There are many types of knee injuries that occur, particularly when one is actively engaged in sporting activities. Typically, these fall into two catagories: acute, and chronic. Acute injuries, such as a ligament tear or a fracture, need immediate medical care, and often surgery. The purposes of this article are to address the second, much more common, type—chronic knee pain. Obviously, there are many factors with any health issue and injury, and it is always wise to seek medical care for concerns. Here, I will lay out the analysis and treatment plan of an extremely common syndrome.
Explanation:
Although chronic knee pain may have had a less dramatic onset, it can be no less painful. It can cause swelling, a loss of range of motion, and severe pain. Often, this starts from a simple muscle imbalance. In simplified terms, muscles cross joints. This is how we move—the muscle contracts, the joint moves.
Diagram of muscles crossing the knee joint
When muscles don’t pull evenly on a joint, dysfunction and pain result. In the case of a knee, the quadriceps (thigh) muscles are the major players here. The “quads” are a group of four muscles (hence the name) whose function is to extend the knee. These four powerful muscles run down the thigh, form the patellar tendon at the lower end, and run through the knee joint.
Diagram of the Quads
Diagram of Vastus Lateralis
Frequently, the outer quad—named “vastus lateralis” becomes tighter and pulls harder than the other three quad muscles. The result—a torque is placed on the patella (knee cap), it stops tracking properly, and starts hurting. Without intervention, this syndrome typically does not correct itself, but usually becomes worse with activity. It is however, very responsive to specific stretches, foam rolling, and to sports massage. These will be detailed later.
There is a secondary aspect to this pain syndrome, again related to musculature. If a muscle is overly tight, it reduces the space between the bones in a joint. This increases friction and causes “wear and tear”. As mentioned previously, muscles cross joints. Overly tight muscles, in addition to causing potentially painful imbalances, also reduce the space between the bones in a joint. This increases friction and causes “wear and tear”.
Joint Space – Healthy Knee vs. Tight Knee
Maintaining joint space is the best defense against “wear and tear” injuries and arthritis. The following techniques, in addition to restoring lateral balance to a knee joint, will help to restore joint space as well. Although these are knee-specific techniques, the basic concepts of stretching, foam-rolling, and sports massage can be applied to all joints.
Treatment:
Vastus Lateralis Stretch:
1) This stretch starts as a basic quad stretch, lying on your side (affected side up). The top foot is grasped by your top hand and pulled in toward your hip until a stretch is felt down the quad area.
Basic Quad Stretch
2) Then, while holding the quad stretch, the lower heel is brought up and hooked over the top knee.
Hook Lower Heel over Top Knee
3) Finally, maintaining 1 and 2, use your heel to pull your bent knee toward the floor. This will place a direct stretch on your outer quad (vastus lateralis)
Pull Knee toward Floor with Heel
Foam Roller Technique:
Foam rollers have recently become a popular therapeutic tool. They are extremely effective, particularly for treating knee, hip, and leg issues. They are available for purchase at many running and sporting goods stores, or for use at most health clubs.
Foam rollers are used by balancing body weight on the roller, and slowly rolling along the roller surface. As problem areas are reached, you can slow your pace, or even pause. This can be quite uncomfortable—verging on downright painful!—but will improve as your tissue heals. What is happening? Basically, the pressure of the roller creates a deep stretch within your muscle, lengthening very specifically exactly where you need it. The more you roll, the better your leg/knee will feel.
There are two different techniques that I recommend for knee pain. (See Below)
A) Roll down the side of your leg from your hip to the top of your knee and back. This area is called your “IT Band” (Iliotibial Band). This is made easier by bringing your top leg in front (as shown) or harder by stacking it on top of your bottom leg for more weight.
B) Roll your quads from your hips to your knees and back, paying particular attention to the outer quad on each leg.
Sports Massage:
Stretching the musculature crossing the joint will maintain muscle length and suppleness, thereby maintaining joint space. Sports massage, in essence, is a micro-stretching of the muscle, targeting specific muscle fibers in a way that stretching alone cannot. Massage relaxes and lengthens tight muscles, reducing their pull across a joint. This reduces the pressure and increases joint space, increasing flexibility and range.
Each joint has many muscles crossing it and affecting it. A sports therapist with a thorough knowledge of anatomy will be able to test and assess which muscles are restricting range of motion and work to lengthen them and increase your joint flexibility.
In addition to the manual techniques used to relax the muscle, most sports massage sessions will incorporate different kinds of stretching to change the neuromuscular settings in the muscle itself. Each muscle in the body contains receptors which communicate with the brain to prevent both over-stretching and over-contraction. By stimulating or relaxing these receptors, the message between the brain and the muscle can be altered, thereby changing the muscle length.
Treating a tight and restricted joint with sports massage is key to preventing injury and extended recuperation periods while engaging in vigorous athletic training.
For any of your sports massage questions or needs, please call Restore Therapeutic Massage at 952.484.4488. We specialize in Deep Tissue, Sports Massage and Injury Rehabilitation. Our highly skilled and experienced therapists are able to help you stay on the road to athletic achievement.
We have special student discount rates.
Convenient online scheduling and information available at www.restoremassagetherapy.com
In health,
Amanda Mazzocchi, NCTMB
Owner, Restore Therapeutic Massage
