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 (highlighted in red), and a little muscle
the size of a finger which runs across the back of the knee. The third
structure is a broad sheet of connective tissue running from the hip to the
knee, called the iliotibial band, or ITB (outlined in blue below). As a result
of sitting most of the time, the ITB tends to shorten, and the vastus
medialis tends to shut off. Together, this muscle imbalance alters the
function of popliteus, whose job is unlocking the knee after each step.
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 (highlighted in red), and a little muscle
the size of a finger which runs across the back of the knee. The third
structure is a broad sheet of connective tissue running from the hip to the
knee, called the iliotibial band, or ITB (outlined in blue below). As a result
of sitting most of the time, the ITB tends to shorten, and the vastus
medialis tends to shut off. Together, this muscle imbalance alters the
function of popliteus, whose job is unlocking the knee after each step.
| Knee pain and muscle imbalance |
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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.
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 patient. 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.
(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 patient. 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.
| Copyright Steve Baroody D.C. 2009 |