Knee injuries can be frustrating and debilitating. Not only are knee injuries extremely common, but as the pain and symptoms associated with the injury develop, an athlete’s ability to train and compete diminishes. Making matters worse, many sports injuries involving the knee are slow to respond to traditional types of care, keeping the athlete sidelined for weeks, or even months.

This often causes an athlete to miss a large part of the competitive season, or even worse, to be unable to participate in an event that he or she has spent months preparing for.

Fortunately, a new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common injuries and is helping athletes get back to training quickly. But before we talk about why ART® works so effectively, we need to understand how knees become injured.

The knee joint is a type of hinge joint that allows the knee to bend forwards and backwards. For most athletic activities the knee is a critical region as it must act both to support the weight of the body, as well as flex and extend to generate the propulsive forces needed to move the body. To help with these tasks is a complex set of muscles that surround the knee. It is essential that these muscles possess adequate strength, flexibility, and coordination as we rely on them to protect and stabilize the knee during virtually every athletic activity.

For example, with sports such as basketball or soccer, the muscles of the knee must contract during running, jumping, or to initiate rapid changes in direction. Similar demands on the knee can be seen within a wide variety of sports such as hockey, football, baseball, racquet sports, and martial arts. These athletic motions require explosive muscle contractions at the knee, but also require finely tuned muscle balance and coordination to control the knee and prevent excessive strain during these movements.

For the knee to stay healthy and retain optimal function it is absolutely critical that there is adequate strength, flexibility, and coordination of the surrounding muscles. However, maintaining proper function at the knee in itself is not enough. In fact, for the knee to stay injury-free, proper function is needed at other regions of the leg and trunk.

For example, in addition to problems in the knee muscles, knee injury can also be linked to problems at the adjacent joints, such as the foot, hip, and pelvis. This is because the knee is directly connected to these structures through the tibia and femur, as well as the surrounding muscles.

This interconnectedness is referred to as the kinetic chain. We can think of the knee as one link in the kinetic chain, but each link can be affected by any of the other links. This can be a big problem for the knee, because the foot and hip move differently than the knee. For example, both the hip and the foot are designed to move in all three planes: front to back, side to side, and in rotation. The knee, however, is designed to move primarily in only one plane: forward and backward. If even a minor problem, such as excessive tightness, weakness, joint restriction, poor muscle balance, or faulty alignment, exists in the hip or foot, that can cause the knee to move excessively into a side-to-side or twisting direction.

This abnormal knee motion will result not only in excessive strain and overload to the bone and ligaments of the knee joint, but will place even further demand on the muscles that surround the knee in an attempt to protect the knee and correct the abnormal movement. This does not mean that the foot or hip will themselves be painful; in fact, the knee is often the site that first develops pain, even if the knee is not the primary cause of the problem!

This situation( when pain develops in one area as a result of a problem in another region) is referred to as “movement compensation.” Because of the repetitive, high-force motions associated with sports, even a minor movement compensation will be greatly magnified and prevent the athlete from properly controlling the knee and generating the propulsive forces required for the athletic movements. As this occurs, instead of forces being transferred effectively through the muscles and joints of the kinetic chain, the forces become concentrated at the knee, which is the site of the movement compensation.

Due to the impact that movement compensation has on the knee, it is critical that the entire kinetic chain be evaluated to ensure all areas are functioning properly. Failure to identify and correct the compensation will not only prolong the injury process, but will also lead to the injury recurring.

Athletic activities place a tremendous demand on the knee and its surrounding muscles. Over time, the repetitive force can accumulate in the body and lead to strain of the muscles, tendons, ligaments, and in the knee joint itself. This process is greatly magnified when movement restrictions in the hip or foot are present, resulting in movement compensation patterns at the knee.

As time goes on and the athlete continues to train and compete, the strain imposed on the knee will develop into micro-trauma. Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles or joints. Although small, this damage needs to be repaired.

The body responds to tissue injury in a very predictable way – the body repairs the strained tissue by laying down small amounts of scar tissue in and around the injured area. The scar tissue itself is not a problem; in fact, it is a normal and necessary part of healing. The problem occurs as the body is subjected to the same forces at the knee over and over again. This causes the same muscles to become strained and subsequently repaired over and over again. Over time this scar tissue builds up into what is called adhesions. As adhesions form, they affect the normal health and function of the muscles. In fact, adhesions will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

Scar tissue adhesion accumulates not only in and around the knee, but also at the hip, foot, and other areas along the kinetic chain. This scar tissue build-up places more and more strain on the knee as the muscles must now stretch and contract against these adhesions. This further increases the strain to an already overloaded knee, which in turn leads to more micro-trauma.

A repetitive injury cycle is set up, causing continued adhesion formation and progressive movement dysfunction. As the cycle progresses, the ability of the muscles to contract properly is affected and the stability of the knee becomes compromised. At this point, it is not uncommon for the muscles to give way and more severe pain to occur. As you can see, this type of injury builds up over time and a more acute injury is often the straw that breaks the camels back.

In an attempt to alleviate knee injuries in the athlete, a variety of treatment methods are used, either singly, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem. This can be a huge problem as athletes often want and need to get back to training and competition as soon as possible.

The main reason these traditional approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop in the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles surrounding the knee and along the kinetic chain.

Passive approaches such as medications, rest, ice, and steroid injections all focus on symptomatic relief and do nothing to address the muscle restrictions and movement compensations. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles; however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercise are often less effective and much slower to produce relief or recovery from knee pain and other associated symptoms.

ART^® stands for Active Release Technique^®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART^® treatment is highly successful in dealing with many knee injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the soft-tissue adhesions with ART^® it allows the practitioner to:

1. Break up restrictive adhesions,
2. Reinstate normal tissue flexibility and movement, and
3. More completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.

You can think of an ART^® treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.

An additional benefit of ART^® is it allows us to further assess and correct problems not only at the site itself, but also in other areas of the kinetic chain, which are associated with movement compensations, and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART^® is how fast it can get results. In our experience, many knee conditions respond very well to ART^® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in 4-6 treatments. These results are the main reason that many elite athletes and professional sports teams have ART^® practitioners on staff, and why ART^® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART^® will be able to help with your Athlete Knee Pain, simply call our office at (248) 477- 2100.