Full Transcript Introduction to Golfer's Knee Pain 0:00 You're on the fourth tee. 0:01 It's a beautiful morning. 0:04 The birds are chirping away. 0:07 You address the ball, you swing, and you rotate through. 0:10 And then right there, right underneath your kneecap, that grinding, aching pressure comes back. 0:21 Dull, nagging throb that tells you that something is wrong, and now it's getting harder to pretend that it isn't. 0:27 If you're a competitive golfer in your 40s, 50s or 60s and that feeling is all too familiar, stay with me right here. 0:34 Because in the next 15 minutes or so, I'm going to tell you exactly why your kneecap hurts, what's actually driving it, And most importantly, 0:42 What you can do about it. 0:44 And that all starts today. 0:45 My name is Dr. 0:46 Gaian Pouvento. 0:47 Over the last 15 years, I have helped thousands of golfers eliminate their knee pain without having to resort to invasive surgery. 0:55 I personally specialize in sports medicine and regenerative medicine treatments, and most of my patients, they've come to me because they already tried 1:03 everything else and they got nowhere. 1:05 And I also golf myself. 1:06 Im the guy that you probably know who hits one or two absolutely pure drives. 1:11 And then I spend the rest of the round playing what my playing partners call army golf. 1:16 Does that sound familiar? 1:18 You know, right out of bounds, left out bounds and left again, then right again and march back and forth. 1:25 So when I say that I understand the frustration of something getting in the way of your golf game, trust me, I mean that on multiple levels.
Patient Story and Patellofemoral Syndrome 1:35 Now some quick and important housekeeping. 1:37 Everything that i'm presenting today in this video is general medical education. 1:41 It is not meant to be personal medical advice and it does not replace a proper evaluation by your physician. 1:47 What this will be, though, is real, evidence-informed explanations of the most common problems with knee pain and golfers, 1:55 and what most dockers simply don't have the time, or don' take the, time to give you. 2:00 Are you ready? 2:01 Let's get into it. 2:03 Let me start with a patient story. 2:05 So this is a friend of mine. 2:06 His name is David. 2:07 He is 54 years old. 2:09 he is 12 handicapped. 2:11 A very successful attorney. 2:14 The kind of man who has spent his entire professional life being excellent at things. 2:19 Not just good, excellent. 2:21 And he doesn't handle, I don't know as an answer, particularly well. 2:25 He came to me after seeing two other physicians. 2:29 One told him, this sounds like arthritis and here's a pamphlet on it and go read up about it. 2:34 And then the second one, because he was really itching to get something done about, it gave him a cortisone shot. 2:39 Then they sent him home. 2:40 Neither one of them asked him single question about his golf swing. 2:44 That was his main complaint. 2:46 It hurts when I golf. 2:47 Now David's pain was right underneath his kneecap. 2:50 It was worse when he walked downstairs. 2:52 it was worst after sitting in the cart for a while.It was getting progressively worse by the back nine. 2:58 By hole 15 and 16 he was protecting that knee without even realizing it. 3:03 His trail leg stopped driving through, his follow through ended up shortening and somewhere on the back nine he started losing about 15 yards off the tee 3:11 every single round and he had no idea why. 3:12 Now what David had is something called patellofemoral syndrome. 3:16 That is a clinical term for this. 3:19 Your kneecap isn't tracking correctly and every time you bend or straighten your knee it is grinding against the wrong part of the joint. 3:27 Here's what's actually happening, and this is the part that most people get completely wrong. 3:31 Your kneecap, or your patella, sits in a groove at the bottom of your thigh bone. 3:36 Can you see this here? 3:38 It's like a train on a track. 3:40 When everything is balanced and working properly, that train glides smoothly up and down every single time. 3:46 But when your muscles around your knee and your hips start to become weak or unbalanced or tight, that kneecap starts getting pulled off its track. 3:55 So instead of gliding, it grinds.
Why the Kneecap Grinds During the Golf Swing 3:59 And this happens round after round, after around. 4:02 Think of it like the grooves on your wedge, right? 4:07 So when they're clean and sharp, the ball does exactly what you intended to do. 4:11 But when there are worn out or they are misaligned, you start to lose control on the shots that matter. 4:16 Your kneecap is no different. 4:18 And the golf swing, unfortunately, is one of the most punishing tests of patellofemoral mechanics that exists in sports. 4:25 Now here's why, the golf swing, remember, is a full body rotational movement that puts enormous repeated load on both knees. 4:34 Your trail knee flexes and loads at the top of the backswing, your lead knee, this is the one that takes the real punishment. 4:40 It absorbs the full rotational force of your body as you drive through impact. 4:45 So if your hip muscles are weak or your quad muscles or imbalanced or if you're IT band is tight, that knee cap gets dragged sideways on every single swing. 4:55 80 swings a round. 4:57 However many rounds a month that you get to play, this isn't bad luck. 5:00 It's a mechanical problem that compounds every single time you play. 5:05 Now, before we get too far, here's few red flags that mean that need to see a doctor now, not later. 5:10 If you have swelling that doesn't resolve or pain that wakes you up at night or a knee that locks or catches or gives way, 5:17 or if you pain is steadily getting worse despite appropriate rest, those are not patellofemoral pain. 5:23 That is not kneecap pain, Those need a proper workup and probably immediately. 5:28 So now that I have your attention, here's the good news. 5:31 Kneecap pain in golfers responds extremely well to a targeted specific intervention. 5:37 Lucky for all of us, this is not a, you need to stop playing golf situation. 5:41 This is a you-need-to-fix-the-mechanical-problem situation, and I'm gonna give you a game plan that's for real, not just a pamphlet. 5:49 So fix number one is strengthen this muscle called the VMO. 5:53 The V-M-O stands for Vastus Medialis Obliques. 5:56 It is a teardrop muscle on the inside of your thigh that lies just above your kneecap. 6:01 This is the single most important muscle in whether your knecap tracks correctly. 6:06 In the vast majority of golfers I see with this problem, the VMO is weak. 6:10 And it's not because they're out of shape. 6:12 Many of my patients are very fit athletic professionals who like to work out and be active. 6:17 But the problem is your VM is chronically under loaded in everyday movement.
Warning Signs That Need Medical Evaluation 6:22 When it is week, your outer quad muscles, ones on the outside, they win the tug of war of your kneecap. 6:28 That knee cap, again, gets pulled sideways. 6:31 That's the grinding that you feel. 6:33 There's a fix for this though, which is great. 6:34 It's terminal knee extensions with a resistance band. 6:38 So what you're going to do is you are going anchor a resistant band at knee height. 6:42 there's link in the description below of the band that I recommend using and the one that i use. 6:46 What you do, is loop it behind your slightly bent knee and then you straighten your leg against the resistance. 6:53 As you're squeezing, squeeze that inner quad muscle as hard as you can at the end of the range.
VMO Strengthening Exercise 6:59 That is your VMO firing. 7:01 Do three sets of this for 15 reps, but do this daily. 7:04 It is very simple, it is VERY unsexy, BUT it's absolutely effective. 7:10 Fix number two is train your hips. 7:12 This is the fix that most golfers never hear about because we're always too focused on just the knee, but it might be just as important as the VMO. 7:21 Weak hip abductors and external rotators, those are the muscles that bring your hip away or your leg away from your body or rotate outwards from the middle 7:29 of your buddy. 7:30 Those end up causing your knee to collapse inwards during your swing. 7:34 When your knees collapse inward, your knecap gets dragged off track on every single rotation. 7:40 so your hip weakness ends up showing up as your knee pain. 7:43 There are two exercises that we can do to address this. 7:46 Number one is clam shells. 7:47 You put that resistance band around your knees, lying together on your side with your feet together. 7:53 Open that top knee against the resistance like you're trying to open a clam shell or like, you see a clams opening. 7:58 Do three sets of 15 of this and you should start to feel it deep in your hips. 8:02 We should not feel in the knee. 8:04 Exactly, in you hip, not your Exercise number two is lateral band walks. 8:09 Now you put your exercise band right above your knees or around your ankles, you get into a slight squat or athletic position, 8:15 and then you're going to sidestep from side to side. 8:18 Do two sets of 20 steps in each direction.
Hip Strength and Band Exercises 8:21 This is the same band that I'm talking about using for all of these other exercises. 8:24 There's a link in the description. 8:26 If you do six weeks of these three exercises consistently, you will feel a difference. 8:31 Not because I'm making guarantees, but it's because we're actually addressing the mechanism and one of the root causes of this kneecap dysfunction. 8:40 Fix number three is your warmup is probably costing you. 8:43 Be honest. 8:44 How many of you walk straight from the parking lot to the first seat? 8:47 Maybe stop at the range and hit eight drivers to try to find something for today? 8:51 No warm-up, no mobility work, just straight to full rotational loading. 8:56 Bad news, cold muscles don't stabilize joints. 9:00 A cold, unfired BMO means that your kneecap starts the round already losing. 9:06 Please, five minutes before you tee off. 9:08 That's the investment I'm asking for. 9:10 Five minutes, do some standing quad stretches. 9:13 Do some hip circles. 9:14 do 10 slow body weight squats, and then do ten terminal knee extensions with that exercise band. 9:19 I am hoping you're carrying it around with you. 9:21 You don't need to look like you are doing a full gym session. 9:24 you just need wake up the right muscles right before asking them to work at full intensity. 9:28 Now this single habit has changed the back nine experience for more of my patients than almost any other intervention that I can recommend. 9:36 Number four is fix your swing mechanics. 9:39 Here is something that doesn't come up enough. 9:42 Swing mechanics and knee campaign are directly connected. 9:45 There are three patterns that we see consistently. 9:48 Early knee extension, limited hip turn, and excessive knee valgus at impact. 9:52 Now that last one, what that means is that your knee is caving in as you drive through the ball. 9:57 So if you're compensating for restricted hip mobility by asking your need to absorb rotation that it was never designed to handle, 10:04 no amount of exercise will fully solve this problem. 10:06 You are recreating the mechanism 80 times per round.
Warm-Up Routine Before Tee Off 10:11 What do you do? 10:11 Get a swing analysis with a coach who understands the physical side of the game, not just the technical side. 10:17 If there's a movement restriction that is driving that pattern, that's something that needs to be identified and addressed. 10:23 The swing is the source, the knee is just where the bill arrives. 10:27 Now let's talk about the bigger picture, because everything I just shared is real, it works, and it's always, always the foundation. 10:35 But some of you that are watching this have been doing the right things for months or maybe even for years. 10:39 You've done the physical therapy, you've had the injection, and then the pain came back. 10:43 So I want to speak to you directly because that experience doesn't mean that you're out of options. 10:49 It usually just means that no one has addressed the underlying biology. 10:53 Here's how I think about the treatment spectrum. 10:56 Level one is mechanics. 10:58 It is strength, it's mobility, everything that I just covered. 11:01 That is always the foundation, that is the root of everything. 11:05 No treatment in the world holds long-term if that movement pattern that created the problem is still there.
Swing Mechanics and Knee Valgus 11:11 Level two is targeted conservative care. 11:14 This is specific, diagnosis-driven physical therapy. 11:19 this includes manual therapy and maybe even strategic bracing when appropriate. 11:23 This is not just some generic, do some squats. 11:25 This focus structured rehab based on your actual deficit. 11:30 Now I can hear some of you out there saying that I've done therapy and it didn't do anything. 11:34 But if you've only had the generic version, you haven't really had real level two yet. 11:39 There are therapists out that are really keyed in and honed into what your problem is. 11:43 And those are the people that you need to be working with. 11:46 Level 3 is where it gets a little bit more sophisticated. 11:49 If there is underlying cartilage stress, if there's chronic inflammation that isn't resolving, or there are early degenerative changes in the joint, 11:55 there're biological tools that work with your body's own healing capacity, and these help address that at the source. 12:03 In the future, I will dedicate full videos to these individually because I think each one deserves a real explanation. 12:08 So the short version is this though. 12:10 These are autologous treatments, meaning that we use material from your own body to reduce the inflammatory environment, 12:17 help support tissue repair, and also restore the biological conditions that allow healing to happen. 12:23 And here's the important part.
Treatment Options Beyond Basic Rehab 12:24 This is not just to mask pain. 12:25 this is to actually address what's driving it. 12:28 Who is the right candidate? 12:30 Someone who has genuinely committed to the conservative approach, they are not responding the way they should, and they want to stay active, 12:37 not just manage their symptoms. 12:39 Someone, who understands that their joint health is an investment, is investment in the next 20 years of competitive golf, 12:46 in ski trips, hiking trails, keeping up with people half their age, it's for people who are serious and not wanting to have a conversation about knee replacement 12:55 when they're 68. Who isn't the right candidate? 12:58 Well, it's someone with severe end stage joint destruction who genuinely needs a structural solution. 13:03 Now, I'll always be honest about that because the right answer for you matters more to me than any procedure. 13:09 So here's what I want you to understand. 13:11 There is an enormous amount of space between take ibuprofen and rest and read this pamphlet and it is time to schedule a knee replacement. 13:18 Most people live in that space. 13:21 We like to call that the orthopedic treatment gap. 13:23 And that space is full of options that most physicians don't have the time, the training, or the inclination to explain properly. 13:31 And THAT is exactly why this channel exists. 13:34 Alright, that was a lot. 13:36 So let's bring it home. 13:37 Your kneecap pain is not a mystery. 13:40 It is a tracking problem. 13:41 It's caused by specific addressable muscle imbalances and movement patterns that the golf swing exposes and accelerates over the years. 13:49 The good news, though, is that you have more control of this than you've been told. 13:53 And here's what I want you to walk away with today. 13:55 Number one, the VMO is the key. 13:58 Terminal knee extensions with a resistance band daily. 14:01 Link in the description below. 14:03 Number two, your hips are controlling your knee. 14:06 Clamshells, lateral band walks, three to four times a week. 14:09 The same band. 14:10 Three, warm up before your round. 14:13 Five minutes, non-negotiable. 14:16 And number four, if your swing mechanics are creating the problem, no exercise program will fully fix it.
Key Takeaways and Next Steps 14:22 So please go get a movement screen. 14:24 Number five, If you've done the work and you're still not improving, there is a biological reason. 14:31 and the biological solution for that exists. 14:33 Do not settle for just managing. 14:36 You don't have to. 14:37 If this video gave you one clear thing to try this week, please subscribe. 14:42 Subscribe to my channel, that's it. 14:43 That's all I'm really asking for. 14:45 What I am trying to do is I try to build this channel to be the most genuinely useful place on the internet for golfers who want to understand their bodies, 14:52 protect their game, and continue to compete at a high level for as long as possible. 14:57 Every week, I will give you real information. 15:00 No fluff, no generic advice, just ice it and rest it. 15:04 The next step is yours. 15:06 Either start those exercises today. 15:08 Seriously, today, not after your next round, or reach out to me if you want to talk about what makes sense for your specific situation. 15:14 I'm Dr. 15:15 Gayan Puvendran, and I hope to see you pain-free on the fairway.
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