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).
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!
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 findthe 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
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!
