Apr 2016 30

Knee pain

By: Dave Wheeler

Have you noticed that it can be hard to locate exactly where the pain is sometimes? That's especially true around the joints like the knee where there's so much going on that pinpointing what hurts can be tricky.

So if your knee hurts, here are some things to think about:


Very sudden onset or developing problem?

If there's a sudden pain in your knee that you've had no inkling of before, especially if it's debilitating, then stop whatever you're doing.

This is an acute injury and it's going to range in severity from serious to really really serious.

Sometimes this will be because ligaments get damaged suddenly - your knee is only meant to move in one plane (front to back) and then only a limited range. Ligaments don't stretch and they stop the joint from moving where they shouldn't. If your knee is suddenly forced beyond it's natural range of movement then the ligaments can be sprained, or tear.

If the ligament is damaged then you need immediately to RICE:

  • rest
  • ice
  • compress
  • elevate

and seek medical attention. I've blogged before about one of the knee ligaments, the anterior cruciate ligament, so there's more advice there.

The other main possibility with acute very painful injuries of the knee is meniscus damage. The meniscus is a "half-moon" shaped cartilage pad between the ends of the 2 bones of the upper & lower leg, acting as a cushion. Torn cartilage should be dealt with in exactly the same way as ligament damage - including seeking medical attention asap.

If you're very lucky, then acute injury might possibly be due to a tendon tear, or strain. A grade 3 strain is severe & immediate. There are a lot of tendons in front of the knee (behind the knee cap, or patellar) and it's possible, if unlikely, to damage one of those.

The "take-away" from all of this is that if you get sudden very severe pain in the knee with no warning at all, then it's probably serious. You need to RICE and see a doc asap.


I knew there was something wrong...

If the problem is something that started out as a niggle, then it's much more likely (not certain, but much more likely) to be a muscular issue.

The best way to try figure out which muscle is causing this chronic problem is to start by locating the pain - is it at the front of the knee, behind it, on the inside or on the outside?

Pain at the front of the knee

The most likely cause of chronic pain at the front of the knee is a problem with the quads. All 4 muscles of the quadriceps turn into tendon at or around the top of the kneecap. Pain towards the top edge of the kneecap (that's the whole "arc" of the kneecap, including little way down both the inside and outside) is most likely due to an overuse issue of at least one of the quads. Stretching and deep tissue massage can help here.

Remember that the tendons of the quads join together behind the knee cap then insert onto the lower leg just below it (so that when the muscles contract they cause the kicking motion). This means that pain behind or just below the kneecap may also be due to overuse of the quadriceps. 2 techniques are particularly useful in this case: soft tissue release and muscle energy technique.

There's one other issue that can affect you just below the knee - "runner's knee" - which is caused by the kneecap rubbing against the bone of the lower leg. There might  be several causes for this including weak quads or overtight hamstrings pulling the joint out of place.

Pain at the side of the knee

If you've got chronic pain on the outside, just below where the kneecap ends, then it's most likely a problem with the ITB (Iliotibial band) which is a band of tendon-like material running down the outside of the upper leg.

To be honest, a lot of runners obsess about their ITB and mis-diagnose a tight outer hamstring (which comes into the kneecap at the outer edge of the kneecap). In the thousands of people I've treated I've only ever come across 2 whose injury was an overly tight ITB. In this case, deep tissue massage and foam rolling can help: see the previous blog post on Why I hate foam rollers.

Pain behind the knee

Chronic pain behind the knee is most likely due to overly tight muscles. There are 2 sets of muscles that cross the knee at the back:

so  the problem could be overuse of either (or both) of these sets of muscles. In some cases, if you've done huge amounts of kicking, it might be the popliteus muscle that's the trouble maker.

Again, good stretching, deep tissue massage, soft tissue release and muscle energy technique will all help here.

As ever, if you think I can help, give me a call.