This is the third post in the knee pain series. Part 1 started with a quick anatomy overview of the knee. I then moved on to the most common type of knee pain- lateral knee pain. Anterior knee pain is the second most common knee injury I see in the clinic. As the image below demonstrates, anterior knee pain (in red) can include the area above or below the kneecap, under the kneecap, or any combination of these. Medial knee pain (in green) is usually the inner edge of the knee and can be a little above or below the actual joint line.
This is where internet diagnosing becomes more problematic. So let me start by saying that what follows is most appropriate for runners who have not had an “event” like falling, tripping, hitting your knee etc. that resulted in immediate knee pain with swelling and/or bruising. Additionally, if your knee has a painful click, pop, locking sensation, feeling of instability, or other feeling that’s “not right” – you should go to have your knee looked at by a physical therapist or other knee specialist. Those symptoms are the signs of something more significant like a meniscus or ligament injury. Knees that pop, click etc. without pain are typically not something to be concerned about.
Whenever someone describes knee pain located above or around their kneecap, I immediately become suspicious of this person’s quad flexibility. A tight quad will lead to improper patella tracking and eventually pain. When the subject of patella tracking issues come up, it’s common to hear medical professionals recommend strengthening the vastus medialis oblique (VMO) muscle. This is outdated information. Unfortunately, there are still websites and people that give this advice. While you won’t hurt anything or make the problem worse by doing these exercises, there are more effective strategies to correct this type of knee pain.
The first thing I have people do is work on stretching their quads. By that I mean REALLY stretching their quads- not just grabbing their foot and bending their knee for a few seconds. I recommend the following “lunge stretch”. It focuses on the quads and hip flexors. There are two versions to this stretch. If you’re not very flexible, start with the left image. Once you begin noticing some improvements, you can try the more advanced version on the right.
- Begin by kneeling on a knee-friendly surface next to something that can be used as upper body support, preferably something on both sides
- The opposite leg goes forward in a lunge position, arms/hands holding on to a stable surface allows your lower body to relax more
- Keeping your head up, torso upright and hips facing forward, slowly move your hips forward and down until you feel a stretch along the front of your thigh of the kneeling leg
- HERE IS THE IMPORTANT PART! Hold this stretched position for 30-45 seconds. Yes, it seems like forever.
- Repeat other side then alternate back and forth three times each side
- To make the stretch more intense, grab your foot or shoe and slowly bring your foot up toward your hip
Shortly after stretching has been incorporated into a person’s daily routine, the next step is to begin strengthening the running specific muscles. Again, refer to Knee Pain Part 2 for descriptions of these exercises. The above stretch, combined with hip and hamstring strengthening has helped many people. If this stretch does not seem to help within a couple weeks of consistent effort, seek help from a medical professional. As always, please send any questions along to me if anything is unclear. Good luck!!
***This blog is intended for information purposes only. It is not intended to diagnose or treat any injury. Please consult with your doctor or physical therapist if you have any knee pain and prior to beginning any exercises or treatment plan on yourself or others.