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Viewing posts categorised under: Chronic pain

Headache 

06.01.20

Headache    If you’re one of the 47% of the global population who experiences regular headaches, you’ll know they’re no laughing matter. For some people, they’re just a minor inconvenience, for others they can be utterly debilitating, condemning you to a dark, quiet room for hours, and sometimes even days.   The trouble is that successfully diagnosing a headache gets complicated, because more than 130 distinct disorders have been identified along with over 300 triggers, which makes a headache almost as unique as an individual. Luckily at Pottsville and Cabarita Physio we specialise in treating headache and can confidently determine if Physiotherapy will help you within the first session. Headache is a unique condition in that you can also simultaneously suffer one, two or more types of headache or a migraine at the same time, where one may cause another, or overlap with each other. These are known as mixed or multi-source headaches and can take longer to resolve as your therapist works through treating the different causes. For example, a dysfunctional painful neck can cause an increase in surrounding muscle spasm, which will increase your blood pressure. In this scenario, you could have a cervicogenic (neck) headache, with a tension headache and a resultant migraine! The most commonly diagnosed headaches are:

  • Migraines (12%)
  • Tension headache (75%)
  • Cervicogenic headache (originating from the neck) (18%)
  • Sinus headaches
If you only suffer from the occasional headache, this is often caused by lifestyle factors such as:  
  • Dehydration
  • Stress
  • Alcohol
  • Caffeine
  • Some foods
  • Skipped meals
  • Lack of sleep
  • Posture
  • Muscular tension
  • Medications
  • High blood pressure
  • Infection
  • Hormonal influences
  However, if you suffer from headaches more regularly, there is some good news, because two of the most common headaches, tension-type headaches and cervicogenic headaches (which originate from musculoskeletal issues in and around the neck) can be significantly improved, and even cured by physiotherapy, both in the short term, as well as the long term.   There is a robust body of research, as well as clinical evidence, showing that physiotherapy is an extremely effective treatment for certain types of headache.   Manual, hands-on therapy manipulating or mobilising your neck can be hugely beneficial in eliminating your headache; or at least reducing the intensity and duration of the headache. Soft tissue work including trigger point therapy and massage, can be effective in relieving spasm in the head and neck muscles which may contribute to your headache. Massage has also been shown to help people cope better during headache episodes, reducing associated stress and anxiety. In addition, poor posture and repetitive movements in your daily life, have also been shown to increase the risk of experiencing headaches as they can cause muscle imbalances, muscle weakness and strain the ligaments and soft tissues in the joints of your neck. In these cases corrective exercises to strengthen weak muscles and stretch tight muscles can be extremely effective.  Our Physios specialise in these corrective exercises. We have some more downloadable resources and advice sheets on each specific headache type at the following link. If you would like to understand more about how we can help in the treatment and prevention of headaches, please don’t hesitate to contact us directly on 02 6676 4000 / 02 6676 4577. https://www.facebook.com/pottsvillephysiotherapy

The role of Accredited Exercise Physiologists in the treatment of Cancer

29.07.19

The role of Accredited Exercise Physiologists in the treatment of Cancer

Exercise has been established as an effective adjunct therapy for the management of cancer. People with exercise interventions have been shown to experience fewer and/or less severe treatment related side effects and have enhanced physical and psychological outcomes after a cancer diagnosis. This current evidence has led to calls for exercise to be incorporated into routine cancer care throughout all phases of the cancer care continuum – before, during and after treatment.   Current evidence-based guidelines recommend all people with cancer:  
  • Avoid inactivity and return to normal daily activities as soon as possible following diagnosis
  • Progress towards and maintain participation in regular moderate to vigorous intensity aerobic exercise and resistance exercise each week
  • Exercise recommendations should be tailored to the individual’s abilities noting the specific exercise programming adaptations may be required for people with cancer based on disease and treatment related adverse effects.
The majority of Australians with cancer are not meeting the recommended exercise dose. Estimates indicate that approximately 60-70% of cancer patients do not meet aerobic exercise guidelines and approximately 80-90% do not meet resistance exercise guidelines. The integration of Accredited Exercise Physiologist (AEP) services within cancer care may facilitate adherence with evidence-based guidelines. Thus, it is critical that all health professionals involved in the care of people with cancer are aware of the scope and capacity of AEPs to work in the oncology setting and to understand how to access these services for their patients.   What do Accredited Exercise Physiologist’s do?   AEP are university-qualified allied health professionals, recognised by Medicare, who specialise in clinical exercise interventions for a broad range of pathological populations. As exercise specialists, AEPs are adept at screening, assessing and applying clinical reasoning to ensure the safety and appropriateness of exercise, as well as developing and delivering safe and effective individualised exercise interventions for people with chronic and complex medical conditions. These skills have led to AEPs having an important role in the care and treatment of people with a broad range of diseases.     The majority of Australians with cancer are not meeting the recommended exercise dose. Estimates indicate that approximately 60-70% of cancer patients do not meet aerobic exercise guidelines and approximately 80-90% do not meet resistance exercise guidelines. The integration of Accredited Exercise Physiologist (AEP) services within cancer care may facilitate adherence with evidence-based guidelines. Thus, it is critical that all health professionals involved in the care of people with cancer are aware of the scope and capacity of AEPs to work in the oncology setting and to understand how to access these services for their patients.   What do Accredited Exercise Physiologist’s do?   AEPs are university-qualified allied health professionals, recognised by Medicare, who specialise in clinical exercise interventions for a broad range of pathological populations. As exercise specialists, AEPs are adept at screening, assessing and applying clinical reasoning to ensure the safety and appropriateness of exercise, as well as developing and delivering safe and effective individualised exercise interventions for people with chronic and complex medical conditions. These skills have led to AEPs having an important role in the care and treatment of people with a broad range of diseases.     Benefits of AEP exercise interventions   Exercise can be safely delivered to people with cancer throughout the cancer continuum when it is appropriately prescribed and monitored. Supervised exercise interventions can:
  • improve functional ability/capacity
  • improve health related quality of life across various domains including physical, mental and social wellbeing, cardiorespiratory fitness, muscle strength, endurance, and power
  • reduce cancer-related fatigue
  • reduce psychosocial distress, and
  • positively influence body composition.
  In addition, exercise may reduce the risk of:
  • cancer-specific mortality for certain cancer types including breast, colorectal and prostate cancers
  • cancer recurrence for certain types of cancer including breast, colon and prostate cancers
  • all-cause mortality and development of new cancers
  • developing comorbid conditions including cardiovascular disease, osteoporosis and diabetes
 

Moving Beyond Cancer at Cabarita and Pottsville Physiotherapy

  Moving Beyond Cancer is an exercise class specifically designed by an AEP for people at any stage along the cancer continuum. The class enhances not only the physical wellbeing, but also the mental wellbeing to the lives of those with cancer. The exercises are tailored to the individual’s abilities, the program is patient-centred, and is responsive to individual patient needs, goals and preferences. An initial assessment is conducted by an AEP prior to joining the class. The classes are individualised exercise programs in a small group setting (1-5 participants).  All sessions are EPC and Health Fund rebatable.   For more details of our Moving Beyond Cancer Class follow this link   

Massage Therapy

14.05.19

Fact: It is estimated that 37% of the population of developed countries and 41% of developing countries, suffer from chronic pain.

It is one of the most common reasons why people visit Rosie at Pottsville and Cabarita Physio (up to 40% of visits).

Other common reasons include rehabbing sports injuries, relief of pain from accidents or muscle strains, relief of stress and as a form of preventative health care.

And also, just that good old relaxation that can only come from human touch.

What is massage therapy, exactly?

People with specific massage therapy training are highly knowledgeable about anatomy and physiology and are skilled diagnosticians with regards to chronic pain and how to treat it.

The underlying idea behind massage therapy is that a relaxed and loose muscular structure promotes the flow of energy through the body, which enables the body to maintain health and heal itself, without resorting to drugs or surgery.

Here are some common massage therapy modalities that you may encounter, ranging from simple relaxation to treatment of complex pain issues and connective tissue realignment.

Swedish Massage

This is your standard relaxation massage. Swedish massage is very popular in spa settings.

As one of the most popular types of bodywork performed today, the overarching goal of Swedish massage is the ultimate relaxation of the entire body. It is exceptional at achieving this, easing tension while promoting the release of environmental toxins stored in the body’s fat and epidermis layers while simultaneously increasing the oxygen levels in the blood.

Swedish massage has also been shown to produce significant reductions in the stress hormone, cortisol.

Trigger Point Therapy and Myofascial Release

A trigger point is a small area of tightly bound and ‘knotted’ muscle that will produce referred pain into another part of the body when pressed upon. For example, a trigger point in the rhomboid muscle in the upper back can produce headache-like pain at the base of the skull.

Trigger points such as these are often misdiagnosed as migraines.

Trigger points range in severity from mildly annoying to completely debilitative. The affected muscle fibres are in a permanently shortened and tense state, and can even pinch nearby nerves, producing even more related symptoms, sometimes spiraling into full-blown fibromyalgia, a disorder of the connective tissues.

This is one area where massage therapy has a distinct advantage over every other form of treatment. Conventional medicine’s answer to trigger points is usually an injection of a local anesthetic or a corticosteroid injection. Both of which are temporary, unnatural treatments and in the case of the corticosteroid, actually damaging to the tissues.

Massage therapy treats these by the application of pressure directly to the trigger point, going over time from light to very deep, (usually within the same session) whereupon the trigger point will begin to release and relax.

Follow-up treatment is nearly always needed to retrain the muscle fibers to lengthen and “smooth” back out. A good massage therapist can often boast a near 100% success rate with trigger point therapy, even when other treatments have failed.

Myofascial release is a broader application of this type of therapy that seeks to restore mobility and function to the body’s underlying network of connective tissue that is present in every muscle in the body. It improves lymph circulation (keeping the blood clean) and enhances the muscle’s natural stretch reflex, keeping the body supple and strong.

It should be noted that these types of massage therapy are not the same as a relaxing Swedish massage and can sometimes be quite painful as the body relaxes, releases, and returns to normal homeostasis. It’s important to communicate to us during your treatment if you are uncomfortable at any time.

Sports Massage

As the name implies, sports massage is focused on the athlete. From the highest level of competition, to the casual weekend warrior, sports massage therapists can be found everywhere from weekend 5ks to professional locker rooms and Olympic fields.

Sports massage focuses on both pre- and post- event training and recovery.

Pre- event for example, may involve stimulating a stretch reflex in the quadriceps muscle of a runner to help lengthen her stride, with repeated treatments resulting in a faster runner who is less prone to injury.

Post-event can take the form of a light, relaxing massage to stimulate healing blood flow to an overused muscle group, enabling the athlete to recover safer and faster, and enable them to perform at the top of their game sooner than otherwise would be the case. Rather than a specific technique as in trigger point or myofascial therapies, sport massage focuses on the dual goals of athletic performance and recovery and may borrow heavily on other modalities to achieve these ends.   Rosie is our skilled masseuse and is looking forward to helping you, to book in phone 0266764000 / 0266764577 For more information click http://bit.ly/2S96ETT https://www.facebook.com/pottsvillephysiotherapy

OSTEOARTHRITIS OF THE KNEE – Day to Day Tips

26.02.19

Day to day Tips 

 
  • Pace your activities through the day – don’t tackle all the physical jobs at once.
  • Wear low-heeled shoes with soft, thick soles (trainers are ideal). Thicker soles will act as shock absorbers.
  • Use a walking stick to reduce the weight and stress on your painful knee.
  • Use the handrail for support when climbing stairs.
  • Don’t keep your knee still in a bent position for too long, it will stiffen up.
  • Think about modifying your home, car or workplace to reduce unnecessary strain on your knee.
  • Learn to relax your muscles and let the tension out of your body.
  • Use heat/ice packs to help eases pain and stiffness.
  • Knee braces for osteoarthritis are available.
  • Speak to your doctor or therapist first for recommendations or referrals for any of the above.

Is screen time affecting more than kids minds?

29.11.18

Is screen time affecting more than kids minds?

    The increased use of screens is probably the biggest change in childhood activity patterns since the introduction of the television 50 years ago. It is likely to have a big impact on children’s health and habits now and throughout their life. The high use of devices in childhood is likely to have a knock on effect later in life with increased risk of; • Obesity • Cardio and metabolic problems • Social and psychological issues • Musculoskeletal problems especially in the neck. Spending numerous hours in a poor neck posture with very little neck movement will make children more vulnerable to neck pain later in life.   There is a lot of research emerging that neck and back problems begin in adolescence – hence the importance of exploring prevention in childhood. The strongest predictor of whether you are going to suffer from neck or back pain in the future is if you have already had it, so stopping that first occasion of pain will have a significant impact! The research also suggests: • that children will also grow up with poor gross motor skills • Children who watch more TV or devices then their peers will have weaker bones by aged 20

Surveys suggest 2/3 of children aged 0-5 are spending at least 30 min per day on devices.

Australian Department of Health guidelines for screen time suggest that children under 2 have NO screen time.

Please click on the below links for guidelines for Physical activity for 0-5 year olds and 5 - 12 year olds.

Link for guidelines for physical activity for 0- 5 5-12 year olds  

Back Pain: The Chain of Command

29.08.18

Back Pain: The Chain of Command

Your spine is essentially the chain that forms the ‘backbone’ of your entire body. Without it you would be a blob of muscles, organs and soft tissue piled on the floor. Your spine commands respect because it is the pillar that supports your body, allows you to walk, stand and sit, as well as touch and feel; because it forms the canal connecting the nerves from your body and limbs, to your brain. While your heart may be the vital organ that keeps you alive, without your spine you wouldn’t be able to move. There are three natural curves in your spine that give it an "S" shape when viewed from the side. These curves help the spine withstand great amounts of stress by distributing your body weight. Between the bony vertebra are spongy discs that act as shock absorbers. The lumbar spine (or lower back) connects the thoracic spine to the pelvis, and bears the bulk of your body's weight. Your spine is not rigid though. It allows movement through the intervertebral joints connecting the bony vertebra. These joints allow you to twist, to bend forward and backward, and from side to side. Large groups of muscles surrounding the spine, pelvis, hips and upper body all interact to allow for movements like walking, running, jumping, and swimming. However, there are also muscles deep in your body that work constantly just to maintain your posture when you’re sitting and standing. It is essential that all elements of the spinal ‘chain’ work harmoniously together to ensure fluid movement without overloading structures resulting in injury and pain. Any link in the chain that becomes ‘stuck’ will not only affect that spinal level but also the movement and strength of the chain above and below it. If the muscles around the spine are uneven in strength and length (flexibility) this too can affect the ‘chain’, altering the alignment and motion of the links. Taking care of your spine now will help you lower the chances of experiencing back pain later. Many of the steps you can take to improve the overall health of your spine involve nothing more than practicing better body mechanics, or how you move and hold yourself, when you do daily tasks and activities.

Taking Care of Your Spine

Pay attention to early warning signs or pain. Although back pain is very common and nearly every person will experience at least one episode of back pain in a lifetime, it is essential to address any symptoms promptly. It has also been shown in studies that early treatment and rehabilitation can prevent recurrent bouts of back pain and prevent the development of chronic lower back pain which can be very debilitating, stressful and depressing. It can affect your ability to work, play sport, socialise and sleep, all of which can further compound your pain cycle. Your back pain could be due to inflamed ligaments, damaged intervertebral discs, nerve irritation, bony formations on the spine, muscle imbalances such as weakness or a lack of flexibility, leg length differences, or muscle strains, to name just a few. Even the way we move (or don’t move) at work, school or sport can all be an underlying cause to the current pain.

How Physiotherapy Can Help with Back Pain

Your physio can treat the pain or stiffness experienced from back pain using massage, soft tissue mobilisation, spinal manipulation, heat, acupuncture and other devices. It is important that you, together with your physio work through a rehabilitation programme (specific exercises and stretches) to correct underlying muscle weaknesses, flexibility issues, and the sequence in which the muscles around your spine work to provide stability. A physio can also give you advice on correcting posture / technique for work and sport. Should you need referral to another professional your physio can also help with this, for example, a dietician to counsel on a meal plan to achieve a healthy body weight. Being active can also help prevent as well as cure back pain. Chat to us today about what we can do to help. Ph 02 6676 4000

Back Pain and Sleep Issues

One of the most common issues back pain sufferers experience is sleep disruption so we have put together an interactive Back Pain and Sleep Guide to help you banish those sleepless nights and wake up feeling refreshed. The guide includes: • 6 Strategies for Improving Your Sleep • 8 bedtime stretches to relieve back pain (with video links) • Sleeping positions that will help relieve pain (with links to videos) • 7 Yoga Poses that will help cure most back pain issues A morning stretch routine that will help ease pain from a restless night (with videos) Click this link to find out more and download the guide Disclaimer: This information is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case.

The Truth About Discogenic Lower Back Pain

The Truth About Discogenic Lower Back Pain

What is it?

As we all know, our spines are made up of vertebrae which are connected with each other by discs. These discs are responsible for absorbing the shock our spine experiences and they also allow and limit our movements. These discs are made up of an outer layer called the annulus fibrosis while an inner layer consisting of a gelatinous material known as the nucleus pulposis. This can be best describe as your jam filled doughnuts. When someone proclaims that “I have slipped my disc” they are actually describing a the pain they felt on their lower back which is really called the discogenic lower back pain. Even though the disc itself has not slipped, this has become the generic term for such injury. A more precise and to the point description of discogenic lower back pain is the disc bulge or a disc herniation, but this will also depend on how severe the injury may be. Disc bulge happen when an internal disruption of the disc and the inner gelatinous nucleus material or the nucleus pulposis moves to the outer edges otherwise known as the annulus fibrosis. This creates a bulging effect. The outermost part of the disc is highly innervated (nerve supply), and this bulging can cause serious discomfort.

Mechanism of Injury

An injury to the spine, otherwise known as disc bulge or herniation may be caused by lifting heavy objects, pain can also be triggered by minor activities such as bending to pick things up from the floor. A person can be injured without his knowledge because the inner part of the disc has no nerve endings that will trigger pain, it is only when the outer part begins to show signs of tearing that pain is felt. And this is best describes as “the straw that breaks the camel’s back”. Aside from repetitive heavy lifting of objects, sitting for a prolong period of time is also a common cause of injury to your lower back because it places great stress to the discs. Individuals who suffer lower back injuries often have some pre-existing condition regarding their proximal stability or weakness to their postural muscles. Signs and Symptoms
  • Severe pain is felt on one side of the lower back, down to one leg and it is also common that the same pain is felt even down to the toes
  • Once pain is felt, bending forwards and other movements are restricted especially when getting up from sitting. 
  • When experiencing neurological signs such as pains of pins and needles, numbness, weakness or bladder and bowel dysfunctions a careful consideration must be given because these may be signs of more serious disc injury.
Treatment Management
  • The most common treatment method to follow is the McKenzie Technique  - It involves proper exercise that reduces the pressure on the injured disc and it allows healing.
  • While dealing with the posterior disc bulge or herniation of the disc, extension based exercise is essential . 
  • Taping the lower back can help maintain comfortable posture and can help reduce muscular spasm to relieve pain.
  • Spinal mobilization and soft tissue massage to restore movement. 
  • Clinical Pilates can help regain stability of the proximal muscle.
  Self Management
  • Find out more about body position and certain activities to avoid pain and allow healing to your back.
  • Enrol in a Pilates based strengthening program.
  • Improve your posture by using lumbar rolls.
 

Patello-femoral Knee Pain

16.04.18

Patello-femoral Knee Pain

Aching knees affect 25 % of the population and are commonly caused by dysfunction at the patella-femoral joint (under the kneecap). It is typically aggravated by bending movements such as sitting, walking up and down stairs or hills, jumping and running. It is also common during adolescence as the long bones are growing faster than the muscles, tendons and ligaments putting abnormal stress on the joints.

Causes

  • Unfortunately genetics have a part to play and this can’t be changes
  • Faulty bio mechanics due to muscle imbalances

Treatment

Treatment is very successful and we will look at correcting muscle imbalances throughout your lower back, hip, pelvis and leg. This is done by manual techniques to the knee cap, massage, acupuncture, exercise and taping.

Remedial Massage and its effects on Fascia

Remedial Massage and its effects on Fascia

What is fascia? Fascia is a type of connective tissue that essentially holds us together. It is composed of mostly collagen and elastin.  The fibres of collagen are the longest and strongest form of protein molecules found within body, they can hold up to ten thousand times their weight.  Collagen provides the tensile strength and structural integrity of the connective tissue. Whereas the elastin fibres allows the connective tissue to stretch, providing flexibility and the capability to absorb shock. These fascial fibres sit in an extremely receptive transparent fluid base that is interwoven in many directions all over the body.     Types of Fascia:
  1. Compartment fascia – surrounds individual muscle fibres, muscles, and muscle groups.
  2. Superficial Fascia – the fascia that lies just under the surface of the skin.
  3. Fascial sheaths – Superficial fascia that covers joints providing support and stability.
  4. Visceral fascia – surrounds each organ.
  5. Myofascial meridians/slings – bilateral systems of receptive connective tissue. These fascial slings relate to how we sense ourselves and how we move through life.
  Fascia and the systems of the body: Fascia incorporates all of the systems, with blood, lymph, nerves and meridians all passing through the fascial network. Fascia has particular connection to the muscular, nervous and endocrine systems. It is continuously reacting to these systems, responding to our emotions, movement and awareness.   Fascial Imbalances: Just like how muscles in the body can become imbalanced, fascial slings can get out of balance too. These imbalances are usually from lifestyle activities such as your job, sport and emotional/mental state. A good example of imbalance within the Fascial slings is between the Anterior Functional Line - which is a functional fascial sling that runs along the fibres of the Pectoralis Major, along the abs like rectus abdominis and the external oblique, down to the pubis, then continuing along the Adductor Longus muscle to the femur/thigh bone. And the Posterior Functional Line - a functional Fascial sling travelling along Latissimus Dorsi and the sacrolumbar fascia, and then connecting to the fibres of Gluteus Maximus on the opposite side, then along the ITB and Vastus Lateralis, ending at the sub patella tendon. A common scenario of fascial imbalance is when the Anterior Functional Line becomes short and tight and therefore medially rotates the shoulder drawing it forward. This shortening results in the Posterior Functional Line activating and lengthening. This is an intelligent response between the fascial slings as they adapt to change and try to maintain centre of gravity. However if these slings stay imbalanced for long periods of time it can have a negative affect on other structures within the body and cause pain e.g. to the spine and shoulder joint, as well as associated muscles. Fascial imbalances affect overall strength, flexibility and stability.   How Massage can help: Remedial massage therapist can help with these fascial imbalances by using Myofascial release techniques (MFR) to lengthen and open the tight/stuck fascial sling, in turn allowing the opposing sling to return back to its healthy functional length. As well as muscular and structural imbalances, it is important for Remedial therapists to look into fascial imbalances when treating pain and postural dysfunctions. At times muscles won’t release properly or structural corrections won’t hold if the associated fascia has not been treated. When MFR is performed on tight fascia, clients notice great freedom and openness; it is a very effective technique.   Talk to your Remedial massage therapist today, and see if fascial work could benefit you!     Rosie Rayner Dip. RMT Ad. Dip. STT

Patellofemoral pain

06.11.17

Experiencing knee pain while walking, running, squatting, kneeling, going up or down stairs or slopes?

You may have a condition known as Patellofemoral pain syndrome.

Patellofemoral pain syndrome is one of the most common knee complaints of both the young active sportsperson and the elderly. Patellofemoral pain syndrome is the medical term for pain felt behind your kneecap, where your patella (kneecap) articulates with your thigh bone (femur). This joint is known as your patellofemoral joint Patellofemoral pain syndrome, is mainly due to excessive patellofemoral joint pressure from poor kneecap alignment, which in time, affects the joint surface behind the kneecap (retropatellar joint). Physiotherapy inventions help strengthen one’s quadriceps and hips, which subsequently aids in restoring the biomechanics of the patellofemoral joint. Physiotherapists are able to advise and design customised exercise programs to improve the strength of your knee and leg muscles and help you maintain good general fitness. If you are experiencing patellofemoral pain, or any pain in your knee and joints, it is important to have your condition assessed by a physiotherapist. Patellofemoral pain typically develops because of 1 of 3 different reasons 1. Excessive pronation of the foot (flattening of the arch). It doesn't matter if you have high arches or flat feet, it depends on how much your arch flattens from non-weight baring to weight baring. This can be addressed in the short term with the use of orthotics but a strengthening program of the muscles that support your arch is recommended. 2. Weak quadriceps (weak thigh muscles). The quads are the largest muscle group in the body that we use to extend our knee. Important for walking, running, squatting, and climbing stairs. We can test your maximum isometric contraction and compare it to your unaffected side to see if this is a contributing factor and address any deficit with an appropriate strengthening program. 3. Weak hip abductors (gluteal muscles). Gluteus medius and minimus help to keep our pelvis level while walking and running. If your opposite hip dips then the knee you are standing on will drift inwards causing poor alignment of the patellofemoral joint. This deficit can be picked up with good observation skills and strength testing.