Many of my clients suffered from knee pain for months or years before they found me. They had imaging done, which showed some osteoarthritis. So their physicians prescribed medication and referred them to physiotherapy. Several clients reported to me that their physio clinic enticed them to sign up for two sessions a week for three or more months. Physiotherapy “treatment” consisted of exercises. They were “put on machines.” Their pain did not go away. In fact, it worsened.

Not seeing results, they abandoned physio exercises and proceeded to “try everything,” such as: acupuncture; massage; chiropractic; osteopath; cupping; laser, infrared and shockwave therapies; TENS; and so on. Yet the pain did not go away. They were sure they needed a knee replacement.

Sound familiar?

Barring any muscle or ligament tears, my clients’ knee pain often has a simple cause: unbalanced muscle tension that pulls the bones out of alignment. Uneven compression causes the cartilage to thin and bones “rub,” creating osteoarthritis, aka bone inflammation.

Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change.—Centers for Disease Control and Prevention

Case 1: 65 Year Old Female

A client presented with left knee pain. Normally, exercise consisted of walking her dogs.

I discovered a huge muscle knot halfway down her left Semimembranosus (medial hamstring). I released it, and after the single initial session her knee was fine for “quite a while.” Then the knee pain returned. Instead of returning to see me, she make an appointment with her physician. He ordered X-ray imaging which revealed osteoarthritis. He referred her to physiotherapy.

After several physio sessions twice a week, which consisted of exercises, her pain was worse. When she complained of the excruciating pain, they told her to do more exercises! She then returned to see me six months after her first session, limping, wearing a knee brace, and in too much pain to walk her dogs.

In her second session with me, I discovered that not only had the large knot of torn fibers in the left medial hamstring returned and enlarged, but that her Gracilis, Adductor magnus, and Vastus medialis had all been strained by the physio exercises. Those tight, sore inner thigh muscles were pulling hard on the left medial knee, compressing the femur and tibia bones together on that side.

She had some pain relief from the second session with me, but she’ll need to return for at least two more sessions spaced two weeks apart because there was so much more muscle damage to address this time.

Why Schedule Sessions Two Weeks Apart?

The simple answer is because muscles and connective tissue need time to heal before more therapy is done. If a person is young, healthy and fit, one week between sessions is usually sufficient. If a person is a senior, unconditioned, has a poor diet, and/or is struggling with other health issues, the body does not have the energy reserves to heal as quickly. Healthy or not, twice-a-week sessions is asking for trouble, because the damaged area is repeatedly reinjured.

Case 2: 62 Year Old Female

Decades ago this client fell down the stairs. Like most people, over her lifetime she experienced several other injuries. Her primary presenting issue was severe right knee pain.

I discovered the following.

Pelvis:

Locked (non-moving) left sacroiliac joint.

Contracted left Gemellus muscle between the sacrum and the left hip.

Right Inner Thigh:

The accessible part of the Adductor magnus was severely tight and knotted from old tears.
Tight Adductor longus and Adductor brevis. (This tension pulls on the medial knee.)

Lower legs:

Several old muscle strains in both calves, and above right ankle.
Contracted right Tibialis anterior. I traced the muscle tension to its origin at a big knot on the bottom of the right foot.

She reported that she stood on her toes 100 times every morning, which is probably how she tore fibers of the Tibialis anterior at its distal attachment. This thin, strong muscle spirals from the lateral knee to the bottom of the foot. When contracted in torsion, it twists the lower leg at the knee.

This complex case involved left ilium/hip misalignment as well. Four sessions spaced two weeks apart were needed to address damaged muscle and unwind compensation. That eliminated her knee pain. She returned five months later for three more sessions. (Once a part of your body has been damaged, it requires maintenance.)

A Note About Imaging

The appropriate type of imaging (X-ray, ultrasound, CT scan, MRI, etc.) is important to diagnose knee issues such as:

a torn muscle or ligament,
cartilage deterioration,
fracture,
bone spurs,
osteoarthritis,
bone cancer,
etc.

However, no form of imaging, not even an MRI, shows muscle tension. There is one instrument that a therapist or physician can use to assess muscle tension.

Image by Niek Verlaan from Pixabay

If imaging shows nothing but mild osteoarthritis, and muscles above and/or below the knee are tight and sore, the pain is likely caused by unbalanced leg muscle tension. In plain language, osteoarthritis in a knee is caused by one or more tight muscles pulling hard on that knee.

When the unbalanced tension is resolved, and the pressure squeezing the bones together is relieved, the bone inflammation can heal. The body is amazing that way.

One caveat: if the pressure on the bones occurs over a long period of time, and the result is too much cartilage and bone damage, you eventually will need a knee replacement.

The Heel Bone is Connected to the Leg Bone….

Please note that knee alignment issues can originate in misalignment of the bones of the feet, pelvis, spine or jaw, as well as those of the leg. Read my blog posts on myoskeletal alignment.

Is Physical Therapy Helping You?

The problem many people have is finding a physical therapist trained to assess and release tight muscles, and therefore restore bone alignment.

There are three metrics that demonstrate whether treatment is effective:

Reduction in pain level
Improvement in range of motion
Muscle function

Did your therapist:

try to sign you up for more than one session a week for several weeks, before you even had an assessment? Walk away…
assess your baseline pain level in the first session? Did the therapist ask for and record your pain level at each subsequent session?
eyeball and record your range of motion at your first session or measure it with a goniometer? Did the therapist measure and record range of motion at each subsequent session?
palpate to assess the muscle tension in the thigh and calf muscles at each session? Remember, a hand is a free instrument, and you don’t have to wait for a written report.
use manual or other techniques such as acupuncture to release the muscle tension? Did it work?

Finally, expect some improvement (reduction in pain level, improved range of motion, ability to walk more easily) after three weekly or bi-weekly sessions. If there is no improvement, the treatment approach is not effective. Find another therapist.

When Can You Resume Exercising?

After the muscles have healed, muscle tension is balanced, and the pain is gone, then appropriate, graduated exercise to strengthen muscles is useful. Start slow. Too much exercise too soon and too often will set back progress. Don’t push it! Stop if it hurts.

Madeline McBride, M.A.Sc., is a neuromuscular therapist and Certified Bowenwork Practitioner in Ottawa, Ontario, Canada. A retired professional engineer, her mechanics and structural design training informs her ability to problem-solve, visualize in 3D, and identify muscle tension and torsion that pull the skeletal structure out of alignment. She is an instructor, and teaches workshops across Canada and the United States. Subscribe to her blog posts at McBridePainClinic.com

Knee Pain