Knee Pain Part III: Reproductive Organs
The last part in this series will discuss our male and female sex organs. In men we are referring to the prostate and testicles while in women we are referring to the uterus and ovaries. The muscles related to these organs are the same for both sexes and include the gluteus muscles (maximus, medius, minimus), piriformis, pectineus, and adductors. While these muscles do not have direct attachments to the knee, if these muscles are not able to fire properly the knees may begin to feel weak or painful. Pain typically refers to the outside of the knee where the IT band attaches as the glutes are part of two muscle groups that form the IT band. Pain can also refer below the knee cap (patella) at the patellar tendon, which is actually a ligament.
The glutes are extremely important muscles and are major stabilizers of our hips and pelvis. The glute med and glute min connect the pelvis to our femur (leg) while the glute max does this but also has attachments to our sacrum (below pelvis) and coccyx (tail bone). Their function determines the positioning and movement of the hip joint and femur which connects to our tibia (shin) to form the knee joint. If the glutes are weak, the femurs will rotate and alter the alignment of the knee further down the chain. The glutes also disperse the forces of gravity as we move and bend, so without the glutes these forces will move through our body to the next available joint, the knees. The muscles and ligaments in the knee are small compared to the hip and cannot deal with these forces nearly as efficiently. The pectineus, piriformis, and adductors have similar roles by aiding in the stabilization of the pelvis and femur. When one of the reproductive organs show up as a primary issue, all of these muscles will weaken. This will lead to an unstable knee and an injury waiting to happen.
If these forces become too much, like if we twist an ankle or one of our cleat studs gets caught in the turf, a serious injury can occur. This is why many ACL tears occur without contact. The muscles supporting the knees have usually been weak for a period of time and one bad move can cause a ligament to take on too much force and snap. Although famous for tearing, ligaments are actually extremely strong bands of connective tissue that must be under heavy strain to fail. Without the support of our glutes, too much force will be directed into the knees which are not equipped to handle such a load. The ability for our body to take on and deal with forces is called reflexive strength. So when we step awkwardly or trip, our stabilizing muscles engage and we can catch ourselves to prevent injury. When the glutes are not physically able to fire properly, our reflexive strength diminishes and we have to rely on our reactive strength, and this might not always be enough.
Men will often have knee issues as they age if they struggle with prostate conditions such as BPH or prostatitis. Common symptoms of an enlarged prostate include ED, premature ejaculation, reduced urine flow, and frequent urination. Low testosterone will also affect men as they age due to issues that arise with their testes. The two most common offenders of the prostate and testes are estrogen and insulin. These two often work together – eating too many carbohydrates or sugars results in excessive insulin leading to an increase in the conversion of testosterone to estrogen through the aromatase enzyme. This leads to higher fat and estrogen production resulting in plummeting testosterone levels. Estrogen either needs to be detoxed more efficiently in the liver with herbs such as artichoke and rosemary, the amino acid L-cysteine, or cofactors like magnesium, B6 (P-5-P), 5-MTHF (folate), and choline. Or, testosterone production needs to be supported through the use of zinc, vitamin E, selenium, and other nutrition. Either way, cleaning up the diet is necessary to keep insulin levels in check and prevent the cycle of influence insulin and estrogen have over each other. Prostate and orchic tissue can also work as well as proper fats and calcium.
Women are at risk of knee injury, especially in sport, due to hormonal influences. Estrogen plays a large role in ligament health as it directly affects the material that makes up this connective tissue. Estrogen dominance is quite common due to the inability to properly detoxify estrogen in the liver. Birth control and Hormone Replacement Therapy (HRT) also contribute to its overproduction. Most PMS symptoms are due to estrogen dominance as estrogen and progesterone have a very important balancing act in the body. When the ratio of estrogen to progesterone becomes unbalanced, common symptoms include PMS, night sweats, and decreased sex drive amongst others. If you are estrogen dominant, play sports, and are on the pill to “manage” your cycle, then this can be a recipe for ligament damage.
if you are not an athlete on the pill and you’ve been estrogen dominant for a long period of time, you could still be at risk for a knee injury if the forces to your knee are great enough. Even after menopause when estrogen levels are known to drop significantly, if it does not drop at the same rate as progesterone, estrogen dominance can result. This is why HRT can cause more problems than it solves. Estrogen levels are supposed drop and be maintained by the adrenals after menopause, so with estrogen levels already being high relative to where they should be, synthetic estrogen throws off the ratio even further. The idea that only estrogen levels need to be maintained to prevent menopausal symptoms and osteoporosis is incorrect as the estrogen:progesterone ratio is much more important.
Birth control pills result in high levels of estrogen, even if the hormone is progesterone, as it will convert to excess estrogen further down the biochemical pathway. IUDs are the worst offenders, not just because of the hormones they release, but because of their physical location in the uterus. Even if the IUD is copper and nonhormonal, having a physical device located in the uterus causes the body distress and creates weaknesses in the muscles related to the uterus – the glutes, pectineus, piriformis, and adductors. Treatment for patients with IUDs are essentially worthless until the device is removed as any successful attempts to treat the uterus and muscles involved will just reappear at the next visit. As mentioned earlier in the article, weak glutes will result in diminished knee stability with the probability of a knee injury increasing dramatically. I recommend all patients to remove these devices.
Just like in men, insulin and estrogen are the main offenders to the uterus and ovaries but stress resulting in high levels of cortisol, epinephrine, and norepinephrine is also common. PCOS and fibroids can also result from sex hormone imbalances typically from excess estrogen or excess testosterone due to high insulin levels. Cleaning up the diet and supporting insulin biochemical pathways with minerals such as chromium and magnesium can help as well as supporting our liver to detoxify estrogen. Common nutrition for estrogen detoxification includes artichoke, rosemary, cysteine, vitamin B-12 (methylcobalamin), manganese, and others.