Today, let’s focus on myofascial treatment of knee pain, specifically in the front, upper area of the knee. The knee seems like a small area but when it gives us trouble it literally dogs our every step. This is the most common area that might be painful for you. Pain on the outside of the knee is often related to IT Band issues. See our article on New Trends in IT Band Pain Relief for more information on this. Pain below or behind the knee may involve other muscles. Pain on the inside or deep within the knee may also suggest degeneration within the joint. However, we should still investigate myofascial factors since trigger points and taut bands can both cause this pain and/or significantly accelerate arthritic processes.
Primary Causes of Anterior Knee Pain
This pain is most often caused by trigger points in the one of the quads – rectus femoris. This is a long muscle, running the entire length of the thigh. It is also the only one of the four quads to cross the hip; the other three attach to the femur and stop within the thigh.
Note that the trigger point for this muscle is very high up in the thigh, just below the crease of the hip. This muscle has the strongest and most direct connection to the knee cap of the quads. So, resting tension causes pain at the end point of the chain – the knee.
These issues tend to persist because the muscle does not ordinarily go through full stretch in the course of daily activities. This requires simultaneous complete flexion of the knee AND extension at the hip. It is not a common movement.
What Makes Knee Pain Worse?
You can develop myofascial dysfunction in the rectus femoris muscle from an accident or fall. However, something as simple as spending a long time with a heavy weight on the lap, such as a child for an extended event, can activate trigger points in this muscle. Try to avoid this during recovery from a trigger point in this muscle.
Problems with this muscle that causes so much knee pain can also be related to any activity that causes extended shortening of the muscle or significant overloading.
For example, sleeping at night with the hip flexed and the knee straight shortens the muscle. This can activate trigger points in it. This can also happen if the hamstrings are too tight because this can restrict maximal extension of the knee in daily activities.
Overloading can be caused by well intentioned attempts to limit the load on the back by transferring the load to the legs. Normally this is OK, but extreme flexion of the knees and hips when lifting can activate trigger points in rectus femoris.
We usually recommend avoiding deep knee bends and squats for many reasons, including activation of trigger points in this muscle. Make sure your butt doesn’t drop below your knees when squatting Consider a wall squat to reduce pressure on the knees.
How Can I Help Myself With Knee Pain?
You will definitely want to try self care as part of myofascial treatment of knee pain. For best results, you should invest in a small, hand-held roller. A rolling pin works, but rollers like the Tiger Tail are designed for this purpose and are inexpensive.
Rolling the Quads
Begin by gently rolling the entire quad, aiming to increase circulation and warm the muscles up. Gradually increase pressure. Then begin to work further up the thigh, searching for tender areas. Move more closely to the rectus femoris trigger point near the crease of the hip. When you feel you have found it, stop rolling and experiment with gently rocking and and wiggling of the roller on this area, while continuing to maintain pressure, until the pain subsides and the muscle releases.
This can be done from a kneeling posture, as pictured, but many find a sitting position is best. Although we are focused on the rectus femoris, the other quads interact signifcantly. Consider working the outside of the thigh to locate and treat trigger points here, in the vastus lateralis muscle. Tight hamstrings can also contribute. You can use the same roller to compress the hamstring trigger points, on the back of the thigh and just above the knee.
Next, we need to stretch the hamstrings. We want do this first because the recommended passive hamstring stretch flexes the hip. We’re looking to extend the hip in the rectus femoris stretch and we’re going to finish with that. In this passive stretch we are keeping both legs straight and simply raising the leg to the point that the hamstrings tighten as we rest it against the door frame for a couple of minutes, until we feel the hamstrings loosen a bit.
Stretching the Quads
Finally, we’re going to stretch the quads, especially rectus femoris. Recall that this requires that the knee be flexed AND that the hip is extended back, behind the body, as shown. If you cannot easily reach your own ankle you can use a strap or belt to assist. Some prefer to flex the knee and then extend the hip. Others extend the hip first and then flex the knee. The hip extension is what makes this different than the typical standing quad stretch.
Professional Myofascial Treatment of Knee Pain
Self-compression is the foundation of myofascial self-care. However, it is important to respect the complexity of the interaction between the knee joint, the hip and the muscles in between. Many of these are large muscles and you may need to use more pressure than in some other areas to get achieve a successful release.
If you are having similar issues, you may find that a few treatment sessions helps identify and treat root causes of your individual case. We also offer professional treatment modalities and techniques that you may find helpful.
No one wants knee pain! It can involve a significant number of muscles and other factors. Issues with the rectus femoris often occur as part of a complex of myofascial dysfunction. We can work together with you to help sort out the issues.
Click here or all us at 630-858-0000 today to make an appointment!