I’m down in Grand Cayman seeing patients at our licensed advanced practice site and injured my right knee yesterday. I was pretty bummed as my family was coming down and I could barely walk. However, I eventually fixed it with a simple therapy that can teach you how the kneecap works. What happened and how did I fix it?
A Bad Workout
Yesterday I went to the gym for a quick 25-minute CrossFit routine. Toward the end of that, I felt a sharp pain in my right knee, under the kneecap. I began to limp, and going down the stairs was miserable. I was really concerned because I had a big day planned for Sunday. I quickly noticed that my muscles and tendons around the knee were part of this problem, which gave me an idea for treatment based on what I know about kneecap pain.
The Quadriceps and the Kneecap
If you have kneecap pain, as I tell my patients, the patella (kneecap) lives at the end of one of the biggest muscles in the body, the quadriceps. The kneecap is one very small part of a huge muscle and its tendon. Hence, what happens to that muscle dictates what happens to the kneecap.
The quadriceps has four parts: the vastus medialis obliquus (VMO), the vastus intermedialis, the rectus femoris, and the vastus lateralis. For me, it’s always my vastus lateralis (VL) that’s the issue. The VL muscle is the outermost of the four that live in your thigh. What makes it special is that this muscle’s outer wall is the iliotibial band.
My VL and My Knee
I’ve blogged extensively on the vastus lateralis muscle and the ITB. Yesterday, while limping around, I took some of my own medicine. I identified trigger points in my VL muscle and spent time performing deep massage on these areas. What happened? My kneecap pain went away. How?
A trigger point is an area of the muscle that’s shut down due to an irritated low back nerve. When that’s there, the muscle doesn’t contract normally. In this case, since it’s connected to my kneecap, this throws the tracking of this bone off. This then causes the cartilage of the kneecap to get extra trauma. Get rid of the trigger points and the muscle works normally and the kneecap tracks correctly. Pretty simple.
How This Works and Why You Need to Understand This Issue
All I did was to feel around in my VL muscle, and I soon found several rope-like bands that were tight. They didn’t hurt (my pain was in my kneecap area). I then applied firm and prolonged pressure on these trigger points for several minutes. I did this several times until my knee began feeling better.
Why is it critical that you understand all of this if you have kneecap pain, also called patellofemoral pain or chondromalacia? Because getting rid of issues with the nerves in your back or the trigger points in your quadriceps can mean the difference between protecting or frying the cartilage under your kneecap. However, often little attention is paid to this problem.
The upshot? I was pretty sure that I was in for a week or two of hobbling around or would have to inject my own knee with platelet-rich plasma. However, a simple deep massage of trigger points had me back to activity in hours. You have to wonder how many people out there never get this type of simple treatment and then end up getting an MRI showing cartilage loss and then surgery.