Knee Self Treatment

This information is for those of you with chronic or recurring knee pain. You may have been diagnosed with osteoarthritis or a meniscal tear, but you are not your diagnosis. Many people have degeneration and meniscal tears with no pain in their knee at all. If you had a serious accident or fall, your knee is hot and swollen for no reason, pain/numbness below the knee, or knee pain with back pain radiating into the thigh, severe pain in the calf with breathlessness and chest pain, history of cancer, please seek a medical professional immediately as this may indicate a serious medical condition.

The knee is one of the most commonly reported sites of pain after the back and the neck. It can be constant, intermittent, only hurt during certain movements, and change locations from the front, back and sides. The majority of knee pain is mechanical in nature. That means the moveable soft tissue components of the knee get injured from being overstretched, overloaded, and distorted.   Things like the anterior/posterior cruciate ligaments that prevent the femur from shifting too far forward backwards on the tibia; the medial/lateral collateral ligaments that prevent excessive side
to side movement; tendons from the quadriceps, hamstrings, calf and adductor muscle groups that support and move the knee; the joint capsule that lubricates and nourishes the knee., and the menisci that provide cushion and shock absorption.

The joint tissues can be damaged suddenly like from a slip or a fall, a sudden twisting movement, or trying to rapidly increase the amount of weight lifted or mileage in a run. For those small acute injuries, some rest allows the tissue to heal. It’s always a good idea to see your local myofascial therapist to speed up the process. When joints are injured, the muscles around that joint develop trigger points causing pain and weakness. By removing the trigger points, pain is greatly decreased and the knee will be more stable allowing it to heal even faster. If you heard a pop, have intense swelling, and are in a lot of pain or if your knee did this to the left, please seek immediate medical care.

I see in my young athletes, but especially as we get older, the majority of the mechanical stress is from prolonged postural positions. The main culprit I have found is when the knees are bent past 90 degrees. This happens when we sit with our feet tucked under our chair all day as on the right, sitting cross-legged, working on your knees (gardening, mechanics, construction, etc), and sitting on your foot with the opposite knee up or down as seen below (worst position to hold as it unlevels your pelvis and spine, overstretches your hip, knee and ankle),. If you have a job where you are on your feet for long periods, it can create knee pain as well, especially when your standing posture Is out of alignment. Do this long enough, day in and day out, and those soft tissues become overstretched, lose their elasticity, and stiffen. The muscles and fascia change their resting tone and also become weak.

To see how overstretched tissue feels, pull your index finger back just before it hurts and hold it there for 1 minute. When you release it, you will probably feel stiffness and maybe even pain as you bend it back. You have strained the soft tissue components of the joints and deformed them slightly registering as pain. It quickly heals with just a little movement. That’s probably how your knee pain began. It felt stiff but if you just stood up and walked around it felt better. Now imagine doing that for hours at a time, for days, weeks, and years. You can see why it takes very little stress to irritate your knees. Our tissues and joints need movement in order to hydrate, pump waste out, and pull in nutrients.

Once we’ve gotten you out of pain, self-treatment is the most effective treatment when postural stress is the main culprit of your pain. Once you realize what you are doing to cause it (sitting/standing in one place for prolonged periods), and what you are not doing (moving, exercising, strengthening) you will know how to keep your pain away. The following exercises are simple things you can do at your desk without any extra equipment and are highly effective. There will be other handouts/videos with self-myofascial release techniques later.

McKenzie Knee Exercises

The purpose of the McKenzie Knee Exercises is to decrease/eliminate pain and restore ROM and strength. When your goal is pain relief, move your knee just into the painful range of motion and then return to the starting position. As you release, the pain should diminish. If not, you may be overdoing it. You should feel less pain and more ROM as you perform the exercises. If you are exercising for stiffness, you can apply some extra pressure to obtain as much movement as you can. You may feel discomfort afterwards for up to 20 minutes. If it persists, you may be overdoing the pressure. Perform the exercises 10 times every 2 hours. Once you are out of pain, follow the maintenance recommendations at the end. Be patient as you are reshaping not just the tissues on the outside, but inside the joint as well.

Always perform the exercises in sequence with the good leg first, then carefully perform with the bad leg. This gives you a baseline to compare where you should be so you know when to move to the next exercise. Exercises 1-6 improve range of motion while Exercises 7-8 help restore strength. Typically, if you are sitting most of the day, knee extension exercises are more helpful. If you are on your feet all day, flexion exercises are more beneficial. However, if your pain is not improving, getting worse, and/or your knee feels stiffer, try moving from extension to flexion exercises or vice versa.

Knee Extension Test

Normal range of motion for knee extension is 5 degrees past neutral but it is more important that you have symmetry between both knees.  To test your knee extension range of motion, sit in a chair and maintain an upright posture throughout the entire movement. Slowly straighten your good knee as far as you can hold for a few seconds.  Then flex your foot up which may cause you to feel even more stretch.  Next, test the bad knee by slowly performing the same movement.  Be mindful of what you feel in the knee and where you feel it. Is there more stretch behind the knee, where is the pain located, can you straighten it as far as your other leg?

Knee Flexion Test

To test your knee flexion range of motion, start with your good knee first. Sit on the edge of a chair and lift your knee towards your chest and grab your shin above the ankle. If you have difficulty, grab your knee first then your shin or use a small towel to grab your shin. Pull your heel as close to your buttocks as possible. Then perform with the other leg being mindful of range of motions stiffness, pain, etc.

EXERCISES

Exercise 1: Active Knee Extension in Sitting

• This exercise helps restore range of motion AND increases strength of the knee because you are actively engaging your thigh muscle. It’s also a great exercise for maintenance and prevention
• This is the same exercise as the Knee Extension Test
• Maintain an upright position, preferably sitting in a firm chair, and slowly straighten your knee
• Flex your foot up, hold for a few seconds, then lower.
• Each repetition flex your thigh harder and try and go a little farther so you can improve your range of motion
• Perform 10 repetitions 6-8 times per day.

Exercise 2: Knee Extension in Sitting

• Sit in a chair and put your heel on another chair of the same height with the knee bent
• If you don’t have another chair, sit on the edge of your chair and rest your heel on the floor.
• Relax your leg and slowly let your knee straighten just past the point of pain and hold for a few seconds
• Relax the knee by bending it then lower again
• For each repetition, try to go a little farther until you get full extension.
• If your bad knee doesn’t hurt in this position but doesn’t straighten as much your good knee, you can give it some overpressure by pushing down on your thigh just above the kneecap. Make sure you push just into pain, hold for 2 seconds and release.
• Perform 10 repetitions 6-8 times per day

Exercise 3: Knee Extension in Standing

• Stand upright and put your heel on a step, stool, or the ground.
• Maintain a straight spine and bend forward putting your hands on your thigh just above the knee
• Apply some downward pressure on the thigh just into pain, hold for a few seconds and release
• Try to go a little farther with each repetition
• If you don’t get full extension, try this variation:
• If the pain is on the outside, rotate your knee in and apply overpressure
• If pain pain is on the inside, rotate your knee out and apply overpressure
• Repeat 10 times 6-8 times per day
• This should be done for about 1-2 weeks or until pain is gone

Exercise 4: Knee Flexion in Sitting

• This is the same as the knee flexion test.
• Sit on the edge of a chair and lean back, bringing your knee to your chest and and grab your shin to pull your heel towards your buttocks.
• If there is no pain, discomfort or loss of range of motion move on to Exercise 5
• Otherwise, hold the flexion for a couple seconds and relax
• If the pain is intense you can roll up a towel and place it behind your knee. This will limit your range but has the added benefit of gapping and opening the joint. Once the pain diminishes remove the towel so you can work on range of motion
• Repeat 10 times every 2 hours
• Once you move on to Exercise 5 you don’ have to do this exercise any more

Exercise 5: Knee Flexion in Standing

• Stand upright and put your foot flat on a chair or stool.
• Slowly lean forward letting your knee move towards your toes without letting the heel come up.
• Push your buttock towards your heel until you feel a stretch.
• Hold for a few seconds then release the pressure.
• Try to go a little farther each repetition for 10 repetitions
• You can put the rolled up towel behind your knee again if the pain is too intense.
• Perform 6-8 times a day or every 2 hours.
• Once you can perform comfortably move on to Exercise 6

Exercise 6: Knee Flexion in Kneeling

• This can be intense as your body weight is going to pressing down on your flexed knee. If the pain is too intense go back to Exercise 5.
• Put a cushion or pad under your knees and get on all fours.
• Slowly sit your buttocks back onto your heels until you feel the stretch or light pain in the knee.
• After each repetition, try to go a little farther
• When you can comfortably get your buttocks on your heels you can lift your hands off the floor and sit up
• Repeat 6-8 times per session and do it every 3 hours or 6-8 times per day

To address the weakness of the muscles, tendons, and ligaments of the knee due to too much sitting or inactivity, perform Exercises 7 and 8.

Exercise 7: Double Leg Squat

• Put a chair behind you and open a door where you can grab both handles for support
• Try not to pull on them too much. The goal is to strengthen your knees, not your arms.
• Keep your feet hip width apart, feet flat, and don’t let your knees cave in as you slowly lower yourself like you are going to sit in the chair
• When you feel good tension in your knee, hold for a couple seconds and then stand back up
• Try to go a little farther each time until you touch the chair but don’t ever sit fully down into the chair.
• When this becomes easy, practice without using the door.
• Perform 10-15 times per session, 2 times per day
• As you get stronger and the pain decreases, work your way up to 3 sets of 15 twice a day.
• This may take several weeks because you are building muscle and strengthening the tissues

Exercise 8: One Legged Knee Bends

• Start this exercise by standing on a telephone book or small step before moving to a box like the one I am using. Place something sturdy next to you like a tall chair and not a PVC pipe. Once you are strong enough you can progress to a taller box and no support.
• Slowly bend your bad knee lowering your other foot towards the floor till you feel strong tension or just to the point of pain.
• This is the most important phase and should take 3-5 seconds
• Keep your pelvis level by lowering yourself down and not reaching for the floor with the good leg
• Make sure you keep your knee pointing forward and don’t let it collapse inwards by rotating the knee out with your hip muscles
• Hold for a few seconds and then lift yourself up by straightening your knee and hip.
• Each time try to go a little lower till you get right above the ground but never rest on the ground
• Perform 10-15 times per session, 2 times per day
• As you get stronger and the pain decreases, work your way up to 3 sets of 15 twice a day.

Maintenance

• Interrupt prolonged sitting by performing active knee extension at your desk or some squats if you are standing for long periods
• Increase physical fitness with walking, taking the stairs, boot camp, personal trainer, gym, etc
• Improve balance with single-leg standing while brushing your teeth, waiting in line at the store, wherever and whenever by just slightly bending one knee so the foot is off the ground

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