Knee Pain

Resolve Knee Pain with Active Release Techniques

Knee pain can be frustrating. In fact, a painful knee can prevent you from enjoying your favorite things, such as walking, running, playing golf, exercising, or gardening. There are many instances where knee pain can even interfere with a good nights sleep. To make matters worse, many common knee conditions are slow to respond to traditional types of care, often creating further disappointment and aggravation.

Now for the good news…..

A new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common knee problems and is helping to get knee pain sufferers back doing their favorite activities. But before we talk about how ART® works so effectively we first need to understand how the knee becomes injured in the first place.

How Does Knee Pain Occur?

All musculoskeletal injuries, including knee injuries, occur through one simple principle, the load (i.e. the physical stress or strain) placed on an anatomical structure exceeds that structures capacity to tolerate that load. This seems logical to most people when thinking about traumatic injuries such as ACL tears or knee dislocations. But what most people don’t realize is that the damaging and excessive loads do not have to happen all at once. Instead, many injuries are categorized as overuse or repetitive strain injuries, meaning pain and tissue damage are not the result of strain or overload from a single event, but instead occur as the musculoskeletal system is exposed to a large number of sub-maximal, repetitive forces over weeks or months. In this sense, tissue damage occurs slowly over time, eventually accumulating to a critical point in which symptoms are felt. This is why in most cases it is difficult to trace the pain or injury back to a specific incident or event.

Browse our Injury Library to Learn More About Common Knee Injuries Including….

Patellofemoral Pain Syndrome Patellar Tendinitis / Tendinopathy Quadriceps Tendinitis / Tendinopathy Pes Anserine Bursitis Nerve Entrapment (Saphenous) Iliotibial Band SyndromePopliteus Tendinopathy Hamstring Tendinopathy Nerve Entrapment (Peroneal)

To better understand the occurrence of overuse injuries it is important to realize that there is a significant amount of stress placed on the muscles of the knee. Even simple activities such as walking or climbing a flight of stairs requires the knee muscles to work hard in a effort to move and stabilize the area. With sports such as running, tennis, or golf, the demand on the muscles is even greater. If any of the muscles that surround the knee become tight or weak it will place excessive strain on the other muscles and on the knee joint itself. Over time, if this imbalance in the muscles and resulting abnormal knee motion is allowed to continue it can eventually develop in more severe knee conditions.

There are a variety of situations that can cause muscles to become tight or weak. For example, repetitive use with certain sports or occupations, poor posture, lack of use, lack of stretching, muscle imbalances, or previous injuries can all affect the normal function of the knee and surrounding muscles resulting in excessive strain to the area.

Over time this strain can develop into what is know as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, and ligaments in response to small levels of strain. Although only small, and at least initially is not painful, this damage still needs to be repaired, which the body does by forming new tissue in and around the injured tissue. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.

Unfortunately, over time this scar tissue can build-up and accumulate in the muscles, tendons, and ligaments of the knee. As this happens it places more and more strain on the area as the muscles must now stretch and contract against these adhesions. This in turn places even further strain on the knee, which leads to even more micro-trauma. Essentially a repetitive strain injury cycle is set-up causing continued adhesion formation and progressive knee dysfunction. At this point pain and tightness at the knee and surrounding area will start to become noticeable.

As this repetitive strain injury cycle continues the ability of the knee muscles to meet the demands placed on them diminishes. At this point it is not uncommon for the muscles to give way and a more severe and debilitating pain occurs. In fact, many patients come into our office explaining how they have knee pain but they did not really have any major type of injury occur. When further questioned these patients almost always describe some mild pain or tightness in their knee or leg that has been building over time. As you can see from the explanation of the repetitive injury cycle, these types of injuries build-up over time until it eventually develops into larger scale injury.

How Can These Knee Injuries Be Fixed?

The Traditional Approach to Knee Pain

In an attempt to relieve knee pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in and around the knee.

Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from knee pain.

Our Approach to Resolving Knee Pain: ART® – A Better Solution

ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART® different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal function of the body. By locating and treating the soft-tissue adhesions with ART®, it allows the practitioner to, 1) break-up restrictive adhesions, 2) restore normal tissue translation and movement and 3) more completely restore strength, flexibility, balance, and stability to the knee and surrounding area.

You can think of an ART® treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, ligament, or joint capsule, and then apply a very specific tension with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. There are over 500 specific ART® treatment protocols which allow the practitioner to “feel” which structures have become problematic and require treatment. In this sense, each treatment is also an assessment of the health of the area as we are able to feel where the problem is occurring.

An additional benefit of ART® is it can allow us to further assess and correct problems not only at the knee, but also in other areas of the “kinetic chain” such as the foot, ankle, hips, and pelvis. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific knee injury are addressed, even if they have not all developed pain. One of the best things about ART® is how fast it can get results. In our experience, the majority of knee problems respond very well to ART® treatments, especially when combined with home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve the condition, we usually find a significant improvement can be gained in 3-4 treatments.