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Knee Pain, A Survival Guide
Movement helps, if not solves, most musculoskeletal issues and the knee is no different with respect to this axiom. If we also consider that it sits between the ankle and the hip, a strong knee capable of moving throughout its full range of motion seems necessary for the health of both of those joints. A telltale sign that your knee is not able to move through its full range of motion is the presence of a painful condition called patellofemoral pain syndrome. This stubborn injury is responsible for almost 30 percent of all knee pain across all age groups. Treating this injury early and moving the knee purposefully throughout its full range of motion can save your summer sports season.
The knee is a hinge that bends one direction, then straightens. However, the knee is actually two joints. First, we have the interaction between the femur (the big bone of the thigh) and the tibia (the big bone of the lower leg). This part of the joint gets all of the attention as it houses the meniscus, the ACL, PCL and a host of other structural components. When there is a major “blow-out” of the knee, it is generally one or more of these structural components that is involved. However, most knee pain involves the other, less glamorous part of the knee. This is the interaction of the patella (knee cap) and the end of the femur. Every time we bend our knee, the patella slides down a bit. The more you bend your knee, the further it slides down the femur, eventually sliding down and partially around the end of the femur when the knee is fully bent. The patella slides up and down the femur in a groove. If it stays in that groove, everything is just fine. However, if it moves just a bit outside of the groove, the pain can become debilitating. Most knee pain that I see clinically is in the patellofemoral interaction.
When the patella begins to move outside of its groove, the surrounding tissue becomes inflamed, causing pain. This is called patellofemoral pain syndrome. While structurally it is not a dramatic injury, there can be a lot of pain associated with it, and consequently it can sideline you. The quadriceps muscle group at the front of the thigh ends in a tendon that envelopes the knee cap and inserts below the knee on the shin. Its role at this end is to control the bend of the knee, and as such, the position of the knee cap. Because of its tendon and function, the quadriceps is quite often, but not always, the culprit with dysfunctional movement of the patella. The quads are then the logical place to begin when treating and preventing this painful and stubborn condition.
If the quadriceps muscle group is tight or holding excessive tension, it will cause the patella to track a bit off center, out of its groove. If you are experiencing knee pain, begin by improving the mobility of this muscle group. Once you feel knee pain, stretching this muscle is often too painful and not an option. It can be more effective to begin with relieving the tension in the muscle by foam-rolling your quad. Begin by placing the foam roller on the ground. Lay on top of the foam roller, positioning it on the front of your thighs. Begin rolling up and down seeking out any areas that are particularly sensitive. Once you find a sensitive area, keep your weight centered over that area and repeatedly bend and straighten your knee for 10-20 seconds. Then, move on to the next area. Once the sensitivity of the knee starts to subside, in 2-3 weeks generally, begin to stretch the quadriceps muscle group after you foam roll. Both the foam rolling and the stretching can and should be done on a daily basis thereafter. Should you also suffer from arthritis, torn meniscus, torn ACL, etc., foam-rolling will benefit these injuries as it improves the quality of movement of the knee.
Preventing patellofemoral pain involves strengthening the knee throughout its entire range of motion. While I never recommend just one exercise when strengthening around a joint, the lunge is a great place to start. However, the lunge should only be performed if you are pain-free, as it will exacerbate a patellofemoral joint that has yet to heal. Begin by standing with your feet together. Step backward a couple feet with your right foot, keeping most of your weight biased on your left foot. Now bend both knees dropping your right knee toward the ground and pushing your left knee forward beyond your toes. Yes, beyond your toes. Continue dropping your right knee until it is an inch or so from the ground, and driving your left knee as far forward as your ankle will allow it to go. When returning to a standing position, keep your weight biased on your left leg driving your force through the balls of your feet. Try this for 30 seconds, then switch legs. Accumulate a couple minutes per leg on a daily basis. A quick note about why you should let your knees go past your toes while lunging. If you lie on your back, bend your knee and pull it up to your chest, you have just expressed the full range of motion of this joint, and yes your knee is past your toes. There is no reason that you cannot express that same knee range of motion while standing. If it were dangerous or bad for your knees to move out past your toes, your body would not have that range of motion available to it. Furthermore, I would argue that to have a functional and healthy joint, you need to strengthen throughout the full range of the joint. If you perform this lunge and your knees are sore the next day, you need to give the joint more time to heal.
While this was not an exhaustive examination of the cause of knee pain or causes of patellofemoral pain syndrome, the information above is a good start.