Licensed Massage Therapist, Amy Montia reveals the different massage therapy methods used to release tension around the knee and explain how acute or insidious injuries are treated.
Knee pain is frustrating, especially when it starts to compromise form and hinder you from performing at your best. If you have a sports related knee injury, I suggest you treat it now. Don’t wait. Your body needs knees to function properly.
As the age-old song implies, your knees are indeed connected to the rest of your body. And the longer you try to push through the knee pain, the more likely you’ll be to find yourself seeking treatment later on for compensatory pain in your neck, shoulder, back, hip, arch, foot or toe.
Massage therapy is a great way to treat and better understand the root of your knee pain.
Is the Injury Acute or Insidious?
Was the pain sudden? Did pain occur following a quick movement, forceful fall, knee twist, kick to the side of the knee, etc? This is an acute injury and you should see a medical professional immediately, as there might be a diagnosis of torn meniscus, muscle strain or ligament injury. In the meantime, RICE (rest, ice, compress, elevate) is the way to go. Massage Therapy at this phase should only be gentle and light with a goal to promote lymphatic circulation and minimize swelling.
Or maybe your knee pain started as a niggling vague annoyance? Perhaps the pilot light was an old ankle injury, minor knee sprain in high school, a bad fall some years ago (that you thought healed just fine), or even poor posture? This type of knee injury is considered to be chronic (or insidious). Micro-trauma accumulates over time. If left untreated, the condition fueled by progressive muscle imbalance and chronic inflammation around the knee can turn into a full blown acute and stubborn injury.
Assessment and Treatment
Massage therapists try to unravel and release structures around your knee that are likely to exacerbate pain. Techniques like effleurage, petrissage, muscle stripping, trigger point therapy, myofascial release, cross-fiber friction, and ischemic compression are used to restore integrity and balance to the knee joint.
There are lots of contributing factors making every person’s knee injury unique. An orthopedic-trained Massage Therapist should first do a simple assessment, and then make a plan of action to work and build from.
The assessment gathers info about your injury history, pain patterns, joint movement and postural alignment. We also assess the length, strength and quality/feel/composition of the muscles and structures around your injured knee, and beyond into your hips, spine and ankles.
Therapists use clues like pain location, simple movements that recreate symptoms, and palpation as a starting point for relieving knee pain.
Along with myofascial work to address any scar tissue around the knee joint line (retinaculum), the following muscles are most frequently addressed during a knee injury-focused massage therapy session:
Quads are comprised of 4 muscles that originate toward the top of the thigh and insert into a single tendon above the patella, attaching to the tibia just below the patella. Overuse, imbalance and trigger points among the quads refer pain above and below the patella. Stretching, deep tissue techniques and gentle quad activation releases tension and pain around the kneecap.
Hamstrings are like the Yang to the quads’ Yin (according to Chinese Medicine, finding Yin/Yang balance is a cornerstone of health). Hamstrings are comprised of 3 muscles that originate at the sit bones and insert behind and just below the knee. For several reasons, hamstrings tend toward hypertonicity (too much tension and overuse). If the hamstrings overpower the quadriceps’ strength, the patella may rub against the tibia, causing pain just below the patella. Deep tissue work into the hamstrings and stretching shortened muscles is helpful in this case. Trigger Point therapy, petrissage and compression along the lower portion of the lateral hamstring (Biceps femoris) may provide relief from pain felt at the lateral side of the knee.
IlioTibial Band (IT Band)
This flat wide band of connective tissue runs, like Adidas stripes, along the lateral side of the upper leg from the top edge of the hip bone down to the outside lower edge of the knee on the tibia. It keeps communication in check between hips and the knees, maintaining baseline tension, especially when moving forward. Due to its composition (connective tissue), job (maintaining tension), and location (overlays the powerful lateral quad, vastus lateralis), the ITB frequently develops fibrotic patches and adheres to the overworked vastus lateralis muscle beneath it. These adhesions then generate increased tug at the tibia and hip attachments, and irritate the nearby structures, causing pain and inflammation. Myofascial Release along the IT band is helpful to minimize the inflammation and pain
The gastrocnemius is a bulky muscle that connects the ankle and knee. It’s the muscle that we see and consider to be “the calf”. Trigger points and adhesions in the upper half can refer pain to behind the knee and into the arch of the foot. Trigger Point therapy, muscle stripping, petrissage and myofascial release, although intense, almost always provide pain relief.
Popliteus is a small strong muscle that crosses from upper lateral edge to lower medial edge behind the knee. Popliteus enables the knee joint to rotate slightly, giving it stability when initiating knee flexion. With knee injuries, popliteus is almost always hypertonic because it tends to overfire in the presence of knee instability and glut weakness. Tendon release and trigger point therapy on Popliteus are notorious for being painful, intense and highly beneficial for most knee injuries, especially ACL injuries.
After reading this article, hopefully you’ll give Massage Therapy a shot for sports-related knee pain. I recommend scheduling regular sessions 1-2 times per week with the same therapist for at least 3 weeks to determine its effectiveness for your injury.
Massage Therapy for knee pain is ideal in conjunction with a corrective exercise plan designed by a chiropractor with a sports injury specialty or a physical therapist, both services available to you at Physio Logic in Downtown Brooklyn.
You’ll be a happier person and perhaps a better athlete if you aim to understand what’s causing (contributing to) your knee pain, and treat it properly.