Knee Pain: The Do's and Don'ts

Knee pain is one of those conditions that often makes physiotherapists roll their eyes in despair because it often either won't go away or keeps recurring.

Here's a typical conventional therapy programme for knee pain:

• Strengthen the quads - wall sits, squats, lunges etc.
• Mobilise the hip joint
• Stretch or release 'tight' muscles around the hip eg. TFL, adductors
• Release the IT band with a foam roller or deep tissue massage

And this is why many cases of knee pain don't go away or continue to niggle, until the patient is diagnosed with good old "wear and tear" or "arthritis", and told they have to live with it.

So what to do instead? This may surprise you....

• Explore and rebalance the feet
• Explore and rebalance the pelvis
• Explore and restore control to the waist muscles

Read on to learn why conventional treatment protocols often fail to deal with knees satisfactorily, and how my approach tackles the common root drivers of knee pain for long-term relief.

To get a better understanding of the knee joint, and what might affect it, let's have a look at the anatomy of the pelvis and leg:

From this picture, you can see the pelvis (pubis and ischium) sits on the hip joint, which is the junction between the acetabulum of the pelvis and the head (top) of the femur (thigh bone).

The knee joint is where the bottom of the thigh bone (femur) meets the top of the shin bone (tibia).

What's at the bottom of the leg? The ankle and foot.

So you can start to appreciate that the knee is the middle man between the pelvis / hip above and ankle / foot below.

Unless you've had a traumatic incident that caused your knee injury, say a skiing fall, car accident or football tackle, many cases of knee pain don't seem to have a single, definite cause.

Many people tell me that their pain either started as a twinge and gradually got worse, or their knee started hurting one day but they can't think of a specific reason why.

It's these cases of non-traumatic knee pain that are often the most stubborn and persistent.

From the anatomy of the leg can you now see why?

Conventional treatments target the knee via strengthening the quads, stretching 'tight' muscles like TFL (tensor fascia latae) and adductors (inner thigh muscles), mobilising the hip joint and releasing the IT band.

This thinking is flawed, because it doesn't address the influence the pelvis and feet have on the body.

In other words, you're tackling things in the wrong order.

Before we look at the muscles, we need to explore what the pelvis and feet are doing. If these aren't balanced, of course your muscles will misbehave and signal tense / tight / weak / sore or whatever sensation labels you want to use.

Let's look at a common example of how imbalances in your feet and pelvis can lead the rest of your body astray and contribute to persistent knee pain:

Foot turns out, Inside knee pain

Imagine you have one foot that turns out ie. the toes point away from the midline of your body. Your may also have a flat inside arch and an ankle that rolls inwards.

This conformation shifts your bodyweight onto the inside surface of the knee joint. You may feel pressure, possibly pain, on the inside of the joint, and the muscles on the outside of the leg and hip may feel 'tight' or 'tense'.

This is your classic ITBS (IT Band Syndrome).

Conventional treatment might include mobilising the hip, releasing TFL and the IT band. I still hear of practitioners prescribing foam rolling or deep tissue massage for the IT band.

If the IT band is the main focus of the treatment plan, it won't work because the IT band isn't a tissue that can be stretched / released / manipulated. It's a fibrous connective tissue that essentially merges with the thigh bone as it runs down the outside of your leg. The reason why deep tissue massages or foam rolling of the IT band (also known as stripping the IT band) is so painful is because you're basically bruising the bone!

Yes, TFL is one of the muscles which can directly influence tension on the IT band - the other is Gluteus medius (the side glutes around the outside of the hip). 

My question before tackling TFL with a massage ball would be "WHY is TFL signalling 'tight?".

My approach:

• Explore the foot - redirect both feet to be parallel to each other, pointing in the same direction and hip width; adjust the inner arch of the foot until there's no pressure on the inside of the ankles, knees or hips
• Explore the pelvis - Arch & Flatten variations to release tension from the front and back of the body; Side Bend variations to level the right and left sides of the pelvis; Back Bend and washrag variations to restore efficient patterns of walking. 

I'd then ask you to re-evaluate your knees, and whether your comfort is improving.

There are other exercises we can do to further establish the connection between the foot, knee, hip and pelvis in standing.

I hope this article has given you food for thought, and encouraged you to consider movement in a new way. 

By moving away from the old "diagnose and fix symptoms" approach, it's easier to zoom out and consider the body as a whole, integrating with the brain and nervous system, to create movement patterns like walking, running etc.

If you're struggling with a persistent pain or recurring injury, and feel confused about what to do, I'm opening my diary for free 15 mins clarity calls. During these calls I'll offer my expert insights so you have a clearer path forwards to recovery.

If you're ready to take action to restore pain-free movement to your body, check out the next steps below......

NEXT STEPS

• Indicate your interest in a 15 mins clarity call, on Zoom where I'll offer insights and tips for a pain or injury you're struggling with, so you have a clear path to recovery. Complete the interest form HERE
• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method for pain relief.
• Come to a pop-up class - a different theme each month, open to everyone, run at a peaceful retreat venue, small group. See the class schedule HERE
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

If you would like help with managing pain or a particular injury please reach out to me on any of these channels:

• Email at norma@unicornhealthandfitness.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.