The knee joint is over-involved in most athletic activities and this critical joint frequently and unnecessarily shelves the athlete!!
Common Forms of Knee Pain:
Anterior Knee Pain: One of the more common forms of knee pain, and is reproduced in activities such as ascending and descending stairs, squatting and sitting for prolonged periods.
This type of pain typically emanates from muscle imbalance between the VMO (inner quads muscle) and VLO (outer quads muscle). The patella (knee cap) will deviate to the dominant muscle side causing friction and inflammation.
Management: Identifying imbalance of quadriceps muscles and strengthening the weak side. Address kinetic chain imbalances by looking at the foot/ankle and hip for joint and/or muscular stress patterns. Frequently, if quadriceps are short and tight, this can create undue force on the patella creating friction stress at this region – assisted stretching and foam rolling will facilitate this effect.
Medial Knee Pain: The inside of the knee is stabilized by the Medial Collateral Ligament (MCL) and this ligament gets inflamed with repetitive stress activities (RSIs) such as in running, biking and racquet sports. The kinetic chain – foot/ankle below and hip above must be aligned and flexible to offset the load stresses on the knee. For instance, if pronation is not supported properly, subsequent torsion of the tibia (lower long bone of leg) will create aberrant rotational forces of the knee and stress the MCL with every step. Similarly, if the hip flexors are short and inflexible, this will in turn create femur (long bone of thigh) torsion stress and force the knee to compensate adversely as well. Many times with knee pain, the pain at the affected joint is just the symptom of a bigger problem above or below!!
Management: Address kinetic chain imbalances from the “ground-up” by correcting foot/ankle biomechanics/alignment, clear out joint restrictions with adjustments(foot-ankle, knee, hip and sacroiliac joints), strengthen the quadriceps, restore quadriceps, calf, hip flexibility and soft tissue compliance (foam roller and assisted stretching), and support connective tissue with collagen based nutriceuticals (Ligaplex I and Collagenics). Orthotics may be necessary to correct pronation dysfunction in foot/ankle that adversely affects knee alignment.
Lateral Knee Pain: The outside or lateral knee can frequently present pain in the athlete as well. This region of the knee has the stabilizing ligament known as the lateral collateral ligament (LCL) and this also interfaces with the distal part of the iliotibial band (ITB). This region is highly sensitive to RSIs and alignment of the kinetic chain. Typically, this pain will be sharp and frequently severe enough to force activities to a halt. Supination of the foot/ankle will exacerbate the lateral knee, as will tight hip abductors (Gluteus Medius and Minimus), tight hip flexor (TFL), outer hamstrings (Biceps Femoris) or outer quadriceps (VLO). As with all knee pain, leg length discrepancy should be ruled out and corrected via adjustments and/or orthotics. Due to the high tension of the ITB, this injury may require aggressive therapy and management.
Management: Aggressive intervention to restore flexibility to above mentioned muscle groups. Employ foam roller to release fascial restriction as well. Address kinetic chain imbalances with adjustments (foot/ankle, knee, hip and sacroiliacs) and corrective orthotics to offset knee stress. If the culprit is the ITB restriction, therapy should be applied to reduce inflammation, adhesions and tightness at the hip. With any ligament involvement, connective tissue nutriceuticals (Ligaplex I and Collagenics) should be added to the healing program for the necessary raw materials of repair.
**As with all knee conditions, a full examination, possible X-Ray and/or MRI films may be required to rule out deeper pathology. When a full assessment is performed, each person’s case is treated individually and management strategies may differ from above mentioned protocols.
In order to keep the wheels down and feet forward, pay particular attention to the body’s symptoms and signals of imbalance as training through pain will only lead to more difficult corrections later on. Next week we will look at the meniscus and how this common knee issue can be managed without surgery.