What can be the major causes of the knee pain?
There are some well-known injuries the medical professions need to check up initially. These injuries usually comes after having some external impact while doing intensive training or sports.
1. Meniscus tear 2. ligament tear or sprain (e.g. ACL/PCL/MCL tear)
If you rule out these internal problems, or if the pain has increased progressively without any traumatic event, it is time to suspect MUSCLE IMBALANCE and ACCUMULATED SCAR TISSUES/ TRIGGER POINTS in the muscle group around your knee.
As a matter of fact, the most of knee pain is something to do with or directly comes from the muscle imbalance of the surrounding muscle groups of the knee. Increased scar tissues (Tight nonfunctional tissues) and trigger points (Irritated muscle knot) deactivate the proper muscle contraction, increase muscle imbalance and stress in the knee joint.
Mechanism of Knee Pain
There are 4 groups of muscles around knee joint.
1. IT (iliotibial) Band muscle group – IT band, Glutues Medius, TFL (Tensor Fascia Latae)
2. Pes Anserious muscle group/ Hip adductors
3. Hamstring muscle group
4. Quadriceps muscle group
The most common muscle imbalance results from the IT band and Gluteus medius muscle group tightness with scar tissues/ trigger points. Tight muscles does not function well due to decreased muscle activation.
Gluteus medius has a function of stabilizing your hip joint and pelvis in the single leg stance phase while running or climbing stairs. If this muscle has dysfunction, your pelvis will drop or your hip will turn inward during the movement.
Also, Quadriceps and IT Band tightness increase tension in the knee cap. Tight IT Band will pull the knee cap laterally and the patient may feel discomfort as if his/her knee cap is dislocated.
Trigger points in Quadriceps, hip adductors, pes anserious and hamstring tendon can cause pain around knee cap and knee joint.
Self Exam for Gluteus and ITB weakness/ Scar tissue
1. Step down test
Good aligntment – knee cap in the line of hip and ankle, both pelvis height is even
Slowly lower one foot and touch your heel on the ground while other leg controlling the speed. If Gluteus muscle is not working well, it will show the second picture above since Gluteus medius muscle can not hold hip and pelvis in place – knee is moving medially and/ or body is dropping the other side or the same side to compensate it.
2. Single leg bridge test
Do one leg bridge position and raise your floating leg up and down. Check both sides and feel which supporting side you feel harder to maintain the alignment. The weaker side Gluteus medius muscle is not firing well due to inactivation from scar tissues or trigger points.
How to restore the muscle balance
1. Scar tissue release
One of the misconception is to focus on strengthening without scar tissue release to improve strengthening. If you decrease the amount of scar tissues on the target muscles, strength will be restored naturally and exercise program works much more effective.
First, the medical profession should spot the key lesion (The major point which needs to be addressed) and apply proper pressure on it until feeling some release. When the release occurs, it presents with vibration, trembling, a sense of moving on the target tissues.
2. Stretching and Strengthening program
Once the key lesion was released, it should be followed by the stretching program to lengthen the tissues. After lengthening the muscles, it should be followed by the proper strengthening program to reactivate. It is recommended to repeat strengthening and stretching the target muscles to normalize tissues and improve power.