Cindi is in charge of the laundry, and the laundry is in the basement. This means stairs, but Cindi’s active, so stairs are no big deal. One day, Cindi’s knee started hurting, and it kept hurting for weeks; then stairs became a very big deal. But she and her husband kept wearing clothes; clothes that eventually needed cleaning; cleaning that meant carrying heavy loads up and down the stairs.
Cindi was in a pickle, but instead of transitioning to a nudist lifestyle, she decided to call Dr. Alex (that’s me) to try figuring out what was going on, so she could fix it. So our journey begins.
What’s Going On Here?
Quickly into our online assessment, it became clear Cindi was having IT Band pain–a mean, nagging pain on the outside of the thigh that hurts when you walk, go up and down stairs, and stretch or use your hip muscles. The muscles that influence your IT band aren’t at the side of the thigh, but higher up at the hip–your glute muscles. When I tested Cindi’s glute muscles (me in Boston, Cindi at home in Duluth, Minnesota) her hip was not only tight, it was also weak.
Cindi hadn’t gotten hurt–she didn’t fall, or get in an accident, or get injured. She just started hurting and that pain escalated, so we dug into her history, because this sounded like something that was developing over time.
What’s Actually Going On Here?
The most obvious event in Cindi’s history was her total knee replacement 5 years ago. Cindi was a good patient, and she had completed a course of physical therapy after surgery. I recommend physical therapy for all patients after a surgery, even if someone tells you that you don’t have to. Technically, none of us have to do anything–like eat vegetables, or brush our teeth, or bathe–but that doesn’t mean we shouldn’t do those things. Doing a round of physical therapy after surgery (with me or any therapist) is one of those things that’s going to be good for your body, so do it.
I Thought I Fixed That
Cindi’s round of PT worked. She returned to pilates, she got back to group exercise and hiking, and she got her knee flexibility back. But she had some muscle tightness that never went away, and her balance on that leg was a struggle. When testing Cindi’s stability now 5 years after her total knee, her surgical leg was not even close to the balance on her other leg.
No one’s body is perfectly symmetrical–the same flexibility and strength side to side–but they’re usually close. Cindi’s was not close. When one leg is significantly tighter or weaker than the other, we can develop compensations in how we move that favor one side, which can then impact how other parts of our body are working. Those compensations can go on for years, and they don’t always hurt right away, but they often do hurt eventually.
Okay, So What’s the Plan?
With Cindi, we needed to get one of her legs caught up with the other when it came to strength, balance and flexibility, so that was the focus.
It didn’t happen in a week. It took a few months because, remember, this was something that had been around a long time; not only in the 5 years since her surgery, but also the years leading up to her surgery when her knee was hurting.
Progress: It’s Not A Straight Path
Cindi’s biggest challenge came a few weeks in, when she started gaining flexibility. When there’s a lack of flexibility, I like to address that right away. We definitely need to strengthen the weak muscles, but we want to strengthen muscles through their full range of motion. If we get muscles more flexible, we can strengthen them through a bigger range. But when you gain mobility you didn’t have before, things can feel weak and unstable at first.
Cindi’s range of motion in her hips and knees improved and, when it did, her muscles felt a little shaky initially. This is very normal, but it can catch people off guard. With Cindi, I made sure to incorporate balance and stability exercises along the way, and week by week, her muscles got stronger and could control her newly found flexibility gains.
Gaining Control Over the Situation
Then, the stairs started getting easier. At first, Cindi felt 50% normal trying to carry laundry up and down, then it was 60%, then it was 80%, 95% and eventually 100% back to normal without any more pain.
“Unfortunately, I’m carrying all the heavy baskets up the stairs again,” Cindi joked with me when laundry felt normal again. We used laundry as the goal until we eventually reached that goal, and then she moved WAY past that goal.
Laundy: Check! What’s Next?
Harder than stairs, Cindi wanted to get back to hiking. Hiking often means stepping up and down from larger and more unpredictable heights, so hip strength and knee control really get put to the test. All the single leg strengthening and control exercises got turned up a notch for more difficult training, but she was up for the challenge.
This month, put her leg to the test and went with her husband Jay on a 10 day trip from Portland down to Napa Valley. They stopped for a hike every single day, and those hikes were at least 2 hours. And her knee didn’t slow her down and it didn’t hurt. The glass of wine or beer at the end of her day was a little easier to enjoy because she wasn’t hurting.
She came home and told me “after a 10 day trip, there was a lot of laundry.”
She Did It
Way to go, Cindi. I may have set you up and guided you through the exercises, but you were the one who did them.
Laundry can be a pain, but at least it’s not that kind of pain, anymore.
What if Day to Day Stuff is Bugging Me?
If you are dealing with injury or pain that’s getting in the way of the things you do day to day, contact us. I, Dr. Alex, am here to support you every step of the way, no matter where you are. Book your free 15-minute consult to talk with me about your concerns and learn more about how we work! Our online physical therapy and personal training can help you regain what you thought you’d lost and go strongly into your future.
At motivPT, we believe your body deserves to feel great.
