Tuesday, May 18, 2010

Knee Pain - Part II: Are your Quadriceps punishing your Knees?

It never ceases to amaze me how many times our bodies can hurt in one place with the cause being somewhere else. Physical therapy & human performance guru Gray Cook is constantly admonishing us to use the Selective Functional Movement Assessment not to seek out what hurts as much as to look for the DN - dysfunctional non-painful link in the kinetic chain.

In an earlier blogpost on the Three Prys, I mentioned how some knee pains & injuries can be caused by faulty knee tracking. It's possible that even with fairly decent knee tracking, you might still be suffering knee pain that's due to other imbalances or asymmetries.

To review the concept of asymmetries in the Functional Movement Systems paradigm, please remember that we're looking primarily at Left-Right asymmetry as a predictive biomarker for injury. But we're also looking at asymmetries in:
- Medial - Lateral
- Anterior - Posterior
- Top - Bottom

So with the knee, let's quickly review the anatomy (since I'm dying to get this blogpost done before I sprint off to see patients and before I need to hop on the plane to St. Paul, MN again for the CK-FMS workshop).

According to a rather insightful entry in Wikipedia, the quadriceps are the most powerful knee extensors.

All 4 heads attach to the patella via the quadriceps tendon, so it's not exactly a stretch (really, no pun intended) to see how this muscle group might play into stubborn knee pain. So if you've been either overtraining your quads or overstretching your hamstrings, that sort of anterior-posterior asymmetry might be leading to dysfunction manifesting at the knee joint itself.

The rectus femoris, since it originates on the ilium, can be considered a hip flexor as well. So knee, hip, or even lower back pain that isn't resolving might warrant a careful look for trigger points in the quads. As soon as you visit your orthopedics or sports med physician to rule out more serious issues, such as meniscal/ligamentous tears, you might want to some deep tissue done on the quad on the troublesome side.

If that gives you a noticeable improvement, pattern some good movement on top of your newly found range of motion with a corrective exercise like the one we're demonstrating here: