Knee Pain is a common complaint especially in runners, walkers and even cyclists. Many have been told they are suffering with a bursitis, tendonitis, runners knee, arthritis, ITB syndrome, patellofemoral pain, chondromalacia patella to name a few. Today I want to address the most common areas of dysfunction that contribute to the above mentioned conditions and what you can do yourself to counteract these issues.
This article will simplify the more complex issues surrounding knee biomechanics and dysfunction, to allow you to implement a corrective exercise program immediately to address your knee pain. I do however, want to state these ideas have been simplified and scrape the surface on underlying causes of knee pain and the full spectrum of rehabilitative approaches that could be implemented regarding a very misunderstood and commonly misdiagnosed area of the body – the knee.
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The most common areas of knee pain in runners are:
The Patella Tendon
The Patelo-Femoral Joint (the knee cap)
The Iliotibial Band (ITB)
The ITB is a thick strip of connective tissue that arises from the tendons of the tensor fascia late and glute maximus, travelling along the lateral side of the thigh and across the knee joint, inserting on the lateral edge of the tibia.
A common injury in runners is referred to as iliotibial band syndrome (ITBS), a condition caused by the friction of the band moving across the tissues on the outside of the thigh. When the knee bends, the iliotibial band moves backwards over the bony ridge of the Hip. It then passes over the hip again when it moves forward when the knee straightens. The repeated flexion and extension involved in long distance running results in the iliotibial band becoming inflamed, irritated and painful.
The Patellar Tendon
The Patellar Tendon runs from the patella (knee cap) to the tibia and is a very strong, flat band.
The Patello-Femoral Joint
The patella sits within a groove in the femur. The underside of the patella is covered in cartilage that glides over the cartilage of the front of the femoral groove. In the patello-femoral joint there is minimal resistance and friction during movement due to the fluid which is present around the knee within the joint capsule during movement. There are also a number of bursa (fluid filled sacks) around the knee joint that allow better gliding of the tendons and ligaments around the joint.
Patella Tendon and Patella-Femoral Joint Pain is most often caused by the dysfunctional orientation and alignment of the patella within the femoral groove during movement. Any deviation can cause overpressure which can result in irritation, inflammation and pain within the knee, underneath the patella and patella tendon.
So I Have Knee Pain – What do I Do?
Often there is a combination of several factors that lead to overuse and overload of the, ITB, patellofemoral joint and patella tendon, such as anatomical or biomechanical abnormalities and muscular weakness, imbalance or dysfunction.
Firstly, if you are suffering from any knee pain then I would always recommend visiting a chiropractor to have your pelvis and lower back assessed. Typically we find that patients have some degree of rotation within the pelvis and dysfunction within the lower back, usually resulting in a leg length inequality.
Commonly, the longer leg tends to experience pain on the outside of the knee and thigh, while the short leg tends to experience pain on the inside of the knee.
Secondly, when assessing a patient with knee pain, there is a muscular imbalance around the hip and knee that effect the alignment and movement of the knee and the tracking of the patella.
This muscular imbalance consists of certain muscles being overactive and tight while others are underactive and weak. This results in the knee tracking inwards (falling inwards) during activities such as walking, running and even squatting.
Overactive and Tight Muscles:
Hip Flexors (Psoas / Iliacus)
Lateral Quad (Vastus Lateralis)
Underactive and Weak:
To correct these imbalances and biomechanics we need to work through a specific strategy.
1. Release (Overactive Muscles)
2. Stretch (Tight Muscles)
3. Specific Activation (Weak & Under-Active Muscles)
4. Core Stabilisation
We will need to release the Quads, ITB & TFL.
QUADRICEPS Release Technique
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ITB Release Technique
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We will also need to stretch the TFL, Hip Flexors & Adductors.
TFL & Hip Flexor Stretch
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Next we will have to activate and strengthen the gluten musculature.
Glute Activation Circuit:
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Finally we will have to retrain core stabilisation using plank variations.
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I hope you have found this article helpful and easy to apply. as i stated at the beginning this article simplified a very complex topic, but will give you an idea what strategies you must put in place to immediately address your knee pain. I will most likely cover further causes and rehabilitative strategies for knee pain in the near future.