Knee pain is a common complaint for many runners, cyclists, and triathletes leading them to succumb to pain medication, anti-inflammatories, knee braces and other contraptions just so they can continue pushing through the miles. From elite athletes to fitness walkers, an individual may be told they have bursitis, tendonitis, arthritis, chondromalacia patellae, iliotibial band frictional syndrome, a meniscus problem or some other ailment as their diagnosis gives a name to the problem but does absolutely nothing to treat the condition or tell them how it even occurred in the first place.
The balance of the muscles surrounding the entire knee joint is essential for the knee to function normally, as well as to provide maximum power and strength. Starting in the front of the leg, the quadriceps make up the majority of the musculature as well as the patellar tendon. Often athletes are told they have tendonitis if there is pain below the kneecap or bursitis if there is pain above the kneecap. The integrity of the quadriceps and their balance with the hamstrings and gluteus maximus muscles is of utmost importance. With respect to gait, fatigued (“weak”) quads will cause an athlete to run with an exaggerated kick back with each push-off. Another symptom of fatigued quads is a feeling of weak knees or thigh muscles when climbing stairs, or being unable to stay in a squatted/kneeling position for a while without pain and/or discomfort in the thigh or knee itself. Often this is because the quads are working too hard because the powerful gluteus maximus muscles are not functioning correctly, perhaps from injury, overtraining, or some disturbance in the gait.
Deep inside the very lower front part of the thigh muscles, just on top of the femur (thigh bone) lies a very small, but sometimes very troublesome muscle called the articularis genu. It is many times overlooked in knee problems, especially those chronic in nature, and can be a major culprit with what may appear to be bursitis-like problems. Deep trigger-point work on this muscle can sometimes be of great benefit, allowing the muscle to heal. But sometimes that fluid-filled sac between the tendon and the bone can be inflamed, which is called bursitis. If it’s on back of the knee, it’s known as a Baker’s Cyst. Bursitis must be treated differently than tendonitis, though often a person is given a pain drug and/or anti-inflammatory drug for any problem, hoping for the best. To heal the bursa, one needs optimal calcium metabolism; this is the key point for bursitis. This does not just mean that calcium needs to be available in the body, but the proper balance of fats is also needed to drive the calcium into the soft tissue to heal the bursa. It is the fatty acid balance that most people don’t have in their favor.
Optimum fatty acid balance means two basic things – no harmful fats and plenty of the healthy ones. Harmful fats are the partially hydrogenated fats, commonly referred to as “trans” fats as well as excess vegetable oils. Trans fats are listed as shortening, margarine, and as partially hydrogenated corn, vegetable, soy, cottonseed or some other oil on a package. These fats cause a lot of inflammation and block essential enzyme reactions from occurring while also preventing the good, anti-inflammatory fats from doing their jobs. Even eating them a little bit is a problem because the half-life is a whopping 51 days. That means after 102 days there is still 25% of the stuff causing problems and over a year before some people can metabolize all of it entirely. This pretty much ends the debate whether to eat margarine or butter. Those still eating margarine because they were told it is better for cholesterol and body weight can see why it’s beneficial to change to butter and get the laboratory-made trans fat out of the diet 100%.
Healthy fats are the essential omega-3 and omega-6 fats. Most people are deficient in the omega-3s because they are primarily from fish and flax seeds, and to some extent walnuts – foods often not consumed in high amounts. Most eat too many omega-6s fats found in processed, packaged, and fast food. Healthy omega-6 fats are plentiful in most vegetables, nuts and seeds, and legumes but the ones found in soy, corn, safflower, and peanut oils can quickly inflame the body, especially when consumed with too many carbohydrates. So a good amount of both omega-3, (perhaps supplementing with flax or fish oil), and omega-6 fats from raw nuts, seeds and vegetables, and a diet absent of trans fats will allow the body to fight inflammation and recover faster, as well as lower cholesterol and heart disease risk. And, for the purpose of this topic, it will allow calcium to be pushed into the tissues to heal inflamed bursa. As a side note, two other symptoms of inadequate calcium metabolism due to poor fatty acid metabolism are calf cramps, especially ones at night that resemble “Charley horses”, and cold sores/fever blisters, including herpes simplex infections. (Yes, these are viral infections, but their eruption is often provoked by a calcium problem.) Also, although olive oil is a great fat to eat and should be included in every diet, it is not considered an essential fat because it is an omega-9.
Tendonitis of knee is perhaps the most common diagnosis given to many runners when there is pain around the knee that isn’t in the meniscus or the actual muscles. One such tendon pain is along the iliotibial band, or ITB, and a major complaint that forces many runners to stop their activity all together, sometimes for many months. The pain, known as ITB Frictional Syndrome, (ITBS), is a stabbing pain over the outside of the knee, and sometimes on the outside of the mid-thigh region. Athletes are told to ice it and take some anti-inflammatory medication (NSAIDs). However, this rarely helps with healing as many know after the fact if they’ve dealt with this miserable injury. The use of these NSAID drugs causes a major amount of sulfur depletion in the body, and this is the same stuff needed to repair the cartilage (such as knee cartilage!) and detoxify hormones in the liver. Instead of using NSAIDs, this problem can usually be treated quickly and without the use of medication by evaluating the balance of the muscles contributing to the pain as well as addressing fatty acid imbalances. Check out the SockDoc video on ITBS here.
Pain on the inside of the knee is just as common, especially at the area called the pes anserinus which is just to the inside of the lower part of the knee. This is where three muscles come together to make up a significant amount of support for the inside of knee. When these muscles are not working as well as they should, they leave the medial meniscus open for problems due to the improper biomechanics of the joint. The imbalance of these muscles, and often pain and/or weakness around the inside of the knee is usually associated with adrenal gland problems. An athlete will often have this discomfort along with other adrenal gland related symptoms – dizzy when standing up, a craving for salt and/or sugar, irritability and blood sugar handling problems, and perhaps a history of shin splints or plantar fasciitis. Sleep problems as I discuss here, and poor performance while training and racing are signs that the adrenals are taxed too. Evaluation of overall stress – training, diet, and lifestyle is of utmost importance.
The muscles of the back of the knee cannot be forgotten as they often are. The hamstrings as well as the calf muscles are two of the major players here – with such a great distance these muscles span on the back of the leg, they are very important not only for the knee, but the foot and low back as well. These muscles functioning abnormally will cause the athlete to have a foot problem, or a knee problem, or a lower back or hip problem, or maybe one after the other – or simultaneously. These also tend to occur from taxed adrenal glands due to too many of life stresses at once, or excess anaerobic activity, or a poor diet.
And let’s not forget how important footwear is and the mechanics of the feet when dealing with knee pain too…
Proper pronation of the foot, a major source of shock absorption, and the muscles of the foot are extremely important for the health of the knee. If the foot is not functioning optimally then the knee takes a lot more stress than it is able to handle leading to various aches and pains as described above. A strong foot is necessary for a strong knee, and that means considering minimalist-type footwear and staying barefoot as much as possible so the muscles, ligaments, and tendons of the feet become strong and supportive to provide proper proprioception, balance ,and power to not just the knee, but the entire body.