A Massage Therapist's Complete Guide To Treating Knee Pain

I have made an entire YouTube music channel that you can check out and use it in your spa/clinic with your clients, or for yourself at home, meditating, or in the car. Anywhere!

Let's first find out where they are having knee pain to get an understanding of what maybe causing it.

Front knee pain is very common. It could be dull or sharp. Here are the 5 most common causes of front knee pain that accounts for pretty much 80% of knee pain that you will see in the clinic.

• Patellofemoral pain syndrome (runners knee)

This is the most common cause of front knee pain which is a problem with the patella not gliding properly in the patella groove. Although it is called runners knee it can happen to non-runners commonly as well.

2. Patellar tendonitis (Jumpers knee)

Jumper's knee, also known as patellar tendonitis, is a condition characterized by inflammation of your patellar tendon classically, hence the 'itis'. However, studies have shown that there is very little inflammation in many cases so it is more likely to be degeneration from wear and tear to the tendon. This is known as tendinosis. This is why ibuprofen and other anti-inflammatories may have no effect.

3. Chondromalacia patella

This is a common knee problem caused by a softening and damage to the cartilage on the back of the patella. The kneecap rubs against the edge of the patella groove. Abnormal knee cap positioning, tightness or weakness of the muscles associated with the knee, too much activity involving the knee, and flat feet may increase the likelihood of chondromalacia patella. Often affects young healthy people.

4. Prepatellar bursitis (housemaids knee)

Caused by inflammation of the bursa generally from frequent or prolonged kneeling. Bursitis means inflammation within a bursa. A bursa is a small sac of fluid with a thin lining. There are a number of bursae in the body. Bursae are normally found around joints and in places where ligaments and tendons pass over bones. They can also be found in other places if there has been unusual pressure or friction placed on that area.

Generally, the function of a bursa is to help reduce friction and allow maximal range of motion around joints. When there is inflammation within a bursa (bursitis), the bursa swells due to an increase in the amount of fluid within the bursa sac.

5. Osgood Schlatters Disease

Osgood Schlatter disease is a common but temporary knee pain that can affect older children and teenagers who play sports. Particularly sports that include a lot of jumping and knee bending – hockey, basketball, volleyball, skating, soccer, ballet, and gymnastics are examples.

This is especially true during growth spurts when the bones are growing rapidly, and the patellar tendon is relatively short. The growth spurts commonly occur in boys (ages 11-18) and girls (ages 10-16). The problem is more common in boys.

The pain occurs where the kneecap tendon attaches to the bony bump (tibial tuberosity) below the knee.

Bakers Cyst (Popliteal bursitis)

This is the most common pain behind the knee.

A cyst behind the knee is usually the result of a problem inside your knee joint (arthritis or a cartilage tear). Both conditions can cause increased inflammation and increased synovial fluid which seeps into the bursa behind the knee. Unfortunately, it seeps through a one-way-valve phenomena and cannot seep back. Baker’s Cyst can be asymptomatic or present with mild discomfort.

Deep Vein Thrombosis (DVT):

A DVT is the occurrence of a blood clot in one or more of the deep veins of your leg. It can occur if you are on a medication affecting how your blood clots. It can also occur if you are immobile a long time due to surgery, long distant traveling (plane or car), or being on bedrest. DVTs can be serious because the clots in your veins can break loose and travel up and block blood flow in your lungs, heart or brain.

Arthritis:

Arthritis can be the result of natural wear and tear of the knee joint (osteoarthritis), or it can be a more systemic inflammation problem caused by rheumatoid arthritis. Arthritis is generally worse with weight bearing, and stiffer in the mornings or after rest.

Muscle or tendon tear or strain:

Hamstring or calf sprain or tear. Indicated by sudden pain in your calf or hamstring muscles. Followed by swelling and inflammation. You may be able to feel point tenderness at the spot the tear occurred. Use of the calf or hamstring muscle generally increases your pain.

MCL (medial collateral ligament) tear

The most common cause of medial knee pain in people under 50. MCL tears are the most common knee ligament injury, and approximately 40% of all knee injuries involve the MCL.

An MCL tear is damage to the medial collateral ligament, which is a major ligament that’s located on the inner side of your knee. The tear can be partial (some fibers in the ligament are torn) or complete (the ligament is torn into two pieces).

Medial Meniscus Tear

The medial meniscus is an important shock absorber on the inside (medial) aspect of the knee joint. It absorbs about 50% of the shock of the medial compartment.

A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. A tear can also develop slowly as the meniscus loses resiliency

Pes Anserine Bursitis

Pes anserine bursitis is an inflammation of the bursa located between the shinbone (tibia) and three tendons of the hamstring muscle at the inside of the knee. It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.

Pain and tenderness on the inside of your knee, approximately 2 to 3 inches below the joint, are common symptoms of pes anserine bursitis of the knee.

Bursitis usually develops as the result of overuse or constant friction and stress on the bursa. Pes anserine bursitis is common in athletes, particularly runners and swimmers (in particular breaststroke). People with osteoarthritis of the knee are also susceptible.

Iliotibial Band Syndrome

Pain on the outside of your knee is often Iliotibial band syndrome. Iliotibial band syndrome (ITBS) is one of the most common knee injuries. It is caused by friction between the iliotibial band (band on side of hip) and the lateral epicondyle of the femur (bony bump on the outside of the knee).

The syndrome often appears with endurance sports such as cycling and long distant running. Weight training with heavy weights may also bring on the pain.

Lateral Collateral Ligament (LCL) Injury

An LCL injury is a sprain or tear to the lateral collateral ligament (LCL). The LCL is a band of tissue on the outside of your knee. It connects your thighbone to the bone of your lower leg and helps keep the knee from bending outward.

You can hurt your LCL during activities that involve bending, twisting, or a quick change of direction. For example, the LCL can be injured in football or soccer when the inside of the knee is hit. This type of injury can also occur during skiing and in other sports with lots of stop-and-go movements, jumping, or weaving.

Some knee problems cause more generalized pain all around the knee and sometimes it even moves around to different areas. Some knee problems present differently depending on which structures have been damaged e.g. meniscus tears can present differently depending on the tear and its location. Also, when there is swelling it can also cause more diffuse generalized pain.

Cartilage/meniscus tear

Tears can often cause general pain and can occur from either a trauma (acute injury) or from gradual wear and tear.

ACL injuries

Injuries to the ACL can cause generalized pain in the knee also.

The classic symptoms are:

• a loud 'pop' is heard/felt in about 50% of injuries

• immediate knee swelling from the injury

• immediate pain

• can be severe instability

• knee will often give way

• knee movements are often restricted especially knee extension

PCL injuries.

These are much less common and are usually caused by a sudden force through the top of the shin bone from the front which hyperextends the knee joint. Sometimes it may be from a twisting injury.

Now...going through all that may seem a little daunting but I assure you that its not only easy to remember BUT, most importantly, when it comes to our treatments and exercise program later in the course it will NOT matter about the diagnosis or lack of one as you will see later.

So now that you have heard about possible causes based on location, not lets try to narrow it down even more by specific symptoms.

Noises-popping, clicking, crunching, snapping, grinding

Many people can hear noises when squatting or standing up from being on the floor. Some people may bend or straighten the leg to get a 'releasing pop' and then it feels better.

When there is painful popping but no injury-whats causing them? Here I go through the major culprits.

Noise coming from doing certain movements such as painless Knee popping on extension which is generally due to gas bubbles or runners knee

Knee swelling up from an injury. Here I explain what the differences are and what to look out for.

WI will explain why a knee could swell up without any injury

Now lets look at some other causes of knee swelling that you should be aware of

Why is it unstable?

One of the first things you want to ask the client is if it is actually giving way or it just feels like it will. In other words, it feels unstable but does not actually give way.

Why is it locking?

You may have clients that complain about their knee locking and that they cant move if from its position, it is literally locked in position if only for a few seconds. There are two types of knee locking that we most commonly see.

Let's now look at how much you already know!

The R.I.C.E Protocol is a MYTH

The RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method of treatment for acute musculoskeletal injuries since its origin in a 1978 publication entitled “Sports Medicine Book” by Dr. Gabe Mirkin.

These guidelines have been used by coaches and healthcare providers for over four decades with the intent of expediting the recovery process and reducing inflammation. Although popular, the implementation of this protocol to attenuate the recovery process is unsubstantiated.

There is, however, an abundance of research that collectively supports the notion that ice and rest does not enhance the recovery process, but instead delays recovery, and may result in further damage to the tissue.

The R.I.C.E Protocol is a MYTH

The RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method of treatment for acute musculoskeletal injuries since its origin in a 1978 publication entitled “Sports Medicine Book” by Dr. Gabe Mirkin.

These guidelines have been used by coaches and healthcare providers for over four decades with the intent of expediting the recovery process and reducing inflammation. Although popular, the implementation of this protocol to attenuate the recovery process is unsubstantiated.

There is, however, an abundance of research that collectively supports the notion that ice and rest does not enhance the recovery process, but instead delays recovery, and may result in further damage to the tissue.

Now that you may have a better idea towards a diagnosis. However, remember that whether you know or dont know it doesnt matter

If you are a massage therapist here is how you can do a deep tissue massage for your clients on the front of the legs

If you are a massage therapist here is how you can do a deep tissue massage for your clients on the back of the legs

If you want to treat your clients or do this for yourself, trigger points can produce knee pain so it can be a good idea that we do some treatment for them

Here I show you how you can do some patellar mobilizations to remove any restrictions of the kneecaps

This is one thing that I did in my clinic when clients have problems bending their knees and it works wonders!

Problems straightening the knee? Here is the fix.