Knee Injury Summary

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Over the past week we have been talking about the different kinds of overuse injuries that can occur at the knee. In this blog post, I want to give you a better visual of how they are all related to each other. To do that, let’s break our knee down into three different zones.

Think of zone one as the beginning of problems in the knee. The injuries that occur here are because of mobility restrictions and muscle imbalances in the knee itself. The front of the knee gets overworked and breaks down. By comparison, zones two and three are the continuations of problems in the knee. Instead of the front of the knee breaking down, the body finds a way to compensate around those restrictions and imbalances. This occurs by rotating the the thigh in as shown by the orange arrows. When that rotation is present, new areas become vulnerable to breaking down. When they do, not only do you have to fix the rotation, you also have to go back and fix those underlying problems.

Let’s take a closer look.

Zone 1 (green/front of the leg + knee cap itself)

As you can see in the picture above, zone 1 is the middle strip. It gets top billing for a few reasons. The first is that problems here typically involve less compensation.

Injuries in this area:

  • Quad muscle strain
  • Quad tendonitis (inflammation in tendon above the knee cap)
  • Patellar tendonitis (inflammation in tendon below the knee cap)

Likely cause:

  • Loss of knee extension (your ability to full straighten your knee out)
    • This can be due to tight calf muscles (especially the gastroc), hamstrings/adductors, and glutes.
    • These restrictions can lead to mobility losses in the joints as well (ankle, knee and hip)
  • Strength imbalance between the front and back of the leg resulting in the front of the leg getting overloaded.
  • A combination of both.

Treatment goals:

  • Restore mobility to the joints and muscles.
  • Balance strength out so that the front of the knee is not getting overloaded.

Zone 2 (blue, outside of the leg/knee)

This area of the knee is the outside of the leg and knee where the lateral quads and IT Band are located. Injuries in this area mean that you are compensating by rotating the upper leg in. This can create friction/inflammation between the IT Band and the lateral quad or down along the outside of the knee cap where the band attaches.

Injuries in this area:

  • IT Band Friction Syndrome (either at lower attachment outside of the knee cap or up higher in thigh between the band and lateral quad muscle beneath it)

Likely cause:

  • Whenever there is compensation, you need to think of the causes in layers that need to be addressed one by one.
    • The first restriction is the rotation. The inner thigh muscles (pes anserine, inner hamstrings/adductors) get stuck in a short position while the IT Band and outer hip get stuck in a stretched out/long position.
    • The second restrictions to consider are what that rotation is trying to make up for. Most likely, this means that the knee has lost its ability to fully extend. Sound familiar? These are the same restrictions we talked about above in the front of the knee.

Treatment goals:

  • Get rid of the rotation so that the leg is straight.
  • Restore mobility to the knee itself.
  • Balance out strength so that the whole leg is working.

Zone 3 (purple, inside of the knee)

This area of the knee is along the inside of the knee where the pes anserine is located. Injuries in this area mean that you are compensating by rotating the upper leg in. This can create friction/inflammation between the the muscles stuck in that short/tight position along the inner knee.

Injuries in this area:

  • Patellofemoral Syndrome (PFS)
  • Pes Anserine Bursitis/Tendinopathy

Likely cause:

  • Whenever there is compensation, you need to think of the causes in layers that need to be addressed one by one.
    • The first restriction is the rotation. The inner thigh muscles (pes anserine, inner hamstrings/adductors) get stuck in a short position while the IT Band and outer hip get stuck in a stretched out/long position.
    • The second restrictions to consider are what that rotation is trying to make up for. Most likely, this means that the knee has lost its ability to fully extend. Sound familiar? These are the same restrictions we talked about above in the front of the knee.

Treatment goals:

  • Get rid of the rotation so that the leg is straight.
  • Restore mobility to the knee itself.
  • Balance out strength so that the whole leg is working.

Want to learn more about how to treat these injuries? Log in today and use the body map to access the knee courses.

2 thoughts on “Knee Injury Summary

  1. I have pes anserine and I T on the same knee. Orthotics for pronation that are new so still have some adjustments to be made . Am doing strength exercises. Any ideas?

    1. Log in to the site and check out the courses specific to the Pes and IT band! They both share a lot of the same areas to work on in terms of self massage, mobilizations, stretching, etc. The courses will walk you through everything with videos and descriptions.

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