SHOULD YOU EXERCISE FOR KNEE PAIN?

UNDERSTANDING HOW EXERCISE & PERSONAL TRAINING HELPS KNEE PAIN

Are you on a fitness journey in Tacoma and struggling with knee pain?

Then this knee pain blog post is for you.

Knee pain affects people of all ages. I’ve helped children as young as 5 years old with knee and leg pain with long-lasting results.

USING EXERCISE TO IMPROVE KNEE PAIN

Here’s what you need to know.

Most people don’t know that exercise and knee pain go hand-in-hand. When we feel pain, we naturally think that rest is best, but pain is often caused by many things that exercise fixes.

HOW EXERCISE IMPROVES KNEE PAIN

• Increased blood flow
• Muscle mass
• Stability
• Mobility

Tacoma Personal Trainer explains personal training for knee pain evaluation

PERSONAL TRAINING FOR KNEE PAIN

It can be scary to start or continue a fitness journey when you’re in pain. Which exercises are bad? Which are good? What’s too much? Too little? There is a lot to know, and an aggravated knee can be discouraging.

It’s counterintuitive to think that working out can improve joint pain, after all, it’s a joint, right? You’re not alone, if that’s how you feel. That’s why we offer personal training for knee pain. Sometimes you just need direction and the certainty of an organization that specializes in pain relief.

However, how do we know IF we should start?

Especially if we are in pain.

Whether you can squat without pain is NOT the evaluation we want to use to understand your knee pain.

Assessing Hip Range of Motion with Your Tacoma Personal Trainer – Foot Turning OUT= Hip Turning IN

BEFORE STARTING PERSONAL TRAINING FOR KNEE PAIN

Exercise helps knee pain, but not always. Before starting an exercise program for pain relief do the following:

1. Seen your doctor or primary care physician and get clearance to train the joint
2. Make a list of the movements and areas that are bothering you when you use your knee
3. Create a list of old injuries ( often they affect your knee)

GETTING CLEARANCE FROM YOUR DOCTOR TO TRAIN YOUR KNEE

Keep reading to understand why this is important for your personal trainer.

Most personal training clients that come to us have gotten X-rays, MRI’s, or been referred by doctors to try exercise to improve their knee joint condition.

If that’s the case you can skip this whole section.

If not, keep reading about your knee.

There are tests your Orthopedic Physician can do to make sure your knee isn’t moving too much.

If you have unexpected motion, your Doctor may determine you have a tear (usually accompanied by pain).

The ligaments around the knee, if torn, don’t regrow themselves.

If you have a tear, you can strengthen your muscles but you want to know WHERE the tear is.

This is called building “LIGAMENTOUS MUSCLE SUPPORT.”

Instability caused by the tear needs to be supported by the muscles around it and will have different tightness or weakness patterns.

Improper exercise or movements with a torn ligament or partially torn ligament can create more or greater knee pain.

LISTING YOUR KNEE PAIN TO GO OVER WITH YOUR TACOMA PERSONAL TRAINER

The knee is a complex joint because it folds and straightens and also ROTATES. It rotates outward, called rotation out, and inward, called rotation in.

Watch the video to understand what that looks like:

INSERT LINK TO TACOMA PERSONAL TRAINER 2 SECRETS TO KNEE PAIN VIDEO

When the joint is missing rotation you can run into the following issues in your day-to-day life:

KNEE IS MISSING ROTATION OUT:

• Difficulties through the 1st part of a squat
• Difficulties through the end range/ bottom part of a squat
• Knees caving in when coming back up out of a squat
• Pain/ Discomfort on the inside of the knee (twisting lengthens the inside constantly)

KNEE IS MISSING ROTATION IN:

• Difficulties bending through the middle range of a squat ( think toilet height)
• Difficulties going down hills
• Difficulties going downstairs
• Difficulties going deeper in a squat
• Pain/ Discomfort on the outside of the knee/ outside of your hamstring
• Difficulties straightening your knee and hip out

ARCHIVING OLD INJURIES TO GO OVER WITH YOUR TACOMA PERSONAL TRAINER

Think of a trauma or injury as an X with a circle around it.

(Or watch the video on pain and compensations below)

TACOMA PERSONAL TRAINER EXPLAINS PAIN AND COMPENSATIONS 

When an X changes a normal pattern, it stays there.

When another one occurs it overlays on top of the X.

It’s the same as having a kitchen counter and having ingredients on top of the counter.

EXAMPLE COMPENSATIONS CREATING STUCKNESS IN YOUR KITCHEN:

• Jelly
• Flour
• Oil
• Grease
• Apple Juice
• Food Coloring

When you go to clean the counter it’s WEDGED.

It just feels “dirty”.

But it’s been a long history of muck.

Every old injury is like that.

Common list of old injuries we find pain and stiffness patterns with our Personal Training Clients :

• Dental Procedures
• Eye Surgeries
• Old Toxin Exposures
• Sport Injuries
• Mystery Pains that Vanished
• Breathing Tubes
• Broken/ Cracked Bones ( fingers, toes etc)
• Work Injuries
• Antibiotics 
• Preservatives/ Heavy Metal Toxicity/ Exposure 

Tracking and cleaning that out of the system can take some specialized intervention.

Having a comprehensive list helps your Tacoma Personal Trainer, therapist, or coach test and evaluate patterns and determine if something else is influencing the joint or perception of pain/ discomfort.

We will cover the big 3 of knee pain and how they affect your joints and muscles tissues below.

TAKING CONTROL OF KNEE PAIN BY UNDERSTANDING THE BIG 3

• MECHANICAL
• SIGNAL
• WEAKNESS

Understanding The Mechanical Part

If the main issue is the way the tissue is pulling on the body we could classify this as a “mechanical” issue.

Meaning the way the knee is moving itself is coming from a “physical” limitation.

EXAMPLES OF MECHANICAL KNEE PAIN IRRITATORS:

• HARDWARE
• BONE GROWTH
• SPASMS
• SCAR TISSUE

Hardware Installed In The Body

• Examples Of Hardware
• Rigidity and False Stability 
• Hypertonicity and Patterns 

Metal or other material hardware installed in the body can pull and tether tissues causing inflammation, restriction, and sensitivity. These kinds of pulls can influence the rest of the body in a specific vector.

Spinal fusions, dental implants, breast tissue implants, stents, and gastric bypass bands are all examples of hardware installed in the body.

By inhibiting (changing a communication signal) of how the body speaks to the hardware location a practitioner can determine the impact of that area on the knee.

EX: A metal plate and screws installed in an ankle can pull and tighten tissues elsewhere in the body.

Rigidity causes stiffness and is a coping mechanism for false stability.

This inability to turn off a stiff structure in the body is known as “ hypertonicity”

A constantly “hypertonic” part of the body will experience overuse and pull the body into a constant direction to compensate.

If the plate was in the left leg the person could experience a right knee problem from the pulling of the left tension.

The hardware could create a bind or a tether.

The bind would stress tissues above and further away from it.

It’s important when addressing the human body and knee pain that we inspect hardware as they are “abnormal” the setup of the body.

Understanding how that is affecting the whole body as well as the knee joint is key to understanding which patterns, movements, or exercises are pulling on the connective tissue.

Bone Growths ( Calfications and/or Other)

Flexibility + Blood Supply

Overuse of a Joint

Bone Bending and Impact On Tissue

Bones have flexiblity and blood supply.

They are living, breathing pieces of tissue.

Without any give in the bones, they would actually shatter.

A gymnast is able to flip, spin and land because the bones can flex and return to “normal” without breaking.

Often when we think of bones, we think of them adapting to stress as in “wolf’s law”.

Which states the body will adapt to a stress given to it.

Many people associate that with thicker bone mass and calcification.

However that isn’t the only way the bones can adapt.

If you look at someone’s shin bones, you’ll realize they turn in, out, twist and swell.

Any ladies have a hard time fitting into “ boots’.

These aren’t increased calfications these are actually demands to pressure and stress.

Many times these have no obvious symptoms in those areas.

When we think about mechanical issues we want to look at how the “joint coupling” works.

In the fascial world, these kind of bone strains are known as “peristeum” strains, and the connective tissue being treated is a “deep bone” artery.

Easiest way to think of this is a person who does too many curls.

They may lose the ability to straighten their elbow because their bicep is “tight”.

However, they had full bone range of motion, yet no one can press their arm down now.

Did they “calcify” from curls?

No they exhausted the arteries feeding the bicep muscles and then had to create demands from the deeper arteries.

This cause the bone to bend to protect itself, however not a ‘permanent” bend at this point.

If the connective tissue is treated the bone will move back to its original state out of spasm. 

When it comes to knee issues, long habits of bone twisting can not only cause the bones to go into spasm but the “joint coupling” to become very poor and can contribute to pain in the knee.

Bones spasm are high on this list because a flexed bone torques all tissue that connects to it.

Think about the body of an airplane and how it being bent would influence the window, wing angles, and the engines attached to the vessel.

SPASM (DYSREGULATED TENSION PULLING THE TISSUE )

Areas of Body Connective Tissue

Axis, Pathways and Neurovascular Reflex Arcs

Clearing Layers of Spasm Influences

This classification I refer to as any structure that is not the bone pulling it. The “rails” aren’t the issue but the items attached to the rail.

Body Connective Tissue :

• Arteries
• Veins
• Organs
• Muscles / Tendons
• Nerves
• Fat/ Adipose ( toxin stores)
• Fascial Chains
• Superficial Fascial Chains
• Ligaments
• Brain Tissue/ Dura…

To name a few.

You can check our Tacoma Massage Therapy Page for a detailed list and explanation of these different structures.

Any of these connective tissue structures can influence the mechanics of a joint.

These connective tissue types would require a different evaluation and different treatment.

As your body runs as a single organism, meaning that all the living tissues communicate with each other inside itself through what’s known as an “axis”.

They also communicate locally within themselves.

EX: If your knee has fluid stuck in it, you could experience “neurovascular” symptoms in the joint, because the inability for the vein to do it’s job correctly pressures the nerve.

If the space is reduced the pressure to the artery would also be modified.

Understanding how the different systems of the body interact with each other to produce function is vital for helping your knee.

It can be an “axis” issue or a local issue caused by a structure in the body not directly related to your symptoms.

It can also be multilayered ( remember the dirty kitchen counter top from earlier).

When looking for exercises and solutions for knee pain, we have to consider the layers of how the body operates instead of just looking at 1 joint.

WRAPPING UP MECHANICAL ISSUES FOR KNEE PAIN

In primarily “mechanical” issues I refer to these as “hardware” problems.

Think like the beams, pillars, and physical parts of your house.

However, these don’t need to be “replaced”.

They can often be repaired or improved to help someone with knee pain.

SIGNALS

• Brain to Body (CNS)
• Glandular Relationship
• Reflex Spinal Pathways

The nervous system is split into the Central Nervous System and the Peripheral Nervous System.

Think about these as brain-to-body functions like “breathing” and other unconscious functions.

Whether we realize it or not we are always processing ENORMOUS amounts of data at one time.

Your knee joint is impacted by these central engines that allow you to make decisions.

To be more specific in how we work with these, you can think about these as different processing engines of how the nervous system works and they keep a storage of how your knee should be functioning.

DIFFERENT CENTRAL NERVOUS SYSTEM ENGINES OF THE BRAIN AND HOW THEY RELATE TO KNEE PAIN

• Limbic
  • Ex: The emotion and related signals to the brain around the knee injury.
• Thalamus
  • Ex: The perceived threat of having a hurt, painful, or unstable knee. How the body perceives the threat of walking on an uneven surface with a painful or unstable knee.
• Pre Frontal
  • Ex: Deciding how to create a plan for your day with the painful knee.
• Pre Motor
  • Ex: Visualizing and arranging your movements and coordinated actions with your cerebellum and other cortexts to give yourself the least amount of knee pain possible.
• Motor: 
  • Ex: Actually moving the knee and sensing what is happening at the joint or other parts of the body to determine how to adjust
• Hippocampus
  • Ex: The memory of your knee pain, or injury, comparing past and present situations of how your joint was and how it is now.
• Visual
  • Ex: Interpreting terrain, timing, and things moving around you to decide how to move the knee pain based on what’s being presented at this time. Since the reaction is based on the past history of what the brain has available, it will interpret visual data and compare it to the memory cortext ( hippocampus) to decide how to respond.
• Auditory
  • Ex: Hearing a sound and determining what that sound is and how your lower body and knee joint should respond.

BRAIN CORTEXT ENGINE AND KNEE PAIN RELATIONSHIPS

It’s easy to see how often we use these intricate systems to use something as “far away” as our knee joint.

During pain, trauma, or just day-to-day overuse we can overload these brain sections and the circuits causing dysregulated signaling.

Ensuring these circuits are running well with the knee is important to keeping the body and the knee joint running in proper order.

This brings us to the next step of nervous system automation which is the glands.

UNDERSTANDING REFLEX SPINAL PATHWAY

1. CENTRAL NERVOUS SYSTEM: The brain communicates sending feedback out
2. PERIPHERAL NERVOUS SYSTEM: input is fed through the body up into the spinal cord and back to the brain.

Think about the Central as a TOP DOWN issue and the Peripheral as a “bottom down” issue.

EX CENTRAL – Head injury causing motor control issues in walking and problems with the knee joint

EX PERIPHERAL – Side Impact to the knee causing pain and stress on the joint causing continued knee pain.

These will store both centrally and peripherally in the brain but it’s important to be able to TEST for the difference in the two.

Reflexes like the “deep tendon reflex” pass up through the “sensory fibers” of the cord and are then translated to the brain.

However, it’s important to note that the body starts reacting to these signals before they reach the brain.

Think about how a Taser works.

A Taser is able to disable the communication system of the body BEFORE it even reaches the brain, working effectively to dysregulate the entire nervous system.

A reflex spinal pathway is the same way.

The body has reflex arcs built in to save itself from dealing with large amounts of data processing.

EX: If you are about to step on a rusty nail, the time it would take for your brain to process that pain through all the brain engines and pull your leg away would be too immense.

The body uses fast and slow pain reflex pathways known as “ nociceptive pathways”.

It’s interesting to note that the “slow pain” pathways are found in “chronic” pain situations, these are called “paleospinothalamic tracts.”

These negate with PRESSURE, which is 1 of the reasons why applying pressure, tape, or other tools helps with pain and is commonly used to help treat tendonitis or other overuse chronic injuries.

However, these reflex arcs can become dysregulated and stored permanently in the signals of the system.

This is especially common in knee pain situations that manifest with temperature changes like cold or hot as these are on specific pain pathways of the reflex arc.

EXAMPLES OF SPINAL REFLEX ARCS THAT CAN AFFECT THE KNEE

Temperature: heat/ cold stimulus that creates pain in the knee

1. Sharp Pain: A focal sharp pain in 1 area, muscle location, or focal bone area
2. Slow Pain: Chronic throbbing in an area, or a muscle, pain in the knee may be more “chronic and less situational
3. Vibration: A frequency of hz to a bone, shaking, vibration that causes pain ( most times found at 128 hz known as a “ruffini” in connective tissue)
4. Golgi: A length receptor from an overstretched knee muscle or other connective tissue, spindle cells regulate the length-tension of tissue to help prevent tearing.
5. Pacini: Pressure sensitivity to a specific area of the knee.
6. Tickle/ Itch: Pain receptors activated to prevent insects from feeding on us, continued signal to the joint may increase swelling and histamine like a bug bite.
7. Mesencephalic: Pain increases when you think about the pain in the knee joint.
8. Visual Tectal: A coping mechanism of the body, when the knee is experiencing pain the body wants to look at what’s causing the pain. In an overstimulated knee pain situation looking directly at the knee would increase pain.
9. Hypothalamic: Pain in the knee increases under stress, breathing or with a sweep in the opposite direction of a hair follicle ( stimulates stress response)
10. Baroreceptors: Pressure receptors are usually found in arteries, in a knee pain situation you might check that the overall artery pressure isn’t forcing the femoral artery that supplies blood to the muscles of the knee to overwork.
11. Sequence: A sequence is an order things are meant to occur in the body, with knee pain an injury can change the normal sequence to protect itself. Occurring long enough the altered sequence can become the new normal and cause the knee to become stiff in the wrong way.
12. Crude/ Fine Touch: These are pain receptors that increase sensitivity. This can be a reason why someone may prefer wearing shorts as the contact over the knee stimulates the pain related to fine or crude touch receptors.
13. Joint Position Conscious/ Unconscious: The person can have an issue with the joint in a certain position either when they think about the position or when they don’t think about the knee. Common to see this in people who if they focus on the knee don’t experience pain or vice versa.

The signals of the body are deep, complex, and often misunderstood.

By sharing these teachings and training I’ve collected from doctors, neurosurgeons, physical therapists, chiropractors, osteopaths, acupuncturists, personal trainers, and researchers from around the world you’re likely starting to understand the layers to your knee pain and discomfort.

I hope this guide helps you understand the many layers of pain and dysfunction that could be causing your knee pain and how not only mechanical but signal-based pain from different systems and engines could be causing improper signaling to your knee.

WEAKNESS FOR MUSCLES AROUND THE KNEE

Many times when hiring a personal trainer people think about getting STRONGER. However, the reality is that your knee pain could be caused by DIFFERENT KINDS OF WEAKNESS.

To understand that correctly we have to understand if all strength is appropriate, what a weakness signals to us, and think about how the muscles around your knee use strength to contact and interact with the floor.

Ex: If your quad muscles ( commonly thought of as knee extensors) can’t relax, they will squeeze your knee too tight all day. This can cause discomfort from walking or standing all day at work or during other activities.

We want the muscles surrounding your knee to be strong in the correct relationship, that relationship is how your neurological system should be using the muscles as well as the relationship required to walk, stand, and do normal functions.

THE 3 DIFFERENT KINDS OF STRENGTH AND WEAKNESS FOR YOUR KNEE

1. General Muscle Action Weakness: A muscle related directly or indirectly to the knee joint does not activate.
2. Lengthened Position Weakness / Connective Tissue: A muscle related directly or indirectly to the knee joint activates but when it is lengthened from above or below it’s origin or insertion no longer can stabilize.
3. GAIT Weakness: A muscle can turn on but can’t turn off making the normal relationship with walking altered.

GENERAL MUSCLE ACTION WEAKNESS IN KNEE PAIN

List of muscles that attach to your knee:

Quadriceps Muscle Group:

• Rectus Femoris: This muscle runs down the front of the thigh and attaches to the patella (kneecap) via the quadriceps tendon. This muscle runs across the hip and the thigh making it a unique knee extensor.
• Vastus Lateral: The outside muscle on the front side that attaches to your knee
• Vastus Medialis: The inside muscle on the front side of your quad that attaches to your knee.

Hamstring Muscles:

• Biceps Femoris: This muscle is located on the back of the thigh and has two heads (long head and short head). The long head attaches to the back of the knee.
• Semitendinosus: This muscle also lies on the back of the thigh and attaches to the upper part of the tibia, below the knee joint.
• Semimembranosus: Another hamstring muscle that attaches to the back of the knee.

Gastrocnemius:

• This muscle is part of the calf and crosses the knee joint, attaching to the back of the femur.

Popliteus:

• This small muscle is located at the back of the knee joint, helping with locking unlocking the knee by rotating the end of the thigh bone with the beginning of the shin bone.

Iliotibial (IT) Band:

• While not a muscle, the IT band is a thick band of connective tissue that runs along the outside of the thigh and attaches to the lateral condyle of the tibia, helping stabilize the knee.

Sartorius:

• This long, thin muscle runs from the anterior superior iliac spine (ASIS) of the hip to the medial side of the tibia, crossing the knee joint.

Gracilis:

• This muscle lies on the inner thigh and crosses the knee joint to attach to the tibia.

Popliteus:

Each of these muscles can be tested in a normal position to see if they are strong with no input.

This would help us rule out general muscle action strength or weakness to determine what function is or isn’t available.

If the muscle is weak, we would want to run through our earlier teachings:

• Weakness from connective tissue spasm or pulling into the knee
• Weakness from a brain system or gland to the knee
• Weakness from a spinal reflex to the knee

Watch the video to understand the difference between a test for STRENGTH and a test for a signal interruption.

After the video, you have an understanding that a test is just a signal and the pairing of tests give you the information you need to understand how knee pain is being influenced in your body.

Each of the standard tests can be done in 2 different ways.

1. Starting with increased length at the top of the body
2. Starting with increased length at the bottom of the body

You can watch the video for examples.

A muscle may test “ strong” in the middle position but when the signal is tested then show weak.

Some signal or issue with the connective tissue in the way it is pulled would be an indicator of needing to further investigate.

Once again using the following techniques but adding another:

• Weakness from connective tissue spasm or pulling into the knee
• Weakness from a brain system or gland to the knee
• Weakness from a spinal reflex to the knee
• Weakness from inability for connective tissue to absorb ( in these cases we would use a personal training approach to using a different phase of ploymetric absorption drills).

GAIT WEAKNESS OR DYSFUNCTION IN KNEE PAIN

Think of a movie studio motion capturing how people walk.

Slowing down every movement that creates the unique walking pattern a person has.

That is GAIT.

Hundreds of actions happen in a second so GAIT can be complex as well as hard to coach.

When we test a muscle for knee pain, we want to make sure that the muscle can be strong as well as turn off or the joint can’t move in the way it needs to for walking.

The way we can test this is 2 ways:

1. Give the body a spindle cell reflex (compression shortens the spindle cells and should result in the body getting the signal to let the muscle relax)
2. Using Parallel lines ( parallel lines represent a pattern in the brain that is against the programming for rotation, in a normal system this should create a shut-off to the muscle or a stop signal)

If a muscle can’t process a shut-off signal correctly it’s problematic for creating rotation.

Lack of rotation and turning off muscles impacts the body’s ability to move through walking.

SEE THE VIDEO TO UNDERSTAND HOW THIS WORKS

If this is the case, we need to figure out what is happening with the body holding that tissue in a state where it can’t relax.

• Incorrect on signal from connective tissue spasm or pulling into the knee
• Incorrect signal from a brain system or gland to the knee
• Incorrect on signal from a spinal reflex to the knee

In summary, looking at local muscle actions to determine how the knee joint is doing in a pain or stiffness situation as well as testing the lengthened position and normal brain functions can tell us a lot about what is happening in the knee.

Before moving into exercises and strengthening it is beneficial to understand how the nervous system is processing its relationship to using the knee.

We often find that when this isn’t taken into account, exercise programs or exercises are unsuccessful because the way the body uses the knee isn’t being taken into account.

The exercise can then cause increased dysfunction or stress to the knee rather than becoming a knee pain solution.

WRAPPING UP THE QUESTION: Should you start exercising with a Tacoma Personal Trainer for Knee pain?

If you’re looking at having a Tacoma personal trainer help you with your knee pain then you’re probably in 1 of 2 groups:

1. You’ve not had much luck with getting help before using traditional medicine.
2. Surgery isn’t an option for you, so it’s exercise or do nothing and you’ve decided something is better than nothing.

We have personal training clients in both categories and we get it.

You have a free license to use your body however you choose.

To have a high quality of life, use your joints the way they were meant to be used, and stay as injury-free as possible keep 3 things in mind.

OUR CHEAT SHEET KNEE PAIN CHECKLIST:

1. Imbalanced joints can wear a knee down to make sure you have enough Turn out and Turn in for the activities you want to do. Pick activities that move you in the right direction.
2. A torn ligament can be made worse with the wrong types of exercise ( it helps your professional to know).
3. Pain and compensation layer on top and removing them with our Tacoma Massage Therapy Speciality techniques may be very helpful.
4. Limited range of motion can cause increased stress on a knee
5. Old layers of Trauma and pain may need to be removed to have a knee feel “ right again”
6. Mechanical factors like surgery implants, connectie tissue strains, or bone torsions can play a part in your knee pain.
7. Brain cortext, glands, and related muscles to organs can play a part in knee pain
8. Spinal reflexes are a large category that can play a part in knee pain.
9. Muscles not getting on or off signals or not being able to lengthen with proper signals can play a part in knee pain.
10. Evaluating and finding the COMBINATION of knee pain solutions is a detailed process that can help your knee pain.

Get Fit. Stay Fit. Encourage Others.

Tacoma Personal Trainer + Tacoma Massage Therapist Isaac