Common Causes for Knee Pain

Let me start by saying I’ve been there. About 3 years ago I was working out and felt this crazy squishy sensation in my left knee. I was doing front rack lunges with a barbell at the time. I stepped forward with my left leg, planted my foot and went to press out of the bottom position when it happened. The next day my knee was sore, swollen and creaky. I iced and rested for a few days with it not changing a whole lot. After consulting with friends in my profession we determined I strained my ACL. Needless to say my knee was no good for about 8 weeks which really took me out of my regular training program. I was really frustrated. I’d never had knee issues, ever, even with playing college football.

I have to admit, I was worried that I may be stuck with a “broken” knee the rest of my life, or needing to have surgery.  After dealing with the mental anguish of being injured I decided to just do what I know how to do to help knee injuries: I exercised.  I followed my own advice and within several weeks my knee was feeling pretty darn good again. I was squatting and jumping and running without pain. I still experienced some light swelling from time to time, however, that eventually went away. And now, I don’t remember the last time I even thought about my knee being injured.

While not every knee injury can fully recover, the vast majority of non-traumatic knee pain induced by exercise has route to recovery. In fact, in my experience, much of the knee pain that adult athletes experience isn’t really a knee problem at all.  In some cases knee pain can result from mechanical dysfunctions above the knee in the hip or low back, or below the knee in the ankle or foot. The key to getting rid of the knee pain is to understand the cause.  So let’s take a look at a couple of common dysfunctions that can cause knee pain.

IT Band Syndrome

On the outside of the hip and running down the outside of the leg is a thick band of fascia called the iliotibial band. Its primary job is to provide stability to the hip joint during movement of the leg. It basically helps move your leg backwards, away from your other leg and turning your hip/foot out. If you think about shuffling from side to side, you would be focused on using your IT band. The secondary job, and the important one here, is it provides stabilization for the knee joint. The IT band actually crosses the knee joint and attaches on the outside of the bigger lower leg bone, the tibia.  If you are exercising at all, you are using the IT Band. Movements like squats, lunges, running and jumping, and activities like plyometrics all put a significant amount of strain on the IT band.

A classic example of knee pain related to IT Band Syndrome is the “new exerciser”.  This is the guy or gal that has decided it’s time to get moving so they decide to jump right in to some kind of activity.  The usual approach is taking up running or joining a new fitness program, like CrossFit or Body Pump. The increased demands on the IT Band result in restrictions and myofascial trigger points in the muscle and fascia of the IT Band. Within a few days or weeks of the increased activity, the IT band becomes inflamed and painful. Inevitably, the exerciser begins to feel a slight “click” on the outside of the knee which soon becomes painful. Granted, there are other presentations of IT Band Syndrome, but this is by far most common.

If this sound like something you experience, I’ve got a few simple tips to help relieve the pain.

  • Foam Rolling:  Try using a foam roller on the outside of the thigh on the leg with knee pain. Roll around and find the painful trigger points. Spend 5-7 minutes rolling out. More is not better as too much rolling can have a negative effect. Be sure to roll out prior to and after exercise for maximum benefit.
  • Warm Up Better: Spend a minimum of 10 minutes going through a dynamic warm up. Include movements like walking lunges, inside and outside heel taps, lateral lunges and the greatest stretch. You can check out our Youtube page for an example of a dynamic warm up.
  • Treatment: Generally speaking, if it doesn’t improve significantly with 2 weeks of self care, get it checked out. A mechanical dysfunction in the sacroiliac joint can lead to chronic strain on the IT band that can’t be released without aligning the pelvis. In this case you may also be noticing some buttock discomfort or low back discomfort on the opposite side of the knee pain.

Patellofemoral Syndrome

On the front side of your leg is a large group of muscles called the quadriceps. These muscles are primarily for extending the lower leg forward. Think about kicking a ball or when running pulling your leg forward and you understand what this muscle group does. At the end of the quadriceps muscle group is the quadriceps tendon. This is where you will find the knee cap and the tendon’s attachment point below the knee joint on the lower leg bone.

When the quadriceps muscles get tight and dysfunctional it causes increased pressure on the knee cap.  As the knee cap is pulled tight to the knee joint during movement like walking, running, climbing stairs, doing lunges or squats it causes inflammation on the under side of the knee cap. Continued use of the leg for these activities repeatedly stresses the quad muscles and irritate the knee cap. The result is intermittent pain in the knee, specifically under the knee cap, and generally with activity.  As the condition worsens you can begin to experience knee pain when getting up from sitting, climbing stairs and eventually with prolonged walking.

The general recommendation for patellofemoral syndrome is rest. I’m not a big fan of rest as it makes it too easy for a person to fall out of routing with their exercise habits. Instead of complete rest, here is my general recommendation for home care for this common problem:

  • Decrease intensity of exercises that involve the leg. Exercise to tolerance is the key. If 15 squats cause pain, but 10 doesn’t, do 10. If you can run 2 miles pain free but any longer duration causes pain, keep it to 2 miles.  After activity, ice the knee for 15-20 min.
  • Spend 10-15 min 2 times each day using your foam roll on the quadriceps. Focus on the sore spots specifically, working them until they diminish in intensity.
  • Perform static stretches for the quadriceps at least 3 times daily. You can find good stretches on YouTube by searching “quad stretches”.
  • Add glute and hamstring strengthening exercises to your workout routine. In many cases the quad becomes dysfunctional because it is a dominant muscle due to weakness in the posterior chain muscle groups.
  • Perform a quality dynamic warm up for 10-15 minutes prior to exercise. Again, visit our YouTube page for a specific example.

Don’t let knee pain slow you down or keep you from your regular exercise programs.  If these simple suggestions don’t do the trick, I recommend seeking a consult with your chiropractor or physical therapist.  If you’re in my area, I’d love to take you through a Functional Movement Evaluation to help get you back to and keep you at your highest performing levels.

Dr. Michael Powell

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