Common causes of knee pain and their solutions

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There are a few really simple solutions to some of the more frequently occurring types of knee pain.  It might not be the thing you need, but the good news is you can try it and it won’t hurt anything. It might make a significant difference to the problem too.  Sometimes knee pain has more than one source, so this could also help part of the problem, even if it’s a more complex problem.

 

Let’s review the anatomy around the knee to help you understand why we’re going to treat it as we do.  Understanding why to do it, instead of just what to do, will help you have more finesse in the fine points of the exercise.

 

On the front of the body, above the knee you have the quadriceps group (quad = four, ceps = heads), three of them attach entirely to the femur (thigh bone) and one of them skips the femur and attaches to the front of the pelvis.  They are some of the biggest muscles in the body. They all meet just above the knee and blend into a band of tough, fibrous tissue called the quadriceps tendon. This band of tissue runs over the front of the knee joint and attaches to the larger of the two lower leg bones (tibia).  Where the fibrous tissue crosses the knee joint it has a floating bone embedded in it, which helps it turn the sharp corner without as much friction. This bone is the patella.

This image illustrates the quadriceps group and their relationship to the knee.
There are several pain problems that are either caused by or contributed to, by too much pulling from the quadriceps.

 

  • If there’s just altogether too much pulling for a long time that leads to irritation of the quadriceps tendon.  This can cause starvation, irritation and degeneration of the tendon.
  • If there’s too much pulling just from the quads on the outside of the thigh this can cause the patella to rub too much in a couple of spots and wear away cartilage.
  • If there’s too much pulling, again more evenly this can compress the patella and mash the cartilage.
  • The force from the pulling (particularly at the outside of the thigh) can also just translate across the knee to the fibrous tissue that wraps the whole area.  This tends to cause pain in the area below the knee and toward the midline.
  • Also the quads themselves can hurt, and if they do the pain will often be felt in the knee.

 

What to do about it:

 

Stretching the quads probably isn’t a bad idea and could help, but the quads are long and mobile muscles and you’ll run out of range before you get them all stretched out.

 

What I recommend is foam rolling the quads.  A foam roller is a 6 or 8 inch diameter tube of dense foam made for just this purpose.  If you don’t have one try using some other thick rod shaped object, such as a rolling pin and wrapping it in a bath towel.  The larger the diameter of the object the more comfortable and easy to tolerate will be the pressure we apply with it.

Next you get into a push-up or plank position with the foam roller positioned just above the knee you want to work with.  Lower yourself onto the roller and roll it up and down the front of your thigh, favoring the middle and outside and the area closest the knee.  It is admittedly an awkward position and you can google “foam rolling quadriceps” for some you tube videos that could help you do the exercise with more decorum.

 

If you find this exercise quite painful, then wrap your roller in another bath towel, try to find a larger diameter roller, and put less of your body weight on the roller.

 

If you find it quite tolerable try doing the rolling with your knee bent so that the quads are lengthened.

 

Either way do the rolling very slowly.  The tissue isn’t play-do to be flattened by mechanical means.  We’re actually using the power of steady pressure as a mirror, so to speak, which we hold up to the body and say, “Hey, did you see how tight you were here?”  Then it says, “Whoa, I had no idea. Thanks for pointing that out to me. I’ll be sure to stop working so hard.”

 

There’s one more pretty common type of knee pain.

 

That is a sharp pain on the outside of the knee that shows up at a particular point in the gait cycle.  As you’re walking (or biking) along each time the knee goes from straight to slightly bent there will be a sharp pain on the outside of the knee.

This image illustrates the relationship between gluteus maximus and the outside of the knee.

This is caused by an important fibrous band that runs down the outside of your thigh (the iliotibial band, or IT band) rubbing against one of the knobby bits of bone at the end of the femur.

 

You stand a good chance of helping this problem by applying pressure to the gluteus maximus.  This is even more awkward than foam rolling the quads. You can look up Youtube videos on foam rolling glute max, but in order to get the right area a tennis sized ball works better.  I recommend going for the part of the muscle closest to the small of your back. This is the area in the low back/ butt transition zone where all the bony knobs stop and the meaty part starts.

 

Again, don’t make it too intense or the body won’t open up to the possibility of change, but instead will just sit there gritting its teeth and waiting for the ordeal to be over.

 

How did that work out?  Was it helpful?  Need more details?

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