Knee pain – Why do My Knees Hurt? – An Overview of Knee Pain

by | Jan 16, 2018 | Healthy Lifestyle, Strength and Conditioning

Here’s an overview of some of the many causes of knee pain you can experience. During my previous career as a professional sportsman I unfortunately had to deal with knee pain and injuries, so I understand first hand how frustrating they can be.

It can also be very challenging to self diagnose knee pain due to the many factors that can influence knee function and pain.

First Let’s get the basic anatomy in check

 You could break the knee anatomy into the following:

  • Four bones meet to form your knee joint namely your thighbone or “femur” shinbone “tibia” the bone on the outside of your lower leg “fibula” , and of course your kneecap or the “patella”.
  • Articular cartilage.The ends of the femur and tibia, and the back of the patella are covered with articular cartilage. Articular cartilage is slippery and helps your knee bones glide smoothly across each other as you bend or straighten your leg.
  • Two wedge-shaped “shock absorbers” between your femur and tibia. More rubbery than articular cartilage.
  • Bones are connected to other bones by ligaments.
  • Muscles are connected to bones by tendons.

N.B. The “ligament” arrow on the right hand side is intended to point to the insertion behind the patella tendon (This is the best and clearest diagram I could find without it having too much detail)

If we can establish where your knee pain is and what movements bring on the pain or discomfort; a bit of further testing can reveal what we need to do to in your strength program to readdress any imbalance or weakness.

 Do you need a strength coach or a physio?

 With most knee injuries a good strength coach will be money well spent. However if you have any of the symptoms below it’s likely too early for one of us and you would be better off seeing a physio who may advise either a scan or some rehab with one of our team.

 Do you:

  • Hear a popping noise and feel your knee give out
  • Have severe pain
  • Struggle to move the knee
  • Have a limp
  • Have swelling at the injury site

 

If you have any of the above we would first refer you to a physio.

Here’s the aspects that a good rehab coach or strength coach at Storm can help with.

Reduced range of motion

A reduction in your range of motion usually has two main culprits. Tight fascia and or Tight muscles.

Your Fascia is a continuous “spider-web-like” connective tissue that runs from the base of your foot to the top of your head. You have three layers of fascia that start just under the fat beneath your skin and some of the deeper fascia actually runs deep enough to run through the joints themselves.

Tight Muscles. For the purpose of this article (which is intended to give you an overview of what may be causing you discomfort at your knee) I am going to break this up into three categories:

  1. Increased nociceptor activity – Your nociceptors are a type of receptor found in the skin as well as many other deeper tissues that provide information on dangerous or potentially dangerous stimuli in your environment and form a continuous feedback loop with the brain.

In my view and in the view of many other professional I’m in contact with; this is something of a master regulator when it comes to the experience of “tightness” and is common with people who have a stressful lifestyle.

  1. Metabolic damage- This is when you have broken down muscle tissue through exercise and it has yet to recover. If this is short term damage from a tough training session it is unlikely to negatively effect movement however if you have had a long period of intense training without adequate rest it can definitely impact your movement negatively particularly in eccentric control for example in the lowering of a back squat.

Soft tissue work like deep tissue massage, myofascial release and foam rolling can all be effective here although in my opinion (through reading the literature on the topic) this appears to be more likely due to increasing your ability to cope with the pain which in turn reduces nociceptor activity.

  1. Shortened muscle tissue

 

Rarer than you might think, the typical culprits for this in my experience are:

  • The adductor magnus (the muscle along the inside of the leg) The muscle right next to the inside of your knee cap (your vastus medialis oblique or VMO for short) some of the muscle fibres of which shares the same insertion site as the adductor magnus and when the adductor magnus is tight it can have a knock on effect of pulling the VMO into a stretched position.
  • Tight hamstrings. The hamstrings insert, among other areas into the fibula (the small bone beneath the knee) and a few fibres also insert into the popliteus a muscle just behind the knee which interacts directly with the interior capsule of the knee. Not only can tight hamstrings prevent knee extensions but can also pull on the popliteus which can also prevent proper knee extension and pull on structures within the knee like the meniscus.
  • Tight quads. All of the quads can contribute to knee pain if tight although the VMO, vastus lateralis and vastus intermedius are the common culprits. The VMO and Vastus lateralis if tight will often cause pain along the inside or outside of the knee respectively and  tightness in the vastus intermedius will commonly cause pain below the knee cap.

 

Muscle imbalance or weakness

Under-active quads and Inactive VMO

One of the most common imbalances at the knee is an overly dominant vastus lateralis and an under-active VMO. This is often accompanied by tight fascia along the outside of the knee. If this imbalance is present you may often feel a clicking or cracking on the outside of the knee particularly when walking upstairs.

 

Another common reason for a weak VMO (and actually a common reason for inactive quads in general) is fluid in the knee. Just 10ml of fluid in the knee, which is the equivalent of a teaspoon can inhibit the quads from functioning correctly.

 

If that wasn’t enough, according to Professor and Principal Research Fellow at University of Queensland even the “fear of knee pain decreases quadriceps function”.

So the cycle goes bad quadriceps function- Knee pain occurs- quads function decreases further- knee pain increases again.

Now how is that fair?

 

Inactive hip rotators in the glutes

 One of the functions of the external hip rotators (obtruator, gemmelus and piriformas) is to prevent the knee from “dropping in” when running, jumping and squatting.

If the external hip rotators are weak or lack the endurance to maintain proper function the knees can often drop in and you will experience pain along the medial joint line (the inside of the knee)

If your external hip rotators are weak, clamshell exercises (like that pictured here) and lateral band walks are good way to activate your hip rotators and alleviate most medial knee pain.

So now you have read my overview of knee pain (most of which I have experienced at some time or another) It’s over to you, if you’d like to get to the bottom of niggling knee pain get in touch using the form below.

We work closely with a team of physios so we can take you from early stage rehab of in the most serious knee injuries right back to full strength!

Good luck with your knee rehab and if I can pass one last insight onto you from my experience; successful knee rehab is the culmination of consistant effort and balancing developing range of movement, strength, stability and providing enough recovery to prevent inflammation from negating your efforts in the above.

 

Spence

 

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