5 tips to help eliminate knee pain

by Trevor Aung Than on August 30, 2012

In my practice in the last few weeks I’ve seen, for some reason or another, an increasing incidence of people complaining of knee pain. This has been in a wide spread of the population – girl, boy, old, young, active, sedentary. In my opinion, in the absence of any specific mechanism of injury, 90% of these cases are reasonably easy to fix and are a case of releasing tight structures which can influence hip and kneecap position. In today’s post I will outline 5 tips you can follow to help alleviate any irritating knee niggle you may have.

1. Release the lateral line

Most of the people I see with knee pain benefit from releasing the Lateral Line (LL). The LL is a single myofascial continuity from the lateral arch of the foot, running up the side of the leg to the iliac crest (the side ‘lip’ of the hip), continuing up the lateral ribcage and ending up at the base of the skull.

Most people will know of the ITB, or iliotibial band, which is the band of fascia running from lateral knee up to the iliac crest. We physio’s love to test the length of it, invariably for most people it is tight, and many a patient has felt the brunt of an elbow or thumb along the ITB and possibly seen their life flash before their eyes – the pain is often that intense!

But for many, their treatment of knee pain from a ‘tight’ ITB actually ends there. An important piece of the puzzle remains – what about the other 50%+ of the LL? If there is a tight link along the train that is not addressed, their knee pain and ITB will most likely remain an issue. It’s akin to plugging a single leak in a hose with many leaks or damming a stream that still overflows. If the fascial structures up the chain (i.e. areas around gluteus medius, tensor fascia lata at the lateral hip) or down the chain (i.e. the peroneals/fibulari muscles along the lateral shin) remain tight and stuck, their knee pain will only return sooner rather than later.

We need to understand that the whole LL can contribute to knee pain and look at the body in a larger context. Now releasing any part of this train is up to the individual and your/their paradigm. Any type of soft/deep tissue bodywork, myofascial release, acupuncture, SMR with a foam roll, banging it with a rolling pin, dynamic stretches, yoga..etc, etc. The triangle pose or trikonasana in yoga is a good stretch for the LL. It doesn’t matter as long as it is releasing the area effectively.

2. Strengthen the lateral hip muscles

It goes without saying that if the lateral hip muscles (gluteus medius and gluteus minimus) are weak, every step you take places excess strain on the knee joint. This is because these lateral hip muscles are pelvic stabilisers – if they are not stabilising the pelvis laterally over the knee and foot, it creates tension through the lateral line and pulls via the knee (not to mention other structures in the lateral line).

Here are two exercises that will help with strengthening the lateral gluts, and they have the added bonus of stretching out the lateral line (sorry, my embed code is not working today…IT help anyone??)

ViPR lateral pivot lunge

Wallbangers

3. Mobilize the entire hip complex

Again, having good extensibility at the hip complex is crucial to good knee health. This is both for the lateral line, which we discussed in Point 1, and also the Anterior Front Line of the body. Often, sedentary people that tend to sit behind an office desk for most of the day complain of feeling stiff or pain in the knee after getting up from their chair. Having good extensibility in the anterior hip will also help create space in the hip and generally help knee health.

The man himself, Ian O’Dwyer, taking us through an anterior hip mobilizer here -

Anterior Hip Mobilizer

4. Go barefoot

If we look at the most distal (lowest) end of the Lateral Line, it’s origin can be found at the base of the 1st metatarsal which is also known as the big toe. This is via the fibularis (peroneus) longus muscle insertion. So if we remember that the Lateral Line is one continuous cord or train of fascia and if it is tight, you can imagine pulling on this cord will also flatten out the arch in the feet. A lot of people that have flattened arches or tend to overpronate also have tightness somewhere in their Lateral Line.

I encourage people I teach and train to go barefoot as it means their feet have to act as ‘feet’ again. Wearing a super-supportive shoe, in my opinion, does nothing for the muscles, fascia and tissue of the foot – it just encourages them to be weak. But the types of movements are important when you are barefoot training. Going for a run barefoot when you’ve been running for the past 10 years in shoes is obviously not the smartest thing to do. Getting the foot to act like a foot again is all about sustainability – making sure you sustain your training or reconditioning regime without getting an injury.

In the link below, Michol Dalcourt, talks about barefoot running and sustainability.  He summarizes hip and foot mechanics quite succinctly, worth watching.

Barefoot Running

5. Get flexible ankles

This ties in with number 4 above. A loss of ankle mobility is quite common as we get older or after injury i.e. ankle sprains. If the ankle cannot afford the mobility we require when we run, jump, dance, etc then that movement is going to need to come from somewhere else. Usually this movement will come from the most adjacent joint so the knee unfortunately gets the raw end of the deal here.

A good way to measure or increase ankle flexibility is with a knee-to-wall exercise. See the video below.

Ankle knee-to-wall

You can get your baseline by measuring the distance of your big toe to the wall at your end range of motion (i.e. before your heel comes off the ground). Check to see if your right and left ankles are equal – they are often not. Doing this exercise as a warm-up drill before activity can be very helpful for increasing ankle mobility.

So next time you experience knee pain check some of the pointers above and you’ll be on your way to finding out where your knee pain is coming from.  The knee pain is most likely a symptom of another issue your body is experiencing. And you’re probably wondering…what, no VMo (medial quadriceps) exercises??; no patellofemoral taping??  In my opinion, you’ve probably tried those already…and where did they get you?  Again, they are just a part of the bigger picture.

{ 5 comments… read them below or add one }

Xin September 1, 2012 at 10:18 am

Interesting videos! The one one barefoot midfoot running is intriguing. I wonder though, why wouldn’t you use the forefoot like in this video?
http://www.youtube.com/watch?v=2OE1OPzBc04

Looking forward to releasing some tension in my lateral line next time I come for a class! Great to see how many of the exercises we do are based on solid research.

Reply

Trevor Aung Than September 9, 2012 at 7:52 am

Hi Xin,

Sorry for the tardy reply! I think for most people, the transition from rearfoot running to midfoot running is enough of a paradigm shift and the transition needs to be a slower one. In my mind, a forefoot running style is even more of a shift so this transition would be more difficult to make. I also think the nomenclature can get confusing: what people are often calling ‘forefoot’ running is in fact what we should term midfoot running.

Hope this helps!
Trev

Reply

Mark October 11, 2012 at 7:13 pm

Hi Trevor,

Very simple and informative information! I was wondering what were the main glute medius exercises you find most effective, and their respective progressions.

Thanks!

Reply

Trevor Aung Than October 16, 2012 at 10:20 pm

Hi Mark
Thanks for reading. I’ve PM’d you.

Cheers
Trev

Reply

Hwida November 30, 2013 at 2:38 am

wow good article I like it and enjoy reading it seriously, the information you put her is so phenominal and helping.

thank you sir for this great article.

Reply

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