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. 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 and 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 kickback 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 squatting/kneeling position for a while without pain or discomfort in the thigh or knee. This is often 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 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 frequently overlooked in knee problems, especially those of a chronic nature, and can be a major culprit in 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 the back of the knee, it’s known as a Baker’s cyst. Bursitis must be treated differently from tendonitis, though often a person is given a pain 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 only 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 that after 102 days, there is still 25% of the stuff causing problems, and it takes over a year before some people can metabolize all of it entirely. This pretty much ends the debate of 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 not often consumed in high amounts. Most people eat too many omega-6 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 bursae. 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 the knee is perhaps the most common diagnosis given to 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 the ITB, and it’s a major complaint that forces many runners to stop their activity altogether, 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 Sock Doc video on ITBS here.
Pain on the inside of the knee is just as common, especially in 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 the knee. When these muscles are not working as well as they should, they leave the medial meniscus open to 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: dizziness 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 and calf muscles are two of the major players here. With such a great distance, these muscles span the back of the leg, and they are very important not only for the knee, but also for the foot and lower back. The abnormal function of these muscles will cause the athlete to have a foot problem, a knee problem, 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 life stresses at once, 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. 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.
Check out the Sock Doc Knee Pain Treatment & Prevention Video here!
