Things I Know about Knee Pain

I have been treating knee pain for years and here are some things I have discovered

  1. Knee pain can be caused by misalignment in posture, your hips and feet
  2. The knee is linked to the hip and ankle with the main purpose of helping us to walk
  3. Over-exercising is also not good for your knees, joints or immune system (‘no pain, no gain’ or ‘feel the burn’ is so wrong)
  4. Equally, not doing any exercise can affect knee pain and intensity, so getting a balance between inactivity and the right amount of exercise is key to keeping knees in good condition
  5. Knee surgery can be avoided in a large percentage of cases
  6. Stretching after exercise tends to be better than beforehand
  7. Being overweight contributes to knee pain as you carry 100s of lbs on a knee that is only around 2lbs!
  8. Knee inflammation can result from sitting for long periods and poor diet
  9. What you think is arthritis, bursitis or tendonitis might just be tight fascia, ligaments and muscles in and around the knee, upper leg and calves
  10. Cracking knees can often be due to dryness within the body system itself (in Ayurveda, we call this a Vata imbalance which can be resolved in most cases)
  11. Paracetamol is not the answer. It can cause more damage than good
  12. Janu Basti is an effective knee pain treatment in Ayurveda that uses warm medicated oils or warm caster oil, which I mix with aromatherapy oils
  13. Trigger Point Therapy and Myofacial Release can help to greatly reduce knee pain and related issues
  14. I love treating people with knee problems as I see them walk, run and cycle again after months, or years, of being frustrated with this issue

Causes of knee pain

The world of knee pain can be a minefield as there are so many obvious but underlying causes.  Some causes of knee pain are:

  • Over-pronation of the foot due to flat feet-when the foot is over-pronated, it rotates the leg and surrounding muscles, causing tension.  The knee can then move inwards causing a pull elsewhere and you feel pain.
  • Under-pronation of the foot can be caused if you have high arches or weak calves or ankles.The foot rolls inwards on landing so you put strain on the outside of the foot.  This can increase stress and aches up along the leg and poor posture eventually leading to knee pain.  A sign of this would be if you have experienced shin splints in the past.
  • Poor flexion of feet.  This is a whole other area but the feet do much more work than you can imagine.  If there are issues in the feet or tendons which run down the leg to the feet and toes, it can indirectly affect the knees. Always make sure your feet are stretched or massaged after exercise as well as your other muscles.
  • Impact from toes-nerve endings affected in the feet change gait with impairment of operation of this area along the posture line.  This can travel up the leg and affect the knee.
  • Referred Pain-referred pain, or trigger points, are often over-looked when it comes to knee pain, or any type of pain. Trigger points build up in areas above or below the knee where the pain is felt and this can often be mistaken for arthritis.  Trigger point therapy is an effective way to reduce knee pain.  I am a qualified therapist in this field and add it into my treatments as necessary.
  • Lack of oxygen in the blood before exercising.  Alcohol reduces oxygen.  When you do not have enough oxygen in the blood, lactic acid forms and this causes stiff muscles and trigger points within the muscle.  Stiff muscles and trigger points cause aches which lead to poor posture to over-compensate. Thus, shortening of the ligaments and tendons surrounding the muscles can occur and this can be one source of your pain. Reducing or eliminating alcohol whilst on a training programme and staying well hydrated can greatly help reduce lactic acid.
  • Low Iron Levels.  Iron helps to improve oxygen in the blood.  Low iron can lead to getting out of breath quickly due to low oxygen mentioned above and having to work harder to move the body. Over consumption of alcohol and caffeine depletes iron levels and leads to anemia.
  • Knee and Hip Surgery-it can take up to 2 years for a knee or hip to fully recover after an operation.  The muscles can seize up from the shock or movement and stay misaligned which can cause referred pain in the knee or elsewhere along the leg.
  • Lack of Pelvic mobility due to weak or tight Tensor Fascia Lata. This muscle flexes, adducts and rotates the thigh and stabilises the knee. Pain on the outside of the knee can be attributed to this.  This may also be linked to issues in the intestines and low iron levels.
  • Many knee problems I have dealt with also stem from poor training techniques that affect the quadriceps (quads at the front of the upper leg).  Not stretching this muscle group can link to not being able to straighten the knee or flex the thigh. This muscle inserts at the patella of the knee and trigger points can form at the top front of the hips and upper and lower part of the knee, as well as tension down the leg.
  • Soleus Muscle-I love working with this muscle as it gets overlooked a lot in massage or training.  The Soleus (latin meaning sole or flat) helps with flexion of the foot.  It runs from outside the knee down the back of the leg and inserts via the achilles tendon into the heel.  It overlaps other important muscles of the leg so we use this to get to the calf muscles (gastrocnemius).  Ruptures are common at this point from jumping or excessive running.  Also emotional stress and adrenal issues can affect this muscle.

    Soleus needs attention with knee pain
  • Pain on the outside of the knee (lateral pain) can be linked to the IT band (iliotibial band).  If you have ITB issues or tightness down the outside of your legs, it may be that the ITB and pelvis will need realigning.
  • Pain on the inside of the knee will need a different protocol as the aductors and sartorios muscle may be to blame.
  • Fibular Collateral ligament which runs from the top bone of the leg to the top of the lower leg. This crosses over the knee and can become tight.
  • Tibial Collateral ligament. This is closer to the bone of the kneecap and can also tighten up as it is a short ligament.
  • I also work with the digitorum and extensor longus, which runs down the outside of the lower leg.  Whilst this muscle does not greatly affect the knee, it can cause more foot pain and issues, as it links to the phalanges of the foot.  So, if you feel pain in the big toe or cramps at night, this muscle could be the cause.
  • Inflammation-inflammation is the body’s way of telling you something is wrong.  It may be an injury to the area, but I find that most inflammation within the body is due to over-exercising on an already weak area and poor diet with foods that cause inflammation in the cells. Examples are sugars, pastries and white flour, saturated fats, fried food, processed ‘short-cut’ meals and alcohol.
  • Inflammation from injury-Knee Bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint. The tendons and ligaments should normally glide smoothly over the joint but with injury it can cause pain.

    weakness in anterior tibial can cause rolling inwards
  • Excess body weight-what do you weigh in LBs?  Most of this weight can be pushing down on just 2lbs of knee, especially the knee cap (or patella). The patella is attached to the quads and helps with leg extension.  The knee joint is made up of 3 bones and tendons and ligaments that connect and stabilise.  Excess weight can affect the power of the cushioning in the joint.  If you are overweight and do not exercise, sitting for long periods can also put pressure on the knees as they were designed for movement.
  • Sitting for long periods of time and then going out to train can be a cause of your knee pain. The sitting position puts pressure on the kneecap.  Extended periods of sitting make your gluts weak and the gluts are so important as they link to other muscles but can often be a cause of knee pain.

Sometimes muscle, ligament and tendon weakness or tightness can be mistakenly labelled as arthritis, bursitis or tendonitis.  A good way to test this is to have 2 or 3 sessions with me and we will be able to trial and eliminate either way.

Treatment Protocols

Treatment depends on where the pain is.  It could be outside the knee, inside, on the knee itself OR on the back of the knee? Working with me as your therapist will help determine which method to use to alleviate pain or tenderness in this area.










Make your ultimate aim to get to the cause of the problem and work on that first

  1. The NHS advice is to take paracetamol.  I would suggest you avoid this unless absolutely necessary!  Paracetamol is a toxin like most other pain killers.  It contains metabolites (N-acetyl-p-benzoquinone imine) which affects the liver’s gluthione and can damage liver cells. Gluthione is your own bodies antioxidant so you need this when exercising to aid recovery. Equally, Voltarol and Ibuprofen only mask the symptoms and do not work on the cause.  By masking symptoms, you may be slowly making the issue worse.
  2. The NHS also recommends using ice.  I would say only put ice on (through a cloth) if you have obvious swelling, acute pain or it is a recent injury.  Do NOT use ice if you know you have narrowing of the blood vessels or a heart condition.  ICE NARROWS YOUR BLOOD VESSELS.
  3. You can use cooling techniques such as ice after working out as you have heated the muscles and exercising tears the muscle fibres.
  4. If you have arthritis, use heat where there is no swelling.  By the way, Arthritis CAN be reduced drastically by a change in lifestyle.  More on that later!
  5. Eat iron-rich foods such as meats, poultry, fish.  If you are vegetarian or vegan, plenty of legumes for protein and green leafy veg (providing you do not get constipated) will help improve your iron levels.
  6. Foam rolling is great for the interlinking muscles to the knees but if they are already tight and restricted you may not be helping.  Get the muscles re-aligned first then self-manage with a foam roller, tennis ball etc. I can advise you on all of this as part of your sessions.
  7. Yoga-as an Ayurveda Consultant, yoga comes into everything related.  I could not write an article without suggesting that there are many poses in yoga that help to sooth knee pain, especially if complemented with remedial massage.
  8. Try a Janu Basti treatment, an ayurveda massage using medicated oil which absorbs into the knee joints to give more flexibility.
  9. Self massage with equal parts eucalyptus oil and ginger oil and half part rosemary oil all blended with sesame oil.  I use and blend this oil combination with great effect.
  10. Book your massage sessions with me to assess which muscles and tendons are affected and to get them working without compromising your exercise routine.

We have to get mobility into the restricted areas first and then get strength and flexibility in the muscles around your joints.  We will then assess how the muscles and brain memory hold this together with your feedback and my analysis at a follow-up appointment.
This will determine next steps and a full treatment protocol.

I have been treating knee pain with various causes for years. Think of your knees as part of your hips or feet as they are linked.

Book your massage to help your knee pain. Call 07903 215524 to discuss how I can help.

Myofacial release can help knee pain

NOTE; PLEASE BRING YOUR TRAINERS TO YOUR SESSION or the results of your recent gait analysis.

Disclaimer: There are many causes and treatments for knee pain. It is worth noting that I do not take anything in isolation when it comes to knee pain.  As it can be caused by a number of factors, not diagnosed by your GP, I will need to conduct a full assessment to the get to the cause of the issue and advise you accordingly.  When it is purely muscular, we discover this after one or two sessions of massage therapy.  This is then progess from a clinical management point of view. I do not claim to have all the answers and this article is written solely on my own personal experience and the feedback and results of my clients. 

Christine Southwell
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