Hey, this is Dr. Steve Gangemi. In this video I want to talk about a common injury or common injuries to the knee that moving athletes experience. The knee is a very commonly injured joint. So let’s talk about some things that happened there. Aside from traumatic type accidents, obviously if you fall and land on your knee or you get in an accident, a car accident, your knee hits the dashboard or something like that, we’re not going to talk about that here, but we’re going to talk about common injuries that people have from overuse, chronic type injuries where your knee isn’t healing up, and some things that you can do for some natural self-assessment and treatment to hopefully get your knee back on track, especially if you have one side weaker than the other. It doesn’t feel as good as the opposite side.
Of the four quadrants of the knee, in this first part we’re going to talk about the front and the lateral aspect of the knee, the outside of the knee. And on the second part we’re going to talk about the back of the knee and then the most commonly injured areas of the medial aspect of the knee, the inside. So the front of the knee pretty much let’s talk about the quadriceps muscle, which is what people think about when they talk about extending, leg extensions, knee extension type exercises and your patella tendon. So you might have pain deep in the patella there because of an issue with your quadricep, with these thigh muscles. They’re not uncommon, but I wouldn’t say they’re the most common by far and you’ll see in a little bit when I talk about other areas of the knee.
But, if you have problems with extensions or even a squat a little bit, like if I was just maybe even just squatting from here to here, but really not so much deeper, typically going down stairs more than up, in other words, walking downstairs or walking down a hill more than climbing up, you have pain in the knee. Think more of the front of the thigh issues. And again, with most injuries that I discuss, I always like you to look a little bit or think outside the box and look further away from where the injury is actually felt. Because typically the area that is injured is not the area that should be or needs to be treated. It’s like the weak spot because other areas aren’t functioning properly and it weakens that area that is trying to work too hard to make up for some other insufficient area.
So, if the tendon is actually feeling tender, your patellar tendon, then I want you to look in the more thicker, meatier, more powerful thigh muscles. And you can just poke around here, like I am, in a squeezing motion with your thumbs for any tenderness in your quad. If I was to hold that here and extend again, and my kneecap feels better, or if I was to hold it here and squat a little bit and I say “Oh, that feels a lot better” then I can work deep into the trigger point here. Pretty much you’re not going to cause any harm unless you had a problem here. You should see, then I might have more pain in that area, but you’re looking for the connection between these two areas here.
Okay, so now we’re going to move to the lateral aspect of the knee, the outside of the knee, and talk about a common injury there that people experience, especially if you’re jumping a lot, running a lot, or if you land wrong, That’s your iliotibial band, which inserts on the outside of the knee. And even runners get this, it’s one of the most common running injuries, actually called iliotibial band frictional syndrome. So the iliotibial band is a thick band of connective tissue that is made up from primarily two muscles, your tensor fascia lata here, which is a thick little muscle on the top outside of your hip and your butt muscle, your glute max. So these two muscles come down and they form your iliotibial band to the outside here, on the back and the outside, and attach just to the lower aspect of the outside of your knee here, in your tibia, which people know as your shin bone. So pretty much that’s a sharp pain and people will feel it primarily when your leg is straight for too long, that can happen, obviously.
If you’re sleeping at night, you wake up in the morning, you try and bend your leg, it’s killing you or walking down stairs will hurt the outside of your knee a lot, running, even walking, any jumping aspect, sharp knife-like pain in the outside of your knee. Medical treatment for this is to shave some of that band off. I’ve never seen if to be necessary because you can fix these things up if you look at it from more than just compartmentalizing and isolating the injury to where it’s felt. You have to go further up here to the glute max and the tensor fascia lata. Again, not even in this band that comes all the way down the outside of your thigh, but right below your hip bone here, that’s your hipbone, and right below it you’re going to find that tensor fascia lata, your TFL, and you need to put your thumb in there, you have to have strong thumbs or have somebody do this for you, and you also want that muscle relaxed. So I don’t want to be standing on my leg like this, I can feel that contract right now when I do that, I want to be on my other leg, and now I can feel it relaxed.
So, you’ll know you’re on the right muscle if you do that. You can feel it contract, and then I want to be on this just to the front of it is my tensor fascia lata. If I poke in there and I notice that my knee feels better, yeah, all the way from here to there that I’m going to work that trigger point out in there. The glute max usually is as important or as common for causing that type of pain, especially if you’re feeling the knee pain more when you’re squatting. A lot of people have knee pain on the front or the outside because of a problem with their butt muscle and nobody thinks about it because they just think about their knee and they forget that the really powerful, or the power when you’re squatting, is not coming as much from your thighs as it is from your glute max.
They’re both important, but your glute max is really what is going to help you jump, sprint, and perform a good mobility squat, too. So you can have a trigger point, think about how big your butt muscle is, maybe it’s too big and it comes all the way down on the outside or the back and wraps and attaches to at least halfway down, if not a little bit longer, with the connective tissue a little bit further in the back of your femur here. So you can have a trigger point anywhere in the back of your femur, your thigh bone, where the connective tissue of your glute max attaches and then connects with your iliotibial band from your tensor fascia lata. So it’s going to go like this and into the outside of your knee. So you can have a tender spot anywhere in there. The most common spots I see are about here and here. If you push in there, it’ll hurt really bad and you’ll see some relief in your iliotibial band. So think about that for lateral knee pain.