Frequent knee pain affects approximately one in four adults. Are you one of them?

Knee pain is often caused by a combination of factors, but the presence of joint pain does not always mean there is an actual injury to the joint. Short, tight muscles and connective tissues (the soft tissues) around the joint commonly occur in conjunction with knee pain, and can be either a direct cause of the pain, or a by-product of it.

Changes in the soft tissue can lead to joint pain by producing small changes in the way the bones and other joint structures work together. Short, tight muscles, fascia, tendons, and ligaments can all create minute shifts in the positions of the joint, and even a tiny shift can lead to increased pressure, inflammation, pain, and long term degeneration.

Soft tissue length and tension while at rest – when you aren’t actively using your body – are influenced by the type and volume of your normal daily activities, your postural positioning, and recent or past injuries to the joints or soft tissues, among other elements. Too much use, too little use, or the wrong kind of use creates excessive tension and shortened soft tissues, which can lead to stiffening and even microscopic scarring of the tissues as the body works to heal and protect itself. This can ultimately increase wear and tear in the joint, which itself can be as painful as a sudden injury. The same increased tension and decreased length can also occur as a by-product of a sudden injury, as the body decreases movement ability at an injured area in an effort to prevent further injury.

In most cases, decreasing tension and increasing the length of the soft tissue around the knee joint will lead to an improvement in knee pain and movement ability regardless of underlying cause. The most effective way to do this is by loosening the tissue (decreasing the tension through massage or self-massage work) and then lengthening it via stretching.

Remedial Massage (also called sports massage or deep tissue massage)

Remedial massage decreases soft tissue tension by physically moving, mobilizing, and stretching them with appropriate pressure. This can help break up scarring caused by overuse or injury, and stimulates a localized healing response. While this process can feel intense at times, appropriate treatment should not be exceedingly painful (too much pressure can actually have a negative effect). Think about no more than a 6 out of 10 on a 1-10 pain scale, or a pressure that feels tolerable uncomfortable. If your therapist is using more pressure than this, it’s absolutely ok to ask them to back it off!

This is the best option for decreasing muscle tension, simply because these sessions will maximize time spent on improving your muscles and other soft tissues. (Physiotherapy or physical therapy also may provide an element of this, but the sessions are shorter and less time is spent on soft tissues. A massage session will also last longer than you’re likely to spend on self-massage – see below).

Always look for a qualified and experienced massage therapist, and help them give you an effective treatment by letting them know the details of your aches and pains. In Brisbane, your best bet for a top quality remedial massage treatment is at No More Knots (in Greenslopes, Taringa, and Newmarket) or at Just Knead It (in Wolloongabba and Spring Hill).

Self-Massage: Foam rolling and trigger point work

You can achieve some of the benefits of remedial massage on your own, using self-massage tools like a foam roller or a trigger point ball (which can actually be any sort of ball that you are comfortable with and have available). The areas that will give you the most knee pain relief can be targeted as follows. Bookmark this page or download the PDF below so you can take this list to the gym or anywhere else you do your self-massage work.

Self Massage: Foam Rolling for the Quads

When tight or short, this muscle group at the front of the thigh can pull the knee cap up, so that it sits slightly above its optimal position. This can lead to pain at the front of the knee, above or behind the knee cap.

• Lay face down with the foam roller pinned between the front of your thighs and the floor. Your upper body should be propped up on your elbows.
• Pushing and pulling with your arms, roll the front of your thighs along the roller.
• Roll as high as the bend at the front of the hips, and as low as just above the knee joint. Pro tip: knees don’t bend backward, so stay off the joint itself!
• You have the option to continue to roll up and down, or stop and hold on the areas that are more painful. Either approach is effective.
• If you need to decrease the pressure, try pushing yourself up through your toes and elbows slightly.

Self Massage: Foam Rolling for the Vastus Lateralis

This muscle at the outside front of the thigh is part of the quad group, but is singled out for its greater impact on outer knee pain – both cause and management. Vasus lateralis tension is often confused for tension of the IT band, as it can create an outward pull through the knee joint.

• Lay face down with the foam roller pinned between the front of your thighs and the floor. Your upper body should be propped up on your elbows.
• Roll to one side so that you are resting on the front, outside of the thigh, at about a 45 degree angle. Don’t roll all the way to the side.
• Pushing and pulling with your arms, roll along the roller.
• Roll as high as the bend at the front of the hips, and as low as just above the knee joint.
• You have the option to continue to roll up and down, or stop and hold on the areas that are more painful. Either approach is effective.
• If you need to decrease the pressure, try pushing yourself up through your elbow and the foot of your other leg.

Self Massage: Foam Rolling for the Adductors

The adductors are the large group of muscles covering the inner thigh, and are often overlooked in favor of the quads and hamstrings. Tension through this group can create an inward pull through the knee joint, leading to pain on the inner side of the knee.

• Lay on your side with the foam roller parallel to the body.
• Place the knee and foot on the far side of the roller, with the knee at least as high as the hip. You will turn slightly towards the ground in doing this.
• Leave the body resting on the ground, and shift your weight back and forth to roll a small area of the adductor group. Then move the roller higher or lower on the thigh and repeat.
• For increased pressure, lift your body by pressing up through your elbow and the foot of the straight leg. Either approach is fine.
• Roll as high as the bend of the hips, and as low as just above the knee joint.

If you have knee pain, book yourself a massage and give these foam roller exercises a shot – you can download a PDF of the foam roller exercises below. For best results, follow up this soft tissue work with the stretches from Part Two of this series, out next week!