F O C U S     O N  .  .  .

Muscles and Knee Pain


All too often we hear that the reason a knee hurts is because we "just aren't as young as we used to be." Oddly enough, the one that doesn't hurt is the same age. What makes the difference? What causes the pain? And why doesn't the other knee hurt?

Muscles and Trigger Points. In knees that haven't suffered actual injuries such as torn ligaments and ripped or ground-away cartilage, pain commonly comes from muscles and the surrounding connective tissue (fascia). This is especially true when the muscle becomes tight or shortened and is no longer able to relax to its full resting length. When muscle fibers become chronically shortened, the result is a tender nodule in the muscle, usually in the middle of the muscle or at its attachments.

These tender areas or Trigger Points (TrPs) are named for their astonishing ability to "trigger" or refer pain to distant areas, far from the actual origin. A muscle with TrPs is shortened and weakened. Historically, "just tension" or "pain of muscular origin" hasn't been taken very seriously, but it can be brutal, every bit as bad as the pain of heart attack or broken bones.

Restoring strength and healing the pain involves gently easing away the TrPs and returning the muscle to its proper resting length.

Pain and Weakness. Why would a shortened muscle be weak? Because a muscle's strength depends on its ability to contract, to shorten.

If a muscle is already contracted due to TrPs, there isn't as much muscle left to do the work required of it. Physiologically, the sarcomeres are too close together. Overstretching is just as bad. Physiologically, the sarcomeres are too far apart to allow the muscle to contract effectively.

In either of these situations, the remaining normal fibers must work even harder to accomplish the same motions. Our bodies attempt to compensate by recruiting other muscles. Muscles trying to do jobs for which they were never intended are easily strained and can also begin to hurt and weaken. If this domino pattern of muscle overload and strain continues, a host of other problems will eventually arise.

Proper Diagnosis. When muscles weaken due to TrPs, a common interpretation is that the weak muscles need strengthening exercises, such as weighted knee extensions to "strengthen the quads." This exercise has its place, but if the problem is actually TrPs and shortening, exercises that contract the fibers even more will only make the problem worse.

Knee pain should always be evaluated by your doctor, but if no structural damage is found, check for shortened muscles. Test muscle length with the Range-of-Motion (ROM) tests. Look for a therapist who is familiar with range-of-motion testing and who deals directly with muscles and fascia.

Proper Treatment. The most qualified professional to treat knee pain is a Myofascial Trigger Point Therapist. You may find one near you through the directory at

However, it is often possible to treat your own muscular pain. ROM tests and pain patterns help identify and isolate the shortened muscle. TrPs can then be treated by yourself or a partner using gentle pressure from fingers, knuckles, or other tools. Always follow treatment with gentle stretching to help return the muscle to its proper resting length.

Tests and Treatments

Quadriceps, hamstrings, and adductors are responsible for a great deal of knee pain, but the list doesn't stop there. Knee pain can also come from the calf muscles, the gluteals and even from the bones of your feet. But we have to start somewhere, so . . . .

  1. Quadriceps Diagrams and Tests

    This section shows pain patterns typical of tight quadriceps. Includes ROM tests for checking and treating rectus femoris. This muscle commonly lurks behind knee-cap pain, but that isn't all. It's also respsonsible (in concert with loose hamstrings and tight adductors) for what is commonly known as "Jennifer Lopez Butt," or "Bubble-Butt." It isn't just a figure flaw. It is a muscle problem that has derailed many careers, leaving former dancers and athletes with mysterious postural distortions, hip and leg pain. And it is easily fixable.

  2. Adductor Tests

    These tests will reveal adductor problems. If you have been hitting the adductor machines at the gym in pursuit of thin thighs, and are now suffering knee and possibly pelvic pain with no obvious organic cause, it isn't necessarily a coincidence. Tight adductors can even trigger migraine headaches and cold feet due to entrapment of the femoral artery and femoral vein where as they pass through the Adductor Magnus via the adductor hiatus, an opening in the muscle near the knee.

Myofascial Overview & Resources

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