Posterior lumbar and pelvic skeletal and surface muscle anatomy with SI joint pain

SI Joint Pain – Help at Home

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Do you have one small, painful spot on your back? Right where the blue arrow is pointing?

ICK.

Pain in this area is one of the main indicators of sacroiliac joint (SI joint, or SIJ) pain. This pain can occur when the joint between your sacrum (your tailbone) and your ilium (the big curved bone of your pelvis) gets pulled out of alignment, usually because of tight muscles around the hip.

Wait, I have a joint there?

You do! The pelvis isn’t one solid block of bone. It’s actually made up of five bones that fit together like puzzle pieces to form a more-or-less solid girdle. I say more or less because there can be some slight give in the joints between the bones. The three bones of the hip (the ilium, the ischium, and the pubis) are fused, and your SI joint is the connection between your sacrum and your ilium.

This joint functions a little like a zipper, with strong layers of ligaments holding the two pieces together while still allowing some small amount of movement. But it’s built for stability, and too much movement or pull in any one direction and you’ll know about it, often with a pain at the back of the hip, towards the top of the SI joint.

Posterior pelvis skeletal anatomy with SI joint pain

The Snowball Effect: The SIJ version

When we have pain or trauma (like slipping and falling, or jarring a joint) to joints, muscles, or other tissues, the body quickly tightens muscles around the area to help protect it from further damage or irritation. Great! Except that the protective tension can also lead to additional irritation via the misalignment discussed above.. And the ball rolls on until you put a stop to it.

Ok, so what should I do if my SI joint hurts?

Joint misalignment is often due to tight muscles, fascia, and other soft tissues; Your SI joint has a lot of muscles and fascia surrounding it. (If you want to dive deep into the muscles, ligaments, and bone related to the SIJ, go here. So loosen them up!

Trigger point self-therapy in the glute region, the adductor region (inner thigh), the outside of the hip, and even through the lower back can provide relief from SIJ pain. All you need is a tennis ball! Here’s how: sit or lay on the tennis ball, or lean into it by pinning it against a wall in the areas shown below.

Trigger Point for Glute (Bum) Muscles

SIJ Line Glute Trigger Point for SI joint pain

Sit with the tennis ball pressing into the soft tissue to the side of the sacrum (tailbone). Roll it or move it up and down to find tight spots and hold it until the tension or soreness disappears. Use a moderate amount of pressure – it should feel like “good hurt”.

Trigger Point for Adductor (Inner Thigh) Muscles

Foam roller adductor trigger point for SI joint pain

Lay face down with one knee out to the side, hooked over the roller so the roller is pressing on the inner thigh, foot to the outside of the roller. Roll it or move it up and down to find tight spots and hold it until the tension or soreness disappears (it’s safe to apply pressure this way anywhere between just above the knee and the crease of the hip). Use a moderate amount of pressure – it should feel like “good hurt”.

Trigger Point for TFL and Glute Min (Outside Of Hip) Muscles

TFL and Glute min Trigger Point for SI joint pain

Lay on your side with a tennis ball in the fleshy part of the outside of your hip, or pin the ball against the wall in the same area. Hold pressure until the tension or soreness disappears, then move to find a new spot (move towards the front or back of the hip). Use a moderate amount of pressure – it should feel like “good hurt”.

Secondary causes can be tight muscles farther from the joint. Give them a stretch with one of the following stretches:

Kneeling Hip Flexor Stretch

Kneeling Hip Flexor Stretch

Kneel on one knee and take a BIG step forward with the other side. Squeeze the glute on the back leg, and drop the hips forward to stretch the front of the hip on the back leg. Not feeling the kneeling? Here are other ways to stretch your hip flexors.

Pretzel Glute Stretch

Pretzel Glute Stretch for SI joint pain

Lay on your back and cross one ankle over the opposite knee. Draw the knee back towards your chest, bringing the ankle with it, and hold in place by wrapping your hands around your shin or the back of your thigh (between your thigh and calf).

Knee Hook Stretch for TFL and Glute Min

Knee Hook TFL and Glute stretch for SIJ pain

Lay on your back with both knees bent, then drop both knees to one side. Hook the ankle of the bottom leg over the knee of the top leg to pull the knee slightly towards the floor.

Important Safety Reminder!

The trigger points and stretches above are great for SI joint pain, but that doesn’t mean they are right for every single person. If you feel pain with any of these, please stop immediately and seek treatment with a remedial massage therapist, an osteopath, or a physiotherapist (or physical therapist). They’ll be able to give you a better idea of what’s going on, and to treat you appropriately.

Three Top Tips for Injury Prevention

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So you want to prevent injuries? If you’re in one of the three following groups, injury prevention should be on your mind, because you’re at higher risk of muscle strains, joint sprains, and overuse or repetitive stress injuries. High(er) risk groups include:

  • Aging bodies (disappointingly, physically this means over the age of 35-ish)
  • People who train hard, often, or both, especially without appropriate physical recovery
  • Weekend warriors, or those who go longer periods of time between workouts or physical activity

Kickstart Things With Hands-On Massage Therapy

Daily life is hard on your body. The normal activities of daily life frequently create tension in muscles and connective tissues, either shortening them or overstretching them. Changed tension and length can create joint stress through misalignment and instability. In turn, this can increase injury risk for both joints and muscles.

What to do? Get some help! Remedial massage therapy, also called deep tissue massage or manual therapy, is the best way to kickstart your injury prevention efforts. While there are many things that you can do at home to mimic hands-on treatment, the fact is that you probably won’t make the at-home effort for the same length of time as a standard remedial treatment. Even if you do, you probably won’t be able to target the soft tissues (muscles and connective tissues) in the same way. You just won’t get the right angle on it!

A good remedial therapist will be able to target the muscles and connective tissues putting you at highest injury risk. They do this by asking you about your injury and exercise history, and by finding out what you would like to be able to do moving forward, whether that’s simply staying pain free or being able to keep up with the kids on the mountain bike. The long term goal for any hands-on therapy should be to get you feeling good so that you can maintain it with just a tune-up every now and then.

For Brisbane’s best remedial massage, check out Just Knead It or No More Knots.

Keep Things Moving Well – At Home

There are many, many different approaches to home-based injury prevention programs. The hallmarks of any good program: Exercises to maintain good muscle and connective tissue tension, and exercises to build and maintain joint mobility. (Joint mobility is the ability to actively move a joint through its full range of motion – similar to flexibility, but with additional contributing physical factors.)

Foam rolling and trigger pointing are two of the most common “exercises” to help maintain good soft tissue tension. They aren’t exercise in the traditional sense, though they can take some work! Instead, they are essentially a DIY remedial massage. These are usually completed by sitting, laying, or leaning on a foam roller or a spikey trigger point ball (or a tennis ball, which works just as well). Holding the pressure on a muscle-y area will trigger a nervous system response that causes the muscle to relax. How long to hold? There’s no single answer to this. It depends on a number of factors including positioning and how long the tissue has been building tension, but I always ask my clients to aim for a minimum of 30 seconds per spot. The wonderful thing about your body is that no matter how tight you might feel, if you do this consistently, you’ll be much looser, very quickly – especially if you’re starting this process after having remedial massage treatment. Once you’re feeling good, aim to maintain this by checking in with your body once or twice a week.

Joint mobility exercises are similar to flexibility exercises, in that they’ll challenge your body to move beyond its normal muscle lengths. As with static stretching, you’ll feel… stretching. The big difference is that with most joint mobility exercises, there’s a movement element as well as the stretch. Paying attention to your body alignment, you’ll move into a stretch in a controlled manner then move back out of it. This lengthens short muscles and connective tissues, provides some slack to overstretched areas, and teaches your brain to control movement through the entire range of motion available the joint(s) you’re working on.

Pro tip: Always do your soft tissue work before doing your joint mobility work. The decreased tension from the foam rolling or trigger pointing will give you more range of motion.

Get Strong

Being able to move your muscles and joints easily is vital to staying injury and pain-free – but only if you’re strong enough to control them! This doesn’t mean that you need to go to the gym and lift heavy weights every day. Rather, it means sticking with a plan for gradually challenging your muscles to get stronger, which can happen at a gym, at home, at the park, or in a group fitness class. A strength training program for injury prevention should, generally speaking, provide the following:

  • Exercises for all major muscle groups of the body
  • More “pulling” exercises than pushing (think moving a weight or resistance toward your centre of gravity rather than pushing it away)
  • Exercises that require large joint movement, preferably through multiple joints

Individualised injury prevention programs will take into account what movements and postures are most common for you on a day to day basis, any injury or exercise history you have, any current injuries or niggles you’re dealing with, and most importantly, what being injury-free (and worry-free) will let you do with your life! For most people without major sporting goals, an injury prevention program can be done in 20-30 minutes a few times per week. A small investment for lifelong peace of mind!

 

Have questions about what exercise physiology can help you with? Get in touch! 

HealthFit Coaching looks after inner city Brisbane and the western suburbs, including Spring Hill, Paddington, Bardon, Rosalie, Milton, Auchenflower, Toowong, Taringa, St Lucia, Indooroopilly, Chapel Hill, Kenmore, Graceville, and Chelmer.

Fit and healthy middle age woman getting ready to run on a treadmill in a gym for a cardio workout

What gym equipment will give me the best cardio workout?

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To improve cardiovascular fitness, you need to challenge your cardiovascular system. Simply put, that means moving your body in a way that increases your heart rate and makes you breath harder. Of course, you can get fit without a gym membership, but the variety of cardio machines under one roof can make your cardio workout a little more enticing. Make sure you get the best cardio workout by picking the machine that will work best for you. That mean safe and keeping you pain free, effective, and maybe even enjoyable!

Stair Climber / Stair Stepper

The rundown: The stair stepper (or stair climber) is exactly what it sounds like. Generally the “stairs” take two forms: A treadmill-type “staircase”, or a set of foot plates that moves up and down.

  • The stairs are tough! Prolonged stair climbing will quickly elevate your heart rate, especially with a faster speed. But “tough” is all relative – you have control over speed or resistance to make the workout somewhat easier or harder.  And don’t feel bad about giving yourself plenty of breaks throughout the workout. It will make it easier to get through the session and you’ll lose little or no benefit from it.
  • The stair stepper can be good for keeping your joints healthy. You need use a bigger range of motion, as each step will require more bend in the hips, knees, and ankles to lift your leg and take the “step”.  This greater range of motion can help keep joints well lubricated and mobile.
  • Provides a nice added strength boost for the lower body. Because you have to take bigger steps, the muscles in your lower body will work harder. This means you’ll develop more strength in the major muscle groups in your legs (your glutes, hamstrings, quads, and calves).
  • The stair stepper may not be the best choice if you have existing knee pain, though that doesn’t automatically rule it out, either.  Use a foam roller or trigger point ball on your quads (front of thigh) and glutes (butt and sides of hips) prior to taking your first step up.  Loosening tension through these areas will take a lot of pressure off of the knees.
  • Getting tired? DON’T lean on the arm railings – this takes away much of the “work” and can put your body in an awkward position, which can lead to physical stress through the joints of your spine and upper body, and can long-term set you up for injury. If you feel the need to lean, take a 1-2 minute break instead, either by slowing the machine way down, or by hopping off and walking around.

The Verdict: The stair stepper is one of the most effective cardio machines at the gym, because the movement is inherently high demand. Plus you get the added bonus of strength building through the lower body and large ranges of movement.

Elliptical Machine

The rundown: This machine guides you through low-impact movement that’s a cross between running and cross-country skiing.

  • Many machine have optional arm bars. Use them! Adding in upper body movement will lead to a larger increase in heart rate than just using the stationary handles. More muscles moving = higher heart rate and more calories burned.
  • This is generally the closest you get to running and still keep in low-impact (actually, no impact). If your elliptical machine has an incline setting, give yourself a boost here for a greater range of motion, which can help joint health.
  • Because you generally keep your feet connected to the foot plates, the gliding motion can sometimes lead to discomfort through the joints, especially if you’re already holding tension through the muscles of the hip and thigh (muscle tension can sometimes create more twist and torque through joints).

The Verdict: Excellent if you like to run but don’t feel comfortable with the impact any longer. If you choose an elliptical workout, get your upper body involved to maximize your results.

Stationary cycle / Spin bike

The rundown:  Another low-impact cardio machine, stationary cycles and spin bikes can give you a great workout with minimal joint stress, provide you set the bike up to suit your body. Because you can set the resistance,  you can somewhat turn your cycle workout into a strength builder as well.

  • These bikes can still lead to joint stress and strain, even without the impact. To prevent joint pain, make sure the bike settings are adjusted correctly for your body. Seat height should be set so that your knees are slightly bent when straight out, and the distance between the front of the seat and the “handlebars” is about the same as the distance from your elbow to your fingertips. This will minimize your risk of knee pain or lower back pain, though again, the risks are small!
  • Increase the resistance to simulate riding up a hill. This can be an excellent way to build strength in your quads, hamstrings, and glutes.
  • Variable resistance and the smooth motion of the pedal stroke means that stationary cycles and spin bikes are great in almost every situation, from knee surgery rehab to cross training for high level sports.
  • Leaning too heavily on the handlebars/arm bars can result in a lot on tension buildup through the neck and shoulders. During your ride, sit up straight frequently and shake out your shoulders and arms to keep everything loose.

The verdict: Great for use in almost every situation, as the speed and resistance can guide smooth movements with minimal physical stress. Make sure you know how to set the bike up for your arm and leg length to keep yourself comfortable and pain free.

Rowing ergometer

The rundown: This machine is one of the most frequently mis-used, which is a shame. It can offer a really phenomenal workout!

  • Out of all the standard cardio equipment you find in a gym, this piece has the highest potential for a high intensity workout. Good rowing technique requires a powerful push with the legs, and a pull with the torso and arms, meaning that almost every muscle in the body is working hard.
  • This machine also allows you to set your own speed and resistance, so the workout doesn’t have to be crazy challenging. An important note though: make sure you have enough resistance to work against, especially with the leg push part of the movement – without this, there is a greater risk of losing control of the movement, which can lead to physical stress and injury.
  • One of the most common complaints with using the rowing machine is a sore lower back, and/or neck and shoulders. This happens when you lean too far back as you pull the handle, and when you pull the handle too high. At the end of the pull, you should be leaning back only slightly, and definitely not more than about 45 degrees, and the handle should be pulled in towards your bellybutton.
  • You might want to start small with this machine. Because there is a lot more upper body involvement, many people tire quite quickly. Interval training is a great option on the rower, or just start with 5 minutes’ work and combine it with another type of cardio.

The verdict: Once you’re comfortable with the technique, this is a really excellent option for a big workout in a short amount of time – big being relative, of course!

Treadmill (Walking, Jogging, or Running)

The rundown: The most well-known of the cardio equipment, you can walk, jog, or run in a controlled environment.

  • The tread can be a little bit more joint friendly than concrete, as it provides some cushion to help decrease the impact of each step. But that and the movement of the tread make it less work than walking or running outside. Get all of the benefits: Use a little incline to cancel out the “give” of the tread. A 1% incline is roughly equal to the work of walking on the ground, without the loss of cushion.
  • Don’t lean on the hand supports or arm railings. If you aren’t using your arms, your missing out on natural body movement and extra calories burned. This is especially true if you’re walking at a high incline, holding the handles and leaning backwards – you’re missing out on a lot of the benefits, and it’s not particularly safe on the off chance that your phone rings and you absentmindedly let go. THE ONE EXCEPTION: If you need some help with balance, by all means, hang on. Help maintain good body mechanics by keeping your hands somewhat in front of your torso, and away you go.
  • One of the benefits of using a treadmill is that you get your workout without going anywhere, so if you get tired, you get to just stop and get off. BUT. Please let the tread come to a complete stop before stepping off. Those videos you see off people flying off the back of the treadmill? I’ve seen that happen in real life and it’s not fun.

You’ll find most of these cardio machines in most gyms, but this isn’t a complete list of the equipment you might have available, nor is it a complete list of pros and cons. Always chat to a personal trainer or exercise physiologist about which cardio workout will be right for you and your specific situation.

 

Have questions about what exercise physiology can help you with? Get in touch! 

HealthFit Coaching looks after inner city Brisbane and the western suburbs, including Spring Hill, Paddington, Bardon, Rosalie, Milton, Auchenflower, Toowong, Taringa, St Lucia, Indooroopilly, Chapel Hill, Kenmore, Graceville, and Chelmer.

Walking along coronation drive in Brisbane

Client Question: Can Walking Uphill Take The Place of Lower Body Resistance Training?

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Thanks to one of our exercise physiology clients in Indooroopilly for a great question!

Hill climbing can be a challenge to the muscles of the lower body, whether you walk outdoors or on a treadmill. As a result, uphill walking can help improve the strength and endurance of the lower body muscles. But it will not completely replace the need for lower body resistance training.

You may feel that walking uphill is a physical challenge, and you are not wrong! The major muscle groups in your legs have to work harder to keep you moving, and that can certainly lead to greater strength development than walking only on a flat surface. Walking will only stimulate strength development up to a point though, and relying on walking for strength will mean you’ll also miss out on other important elements of fitness.

Resistance Training Develops and Maintains Joint Mobility

Most strength or resistance training exercises require larger movements than walking does. These larger movements are the key to maintaining joint mobility (the freedom to move your joints through a normal, full range of motion). This keeps you moving well and can reduce wear and tear on the joints – one of the biggest causes of joint pain.

Resistance Training Develops and Maintains Muscle Strength

Strength is important, even if you don’t see yourself entering any future strongman competitions. You need a minimum, basic level of strength to meet the demands of daily life, whether that means lugging a heavy bag or briefcase around all day, carrying the groceries, or picking up the kids. While any activity that makes you work hard will develop muscular strength to some degree, resistance training is the best for this. A dedicated strength-building workout will promote far more strength than any you might build as a by-product of other exercise.

Resistance Training Helps Maintain Movement Abiliity

The combination of strength and joint mobility will help you maintain your overall movement ability, agility, balance, and gait well into your golden years. These two components of fitness and musculoskeletal health are what give you the ability to catch yourself if you trip, reach overhead to grab things down from shelves, and generally maintain your ability to walk, jog, and run well throughout your entire life.

Resistance Training Helps to Maintain Muscle Mass

Around about your mid-30s, you’ll start to lose about 1% of your muscle mass every year. Over time, this has a huge impact on your movement ability (muscle mass is directly related to physical strength) – if you don’t take action. Your body will keep the muscle it uses. Use resistance training to maintain muscle mass and your muscle mass will keep you moving.

Over time, muscle loss can also substantially slow your metabolism, one part of why many people gain weight with age. Remember that old saying “muscle burns more calories than fat”? It’s true! Resistance training keeps your metabolism revved up, helping you more easily lose weight and keep it off.

So you can’t rely on the treadmill to build lower body strength. Do you have to join a gym? Not at all. If the rise of in-home personal training options and other at-home workouts tell us anything, it’s that you can get a great workout at home with little to no set-up. Our in-home personal training, exercise physiology, and coaching options do recommend a few different training tools, but you can start resistance training at home using just your bodyweight and branch out as you need to. You’ll probably find that you actually have a few things already lying around the house that you can use to provide resistance. Get creative and enjoy the benefits!

For more information:
Plowman, S. A., & Smith, D. L. (2017). Exercise Physiology For Health, Fitness, and Performance (5th ed.). Philadelphia: Lippincott Williams & Wilkins.
Franz, J. R., & Kram, R. (2013). How does age affect leg muscle activity/coactivity during uphill and downhill walking? Gait & Posture, 37(3), 378-384. doi:10.1016/j.gaitpost.2012.08.004
Fit healthy middle age man swimming in an outdoor pool in Brisbane

What Are The Most Common Types Of Exercise?

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Depending on your workout or the type of physical activity you do, you can gain muscle strength, cardiovascular and aerobic endurance, improve your flexibility and joint health, or help maintain other components of good physical function like balance and coordination. The most common components of exercise programs are resistance training, cardio or aerobic exercise, and flexibility. Since they all provide different benefits, it’s essential to include a balance of these different types:

Resistance training (also known as strength training or weight training): Resistance exercises are those that train your body to produce force against some sort of resistance, whether that is your own body weight, resistance bands, traditional dumbbells and barbells, or a multitude of other training equipment.

Moving against resistance stimulates your muscles to develop size, optimal length and muscle tone, and contraction ability, as well as the coordination to be able to complete daily tasks with ease. These characteristics can promote good posture, reducing the risk of injury and poor health, improve body composition (the ratio of body fat to lean body tissue), enhance movement abilities, and generally boost self-confidence and self-esteem.

Resistance training can be further broken down into training programs that are focused on developing maximal muscular strength and power, muscle size, or muscle endurance. For most people with non-athletic goals, development of muscle size will provide the greatest all-around benefit for lifelong muscle health. It’s important to consider that the training benefits are directly related to the amount of work you put in – regardless of the training focus, if you aren’t training with enough effort, no benefit will be seen.

Cardiovascular training (also known as aerobic training or endurance training): This is exercise or activity that is made up of repeated, often rhythmic movements that use the large muscle groups of the arms and legs. These types of exercise usually don’t require much or any special training or practice, and are often done for an extended period of time – though “extended” is all relative. (If you’re just starting out with aerobic exercise, extended might only mean five minutes.) Some of the most common examples include walking and running, cycling, and swimming, though many other activities also fall into this category.

Cardio exercise helps your heart to beat more efficiently, in turn using less energy to move oxygen and nutrients, and keeps the blood vessels healthy and able to respond to the demands that movement can place on your body. This decreases wear and tear on the heart and the blood vessels, lowering the risk of heart disease and cardiovascular conditions, as well as the risk of sudden conditions like a heart attack.

Flexibility or Stretching and Joint Mobility Training:  These exercises have two specific but closely related training goals. Flexibility exercises are designed to promote optimal length in the soft tissues surrounding a joint or a series of joint, which will allow the joint to move freely within its available range of motion. Flexibility training targets the muscles and connective tissues around the joint. Joint mobility refers to the ability of the joint itself to move freely. Joints can become stiff with lack of movement, which can stiffen the connective tissues within the joint, or can lose movement ability when the flexibility of surrounding muscles and connective tissues decrease. In order for a joint to be mobile, the soft tissues surrounding it must be flexible, and in order for the soft tissues to develop or maintain flexibility, the joint must be able to move freely. Both of these components are important in maintaining good posture and movement ability – key components to an active, pain-free lifestyle with low injury risk.

Flexibility can be developed by traditional static stretching exercises, which involves moving to the point of moderate stretch and holding that stretch for at least 30 seconds (the minimal amount of time required to create a lasting change in flexibility). Dynamic stretching is a better option for joint mobility training, as it’s performed by moving into a stretching position, holding it for a few seconds, and then backing off. By combining this stretch with a greater degree of joint movement, you can develop and maintain optimal joint mobility. Spending time on both static and dynamic stretching will give you the best results.

Resistance training, cardiovascular exercise, and flexibility are the three most commonly discussed components of a balanced exercise program. But there is another component that is often overlooked, yet is perhaps the most important component of exercise and activity, especially when it comes to maintaining good functional movement throughout your entire life. Be sure to check out our upcoming post on Neuromuscular training at the end of the week!

 

Looking for the best in-home personal training and exercise physiology program? Look no further. HealthFit coaching provides exercise programs that are real-life ready – flexible enough to work with your lifestyle without sacrificing your health and fitness goals. Take the first step to lifelong health and fitness – Contact HealthFit Now.

model of person holding knee in pain from an injury

Easy Steps To Decrease Knee Pain: Part Two

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Many cases of knee pain aren’t caused by a single traumatic injury. Instead, knee pain is often caused by overuse of poor movement patterns and the shortening and tightening of the muscles that accompany that. This can lead to poor alignment between the bones and tissues of the joint, in turn causing tissue stress, inflammation, pain, and long term degeneration.

The first step to stop knee pain in these situations is to decrease the tension in the muscles. It’s very helpful to do this PRIOR to stretching, as decreasing muscle tension makes the muscle easier to stretch, and more likely to maintain the increased flexibility. The best way to decrease muscle tension is to go and get a deep tissue or remedial massage from a qualified massage therapist. The second best way is to do self-massage work on your own at home. You can find the best DIY self-massage techniques for knee pain here.

After you’ve gotten the muscles around the knee loosened up with some massage work, try these stretches to return the muscles and other soft tissues to a better resting length.

Guidelines for all stretches:
  • Stretch to the point of discomfort, but NOT pain. Too much stretch can cause damage. Start the stretch and move into it until you feel a pull, and then move into it a little more and hold
  • Hold at least 45 seconds to create a lasting change (less than 30 seconds will not create a long term change in tissue length)
  • Breathe and relax – this helps tell your nervous system that the body is not in danger
  • As the stretch eases, you can move into it a little more to continue to increase the stretch benefit
  • Maintain good alignment to maximize the stretch. If you adjust the position to make it feel easier, you’ll lose some of the benefits of the stretch

 

Quad stretch

The quadriceps are the muscle group at the front of your thigh. When these muscles shorten, they can pull your kneecap slightly out of position, which can cause rubbing between it and the other joint tissues.

  • Stand tall and tilt your pelvis back slightly to flatten out your lower back
  • Bend one knee and reach behind to grab the top of the foot
  • Pull back slightly on the foot to increase the stretch through the front of the thigh
  • Keep your knees together to stretch the muscle fibers in the right alignment
Adductor stretches

The adductors are the group of muscles along the inner thigh. While they aren’t as commonly talked about as the quads (at the front) or the hamstrings (at the back), they are just as important. They are actually the largest group of muscles in the thigh, and are active in every movement you can make with your legs. Unlike the quads and hamstrings that run the whole length of the thigh, different adductor muscles are different lengths. Some run from the pelvis to different points along the top half of the thigh (the short adductors), while others stretch from the pelvis to down around the knee (the long adductors). Targeted stretches will help focus on the different areas.

Short adductor stretch
  • Sit up straight and bring the soles of the feet together in front of you
  • Tilt forward slightly from the hips until you feel a stretch through the inner thighs
  • Maintain a neutral spine – don’t let the back round out or the pelvis tilt backward as you lean into the stretch
  • Option: Use the elbows to put slight downward pressure on the inner thighs to increase the stretch

Long adductor stretch
  • Sit up straight and move your legs out in a “V” shape in front of you. This may be enough to give you all the stretch you need!
  • Keep toes pointed straight upward
  • If needed, tilt forward slightly from the hips until you feel a stretch through the inner thighs.
  • Maintain a neutral spine – don’t let the back round out or the pelvis tilt backward as you lean into the stretch

model of person holding knee in pain from an injury

Easy Steps To Decrease Knee Pain: Part One

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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!