Chronic Knee Pain, Mystery No More!

by Alexandra Papazian

Have you taken a moment to appreciate your knees lately? You may not know it but your knees are some of your body’s largest and most complex joints, meaning they’re quite important. Separating the thighs from the lower legs, they allow your body to move in all sorts of amazing ways! That being said, the knees are often underappreciated and even written off due to the common chronic mystery pain associated with them. Does that sound familiar? For many, the answer would be a regrettable and resounding yes. Fortunately, there’s good news. First, the cause of such pain is no mystery and second, a few simple stretches a day will begin to alleviate the pain and restore the knees’ proper function!

Let’s begin to debunk the mystery.

BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. / CC BY (https://creativecommons.org/licenses/by/3.0)

Take a look at this picture. As you can see, the knee joint is affected by three main muscle groups: the Quadriceps, the Hamstrings, and the Calf Muscles. Muscle tightness in any of these three areas will cause the knee to misalign in relationship to the hip, resulting in pain. Consequently, CHRONIC muscle tightness in any of these areas will result in CHRONIC pain. Seems pretty straightforward, right? Let’s delve a little bit deeper. You have a small, triangular shaped bone called the patella (also referred to as your kneecap) that is embedded in the quadriceps tendon sheath that passes over the front of the knee. Tissue continuous with the rectus femoris (the center muscle of the quadriceps group) passes over the top of the patella through the quadriceps tendon. When the rectus femoris is tight, it pulls on the patella, forcing the bone, which normally floats nicely on top of other tendons and ligaments, back into the space of the knee joint. This irritates all of the tissues underneath the patella causing that kneecap pain we’re all too well aware of.

Knowing that the quadriceps’ pull on the patella is the cause of kneecap pain, let’s see how the calves and hamstrings are involved. If the calf muscles are tight, they restrict the leg’s ability to straighten, keeping the knee joint in flexion (a bend). When the knee joint is in flexion, the quadriceps muscles are active and, thus, pulled tight. Likewise, tight hamstrings also restrict the straightening of the leg, producing the same effect on the quadriceps and patella. Now imagine having both tight calves AND tight hamstrings. That’s a lot of pain!

As I mentioned before, a few simple stretches/exercises every day will help you begin to ease out of this never-ending pain cycle: 1) Calf stretch, 2) Hamstring stretch, and 3) Kneecap Release. For both stretches, start standing with straight legs hip-width apart and outside edges of the feet pointing straight forward. For the calf stretch, place a rolled towel underneath the ball of one foot and stand with the other foot slightly behind. Slowly progress the back foot forward until it is in front. For the hamstring stretch, stand with a chair or table in front of you with your feet flat on the ground. Hinge the pelvis forward over your legs without bending at your waist or changing the alignment of the spine. For more of a challenge, place both feet on a rolled towel, heels on the ground, and repeat the stretch this way (see picture below right).

For the kneecap release, begin sitting or leaning back against a wall. Tighten your quadriceps muscles, feeling the patellae slide up your legs, then release your quadriceps and let your kneecaps fall. If you find that you cannot engage your quadriceps to lift the kneecaps, chances are your quadriceps are already engaged and the patellae are already lifted, so work on relaxing the quadriceps and releasing the patellae back down. Ideally we want our quadriceps to remain relaxed when standing, keeping the patellae floating nicely in front of the knee joints, rather than being compressed into the joints. Eventually you can progress to standing upright, fully weight-bearing.

If you work on incorporating these stretches into your daily routine, your knees will thank you!