(Last updated May 4, 2020)

What Type of Knee Pain Do You Have?

COMT and Pilates, a Functional Remedy for Knee Pain

Knee pain may occur on the anterior or posterior knee. The location of the knee pain determines where Clinical Orthopedic Manual Therapy would be applied on the knee. COMT is a functional remedy for knee pain. When combined with Pilates, the pain-relieving therapy becomes even more effective.

MOST KNEE PAIN HAPPEN GRADUALLY

Knee pain can be caused by an injury like a fall or a collision when playing a contact sport like soccer or rugby. Traumatic knee pain is due an event which you can remember. 

But knee pain can also happen gradually, where there is no traumatic event. You could not remember how it started. The pain simply worsened overtime. Gradual-onset knee pain is more common of the two types of knee pain.

The common causes of progressive knee pain are long hours of sitting which weakens the anterior thigh muscles, and poor walking or running posture. Muscle imbalance develops as result. The muscle imbalance — where certain muscles become more active than others at the knee joint — causes tension or knots to build up at the knee. The tension creates pain when walking, running or stair climbing. The pain increases overtime. There is no single event that causes the pain.

WHAT IF WE HAVE NO KNEE JOINT?

To understand what causes gradual-onset knee pain, we have to first understand the purpose of the knee joint.

A joint is basically the space between any two bones. So the knee joint is the space between the thigh and leg bones, which divides the bones.

If we don’t have a knee joint, and the thigh and leg is fused into one entity, we would look like toy soldiers or guard men’s in a ceremonial march when we walk: straight and stiff. We have to lift the entire leg up to avoid hitting the floor if we can’t bend at the knee joint.

KNEE FLEXION & EXTENSION

Having a knee joint makes walking easier and more efficient. Knee flexion allows us to pick up the leg when we walk. It also cushions the impact of the landing when the leg hits the ground. If we were to land with a straight leg, the impact would have reverberated up the thigh and to the spine. Not being able to bend at the knee joint could potentially cause low back pain.

The knee joint is capable of knee flexion, as well as knee extension. Being able to extend the leg at the knee joint increases our stride length when we walk. Knee extension also allows us stand tall.

Hence, there are many benefits in having a knee joint. The knee joint makes our gait efficient and absorbs the shock to the body when we walk.

KNEE LIGAMENTS LIKE STRONG ROPES

If the knee joint is the space between the thigh and leg bones, what keeps the thigh and leg bones in place at the knee joint? Knee ligaments. Imagine knee ligaments like strong ropes. We have anterior, posterior, lateral, medial and cruciate knee ligaments. Similar to strong ropes, they bind the thigh and leg bone together from all sides. The menisci (a pair of meniscus) provide the cushioning between the two bones at the knee joint.

But neither the knee joint or ligaments are responsible for moving the thigh or leg. They create the structure, but they are not responsible for movement like knee flexion or extension when we walk, run or squat. The task falls on the muscles at the knee joint.

MUSCLES LIKE STRETCH BANDS

Muscles attached to the thigh and leg, particularly the quadriceps and hamstrings are responsible for knee extension and flexion, respectively.

Muscles are connective tissues like ligaments except they have different fibrous makeup. If ligaments are like ropes, then muscles are more like elastic bands as they are stretchable like bands.

ANTERIOR KNEE PAIN

Quadriceps are thigh muscles that cross the knee joint anteriorly. So when the quadriceps contract they pull the leg closer to the thigh to create knee extension at the knee joint (see Figure A.)  Imagine having several pieces of elastic bands pulling the leg to the thigh. If we were to tie knots on the elastic bands, the knots will shorten the length of the bands.

Similarly, when the quadriceps are shortened by knots in the muscle fibres, they could pull the leg and thigh bones too close together for comfort at the knee joint. The rubbing of bone to bone creates friction and anterior knee pain.

Hence, the rule of the thumb — though there are exceptions —  is when you have anterior knee pain, quadriceps (anterior thigh muscles) are likely to be knotted and tight. 

POSTERIOR KNEE PAIN

In contrast, hamstrings are posterior thigh muscles. When the hamstrings contract, they pull like elastic bands but this time on the posterior leg. The action brings the posterior leg closer to the thigh, which bends the knee.  So the hamstrings are responsible for knee flexion at the knee joint.

When the hamstrings are knotted, they shortened the distance between the thigh and leg posteriorly. This results in posterior knee pain.

The anterior and posterior thigh muscles are big muscles. They are build large to carry the weight of the upper body when we move from knee flexion to extension, every time we transit from a seated to a standing body.

MEDIAL & LATERAL KNEE PAIN

Apart from knee flexion and extension, the knee joint also allows for medial and lateral knee rotation when knee is flexed. The medial knee muscles are responsible for medial rotation, while the lateral knee muscles are tasked with lateral rotation (see Figure C.)

So if you are experiencing pain on the medial knee when you walk, the medial thigh muscles are likely knotted and tight. Conversely, if the pain is on the lateral knee, then the lateral thigh muscles are tight.

KNEE ROTATION ALLOWS US TO CHANGE DIRECTION

Medial and lateral knee rotation allow us to change direction when we walk. We can turn to left to right, or make 180-degrees U-turn to head back, mainly because the knee joint allows for rotation.

Good knee rotation is also important in sports like soccer, basketball, tennis and badminton, which require frequent directional shifts. A good soccer player needs to be able to cut in and out as he dribbles a ball, while a badminton player needs to shift and turn at the knee joint to chase down each shot.

DIRECTION OF THE PULL DETERMINES THE PAIN

Hence, the direction of the pull of the tight muscles at the knee joint determines the type of knee pain you have. So if you have anterior knee pain, loosening the anterior knee muscles with manual therapy will bring relief and remove the movement restriction at the anterior knee joint. Similarly if you have medial knee pain, removing the knots from the medial thigh muscles reduce the medial pull on the knee joint and relieve pain.

WHY KNEE PAIN IS OFTEN ACCOMPANIED HIP PAIN

However, there is exceptions to the rule. Sometimes, the cause of the knee pain is not due to tight muscles at the knee joint, but at the hip and/or ankle joint, which can also affect how the knee moves. For example, if the hip joint is tight, the knee has to compensate for the lack of hip movement by moving more when we walk, run or dance. Excessive movement at the knee joint makes the joint unstable, and vulnerable to injury.

So the cause of the knee pain is not always due to muscle tension at the knee joint. It can also be due to tightness at the hip joint. When you know more about how the knee works, it decreases frustration because you know you can play an active role in maintaining your knee health.

HOW DOES COMT WORK?

Manual therapy like COMT provides relief, particularly from gradual-onset knee pain, where muscle imbalance is the cause of the pain. COMT targets the muscle imbalance. So how does it work?

For example, if you suffer from anterior knee pain, the manual therapist would assess the knee muscles like quadriceps for muscle tone and tension. The assessments will include checking the function of the quadriceps which is responsible for knee extension. Your range of knee extension will be tested at the assessment. If the quadriceps are indeed tight, manual therapy will be applied. Find immediate relief and an improvement in the range of motion.

COMT is a functional remedy for knee pain, compared to knee surgery which is a structural remedy. COMT treats the muscle imbalance, while knee surgery treats the bone structure. Both are remedies for knee pain but the approaches are different.

What is COMT?

MORE EFFECTIVE WITH PILATES

COMT becomes even more effective when combined with Pilates, as the exercise further corrects the muscle imbalance. Pilates has a long history as an exercise programme for rehabilitation. Pilates is gentle on the body. For example, if doing standing knee exercises have been  challenging for you, the Pilates reformer replicates the same knee exercises lying down. The position decreases the stress on the knees, and at the same time, improve your knee function and leg strength.

Pilates also improves hip movement and core strength, which translate to better balance when you walk and less stress on the knees.

Learn More About Pilates

BOTH PAIN RELIEF AND EXERCISE 

When we know more about our knee function and muscle imbalance, we are better able to remove the source of pain. Imagine muscles like stretch bands. A tight muscle is like a stretch band with knots. When there are many knots, the knots shorten the range of motion which the thigh and leg bones can move in relation to each other. The action results in knee pain and excessive bone-to-bone rubbing which increases wear and tear at the knee joint.

A combination of COMT and Pilates is a functional remedy. COMT relieves knee pain, while Pilates provides a good exercise programme to improve knee function and leg strength. Give COMT and Pilates a try. Start Today.

Medical Disclaimer: Always consult your physician if you have an existing pain or a pre-existing medical condition before beginning any exercise. The above information is not intended to diagnose any medical condition or replace your healthcare professional.

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Exercise, 1st Choice of Treatment for Knee Pain

Given the popularity of knee arthroscopy and knee replacement surgery, it may seem like surgery is the treatment for knee osteoarthritis. The truth is exercise is the first choice of treatment, as exercise is relatively safe. Regular exercise also keeps your weight down which reduces the load on the knees.

However, few people with knee pain actually exercise because exercise makes their knees feel worse. Research shows including manual therapy to an exercise programme — where the pain is relieved — would help you stay long enough with the exercise to see the benefits…