Soft Tissue Treatments & Exercises For Knee Pain

Knee Injuries & Soft Tissue Treatments

Knee Injuries can be internal ligaments and structures. Most times knee pain is a combination of several muscles, tendons, and ligaments that are damaged from chronic repetitive stress. Poor muscle strength, endurance, and stability lead to multiple sites of tissue damage. Knee joint pain can be treated by several conservative methods that don't require surgery in order to retrain and stabilize the knee: active therapy, Graston Technique, ART, vibration therapy, and functional movement exercises.

Treatment options vary depending on what muscles and tendons are damaged, level of weakness, previous history of knee injuries, arthritis, and overall goals. Are other hip, knee, or ankle injured and changing walking gait.

Anatomy of the Internal Knee

The large femur sits atop of the tibia, much like two pillars stacked on top of each other. The smaller fibula bone is on the outside of the tibia in the lower leg. The fibula provides some weight bearing but not nearly as much as the tibia. At the end of the femur are two large condyles with rounded edges that allow for the rocking or hinging motion associated with knee movement.

In between the femur and the tibia are fibrocartilage shock absorbers or meniscus. The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL), both stabilizing ligaments, prevent excessive forward and backward movements. The large stabilizing ligaments on the outside and inside of the knee are the Lateral Collateral Ligament (LCL) and Medial Collateral Ligament (MCL).

The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded by muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.

The knee is a complex joint that is surrounded by a ligament joint capsule and lined with a synovial membrane that produces synovial fluid. This fluid helps lubricate the knee. The lubrication reduces friction and damage to the internal components of the knee. Bursa are fluid-filled sacs that help reduce friction as muscles and tendons glide across the bursa.

Medical Treatments and Imaging

NSAIDs, or nonsteroidal anti-inflammatory drugs, are often prescribed for the initial acute knee injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can also be treatment options. Pain management is not usually required unless stronger medications or joint injections are required for treatment.

MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory, or reflex loss.

Conservative Treatments

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, cold laser therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

Massage therapy is an excellent treatment for many knee injuries, especially knee tendonitis. It helps reduce the pain of swelling knee cartilage and knee tissue by releasing serotonin, a natural pain reliever. If surgery is required for a severe knee injury, scar tissue can sometimes build up. Massage therapy helps to break down the scar tissue, which improves the recovery process.

Cold laser therapy is a noninvasive procedure, meaning no surgery is required. This treatment uses specific wavelengths of light to interact with knee tissues. The non-thermal photons of light are emitted from the laser and pass through the skin layers to the damaged tissue where it interacts with the light-sensitive elements within the tissue. Cold laser therapy is often compared to photosynthesis because the tissue absorbs the light and converts it to useable energy, which aids the healing process and provides relief for knee pain.

The Graston Technique is a very effective and popular treatment for muscle, tendon, ligament, and soft tissue injuries. This treatment uses specifically designed stainless steel instruments and therapeutic exercises to detect and treat areas of swelling and inflammation. The instruments are also designed to find and treat the cause of the symptom, as well as the area of the internal knee pain. Adding the Graston Technique to any treatment plan decreases recovery time and reduces the need for anti-inflammatory medication.

Active Release Technique (ART) is a movement-based massage technique. It is used in the treatment of muscles, tendons, ligaments, fascia, and nerves. The technique is a hands-on manual therapy approach to lengthen muscles and release adhesions to tissues and nerves. The ART provider uses his or her hands to evaluate the tightness and movement of the injured area. Injury of knee tissue or knee cartilage is treated by precisely directed tension and specific patient movements to shorten and lengthen the muscles surrounding the knee.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle.

Exercises for Knee Pain Relief

The lower extremity works as a comprehensive unit performing many of the repetitive tasks required at home, work, and in recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises. In these exercises, the knee muscles tense up without moving or changing lengths. It allows the muscles to gain strength to prevent future knee injuries. An example is a single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, an exercise ball, and BOSU balls can be performed on the floor. The more unstable the surface, the more effort and stabilization is required of all the lower extremity muscles, increasing strength gain.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.

Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back pain patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with residents of all ages and abilities in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.