Download Knee pain is one of the most common problems encountered by

Knee pain is one of the most common problems encountered by runners and
cyclists. Initially, most people, quite reasonably, are concerned they have injured
themselves, tearing the infamous ACL (anterior cruciate ligament) or MCL (medial
collateral ligament). Frequently, however, knee pain (particularly in runners and cyclists)
is the result of long established imbalances between certain muscle groups. With these
imbalances altering the mechanics of the lower limb, abnormal stresses are placed on the
tissues. If the body is then asked to work harder than it is used to, inflammation and pain
can result. Often, this pain can be surprisingly severe, leading one to wonder whether
something serious is going on. Nonetheless, treatment to restore normal function to the
limb, followed by therapeutic exercise, can bring quick resolution.
Non-surgical knee pain revolves around three structures. Two are muscles, a
portion of the quadriceps (big muscles on the front of the thigh) called the vastus
medialis, and a little muscle the size of a finger which runs across the back of the knee.
The third structure is a broad sheet of connective tissue running from the hip to the knee,
called the iliotibial band (ITB). As a result of sitting most of the time, the ITB tends to
shorten, and the vastus medialis tends to shut off. Together, this muscle imbalance alters
the function of popliteus, whose job is unlocking the knee after each step.
Changes in these three structures can have a couple of effects. First, in a
repetitive activity like running or cycling, the now-tight ITB can become inflamed by
friction. This is usually labeled an iliotibial band syndrome. Second, the kneecap may
begin to track towards the outside of the knee, irritating the underlying cartilage. This is
usually labeled a patellofemoral pain syndrome (PFPS). In many cases, I have seen this
manifest as a severe pain directly behind the knee that comes about a mile into a run.
Third, both problems can be present (and usually are).
So if you have these problems, what can you do about it? You may think you can
stretch your way out of it; unfortunately, the muscle imbalances usually throw off the
mechanics of the joints in the low back, pelvis, and leg. Furthermore, it is very difficult
to effectively target the tight muscles with stretching, because as they shorten the fibers
become glued together, in what are know as fascial adhesions. The best treatment for this
is known as Active Release Technique (ART). ART is a soft tissue diagnosis and
treatment system which breaks up the adhesions by having the patient actively lengthen
the muscle, while the practitioner uses their hands to trap the muscle in a shortened
position. The process is often somewhat uncomfortable, but the process also reinforces
normal movement patterns, neurologically re-educating the patient. With the ITB
syndrome, the practitioner may decide to use ultrasound before ART treatment.
Ultrasound uses high frequency sound to soften the adhesions, allowing them to release
with less pain to the patient, and less effort for the practitioner. Finally, chiropractic
adjustments are applied to the pelvis, leg, or low back, allowing the joints move freely
within their normal range of motion.