This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2023. For the original video go to https://youtu.be/1RMxQu2gdmA
Brad: Are you experiencing knee pain with daily activities or exercises? Well, there are several reasons that you could be having this, and we're going to go through them.
Mike: Many individuals will assume knee pain is related to arthritis, but there are many other things to consider.
Brad: And we're going to go through these and show you some exercises, some things that you may not have thought of to get rid of this at home by yourself.
Mike: So we've worked with many people over the years and they often come in with knee pain, specifically in the front of the knee, kind of over the kneecap, and often they complain about pain increasing when they go up or down stairs.
Brad: I found a lot of times, it's even more down steps, but it can be either direction. But there's good news with this if we need to assess the knee a little closer. And oftentimes, you can see Mike is working with his patella or the kneecap and it should be movable and mobile like that.
Brad: There's a tendon above and a tendon below the knee cap that connects the quadriceps and the patella to the bone.
Brad: Those two tendons can oftentimes lead to knee pain. My sister had knee pain so terrible that she was crawling on her hands and knees, and ended up finding out it wasn't her knee joint, it wasn't arthritis, and we'll tell you what it was and how she took care of it.
Mike: So there are six solutions we're going to go through to help decrease your knee pain here. The first one is to simply avoid activities that irritate this pain or make it worse, which we talked about earlier. It could be the stairs.
Brad: That's right. So it's just a simple thing. Number two is we're going to take a closer look at the kneecap or the patella. You want to get your leg up in a position like Mike has and have the leg completely relaxed, particularly the quadriceps muscles. Now, when these are completely relaxed, you're going to find a very interesting thing that some people may not be aware of, the patella or the kneecap is very mobile. You can see me moving it right to left and we're just want to make sure that all the connective tissue has no scar tissue or not tight from being immobile if you've been sedentary over the past months or years. So you can go right to left. You can move it up and down. This should not be painful. If it hurts a little bit the first couple of motions, that's okay, as long as it feels better with time and I mean over five to 10 seconds. So right to left feels better. Does it feel better?
Mike: It feels great.
Brad: If it feels good or better, go ahead up and down, the same thing. And you can actually kind of work some angles on it as well. You'll spend maybe 30 seconds to a minute probably doing this. This will help a certain amount of people. There are going to be other people who'll do this and they'll find it moves, everything's good. So then we're going to go on to the next solution.
Mike: So the third solution is to do manual cross-friction massage. It's a fancy way of saying you're going to massage the painful areas. So if your pain is below the kneecap, you can take two fingers, cross it over, or I'm going to use my thumb, because it's a little bit easier for me. I'm going to put my other thumb on top. I'm going to push down and I'm going to go back and forth on this tendon. You're going to do this for two minutes if you can tolerate it.
Mike: Obviously the harder you push, the more it's going to dig in there. Now, if your painful area is above your kneecap in the quad tendon region, you can do the same thing up there. Do it for two minutes as I mentioned before, and this will increase the blood flow to these tendon areas, helping decrease your pain, bring nutrients, and make it recover faster.
Brad: There's one exception I want to bring involved with this. As you're doing the cross-friction massage, like Mike described, after about 30 seconds, if the pain doesn't reduce or if it feels numb, then it's okay. But if it just continues to irritate it and you're getting into that 30 seconds to 60 seconds and it feels like it's, ugh, this hurts more, then you need to stop. It's too early to do this cross-fiction massage. You're going to need to wait a day or two. All right. So you're going to find out after massaging your tendons or the muscles with your hands, which works quite well actually, your fingers will probably get tired, particularly if you're having success and you're doing it for that two minutes as Mike had suggested. If you happen to have a massage gun or a friend that has one, use it. It'll save your fingers. If you want to purchase one, that's an option, but you don't need to. So when you use a massage gun for this particular cross-friction massage, you have to have a massage gun that reciprocates back and forth. Okay? Otherwise, you will not get the same results and you need about 10 millimeters of amplitude in that direction. That's really not that critical. It just gives you an idea if you're shopping around. The headset you'll want to use is the round head, which I am using. That's my preference for this technique.
Brad: Or you can use the cushion head. It's an air cushion head because you're going to be around your kneecap and the bones of your knee, and if you massage your bone anywhere on your body, it is not going to do anything except create pain. We don't want that.
Brad: So we're not going to massage the bone at all. And I'll show you the technique. Now, the tendon that we talked about below the kneecap, there's a soft spot right below the kneecap. We talked about that. You take the massage gun and I think this part particularly works best with the round head. Do not go straight in. That's going to pound and beat up your tendon and your knee. It's going to do nothing but bad. Go sideways. And then you get that cross-friction massage, just blow that kneecap and that hollow spot. It's so much easier and it's just a delight. It works out very well.
Brad: Now Bob had this tendonitis knee pain, same as my sister, above the kneecap where the quadricep muscles all come together and connect to the kneecap. So we're going to do it this way.
Brad: And Bob was massaging his manually and his fingers were getting tired, right, Bob? Yeah, he's shaking his head and he started the gun. And how long? Within how many days?
Bob: Two days.
Brad: Within a couple of days the pain improved, and things are going well. Now, one thing that you may want to assess is to see if the muscles up toward the hip are tight or have any knots in them. That may be the case and you'll know because when you're pushing around and you'll feel like a tender spot, kind of like a Tootsie Roll in that muscle. If you have that, then you can go into that muscle with the massage gun because you have more mass, more muscle mass, and muscle fibers. Then you can get more aggressive when you're away from the knee. And again, work that for a few minutes. This was the case with my sister's knee problem. Part of it was the knee, part of it was the tendons or the muscles up in the thigh were tight and limiting that kneecap mobility, which is needed for a healthy knee. Wow. And actually, it's a nice deal. We could probably go on like this for five or 10 minutes, but we've got more information to help you out with. All right, the last technique, number six is we want to stretch the quadriceps muscles. Again, they connect to the kneecap, up to the pelvis area. We're going to show how to do that, as well as there's another structure, which is the IT band. It's kind of like a wide ligament that connects up from the pelvis down to just below the knee on the side of the leg, and we need to stretch that out a little bit as well. That can take pressure off that knee as well. So, Mike, it's all yours.
Mike: So you're going to lay on a firm mattress or bed of sorts. You can also do this on a table if your bed is too soft. You don't want to fall off the edge. So you're going to start on your back. Your feet are going to be off the edge of the bed. If you want more of a stretch in the front hips, you scoot more towards the bottom of the bed here. But for now, I will stay here. Try to bring both knees to your chest to start, and now you're going to drop the side that's painful down. Now when you go down, you want to try to keep the leg in a straight line. If it's too tight pulling out or pulling in, that's not going to be the stretch you want. You want to keep your leg straight. Now to get my quad stretched even more, all I'm going to do is bend my heel back and I feel it more.
Mike: Now if this feels good, you don't feel stretched at all, just scoot your buttock off the edge more and you'll start to feel it. Now, an important thing to remember is to bring your opposite leg up to your chest. Bring your knee towards your chest and hold this position. Try to do it for 30 seconds. After 30 seconds, bring the leg back up to your starting position, and rest here for a second. Then you're going to switch sides. And you might notice one side is tighter than the other. If one side is tighter, really focus on that side, but it is good to do both sides. Do 30-second holds and do it two to three times a day.
Brad: And I do want to mention it's real critical when you do this that you have either some shorts on, some stretchy pants. Are these those stretchy jeans?
Mike: They are stretchy.
Brad: He's got jeans on, but they're the stretchy kind. If you wear jeans, things bind up and you will not get a good stretch. All right, nice work, Mike. Stretch away.
Mike: So those first six steps were to help remedy your pain in your kneecap. So if your kneecap is feeling good now and you want to start progressing more, what you want to do is start walking again. You want to make sure it is pain-free walking. Start on flat surfaces and slowly progress. Don't go out walking a mile if you haven't walked in weeks. Just start slow. Maybe do a quarter mile. Progress each day as it feels comfortable.
Brad: That's right. And remember, if you have hills, make sure you avoid those, walk on the flat. And actually at roads, like on the road I live on, there's no sidewalks and the roads always have a camber, so the water runs off. Well, that angle that you're walking on can put stress on your ankle, your knee, and your hip. So if you walk down the road on the right, turn around, and walk on the same side of the road. This will balance things off. Sometimes that's not safe. If that's the situation, try to get to a spot where it's a flat sidewalk or trails where you don't have the unevenness.
Mike: Now, if you were doing some form of resistance training before or exercises and you want to start those again, it's important to remember to do a partial range of motion early on or drop the weight significantly if you were using weight while doing these. So we're talking about things that involve your knees. So such as some type of squat or some type of lunging form. Just do a partial range of motion as long as it feels good. If it creates pain, hold off for a while till you try again.
Brad: And a lot of you may not have used weights in the past and that's fine if you want to get back to this. So again, as Mike mentioned, if you want to decrease the intensity and you don't use weight, just body weight, you're going to do that by how far you go down. So previously, if you were squatting deep down without any problems, the knee is feeling better now and you can do it pain-free, even if it's a little baby squat. You may think " What good is this doing?" But if you get down and it hurts, do not do that. Pain-free range, give it some time.
Brad: Or if you're doing lunges, you might've been going until your knee touched the floor at one time before the injury. You may only go down half the distance. And give it a week or two. Be patient with it because you don't want to re-irritate the old injury and set yourself back to where you were. Things will come along. Just be happy and be glad that you can do them.
Mike: We should add that you want to make sure you're using proper form with any type of leg exercises. So if your knee tends to track in, that is a no-no. You need to work on your outside leg muscles and keep it straight. So make sure your knee is staying in line or even going slightly out is okay, but you don't want to go in like this.
Brad: Right. That's the most common error, the knee going in. It's no good. I always tell my patients, to get that knee over the top of their toes when looking down and that'll help keep that sagittal plane, which is what we call it in the therapy world. All right, very good. Give these tips and tricks a try. There's a good chance you're going to find some relief with them. If not, it may be something more. Maybe you do have arthritis and you have to try a different approach.
Mike: So if you want to find out more videos related to this topic, you can check out our Knee Pain Relief Program.
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