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Why knee pain sustains even after stretching the muscles?

Most of joint and muscle pain begin with poor muscle condition. Poor muscle condition decreases the activation of the muscle and it leads to muscle imbalance in the joint. Imbalanced muscle group makes abnormal force vector in the joint which results in poor joint alignment and pain in movement.

Today’s topic is knee joint.

OpenStax [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)]

Knee Pain Mechanism

1. IT Band, Quadriceps and Hamstring lateral muscle group tightness (trigger points, adhesion and scar tissues)

ITB and the adjacent Quadriceps (Vastus Lateralis) muscle are gliding each other while the knee and hip joints are moving. Once these muscles develop adhesions and trigger points, it does not glide well each other and creates the tensile force pulling the knee cap (patella bone) outwards. Also, tight IT Band and Hamstring lateral portion (Biceps Femoris) can rotate the lower leg externally (Tibia external rotation).

2. Pes Anserinus and Vastus Medius muscle group weakness

Pes Anserinus muscle group (sartorius, gracilis and semitendinosus muscles) has a function rotating tibia (lower leg) internally working as an antagonist of the 1st muscle group above. If ITB and lateral Hamstring tightness rotate tibia externally, this antagonist muscle group can be stressed and stretched while moving knee joint. It will result in poor muscle condition and weakness in this muscle group.

Medial side knee pain usually occurs in Vastus Medialis and Pes anserinus muscle with tendon area trigger point and scar tissue.

3. Externally rotated tibia or limited tibia internal rotation can cause knee joint pain

These muscle imbalance (1st muscle group tightness and 2nd muscle group weakness) limits lower leg (tibia bone) internal rotation since strong ITB and lateral hamstring tightness will pull the lower leg externally while moving the knee joint such as squatting or lunge movement. If the joint alignment is not in the correct position during movement, brain increases pain in the joint immediately.

In conclusion:

Muscle imbalance results in poor joint alignment (Externally rotated tibia) which can be a main source of knee pain while moving the joint.

Treatment Direction

  1. Releasing tight muscles, trigger points and scar tissues
  2. Restore joint alignment (Tibia-fibula on Femur)

How can we restore joint alignment?

  1. If it is not a severe case, trigger point release, massage and stretching are enough to restore joint alignment
  2. If pain still remains with movement, try movement with mobilization (Mulligan technique) – manually turning the tibia – fibula bone when patients are squatting or lunging.
  3. Ankle inversion exercise against theraband in sitting helps balancing the muscle group.
  4. Mulligan taping for tibia internal rotation has sustained effect during the day
  5. Teach the patient self stretching technique for hamstring, Quadriceps, IT Band and adductors

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