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In Part 1 of "Cracking the Code of Knee Pain: Understanding the Root Causes and Relief Solutions", we discussed the anatomy of the knee, the common causes of knee pain, and the risk factors for developing knee pain.

In Part 2, you will learn how to effectively treat your knee pain at home. 

I will go over three common conditions that may cause knee pain and describe the treatment protocols for each in detail.

Please note that severe injuries associated with trauma to the knee, such as an ACL tear, severe meniscal tear, or fractured patella, require the immediate attention of an orthopedic surgeon.

Here we are talking about common knee pain, most likely created by an overuse, incorrect exercise form, and other factors described in Part 1.

So what do you do if you have knee pain? 

The same principles apply to treating acute knee pain as to treating any injury.

Below I lay out a step-by-step program on fixing your knee pain based on the Four Phases of Injury Rehab.

Phase I - In this phase, the focus is on reducing or eliminating the symptoms of pain and discomfort.

Phase II - In Phase II, the focus is on improving general mobility and flexibility to make you more resilient and able to tolerate movement without recreating the pain.

Phase III - In Phase III, the focus is on improving strength and stability to protect the injured area and improve overall support.

Phase IV - In Phase IV, you add activity to improve your overall endurance and aerobic condition.

1. Stop exercising. Remember: pain is your body’s way of telling you something wrong is happening. 

I remember evaluating a patient with calf pain who was referred by an orthopedic surgeon.

The surgeon was concerned enough to call me ahead of the patient’s first visit. He told me that she has a severe calf strain and Achilles tendinitis, and, if it is not rehabilitated properly, she might end up with a torn Achilles. 

The patient was a female in her early forties. She told me she had started running 6 months ago to “get in shape”. She was slightly overweight and not very athletic. Before starting running, she had not participated in any strenuous physical activity.

I asked how long and how often she ran. The patient told me that she ran 5 miles every day. She started running 3 miles on the first day and progressed to 5 miles after two weeks.

After running for about a month, she began having pain in her calf. Despite worsening pain, she continued to run. Finally, she decided to go to the orthopedist who prescribed an anti-inflammatory medication and referred her to physical therapy.

Her calf was swollen and tender to pressure, and her Achilles tendon was almost twice as thick as the one on the other leg. She was walking with a limp and avoided pushing off with the affected leg. 

I explained the treatment plan and told her she would have to stop running for about 3 months. She had tears in her eyes and told me that she has to keep running. Stopping was out of the question. 

She never came for the follow-up appointment. A month later the surgeon called and told me that she had a complete rupture of the Achilles tendon and had surgery to repair it. He was doubtful she would ever run again.

The moral of the story, “no pain, no gain” can be a dangerous philosophy. 

If you don’t let your injury heal completely or skip the correct rehabilitation steps, it might get much worse.

2. Ice the knee. 

3. Use E-stim to help with the pain.

4. Wrap the knee with an ACE bandage or wear a brace to provide stability, compression, and protection to the knee joint. 

5. Elevate the leg.

When can you begin exercising the knee after an injury?

When the initial pain subsides, and you feel more stiffness than pain, you can start gently working on stretching and strengthening your knee.

Let’s discuss some common conditions that cause knee pain and how you can treat knee pain at home.

Iliotibial Band (ITB) Syndrome 

ITB Syndrome occurs when the Iliotibial Band becomes irritated and inflamed due to friction, usually at the point where it attaches to the outer side of the knee.

It is common in runners but can also happen to people with weak quads and glutes, faulty foot biomechanics, or those who increase the exercise intensity too fast. 

Besides creating knee pain, a dysfunctional IT Band can cause hip and lower back pain, therefore, taking care of ITB dysfunction will go a long way toward helping you to prevent knee pain, lower back pain, and hip pain.

Two of the most effective ways to manage ITB dysfunction are 

• stretching

• foam rolling. 

As I discuss in the post Stretching Essentials: Types, Benefits, and Best Practices, active stretching is a preferred method because it allows the stretching tissue to relax while the opposing muscles are contracting to perform the stretch.

Below is an example of an IT stretch using a belt. You can use a stretching strap, a rope, or a bathrobe belt. 

ILIOTIBIAL BAND (ITB) STRETCH

Courtesy of HEP2GO

• Lay on your back.

• Loop a belt around your foot.

• Keeping the knee straight, bring your leg across the midline for a gentle stretch along your outer thigh.

• Make sure that you make the muscles on the inside of your thigh do the work before assisting with the belt. 

• Hold the stretch for 2 seconds and bring the leg back down. Repeat 10-12 times.

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  A variation on a straight leg raise exercise can also help to stretch a tight IT Band while strengthening the quadriceps muscle.

  

STRAIGHT LEG RAISE - SLR EXTERNAL ROTATION

Courtesy of HEP2GO

• While lying, raise your leg with a straight knee and your toes pointed outward.

• Hold 2 Seconds

• Repeat 10 Times

• Complete 2 Sets

• Perform 2 Time(s) a Day

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To foam roll the ITB, lie on your side with the foam roller under your hip and roll back and forth along the ITB from hip to knee.

FOAM ROLL - ILIOTIBIAL BAND - ITB 

Courtesy of HEP2GO

Patellar Tracking and ITB Dysfunction

During bending and straightening the knee, the patella bone glides on top of the joint in four directions depending on the movement. This is called “patellar tracking”.

A tight ITB can cause faulty patella “tracking” thus creating knee pain.

The muscle that helps the patella to track correctly is part of the quadriceps called the vastus medialis. Therefore, it is important to strengthen the quadriceps muscle, especially the “tear drop” muscle, vastus medialis, to counteract the tightness of the iliotibial band. 

Exercises like Straight Leg Raise and Short Arc Quad are helpful in the beginning stages of your strengthening. Then you can progress to squats, leg presses, and other weight-bearing exercises.

SHORT ARC QUAD - SAQ

Courtesy of HEP2GO

• Place a rolled-up towel or a bolster under your knee

• and slowly straighten your knee by lifting your foot.

• Hold 2 Seconds

• Repeat 10 Times

• Complete 2 Sets

• Perform 2 Times a Day

SLR: STRAIGHT LEG RAISE - SLR

Courtesy of HEP2GO

• While lying, raise your leg with a

• straight knee. Keep the opposite knee bent with

• the foot planted on the ground.

• Hold 2 Seconds

• Repeat 10 Times

• Complete 2 Sets

• Perform 2 Time(s) a Day

Strengthening exercises for the gluteal muscles can also help reduce ITB dysfunction. These can include glute bridges, clams, and lateral band walks.

BRIDGE - BRIDGING

Courtesy of HEP2GO

• While lying on your back with knees bent

• tighten your lower abdominal muscles

• squeeze your buttocks

• raise your buttocks off the floor/bed creating a "Bridge" with your body.

• Hold 2 seconds and then lower yourself

• Repeat 10-12 times

SIDELYING CLAMS

Courtesy of HEP2GO

• Lay on your side, hips directly over one another and knees bent. Place a band around your knees.

• Lift your top knee upward stretching into the resistance of the band.

• Make sure to keep your hips over one another and your feet together.

• Hold for 2 seconds and then lower knee back down.

Repeat 10 times

SIDE STEPS WITH RESISTANCE BAND

Courtesy of HEP2GO

• Start with your feet shoulder-width apart and knees slightly bent.

• Make sure that your knees do not cross over the toes.

• Your feet should be facing forward the entire exercise.

• The band should be tied around the top of the knees.

• Resist the band pulling your knees together.

• Then, take steps to the side keeping your feet apart, and do not let your knees come together as you take your steps.

• Maintain the same squat depth the entire time.

• Perform 10-15 steps in one direction and then in the other direction

How to Relieve Knee Pain Caused by a Trigger Point in the Popliteus Muscle

In Part 1 I mentioned Popliteus, a small muscle that typically gets overlooked but can create symptoms similar to a meniscal tear.

Releasing a knot (a myofascial trigger point) in this muscle can help with knee pain.

Usually, tight popliteus will cause

• difficulty straightening the knee

• pain behind the knee

• pain on the inner side of the knee

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Polygon data were generated by Database Center for Life Science (DBCLS)[2] - Polygon data are from BodyParts3D[1], CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=87827933

Locating and releasing the popliteus muscle can be done through the following steps:

1) Position yourself in a seated or lying down position with your knee joint flexed (bent) to about 90 degrees.

2) Place your fingers on the back of your knee joint, just below the crease at the back of the knee.

3) Look for a small, cord-like structure or band of muscle that runs diagonally across the back of the knee joint.

4) As you gently move your knee joint by turning your foot in or out, you may feel the popliteus muscle contract or relax beneath your fingers. It is typically located slightly to the inner side of the knee joint.

5) Find the painful spot and apply gentle but firm pressure. 

6) Hold the pressure until you feel the pain diminishing and finally going away completely. This might take one to two minutes.

Another way to release the trigger point in your popliteus is demonstrated in the photo below.

POPLITEUS TRIGGER POINT RELEASE

Courtesy of HEP2GO

Place the ball under the outside of the top calf. Alternate between resting with your leg over the ball, straightening and relaxing the knee, and ankle pumps (pointing toes down and bringing toes/ankle up towards you).

IMPORTANT: If there is swelling behind the knee, do not attempt the popliteus release. This swelling may be a condition called a Baker’s Cyst.

A Baker's cyst, also known as a popliteal cyst, is a fluid-filled sac that develops behind the knee joint. The cyst can range in size from very small to large and can cause pain, stiffness, and swelling behind the knee. The pain may worsen with activity or when standing too long, and can ease with rest. Treatment may involve addressing the underlying condition and managing symptoms with rest, ice, compression, and medication. In some cases, the cyst may need to be drained or surgically removed.

WARNING: If your lower leg is sore, swollen, discolored, and you feel feverish, this might be a sign of Deep Venous Thrombosis (DVT). Please see a healthcare practitioner as soon as possible!

SYMPTOMS OF DVT MAY INCLUDE:

• Swelling of the affected leg, particularly in the calf

• Pain or tenderness in the calf that feels like a cramp or soreness

• Warmth and redness in the affected area of the calf

• Pain when squeezing the calf while pointing the toes up

• Skin discoloration, such as red, blue, or purple

• Increased pain when standing or walking

DVT is a life-threatening condition. SEE A DOCTOR IMMEDIATELY!

Patellar Tendinitis (the Jumper’s knee)

 The main indicators of patellar tendonitis include:

• Pain below the kneecap during activities like jumping, running, or squatting

• Discomfort or pain with pressure to the tendon, like kneeling or touching the area

• Stiffness and aching after physical activity

• Knee Stiffness in the morning

• You may notice that the patellar tendon of the affected knee is getting thicker

Again, beware of the “no pain, no gain” attitude when you suffer from patellar tendinitis. It's crucial to completely rest from any activities that cause pain to give the tendon time to heal. Continuing to stress the tendon interrupts the healing process, leading to further injury and prolonging healing time. It may take up to 3 months before returning to your usual exercise routine after patellar tendinitis.

Progression 

1. Use an Ice Pack or Ice Massage. You can use a bag of frozen peas as a substitute for an ice pack. Or you can choose a commercial cold pack.

2. Use E-stim. TENS will help to alleviate the symptoms faster. Combine TENS with a cold pack.

3. Avoid activities and exercises that stress the patellar tendon: squats, jumps, bicycling, running

4. Positioning – supine with a pillow under the knee to maintain a slight flexion

5. Exercises: Start with isometrics – 

a. While sitting, place a Resistance band around the lower leg and secure it by stepping on it with your unaffected leg. 

b. Extend the leg about 45 degrees, hold the contraction for 15 seconds; progress to about 45 seconds. Start with pain-free effort, usually about 30% of maximal effort. Progress to about 70% of maximal effort.

c. Progress to mini wall squats isometric holds – Stand with your back against the wall and bend your knees to a pain-free position with your thighs above parallel. Hold this position for 15 seconds. Progress to 30 seconds. 

MINI WALL SQUATS 

Courtesy of HEP2GO

d. Progress to more advanced exercises to strengthen your quads, hamstrings, and glutes. Stick to closed chain exercises like squats, lunges, and leg presses.

e. Use E-stim to assist in rebuilding strength in your quads. Refer to my post "Beyond Pain Relief: Unlocking the Power of Electrical Stimulation for Muscle Strength and Performance" to find out more about using E-stim for muscle strengthening.

Ice Massage for Patellar Tendinitis

Ice massage over the patellar tendon is an effective method to reduce inflammation.

ICE MASSAGE

Courtesy of HEP2GO

• To make an ice cup, fill a small paper cup with

water about two-thirds full, and freeze it until it

is solid.

• To use the ice cup, peel off the top of the cup

so about 0.5 in. of ice is showing. The

the remaining part of the cup is for you to hold on

to.

• As the ice melts, it will drip, so put a small

towel under the area you are icing.

• Rub the ice in small circles all over the

affected area.

• Continue for 3 to 5 minutes. The area will feel

cold at first, then it may burn, then ache, then

finally, become numb. Your skin will be pink and

cold when you finish.

• You can do an ice massage several times a

day.

Wearing a knee strap can be effective in reducing symptoms of patellar tendinitis.

Additional Exercises

PRONE HIP EXTENSION

Courtesy of HEP2GO

• While lying face down with your knee straight

• slowly raise your leg off the ground.

• Hold for 1-2 Seconds

• Repeat 10 Times

• Complete 1-2 Sets

• Perform 2 Times a Day

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HIP ABDUCTION - SIDE LYING

Courtesy of HEP2GO

• While lying on your side

• Slowly raise your top leg to the side

• Keep your knee straight and maintain your toes pointed toward you the entire time

• The bottom leg can be bent to stabilize your body.

• Hold for 1-2 Seconds

• Repeat 10 Times

• Complete 1-2 Sets

• Perform 2 Times a Day

HIP ADDUCTION - SIDE LYING

• While lying on your side

• Slowly raise up your bottom leg towards the ceiling

• Keep your knee straight the entire time

• Your top leg should be bent at the knee and your foot planted on the ground supporting your body

• Hold for 1-2 Seconds

• Repeat 10 Times

• Complete 1-2 Sets

• Perform 2 Times a Day

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When Should You See A Doctor?

While most cases of knee pain will settle down with simple treatment, some symptoms of knee pain require immediate medical attention. These include:

1. Severe pain, swelling, and redness that occurs suddenly, especially after an injury

2. Inability to bear weight on the knee

3. A popping or snapping sound at the time of injury, followed by immediate pain and difficulty moving the knee

4. Visible deformity or unusual shape of the knee joint

5. Numbness or tingling in the knee or leg

6. Fever or signs of infection, such as warmth, redness, fever and chills, and drainage or fluid buildup in the knee joint

7. Significant loss of motion in the knee joint, or the feeling that the knee is locking or catching

8. Pain that persists for more than a few days or that is accompanied by other symptoms such as swelling, stiffness, or difficulty walking.

If you experience any of these symptoms, it is important to seek medical attention as soon as possible to determine the cause of your knee pain and prevent further damage or complications.

 Disclaimer

Although we strive to provide the most accurate information possible, please note that all of the content found on ReliefSolutions4you.com, including text, audio, video, and/or other formats are provided for informational purposes only. The content on ReliefSolutions4you.com is not a substitute for professional medical treatment, advice, and/or diagnosis. Always seek out the advice of a physician or other qualified health provider when seeking information for a medical condition or before engaging in physical training. The information on ReliefSolutions4you.com is not to be taken as medical advice. Always consult with your physician when starting a new physical training regimen and/or diet.