Hip, Knee, Ankle, Foot Pain

Hip Pain and Causes

Hip pain is very common among all ages and can cause mild to severe discomfort when performing daily activities such as standing, walking, squatting, bending, and climbing stairs. Hip pain can be described as dull, achy, sharp, shooting, or tingling.  Muscle strains, tendinitis, or bursitis can occur outside the hip joint and femoral acetabular impingement (FAI), labral tears or osteoarthritis can occur inside the hip joint. The hip joint, also referred to as the femoral acetabular joint, is extremely important because it helps connect the upper body to the lower extremities. It is responsible for dissipating loads from the upper body to the lower body, while providing stability, trunk control, and balance. While the hips are designed to support our bodyweight, every hip is different in terms of alignment and orientation. As movement experts, a physical therapist not only treats conditions such as strains, tendinitis, bursitis, and osteoarthritis, but also assesses each patient’s biomechanics to treat underlying impairments that can cause hip pain.  

Common causes of hip pain include: 

• Muscle Strains and tendinitis: A strain occurs when a muscle supporting the hip is stretched beyond its limits. This results in pain, tenderness, and tightness around the hip. Muscle strains can occur in the front of the hip, in the back of the hip, or on the side of the hip. Strains usually occur when the muscle is in its most lengthened position (think of a runner pulling his hamstring when the leg is completely straight). Overuse of the muscles in these areas can also lead to tendinitis and tendinopathy.  
• Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. With trauma or overuse, the bursa can become inflamed or swollen, causing pain and limiting range of motion. The most common is greater trochanter bursitis, which causes pain on the outer most aspect of the hip. Usually, bursitis is a secondary result of tendinopathy of a muscle.  
• Snapping hip syndrome (often referred to as dancer’s hip): Snapping or popping while walking or with leg movement can occur along the front of the hip (snapping of the iliopsoas), or along the outside of the hip (snapping of the IT Band/glute complex).  
• Femoral Acetabular Impingement (FAI): Impingement of the hip is very common and can be described as abnormal contact between the femur (the long thigh bone) and the acetabulum (the socket of the hip bone where the femur inserts). This results in increased friction with hip movement overtime that can to labral tears. Hip impingement causes pain and stiffness throughout the joint and results in progressive loss of motion if not treated. Popping and clicking occur with hip flexion and rotation. 
• Acetabular labral tears: Tears to the labrum be degenerative due to FAI or caused by a trauma to the hip. They are characterized by clicking and popping along the groin area. With labral tears, lying on your back and raising a straight leg will cause pain. 
• Osteoarthritis: Hip OA is one of the leading sources of pain for elderly individuals. Pain is usually worse in the morning and decreases throughout the day with movement. However, there is much more to it than the joint simply being bone-on-bone! Abnormal changes such as cartilage degradation and bone spurs can alter normal joint function, resulting in pain, limited range of motion, and compensation through areas of the body. 
• Pinched nerves: Numbness, tingling, and radiating pain into leg can be caused by impingement of a nerve in the hip (it is not always stemming from the back!). We’ve all heard of the dreaded sciatica that can shoot pain down the back of your leg. Other nerves can also be impinged causing pain to radiate down the front, middle, and outer aspect of the leg as well.  

How can Physical Therapy help? 

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. Your past medical history will be reviewed to determine any possible underlying causes of pain. The problem is often coming from another non-painful part of the body. If you keep putting air in a tire without fixing the gash, then you will continue to have a problem. For example, progressive hip impingement (FAI) can be the result of stiffness and/or weakness in the core, low back, hip, knee, or ankle. Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest! 

Knee Pain and Causes 

The knee is arguably the most injured joint in the body. It is a complex joint that takes the brunt of compressive forces during standing, walking, and running. Even in people not experiencing pain, the knee can make sounds like Rice Krispies Cereal: Snap, crackle, and pop. Knee injuries can occur at any age and are the result of sudden trauma, overuse, lack of use, or underlying conditions such as arthritis. Pain can be felt around the kneecap, behind the knee, or inside the joint. Common injuries include muscle strains, ligament sprains, patella femoral pain syndrome, patellar tendinitis, IT band syndrome, bursitis, meniscal injuries, and osteoarthritis. Each can have a negative effect on everyday activities such as standing, walking, squatting, climbing stairs, and even getting in and out of a car. Luckily, most knee injuries respond very well to physical therapy and conservative management.  

Common knee injuries include: 

• Muscle strains: A strain occurs when a muscle supporting the knee is stretched beyond its limits. This results in pain, tenderness, and tightness around the knee, behind the thigh, or in front of the thigh. Strains usually occur when the muscle is in its most lengthened position (think of a runner pulling his hamstring when the leg is completely straight). Overuse of the muscles in these areas can also lead to tendinitis and tendinopathy.  
• Ligament sprains: There are numerous ligaments that stabilize the knee, but the four most important are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Like muscles, a ligament can be sprained when it is stressed beyond its limits. When this occurs, it will leave the knee feeling unstable, often causing it to buckle with weightbearing movements.  
• Patella femoral pain syndrome (PFPS): Pain is usually felt around or underneath the kneecap. PFPS is more common in young, active populations during activities such as running and jumping, but pain can also occur during prolonged sitting. The culprit causing the pain is weakened quadriceps and weak areas of the hip that cause the kneecap to move abnormally.  
• Patellar tendinitis: Pain is felt below the knee, along the patellar tendon, close to the tibial tubercle (the bony area below the knee). It is a common injury in activities requiring sprinting and jumping when the patellar tendon is loaded or stressed excessively.  It can also make going up and down stairs very difficult. In adolescents, you may see similar injuries referred to as Osgood- Schlatters or Sinding-Larsen-Johansson disease.  
• Iliotibial Band Friction Syndrome (IT band syndrome): The most common running injury is known as IT Band syndrome and pain is usually felt along the outside of the thigh and knee. The IT Band moves over the outside of the knee when the knee is flexed and extended. So, activities that slowly and repeatedly bend and straighten the knee such as speed walking and jogging can cause a great deal of friction and tension along the IT Band. However, even though pain is felt in the knee, IT Band syndrome arises from strength deficits at the hip.  
• Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. The knee has five bursae, but the pre patella bursa on the front of the knee is the most commonly irritated with kneeling or a direct blow to the kneecap. It becomes inflamed or swollen, which causes pain and limited range of motion. 
• Meniscal injuries: The two menisci play a very important role in making the femur (the long bone in the thigh) and tibia (lower leg) fit together perfectly (the knee would be incongruent without the menisci). They also absorb up to 70% of compressive forces placed on the knee. Injuries to the menisci can be acute from sudden twisting or degenerative in nature due to long periods of poor biomechanics and muscle imbalances. Symptoms include pain around the knee joint, as well as popping and clicking with movement.  
• Osteoarthritis (OA): Knee OA can be debilitating and can get progressively worse if not treated. Pain is usually worse in the morning and decreases throughout the day with movement. However, there is much more to it than the joint simply being bone-on-bone! Abnormal changes such as cartilage degradation and bone spurs can alter normal joint function, resulting in pain, limited range of motion, and compensation through areas of the body. However, surgery does not have to be the answer and should never be the first line of defense.  

How can Physical Therapy help? 

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. The problem is often coming from another non-painful part of the body. Remember, a great deal of compressive and shear force is placed on the knee with everyday activity. If other structures in the leg are not functioning optimally, these forces will increase, leading to injury. For example, patellar femoral pain can be the result of stiffness in the hip or ankle and/or weakness in the gluteal muscles. IT Band Syndrome stems for hip stiffness and/or weakness in either the gluteals or the tensor fascia late (TFL). Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest! 

Foot/Ankle Pain and Causes

From elite athletes to a person walking on the street, ankle and foot injuries can happen to anyone, at any time.  The ankle/foot complex consists of 26 bones and over 30 joints, all of which are vital in helping people get around. The ankle and foot have three major functions: 1) An adaptor that conforms to terrain and provides balances strategies. 2) A rigid lever to allow individuals to propel themselves from point A to point B. 3) A shock absorber to transmit forces when the ground is contacted. Examples of injuries to the ankle and foot include ankle sprains, calf strains, Achilles tendinitis, shin splints, plantar fasciitis, calcaneal bursitis, and bunions over the big toe. Overuse injuries can cause pain upon waking up or after prolonged activities. Sudden, acute injuries, such as ankle sprains, can occur out of nowhere, like stepping awkwardly on a curb. Physical therapy will treat the injured structure, as well as address any underlying impairments that may have led to the injury.

• Ankle Sprains: Ligament sprains to the outside of the ankle are considered the most common ankle injury. They occur when the foot twists or rolls inward, causing the ligaments along the outside of the ankle to be overstretched. A less common sprain can occur to the inside of the ankle when the foot rolls or rotates outward. This disrupts the syndesmosis between the tibia and fibula (the joint between the two lower leg bones) and is often referred to as a high ankle sprain. A physical therapist can determine the severity of the sprain by examining range of motion, swelling, bruising, and tenderness.
• Calf strains: The calf runs along the back of the lower leg and can be strained when it is stretched beyond its limits. This occurs when the foot is flexed upward while the knee if fully extended. The result is pain and tightness along the back of the lower leg.
• Achilles tendinitis: The Achilles is the largest tendon in the body. It spans from the calf muscle to the heel. It is commonly injured when the tendon is placed under excessive load during activities such as running, jumping, and climbing. The abrupt action of pushing off and lifting your foot can cause pain just above the heel. Instances where a popping noise occurs could be due to a tear of the Achilles tendon.
• Shin splints (Medial tibial stress syndrome): Aching pain to the lower half of the leg during activity has often been referred to as shin splints (although the more accurate term is medial tibial stress syndrome). The pain usually occurs at the beginning and after running activities due to repeated microtrauma to the lower leg. Also, the aching symptoms are reported along most of the front of the leg. Conversely, stress fractures are characterized by a pinpoint pain location. Muscle imbalances in the lower leg, weakness in foot musculature, and decreased ankle range of motion can cause medial tibial stress syndrome.
• Plantar Fasciitis: Excess pressure to the bottom of the heel can cause irritation to the tissue that runs along the bottom of the foot. Pain is felt on the heel, usually within the first few steps of the day or after prolonged activity. Risk factors for plantar fasciitis include decreased ankle range of motion, decreased big toe extension, an increased body mass index, and even hamstring tightness.
• Calcaneal Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. The calcaneal bursa is located between the Achilles tendon and the calcaneus (heel bone). The bursa can get inflamed or swollen with overuse and pain is experienced at the end of the day or after prolonged activity.
• Bunions at the 1^st Ray: When there is decreased ankle/foot range of motion and poor biomechanics with walking, a bony bump (bunion) can form at the base of the big toe. The base of the big toe begins to stick out and the tip is pulled towards the other toes. Poor mechanics with walking can also be caused by impairments higher up the lower extremity chain in the low back, hip, and knee.

How can Physical Therapy help?

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. The problem is often coming from another non-painful part of the body. If other structures in the leg are not functioning optimally, the ankle and foot will be forced to compensate, leading to injury. For example, a bunion at the first ray can be the result of weakness in the gluteal muscles and/or deep muscles that rotate the hip. This leads to overpronation when walking (the arch of the foot collapses) and excessive stress at the base of the big toe. Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest!