A Pain in the Butt…Or Knee…Or Ankle…Or Foot

A few weeks ago I wrote an article about shoulder pain and how one shoulder issue can lead to the next, and to the next.  This week, I want to cover a similar topic in the leg.  It is funny the way the body works, in that every person is so different, but also very similar.  This is why we see many of the same pain patterns, like those I am going to cover today, in many different individuals. 

As implied by the title, the chain reaction I am going to discuss starts in the glutes and is related to a postural imbalance caused by sitting too much.  There are three glute muscles on each side of the body, but the one that is most commonly affected by poor posture is glute medius.  Glute medius’ responsibility is to keep the hip and leg externally (outwardly) rotated through actions like walking, running, squatting, and lifting…basically any dynamic movement of the leg.  The problem begins when the glute medius gets weakened from spending too much time sitting and not enough time staying activated.  This can result in pain itself, but this muscle imbalance more commonly leads to other issues down the leg. 

Staying towards the top of the leg, one area that is often affected by a weakened glute medius is the Iliotibial (IT) band.  The IT band starts as a muscle on the upper, outer portion of the leg, and turns into a connective tissue band that runs down the outer thigh and attaches to the outside of the knee.  When the glute gets weak and the leg internally rotates, the IT band becomes overstretched.  This is particularly common for runners and other athletes who constantly put their legs through repetitive dynamic movements.  A tight IT band can result in pain along the outer thigh, as well as in the attachment point on the outside of the knee. 

On the opposite side of the knee, issues also arise from the glute medius failing to keep the leg in external rotation.  Here, the knee has caved inward, putting extra stress and strain on the tendons, ligaments, and cartilage on the inside of the knee.  The most likely piece of the inner knee to be injured from this pattern in the MCL, which is the ligament connecting the top, innermost part of the knee to the bottom.  Once again, this pain pattern is most common in people who rigorously use their legs in repetitive movements. 

The glute medius-induced chain reaction ends in the ankle and foot, which become rotated toward the arch of the foot when the knee caves in and the hip and leg internally rotate.  This flattens the foot upon every step, as well as putting more stress on the inner part of the foot and ankle.  The tissues that are in danger of injury at the foot and ankle are the plantar fascia, a connective band that runs the length of the bottom of the foot, and the Achilles tendon.  Ankle sprains can also become more likely with this pattern.  Anyone who has dealt with these problems knows how painful they can be, and how long these areas can take to heal. 

Although it may be difficult to identify the cause of a problem, following patterns like this can be helpful in finding the true source of where the pain is coming from.  The tough part is making the changes last, which in this case comes from changing posture and getting away from sitting too much.  It is difficult, but it can be done!

Yours in Health, Dr. Alex

Project Wellness Company Madison, WI