In this video, I'm going to show you this rare diagnosis.
That is easily the biggest reason for inner knee pain.
This video is a follow up video where I mentioned this rare diagnosis is called a tibial shift.
But I'm going to give you more details about it today.
And that's all this video is going to be about.
I'm also going to tell you how to identify it on yourself, and how to begin to treat
it so that you can get relief.
Now, as I already said, this is a tibial shift.
And just to show you on the skeleton, what this means exactly.
I'm going to orient you here on the knee, here's the thigh bone, here's the kneecap,
the shin bone right here, the bigger bone of the two that are down in the bottom, that
shin bone is called the tibia.
That tibia is what makes up the bottom part of the knee joints.
And when you bend and straighten your knee, that's the part that moves.
Everybody thinks of motion in this knee joint as just being bending and extending the knee
because that's the main motion that you see.
But if you think about it, you have a little bit of wiggle room to rotate.
And you can even slightly bend your knees sideways.
There's also a side shift that can happen this way.
In this way, if you look at that, the idea of a tibial shift is that the tibia of this
shin bone has shifted to the side, one side or the other, the most common way that it
happens is inward, we call it a medial tibial shift.
And this is the source of a lot of inner knee pain.
Now there's many different diagnosis that diagnoses that you might have, if you visit
the doctor, they'll never tell you, you have a tibial shift unless they've seen this video
or have learned about it.
In some rare circumstance, they'll typically tell you that you have a meniscus problem.
arthritis in your knee may be a cartilage injury, there's even nerves that come into
the area that can be aggravated, and sometimes those are identified.
But if you think about it, if that knee bone has shifted that the tibia has shifted this
way, it's going to tension your meniscus, it's going to add tension to the nerve and
irritated.
It's also going to ruin the mechanics in the knee.
Oftentimes, when people have this tibial shift, they can still bend and straighten their knee
just fine, it just doesn't feel the same, it feels like the alignment is off because
it really is.
And there's usually a spot on the inside part of the knee that you can poke and feel and
it's tender.
Sometimes it really is a meniscus problem, that is the main issue.
But if that alignment is off, because of the shape of the of the fin, the thigh bones down
here, they're big kind of round surfaces that sit on a concave surface a convex on a concave
surface.
If the alignments off, it's going to compress the meniscus differently.
That's why some meniscus injuries just don't heal very well over time just giving it rest,
it still hurts, what needs to happen is that tibia needs to be shifted back into the correct
position.
Now a lateral shift or an outward shift can happen.
But the only thing I can tell you, there's no research behind this.
There's no scientific evidence, which doesn't mean that it's not a thing, it just means
we haven't discovered it very, very easily.
It's not something that is taught in mainstream schools and medical schools, physical therapy
schools.
This is a rare diagnosis.
But it commonly happens in people that have knee pain, especially inner knee pain.
So let's talk about how to find this on yourself.
I've got my friend here.
To help demonstrate.
I'm going to show you if I were to find this on you here in the clinic, what I would be
doing is feeling the sides of the knee and right here, let me show you the skeleton.
I'm feeling for the end of the thigh bones.
So on the skeleton here, I'm coming down and feeling the bone right here.
And then I want to feel the bumps on the inside of the knee and the outside of the knee.
As I slide off the thigh bone right in there.
That's where the first bump is.
I know that that bump is the joint line.
So now I can start feeling we call it palpating in the medical field, the inside part of the
joint line and if you have a shift, it's usually tender.
As you can see on the skeleton here, the knee is a big joint so the joint line isn't just
here, it's all the way around the knee.
So you can just find one spot you have to kind of poke around on the borders of the
knee joint line to see where it's most tender.
Some people feel it in one spot.
Some people feel it all around the knee joint line.
So once I get on there, I'm looking for symmetry side aside, but also I'm looking at the way
the bones are aligned.
So right now the way that I position the skeleton.
This is probably for alignment, the thigh bone should be more inward, and the shin bones
should be more outward.
They're all kind of vertical on each other.
But I'm talking minor differences.
That's why this is an expert diagnosis, because we have to be able to feel those minor differences.
If the shin bone is shifted literally, that much, you should feel a shelf, the bone sticking
out like a shelf popping up right there.
And that's typically where it's most tender.
If that's the case, then what we have to do here in the clinic is shove that bone outwards
to get the alignment back into position.
So that's how I would find it here.
Let me show you how to find it on yourself.
So if you can take your thumbs like this, slide them on the bone just like I was showing
you and find the bumps in there.
Some people are Bonier than others.
Some have a little more padding, if you just kind of go through the padding.
If you have padding, and find the bones and the bumps, then you can get an idea for are
they the same side to side, that's you're asking yourself, and then if one side sticks
out, poke it.
And if it's tender, you probably have this Medial Tibial shift.
And you have to put this together with your history.
Have you had a meniscus injury?
Have you did you have a recent knee injury, it could be trivial you I had a patient who
was watering the grass outside in his lawn, and just took a funny step in a little lower
ground in his yard.
And after that his knees started to hurt.
And it was a tibial shift that was bothering him.
He came in early enough before a meniscus problem began and arthritis began to bug him,
I was able to shift the back in position and he was just fine.
It was it was a magical treatment where we, we just did a couple things, and he was a
lot better.
But that's because he caught it early, very often, these tibial shifts are there for a
while.
And it takes more treatment to get it to improve.
But that's the root problem of the meniscus injury or the arthritis problem.
So did you find the joint lines there, if you come down right there, once you're on
the joint line, then what you're going to do to treat this on yourself, on your left
leg, this is her left leg right here, you're going to use your right hand, let me just
do it myself.
Right hand on the bottom part of the joint line, the webspace, your hand goes in the
bottom part of the joint line, then your left hand is going to be on your thigh kind of
above your knee and you're going to have to slide your leg out just a bit.
Yep, just like that leaned over.
And then you're going to press your hands this direction, of course on your knee, just
like that, and hold it for about 10 seconds.
And while you're holding it, if you can do little bounces while you're there, that's
even better.
And ideally, you want to relax your legs as much as possible, you're going to put some
pressure through your leg, obviously, because you have to lean forward to get in in the
right position.
But you're just trying to bounce right there.
Now, if you're on the tender spot, you need to move down a little bit, a lot of people
are commenting on our last video that they're pushing on the spot where it's tender, this
was kind of painful for them to do, it was logical to get relief to.
But the tweak that you make here is you just slide your hand down a little bit on the inside
of your knee.
And this one should be fine out here, you're just pushing an oscillating, you want to go
through a good minute of this, you could do two or three minutes worth, but you're going
to hold it for about 10 seconds, give it a little wiggles after about 10 seconds because
it's going to be tiring in your arms, you can take a break, and then go for it again,
whenever you're ready.
About 10 seconds oscillate just like that, give it little wiggles.
That's what oscillate means.
And then take a break and you do 3456 rounds of this.
If you think of you know, 10 seconds each time a little breaks in between, it's a couple
of minutes worth that should in and of itself begin to make it feel better.
If your knee problem is coming from a tibial shift this this rare diagnosis that I'm talking
about, you should begin to feel like this is helping you out, it might help out tremendously.
The first time you do this, you might need to be doing it for consistent days.
for weeks on end, I have patients coming in here for this type of problem, we'll see them
for two to three months, sometimes.
that's especially the case if they've had this problem for years, like for five to 10
years or more, which isn't a bad deal.
If you have to work on this for two or three months after having this problem for five
years or 10 years.
That's a pretty good deal.
And hopefully yours resolves a lot quicker and you haven't had it that long.
But you basically need to do this as long as you need to.
Now let me show you how to do this on the other side and there's an exercise you're
going to have to learn as well.
So on your other legs, put your foot out a little bit, then you're going to use your
left hand on the on the I'm sorry, turn your head over this way.
Yeah, like that.
Left hand on the inside of the knee webspace like this.
So pinky down thumb is going to be kind of behind your knee.
And then your right hand is going to be on the outer part of your thigh above them.
He makes sure you're comfortable and loosen your leg.
And then you're going to be pushing this direction, hold it in oscillate there, hold for 10 seconds,
and you're just giving it little wiggles.
You should feel like it's relieving your knee.
If you don't feel like it's relieving, you feel like it's making things worse, stop.
This probably isn't the problem that you have, of course, go see a doctor in person and see
what's going on, see if you can find exactly the root cause of your issue.
But if it is relieving your problem, proceed, you're going to do two minutes worth of this.
Let's do one more time here for our viewers.
So hit webspace.
Right below the joint line, you have to found the bumps in there and then get below, not
on it below it.
Then hand on the outside of your thigh, you're just pushing inwards.
Yep, just like that.
oscillate.
Perfect.
You got it.
And I love how you position this elbow on your other knee just for some support.
That way you can last the whole time because it's tiring, especially if you have a weak
upper body, who you get tired quick, you might even start to break a sweat.
Awesome.
Now we have a friend here barefoot for a reason, because you're going to do an exercise next,
to help facilitate the alignment, the proper alignment of the knee joint, what you're going
to do is put one foot out to the side that you have the problem on, let's pretend it's
your right foot here, turn your toes all the way in.
And then you're going to drag your foot inwards with your foot turned in, you're bending your
knee here as much as it can go comfortably.
Ideally, sit somewhere where your foot can kind of go under you just like we have set
up here.
If you just can't get to a place like that, that's okay, do your best.
Start over again, turn your foot in, extend your leg out comfortably and drag it in.
This is not a tiring exercise, it's not intended to be real aggressive, we're going to do 30
reps, by the way, they're 30 reps.
And you should be able to do them all without stopping.
If you feel like you need to stop, that's okay.
And the idea here, let me just explain the science behind this.
If you think of that bone that's shifted.
So in her right knee, it's this shin bone has shifted in words, we're trying to activate
the inner hamstrings, which helps to turn the foot inwards and pull that bone into the
right position.
I've seen this work so many times, it's pretty crazy.
I would do this hourly, if our you slip your shoe off, you can be in socks, if you feel
like you can do it in your shoe, that's fine, I just find that my shoe grips the ground
a little much.
If I take off my shoe and I'm in my sock it slides lot easier.
The point here isn't to get a lot of resistance.
That's why take off your shoe.
It's just to activate the muscle.
That's the inner hamstring muscle, not your groin, not the absolute inside of your thigh.
It's more the back of the thigh but the medial side of the inner part of the hamstring, you're
trying to get that muscle to just work.
You're not trying to really work it out hard, you're trying to just wake it up, activate
it and gently use it.
Now 30 reps is a guideline, if you feel like you're getting cramps or you're getting issues
because of this exercise, you can stop but next time you come around next hour or so,
shoot for 30 You're trying to basically work your way up to 30 I find that I get diminishing
returns with patients.
If they do this for more than 30 reps.
I've had some people say I did 100 I do 100 every hour or two.
They still benefit doesn't hurt them to do that unless they're having cramping or some
other problem.
But they still find that they get the results.
Less than 30 reps I've found to not get the same results.
So that's I'm just sharing with you my clinical experience my personal experience.
Again, there's a research behind this.
Do you feel the inner hamstring working?
Like, right?
It's not like she's not swayed.
And she's not showing her face of concern here.
Like When is this going to stop?
Oh my gosh.
Good job.
And obviously, if you were to have this on the other side, why don't we switch sides
here, you do the same thing on the other side, you're still turning your foot inwards and
sliding your leg in the same way.
And you see how hurt the inside of her foot is off the ground.
That's kind of what's trying to do and she's got a lot of flexibility.
So if you can't quite turn your foot that much, it's okay.
Just do what you can.
It's not about the foot position.
It's about firing the right muscle on the inside part of the back of your thigh.
If you have inner knee problems need to go down in the description below.
I've got a playlist full of inner knee pain videos.
And we've got a bunch of other playlists have a ton of videos on this channel for meniscus
problems, knee arthritis problems, cartilage injuries and much more.
So subscribe to our channel.
Check it out.
And in case you haven't met me before.
My name is Dr. David Middaugh.
I'm a specialist physical therapist.
Thanks so much and I'll catch you in the next video.
Bye