Q: I have been a recreational walker for many years, walking anywhere from thirty minutes to two hours at a time on all kinds of elevations, but in the recent few months I’ve noticed going down stairways creates a sharp pain on the outside of my right knee. It is worse when I am bending my knee going down stairways. Could you please explain what this is and why it might be happening now after so many years of walking without injury?

A: From your description, this sounds like Ileo-tibial band syndrome (ITB), which is pain due to over tightened lateral thigh tissue that starts in your hip region and extends down to the outside of your knee. The pain is made worse when contracted, especially by flexing the knee in activities such as going down stairways, kneeling down, or squatting. The more complicated part is in understanding Why now? Pain without injury is most commonly due to a mild deactivation of supporting muscle groups. For example the gluteus medius muscle can de-activate causing the quadriceps to over work controlling knee and hip motion. The other possibility is a leg length difference. The first thing to try is stretching the region using long holding times of 45 to 60 seconds. If it helps but does not resolve, get an assessment to locate the cause.
— Bryan Baisinger, DC

Q: I’ve been diagnosed with bilateral chondromalacia and I want to continue walking. Am I doing more harm to my knees by continuing to exercise?

A: Chondromalacia is an irritation caused by abnormal tracking of your patella (kneecap) over your femur (thighbone). When the kneecap is tracking incorrectly then potential irritation and deterioration can occur. This may result in severe tenderness and often times swelling during many activities. A common misconception is that it is the activity creating the damage. The fault does not lie within the activity but how you are using your knee for the activity. The key is to modify your muscular function to allow the proper tracking of the knee, and then the activity will become a positive reinforcement of a proper functioning knee. Reducing activity will only allow the current muscular pattern to solidify.

Due to many current lifestyles (primarily sitting) there is not sufficient muscular movement during the day to ensure proper function in many joints of the body. You must constantly remind your muscles how they are intended to function. These exercises that I suggest act like a physical supplement to your muscular function in the same way your vitamin supplement will make up for nutrition deficiencies in your diet. Use these exercises before and after activity. You should progressively reintroduce your activity, start slow and gradually begin to increase activity levels. Let pain be your guide. If your knee begins to become irritated, then you know you have reached a fatigue point; you have lost the muscular integrity of your leg and you are now grinding on the kneecap. Your muscles will need time to develop the strength and endurance required to sufficiently hold your knee in the proper tracking position during your activity. The best activity you can do is walk. The impact from walking is beneficial to your joints as long as your muscles are functioning properly.

These exercises are just a starting point in reintroducing proper muscular function, but they will begin the process in strengthening the necessary muscles to help alleviate your condition.

Make sure that you check with your physician before beginning any physical program.

Sitting Floor Sequence: The first three exercises are to be done while sitting on the floor with your back flat against a wall, your legs straight out in front of you, and keeping back and gluts as close to the wall as is comfortable. Flex thighs tight while pulling toes back.
Static – 2 min hold the sitting floor position.
Leg Lifts – 3 X 5 each leg in sitting floor position, keeping thighs tight and toes pulled back, lift right leg off the floor and back down. Make sure your heel lifts before your knee; repeat up and down then switch legs.
Femur Rotations – 3 X 20 both legs in sitting floor position, split both legs out to 45 degree angles, keep thighs tight, toes pulled back, rotate legs in and out.

Repeat the entire sequence up to three times to improve strength and endurance.
— Brian Cassidy

This issue’s experts
Bryan Baisinger, DC, owner of Clearwater
Chiropractic & Massage. To contact Bryan call 503-279-0205 or email him at bryan@clearh2o.org.
Brian Cassidy, president/founder of Function Dynamics Inc. To contact Brian call 503-646-8482 or email him at cassidy@function
dynamics.com.