Knee problems can be very frustrating. In fact, a painful knee can prevent you from enjoying your favorite things, such as walking, playing golf, exercising, or gardening. Knee pain can even interfere with a good night’s sleep. To make matters worse, many common knee conditions are slow to respond to traditional types of care.

Now for the good news: a new treatment technique Active Release Techniques® (ART®) is proving to be a very effective method to treat many common knee problems, and is helping knee pain sufferers get back to performing their favorite activities. Before we explain why ART® works so effectively, we will tell you how the knee can be injured.

The knee consists of three bones: the femur, tibia, and the patella, or kneecap. Where the femur and tibia join, they form a hinge joint designed to move back and forth. These movements are called flexion and extension. The knee is designed to allow a large amount of movement, permitting us to do a wide range of activities such as walking, running, crouching, and kneeling.

In order to move properly and protect the area from injury, the knee joint relies on the complex system of muscles that surround the area.

These muscles include the thigh muscles (the quadriceps group), the hamstring muscles, the inner thigh muscles (the adductor group), the calf muscles, and some smaller muscles around the knee, such as the popliteus muscles. Underneath these muscles are several long ligaments that help protect the knee joint. When the muscles are all working properly, the knee moves as it should and the chance of pain and injury is very small, but is common for these muscles to become tight and weak, which can lead to a variety of knee problems.

We rely on the muscles that support and control the knee for all of our daily activities. Simply climbing a flight of stairs or bending down to pick up the newspaper requires a complex interaction of the knee muscles to move and stabilize the area. With sports such as running, tennis, or golf the demand of the knee muscles is even greater. If any of the muscles that surround the knee become tight or weak, excessive strain is placed on the other muscles and on the knee joint itself. If this imbalance in the muscles and the resulting abnormal knee motion is allowed to continue, more severe knee conditions can eventually develop.

A variety of situations can cause pain, weakness, and abnormal function of the knee. Repetitive use with certain sports or occupations, poor posture, lack of use, lack of stretching, muscle imbalances, or previous injury can all affect the normal function of the knee and surrounding muscles resulting in excessive strain to the area.

Over time, this strain can develop into micro-trauma. Micro-trauma is very small-scale damage that occurs in the muscles, tendons, joint capsules, and ligaments in response to small levels of strain. Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although small, this damage needs to be repaired, and the body responds to tissue injury by laying down new tissue to repair the injured tissue. Over time, this scar tissue builds up and accumulates into adhesions. As these adhesions form, they affect the normal health and function of the muscles. In fact, they often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

As scar-tissue adhesions accumulate in and around the muscles of the knee, more and more strain is placed on the muscles because they must stretch and contract against these adhesions in an attempt to move and stabilize the knee. This places even further strain on the knee muscles, which in turn leads to even more micro-trauma. Essentially, a repetitive injury cycle is established, causing continued adhesion formation and progressive knee dysfunction. At this point, pain and tightness at the knee and the surrounding area starts to become noticeable.

As this repetitive strain cycle continues, the ability of the knee muscles to meet the demands placed on them diminishes and it is not uncommon for the muscles to give way and for more severe and debilitating pain to occur. Many patients come into our office explaining that they have knee pain, but that they did not really have any major type of injury. Patients almost always describe some mild pain or tightness that has been building over time.

When discussing any type of knee problem we also need to review the relationship that the knee has with other joints in the body, particularly the hip and the foot. The foot, knee, and hip make up what is called a kinetic chain. The majority of the muscles that act at the knee also cross either the hip or ankle joint. As a result of this relationship, with any knee problem, both the foot and the hip must be closely examined, because an abnormality in either area will greatly influence problems at the knee.

A common example of how the knee is influenced by the kinetic chain occurs in someone whose foot excessively pronates. Hyper-pronation of the foot occurs when the foot rolls inward, causing the foot to flatten when walking and running. This causes the tibia to rotate inward, resulting in a twisting stress at the knee. This results in injury to the knee joint and also strains the muscles of the knee, hip, and foot, as they have to work even harder to control the excessive strain and combat the effects of the hyper-pronation. This greatly magnifies the effects of the repetitive strain cycle, leading to knee dysfunction and injury. Even though pain may be at the knee, the entire kinetic chain must be evaluated and treated to fully resolve the condition.

Active Release Technique^® (ART^®) can help resolve many common knee conditions, including:

• Patellofemoral Pain Syndrome
• Quadricep Tendonitis
• Arthritis
• Pes Anserine Bursitis
• Hamstring Tendonitis
• Iliotibial Band Syndrome
• Patellar Tracking Disorders
• Meniscus Injuries
• Ligament Strains
• Nerve Entrapment Syndromes
• Popliteus Tendonitis
• And many more…

In an attempt to relieve knee pain, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include anti-inflammatory medication, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Most of these traditional approaches require a long period of time before they provide any significant relief, and in many cases they provide only temporary relief from symptoms instead of correcting the underlying cause of the problem.

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

Passive approaches such as medications, rest, ice, and ultrasound 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 rehabilitation of the condition and to restore full strength and function of the muscles; however, they 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.

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

break up restrictive adhesions
reinstate normal tissue flexibility and movement
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 first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthens, 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 problem area. In this sense, each treatment is also an assessment of the health of the area, because we are able to feel specifically where the problem is occurring.

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

One of the best things about ART® is how quickly it provides results. In our experience, many types of knee injuries respond very well to ART® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and several factors determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six 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® can help with your knee pain, call our office at (248) 477- 2100.