Articles

      Knee pain is one of the most common problems encountered by runners and
cyclists. Initially, most people, quite reasonably, are concerned they have injured
themselves, tearing the infamous ACL (anterior cruciate ligament) or MCL (medial
collateral ligament). Frequently, however, knee pain (particularly in runners and
cyclists) is the result of long established imbalances between certain muscle
groups. With these imbalances altering the mechanics of the lower limb,
abnormal stresses are placed on the tissues. If the body is then asked to work
harder than it is used to, inflammation and pain can result. Often, this pain can be
surprisingly severe, leading one to wonder whether something serious is going
on. Nonetheless, treatment to restore normal function to the limb, followed by
therapeutic exercise, can bring quick resolution.
   Non-surgical knee pain revolves around three structures. Two are muscles, a
portion of the quadriceps (big muscles on the front of the thigh) called the vastus
medialis, and a little muscle the size of a finger which runs across the back of the
knee. The function of vastus medialis is to extend the knee the last 15º. The third
structure is a broad sheet of connective tissue running from the hip to the knee,
called the iliotibial band (ITB). As a result of sitting most of the time, the ITB tends
to shorten, and the vastus medialis tends to weaken. Together, this muscle
imbalance alters the function of popliteus, whose job is unlocking the knee after
each step.
   Changes in these three structures can have a couple of effects. First, in a
repetitive activity like running or cycling, the now-tight ITB can become inflamed by
friction. This is usually labeled an iliotibial band syndrome. Second, the kneecap
may begin to track towards the outside of the knee, irritating the underlying
cartilage. This is usually labeled a patellofemoral pain syndrome (PFPS). In
many cases, I have seen this manifest as a severe pain directly behind the knee
that comes about a mile into a run. Third, both problems can be present (and
usually are).
So if you have these problems, what can you do about it? You may think you can
stretch your way out of it; unfortunately, the muscle imbalances usually throw off
the mechanics of the joints in the low back, pelvis, and leg. Furthermore, it is very
difficult to effectively target the tight muscles with stretching, because as they
shorten the fibers become glued together, in what are know as fascial adhesions.
         The best treatment for this is known as Active Release Technique (ART).
ART is a soft tissue diagnosis and treatment system which breaks up the
adhesions by having the patient actively lengthen the muscle, while the
practitioner uses their hands to trap the muscle in a shortened position. The
process is often somewhat uncomfortable, but the process also reinforces
normal movement patterns, neurologically re-educating the body. With the ITB
syndrome, the practitioner may decide to use ultrasound before ART treatment.
Ultrasound uses high frequency sound to soften the adhesions, allowing them to
release with less pain to the patient, and less effort for the practitioner. Finally,
chiropractic adjustments are applied to the pelvis, leg, or low back, allowing the
joints move freely within their normal range of motion. Most patients experience a
50% decrease in symptoms in 3-4 treatments. Regular exercise is also
necessary in most cases to prevent a recurrence.