Lateral Knee Pain

This is going to be a relatively short, quick blog post...almost specifically for a friend of mine, who is currently experiencing the dreaded condition known as...Lateral Knee Pain.

Nearly all runners and cyclists have, at one time or another, experienced lateral knee pain.  Many times, this pain is also accompanied by some serious tenderness on the lateral most aspect of the thigh...the IT Band. This type of pain is most commonly associated with repetitive overuse, and a lack of preventative care.  

So what can we do about it?  

First of all, let's take a quick look at what could be the root cause of the pain.  Like I said, it's typically a repetitive overuse issue...but what exactly is repeatedly being over used?

There are two culprits that can play a major role here...the Vastus Lateralis (VL) and the Tensor Fascia Latae (TFL).  The VL, as shown in the pictures below, is the outermost muscle, of the quadriceps complex.  To find it on yourself, place your palm on your upper thigh, positioned right down the middle.  Run your hand downward until it is located about halfway down your thigh.  Now move your hand approximately 45-degrees outward.  Your palm is now resting on your VL.  If you are a runner or a cyclist, applying a little pressure to this area may result in some minor (or major) discomfort. 

Vastus Lateralis is the OUTER red area.

The TFL is small but mighty!  It has a number of functions.

If that is that case, you need some soft tissue work, to break up the adhesions (knots) that have formed due to repetitive stress, and something known as the cumulative injury cycle.  Adhesions in muscle tissue can cause severe pain, as well as limiting the force production capabilities of the tissue itself.  If these adhesions are not addressed, they can result in compensatory movement patterns, which can ultimately lead to varying degrees of injury.  

Injury is inversely proportional to performance...just sayin'.

The next culprit is the TFL muscle.  This little guy is located in our hip complex, and is responsible for a number of functions.  It truly is a small muscle, relatively speaking, that has it's work cut out for it...so it's no surprise to learn that it too is easily affected by repetitive stress.  The TFL is easily found by taking your hand, and acting as if you were placing it into your front pocket.  As your fingers enter your pocket, press gently on the flesh in that area.  You are now touching your TFL.  Once again, applying a moderate amount of pressure to this area, may result in a bit of discomfort.  One reason for this, is that one of the functions of the TFL is that of hip flexion.  

Is there a bit of repetitive hip flexion that occurs during either cycling or running?  You bet there is!  This is also compounded by a concept known as Adaptive Shortening.  Adaptive shortening refers to the body's response to being repeatedly, and often for long periods of time, into specific positions.  The muscles tend to take on a 'memory' of sorts, and 'adapt' to what the brain tells them is now the 'normal' position.  For example; when we sit for long periods of time, or hips remain in a flexed position.  Over time, the muscles that play a role in hip flexion, adapt and shorten to the position that has become the new-norm.  When we stand, rather than just bouncing back to their normal resting length, these muscles remain in their new, normal, shortened position...ultimately changing the position of specific joints throughout our body.  In this particular case, shortened hip flexor muscles end up pulling the pelvis out of normal alignment, which can ultimately cause low back pain, and even injury.

So...we need to take some steps to help return these shortened, over-active muscles to their normal resting length.

 To do this, you could make an appointment with you favorite Physical Therapist, or Massage Therapist to have those adhesions worked out, and your overactive muscles released via soft tissue massage...or you could simply grab your trusty self-myofascial release (SMR) tool...such as a good foam roll...and get to work on those tender spots.  If you opt for the foam roll, or other SMR tool, it is important to note that there are a few things you should keep in mind...a couple 'rules of thumb' so to speak.

The HYPERICE Vyper...a game changer is Foam Rolling!  It

First and foremost...NEVER and I repeat - NEVER roll your IT Band without first addressing the tension and over-activity within the TFL!  This is worth repeating...but you can do that yourself, and save me the keystrokes.  

Why? You ask.  I'll tell you.

The IT Band is simply a piece of minimally elastic (if any) fascia, that originates from the TFL, runs down the lateral aspect of the thigh, and inserts just below the knee joint line, onto the lower leg.  Often times, runners and cyclists have pain directly on that knobby little bone that sticks out just below the knee, on the outside of the leg.  This little bony prominence is actually the head of the fibula bone.  Repetitive knee flexion, such as that which occurs during both cycling and running, can create friction over this area, and result in some inflammation of the IT Band, and the bony surface.  Many athletes experience significant discomfort by applying minimal pressure to this area...which means something needs to be done.

First of all, we can reduce the prevalence of inflammation to the fibular head, simply be reducing the amount of tension across the IT Band.  This however, is where many make the mistake of simply rolling the IT Band with some sort of SMR device.  This will most always result in an increase of pain and inflammation, rather than a decrease.  The TFL is really the culprit here, and needs to be addressed prior to the TFL itself.  I prefer to use a tennis ball when addressing a tight TFL, but a short foam roller works well too.  

As seen in the picture below, position the tennis ball (or short foam roll) directly on the TFL.  Transfer the bulk of your weight to that side of your body.  You may have to rock forward-backward, or side to side slightly to get the right spot.  When you get it however, you will certainly know it!

Spend a little time resting on this muscle.  Take some deep breaths in and out, and try your best to relax.  The TFL will start to relax after about 20-30 seconds of constant pressure.  Once you begin to feel the release (the discomfort will start to reduce), make small circles on the ball, or rock back and forth lightly on the foam roll.  Dont go to fast, or you may cause the muscle to tense up again.  Slow controlled movements are preferred.  

Once the tension is relieved within the TFL, it is now time to work your way down the leg.  It is probably okay to go right into the IT Band now, but I prefer to start working on the VL prior to the IT Band.  The reason for this is that the VL is also attached to the IT Band along its outer-most border.  Releasing tension in the VL will also have an affect on the total tension placed across the IT Band.  

To release the tension in the VL, position your SMR device along your VL...now that you know how to find it!  Begin with the foam roll at the upper-most (proximal) region of the muscle, and slowly begin to roll your body upward, causing the foam roll to move downward along the length of the VL.  Your body should be rolled slightly toward the side you are working, to ensure direct pressure on the VL muscle.  When you find an overly tender spot - an you will - rest on that spot for 20-3- seconds, and try to get it to release...then move on to find another tight and tender spot.  These tender spots are the adhesions I mentioned earlier.  

Once you have completed this process, you can move on to the IT Band.  Understand however, that there are some who believe that it is not necessary to roll your IT Bands directly, and that doing so may cause increased discomfort...even AFTER taking care of the TFL and VL.  I will let you be the judge of what feels best for your body.  

If you choose to roll out your IT Bands, you will want to start easy.  By positioning yourself as shown above, with your opposite leg crossed over, your foot in contact with the ground, and your body resting on your forearm - you will have the ability to modulate just how much pressure you apply to the IT Band.  Follow the same procedure described for the VL.

So far, we have only discussed how tightness and over-activity of muscles ABOVE the knee, can affect the knee.  It is also important to understand that these same issues can reside BELOW the knee, and have a profound impact on knee pain/discomfort as well.  You see...any time muscle imbalances are present, the joint that is controlled by the affected muscles, is compromised.  Compromise can come in the form of altered joint mechanics which, over time, can result in degradation of other tissues such as ligaments and cartilage. 

If the techniques mentioned above do not resolve your knee pain, you should consider making an appointment with a Sports Medicine Dr. and/or a Physical Therapist, to determine the the definitive treatment to relieve the problems.  As great as these techniques and tools are for relieving a great deal of compensatory movement issues (such as pain), injury is injury, and often requires advanced level care.

The use of SMR tools and techniques, such as those mentioned here, are great for inclusion into a regular 'maintenance' program to reduce the prevalence of injury, due to repetitive stress.

Thanks for taking the time to read my rants!

Yours in Health and Performance,

John