee brace will help you reduce the direct pressure on your knee.
Knee Joint Strain
During driving trips, you are likely spending hours at a time in the same position. When you do not have the ability to stretch out or exercise, you put a lot of strain on your knee joints and may experience a lot of pain when you get up and try to walk around.
Knee joint strain may also increase in drivers who are tall or overweight. Taller drivers may have their knees bent at more dramatic angles. Overweight drivers may experience increased pressure on the knees due to the excessive weight. Treatment options may include extensive joint repair, rehab, and weight loss programs.
Through tips, training, and treatments, extended knee joint pain may fade away over time.
Directly underneath the kneecap is a lot of cartilage that helps protect the knee and prevent bones from grinding together. When knees bend repeatedly in a vehicle, the cartilage may soften and cause a condition known as chondromalacia patellae.
With this problem, your knees may crack or grind when you stand, walk, or bend down to sit in a vehicle. In some cases, chondromalacia patellae may lead to a misaligned kneecap or severe pain while walking or stretching your knee out. The early forms of chondromalacia patellae may be treated through physical therapy, but the condition could reach a point where arthroscopic surgery is needed.
A surgery on your knee will help correct these problems and build a foundation where your knees feel better for the long haul. Through treatments, you will learn the best stretches and exercises to help reduce strain and keep your knees healthy for years.
Of course, preventive care is often the best treatment option, so any knee issues or pains should not be ignored, especially if you drive for extended amounts of time on a daily basis.
For all of your knee issues and problems, contact our experts at the Noyes Knee Institute. We can help get you evaluated and set up a proper treatment plan.