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

SI Joint Pain – Help at Home

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.

 


two medicine balls for at home strength training exercise and fitness

Client Question: What is functional exercise?

This is a great question!!

“Functional” has been a buzzword in the fitness industry for years now. It likely conjures up images of someone exercising while standing on one foot, doing much of their workout sitting (or standing – though please don’t!) on a big rubber fit ball to switch on their core. Spoiler: This isn’t actually what it means!**

In reality, most exercise can be functional exercises: Functional exercises are those that have a direct benefit to the movements you make in real life, whether that’s going about your day to day activities, going to the gym to get stronger, starting a beginners running program, or even training to compete in a big race. There is no particular group of exercises that are “functional”.

** As people (personal trainers, coaches, clients, and athletes) have seen how little the above types of exercise help in daily life and performance, the industry has moved away from the balance and instability elements that are the hallmark of the early “functional” trend. In fact, these exercises can lead to poor exercise technique, increased compensation patterns, and minimal additional benefit. They aren’t terrible across the board, but you can make better choices with your time!

Writing A Functional Exercise Program

When I see a client who’s interested in getting into functional movement or exercise, I get really excited, since it lets me stretch my creative juices a bit (and also because these clients have the highest chance of long term success – winning!). The process starts with a good chat about what real life looks like for you, what kind of movements you might struggle with, what kind of movements you get pain with, and what you would like to be able to do more easily. We’ll do a brief movement screen to let your body tell it’s side of the story, since most of us have movement compensations we are not aware of, and then we’ll get started on creating a balanced exercise program to match your needs and goals.

Here’s where the art comes in. When I think about what exercises should go in this program, I think about the movements you make in daily life and/or training. I’ll pick exercises that are similar to those movements to help strengthen the muscles that keep you going day to day. I’ll also pick exercises that will turn on any muscles that aren’t quite pulling their weight in your normal movements (under-active muscles play a key role in injury rates) and exercises that provide a balance to your main working muscle groups, which will further decrease injury risk. You should be able to recognize your in your workout exercises that mimic the movements of your job, or that help you improve strength or cardiovascular fitness levels so that the activities of everyday life become easier.

Common Examples of Functional Exercises

Functional Exercise

Similar Real Life Movement

Squats Sitting down and standing up, as from a chair
Step Ups Walking up stairs
Bicep Curls Picking up a small child
Farmers Carry Carrying the grocery bags

Is Your Program Functional For You?

Whether it’s called functional or not, the best program will evaluate your daily movements, energy needs, and lifestyle goals, and focus on exercises that will improve or maintain your abilities in these areas. Not every exercise will seem like something a movement you make every day, since creating strength for movement can require different muscles and joint angles than you might expect. Your body is a complex machine, and it’s rare that you’ll ever sit down, stand up, walk, carry, or lift things in the same perfectly straight line every time! Overall though, you should be able to see the similarities to your daily life, and within a few weeks should be able to feel the benefits.

If you’re not sure that your program is ticking these boxes, HealthFit can help. Your exercise physiology program is designed to be done in-home, at your gym, or anywhere else you feel the most comfortable and likely to do it, and if that’s not functional, I don’t know what is!

HealthFit looks after residents of 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. 

Want more info about how HealthFit can help you? Get In Touch

 


Hypermobile woman doing the splits

Improving Hypermobility

Joint hypermobility is a condition where the ligaments surrounding a joint aren’t as tight as they would normally be, which gives that joint greater movement ability than someone without hypermobility would have. Many people call this condition being “double jointed” or having “loose joints”; clinically we talk about having various degrees of joint laxity.

Joint hypermobility isn’t a black-and-white diagnosis. It actually occurs on a spectrum – everyone has more or less laxity in every joint. Hypermobility is seen more commonly in younger people, since your joints will naturally stiffen as you age. And interestingly, your level of hypermobility can greatly vary between your joints. You may be hypermobile in your elbows and shoulders, and much more stiff in yours wrists and knuckles. You’ll generally be diagnosed as hypermobile when you have extreme ranges of motion in several joints. The most common test for hypermobility is the Beighton Score. You can read more about that test at this link.

There’s a small percentage of the population that stays hypermobile throughout their lives. This can be a positive for some sports and activities, like gymnastics, dance, and martial arts, but for many people, hypermobility can lead to moderate to significant muscle and joint problems: When we look at normal physical structure and function (anatomy and physiology), we see that the role of ligaments are to hold the bones in a joint together in a way that allows smooth, pain-free function. When these ligaments are loose (increased joint laxity), the bones won’t be held together as securely. This can lead to increased wear and tear on the bones and cartilage in the joint. Muscle tension around the joint will also increase as the nervous system tries to create substitute support for the joint.

As such, hypermobility can lead to several annoying or painful symptoms:

  • Pain and tension in muscles and joints
  • Joints that click or pop
  • Joints that dislocate or sublux (come out of correct position) easily
  • Tiredness or fatigue, thanks to your muscles working hard
  • Increased joint injury risk for things like twisted and sprained ankles, or for joint overuse injuries

The most common complaints that my hypermobile clients have are muscular tension, sometimes leading to muscular aches, referred pain, or headaches (when the joints of the neck are affected). Many people don’t actually realise that hypermobility is the fundamental cause of this, instead thinking that it’s stress, or something they are doing in their daily lives that’s creating these aches and pains.

Now, the important part: What do to about hypermobility

There’s no “cure” for hypermobility (short of having surgery to shorten your ligaments, and you’d be hard pressed to find a surgeon who would do that!). It’s also not something that you should think is “wrong” with you. It’s just how your own body works. There are lots of ways that you can help manage hypermobility symptoms though, if you’re finding it to be unpleasant.

DON’T StretchFor Hypermobility

This might seem counter-intuitive, since tight muscles often feel like they need a good stretch. However, if you’re hypermobile, your joint laxity means you’re already “stretched” longer than your body wants you to be. Since stretching may further decrease your joint stability, it can actually backfire and increase muscular tension.

What to do instead?

Get A Remedial Massage

Remedial or deep tissue massage can decrease muscular tension without increasing muscle and connective tissue length. This tension often occurs in both the small stabilizer muscles and the larger muscles that power movement. It’s important to note that the body is using this tension to create joint stability and protect the joints, so by decreasing tension, you’ll have a small drop in joint stability. A good remedial massage therapist will be able to gauge how much tension to relieve. (Great remedial massage choices in Brisbane are Just Knead It and No More Knots.) This is still the number one way to decrease the feelings of tension though, so don’t skip out on it. Instead, think of it as one half of managing the symptoms.

What’s the other half?

Build Strength In The Muscles Surrounding Hypermobile Joints

Strength training builds muscle tension. This might sound bad (and too much of it can make you feel uncomfortably tight), but with hypermobility, this tension is actually a good thing. Stronger muscles hold a slight contraction at all times, even at rest, which can provide the joint stability that your body is looking for. As such, your nervous system won’t be pushing your body so hard to protect your joints, so you end up feeling less fatigued, feeling less muscular aches and pains, and may see a decrease in joint popping, clicking, or otherwise doing weird things. Plus you get all the other benefits of strength training too!

A strength training program for hypermobility should have a large focus on building activation ability and strength in your stabilizer muscles, since these are what the joint rely on for support and integrity. You can follow a program that address that alone, or that incorporates stabilizer training into a well-rounded fitness program.

Hypermobility is one of the more common complaints that HealthFit Coaching provides sessions for. If you’re in Brisbane and are interested in finding out how exercise physiology can help you manage your hypermobility, get in touch today!

 

Want more info? Check out these links:
Gazit, Y., Jacob, G., & Grahame, R. (2016). Ehlers–Danlos Syndrome—Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Medical Journal7(4), e0034. doi: 10.5041/rmmj.10261 Read it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101008/
Joint hypermobility symptoms and treatments. (2019). Read it here: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/joint-hypermobility 
Featured Image Sourced From: https://commons.wikimedia.org/wiki/File:Yoga_Split_2.jpg?fbclid=IwAR1mgs9wappmEXULt8ZfSYoD9zCuduyozzEwukYqWI_qFrETlyeGYOAjpHU

Three Top Tips for Injury Prevention

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 exercise physiology? Interested in signing up for in-home sessions? 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.


model of person holding knee in pain from an injury

My Knee Hurts. Who Should I Go See?

On first appearances, your knee is a simple joint. It doesn’t move as much as the hip or shoulder. It’s got fewer bony parts to worry about than the elbow does. And it’s built to hold your body weight, all day every day, so it’s pretty sturdy. But many things can create knee pain, and when this happens, it can sometimes be tough to figure out what to do about it.

  • If you are one of the almost 20% of the population experiences knee pain, it’s worth finding out what’s going on. Here’s how to take the first step (no pun intended):
  • Did you recently have an accident or injury where you twisted, jammed, jerked or otherwise injured your knee? Go to the doctor (or the emergency department).
  • Is your knee swollen, red, and/or hot? This can be a sign of an infection, especially if you also have a fever, excessive fatigue, or are having hot or cold flashes. Go to the doctor!!
  • Does your knee click, lock out, give way when walking or standing? This may be a sign of a past injury that didn’t heal well. Get yourself to an orthopedic doctor or a physiotherapist/physical therapist. You may need a referral for these, but not always. If you aren’t sure, call the offices of the doctor or therapist and ask them.
  • Current or old injuries to the knee joint and other types of knee pain can also lead to compensation patterns in the way your muscles work and develop tension. This can be helped with soft tissue therapy – i.e. some type of massage.
  • Do you have the sensation of joint weakness, especially in conjunction with a history of injury or a low-activity lifestyle? Go see an exercise physiologist to help you rebuild strength and control in the muscles that surround the knee. (If you can’t find an exercise physiologist, go see a personal trainer or strength coach that specializes in late-stage rehab and injury prevention.)

Want to know why? We’ll talk in more depth about this in our next post. Be one of the first to see it by following HealthFit via email below (you’ll only ever receive notifications of new posts on the website).


model of person holding knee in pain from an injury

Caring For Chronic Knee Pain

Your knees do so much work for you. What can you do to take care of them?

Ongoing, chronic knee pain is a common complaint, and made more common by numerous causes. Whether you have stiff and slightly swollen knees from osteoarthritis, referred pain from tight muscles in the hip and thigh, or an old injury like a meniscus or ligament tear that still bothers you, there are a few easy things you can do to help yourself out and better manage your knee pain.

If you’ve had a recent injury or flare up of knee pain, put some ice on it!

Ice is great for managing pain and promoting the healing process in almost every situation, from a referred pain point that’s just occurred to a decades old knee sprain that lets you know when it’s going to rain. Ice has an excellent pain-numbing effect, so it’s a great option for pain management when you don’t want to take painkillers, and is also useful in managing how the body responds to pain and injury, minimizing the effects of swelling and speeding the healing processes.

While there are no set-in-stone rules for the use of ice, guidelines suggest use for at least 10-20 minutes, though these numbers can vary based on the type of ice treatment you’re using, such as ice bath, ice massage, or ice pack. If you’re applying ice to help manage an injury to deeper tissues – like if you have a diagnosed ACL tear, which is deep, and you’re working to manage the swelling throughout the joint – you may need to leave the ice on for a longer period. The same applied to icing a body part that has greater levels body fat. In either case, more time is needed for deeper tissues to decrease in temperature.

Feeling stiff, tense, and spasmy? Throw a heat pack on that!

Heat is a great option for knee pain that’s stemming from stiffness or muscle spasm.  Like ice, heat treatments can have a painkilling effect, and will also improve circulation to an area, increasing oxygen and nutrients and helping eliminate cellular waste products and speeding the healing process. It’s also an excellent way to relieve muscle spasm, which can indirectly decrease knee pain by decreasing tension in supporting muscles.

Like ice, heat applications need 10-20 minutes to be effective, and may need even longer to be effective when target tissues are deeper under muscle or fat layers. Also like ice, heat can be applied directly to the knees, or to the muscles surrounding them. And it’s common sense, but bears repeating: Always use heat or ice with a towel between the heat or cold and your skin.

And get moving!

While somewhat counterintuitive, movement can work quite well to decrease knee pain. Your knees (and the other major joints in your body) keep themselves “well oiled” with a particular body fluid called synovial fluid that found within many major and minor joints. This fluid is the “oil” that keeps the joint moving well, and movement stimulates the body to create more of this fluid. This is still the case even when movement is painful. Work around this by keeping movement to a non-painful range. Maintaining the movement you have is an important step in moving towards being pain-free.

Movement (especially the right kind of movement) also builds strength through the muscles surrounding and supporting the knees. This is where a physiotherapist, physical therapist, or exercise physiologist comes in: These professionals can help identify the pieces of your movement patterns that might be creating joint stress leading to your knee pain. They can provide you with the right exercises to reset those patterns and get you feeling better. The ultimate goal: Move well, get strong, and get on with enjoying your life!


Lean middle age man trying to open a jar

What is Functional Training?

The short answer: Functional training is exercise that mimics and prepares you for the movements you make in everyday life.

The longer answer: Will depend on who you talk to! Functional training can have as many definitions as there are trainers.

In exercise science, functional training refers to an exercise or training program that will keep you physically capable of meeting the demands of daily life. Programs are designed around your day to day activities and include exercises that develop strength, endurance, and mobility in the same movement patterns that your daily activities use. As an exercise physiologist, I see functional training programs as those meeting your physical needs, whatever they are, which of course leaves a lot of room for variation. For instance, the program for an avid runner might include specific exercises to increase running speed, or to help the body better absorb impact. A program for a stay-at-home parent with young kids might be focused on maintaining good hip mobility to help with getting down and up off the floor, and on building upper back strength and core strength to help balance out the changes in posture that happen when you carry kids around. In other words, true functional training is really specific to YOU.

How does this mesh with functional training programs provided by different gyms and personal trainers?

Functional has been a fitness industry buzzword for a while now, but it’s often not clear what you might get in any given functional workout. Early functional training programs were focused on neuromuscular training exercises, generally involving moving with your eyes closed or balancing on a stability ball to challenge balance or reaction times. One might think of this training as developing the finer points of physical coordination and movement.

More recently, Crossfit and other fitness and training companies like F45 have grabbed onto the “functional” term, though these workouts have moved far away from challenging the finer points of movement. I’d argue that this current crop of functional training providers actually provide cross-training, as the workouts are changed on a daily basis with an emphasis on developing a broad base in strength, power, and cardiovascular endurance. These are all elements of fitness that are needed for high quality functional movement and for good health in general.

When I compare them to the movements of daily life though, I find them somewhat lacking – from a true functional perspective. Heavy squats, battle ropes, box jumps, chin-ups, sprints, and other exercises are common components of these workouts. But when in day to day life do you find yourself needing to jump up onto something as high as your knees?

How much do the differences between functional personal training or gym programs and other functional programs really matter?

They might not matter at all. It really depends on how much you feel like you need a specific, individualized exercise plan. Some people will be fine with the generalized, cross-training style “functional” training, namely those who already have a moderate level of fitness and good movement control. True functional training provided by an exercise physiologist or a personal trainer with significant additional training in movement assessment and movement quality is the right choice for you if you:

  • Are starting physical activity or exercise for the first time, or after a long period off
  • Have a history of joint pain or injury
  • Have a long-term health condition, especially if this impacts your movement ability and physical capacity
  • Want to refine your movement technique to prevent injury and maximize progress

You will always be the best judge of what will work best for your lifestyle and your body. If you want to focus on functional training that supports your everyday activities, think about what movements are required, and look for exercises (or professional guidance) that will help you replicate those movements with just a little more intensity.

 

 

HealthFit Coaching provides in-home personal training and exercise physiology in Brisbane. HealthFit Coaches specialize in providing individualised functional training for general fitness and long-term health conditions. Contact HealthFit now for an obligation-free phone call to find out how we can help you be healthy, fit, and happy.


model of person holding knee in pain from an injury

Easy Steps To Decrease Knee Pain: Part Two

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

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!