Knee Pain

SPOILER ALERT: It’s the hip flexors.

The structure of the knee is complex. On one end you have the biggest bone in the body, on the other end you have two smaller bones, and lying on top of the joint you have this floating bony cap. I forget how many ligaments hold it all together, because I can’t palpate them anyway, but I’m not sure you can count them on one hand.

Doctors think of the knee as poorly designed, and when it’s painful for long enough, they’re pretty happy to take it out and replace it with their own version. I don’t want to dis that because I know so many people who can walk without pain because of their titanium knees. (Let’s just not talk about the woman who got a MRSA infection during her knee replacement surgery and didn’t walk without pain until the leg was amputated two years later.)

Before surgery, though, preferably years before, massage therapy can actually make a huge difference. Arthritis of the knee is quite common, but not every person suffers from knee pain. In my opinion, one big reason for that has to do with the way the bones articulate. If there’s pressure or tension from above or below the joint, the bones rub together the wrong way. That can be painful without arthritis, but with arthritis it can create friction where the cartilage is thinner to begin with. So whenever I see a client with knee pain, I skip the knee, and go straight for the hips. Specifically, the hip flexors. (Feet are also important for knees, but I find people usually get more relief from hip release.)

Many massage therapists don’t do much with the hip flexors, and I have no idea why. People who sit a lot, or drive, usually have shortened hip flexors. A couple techniques can release them, and the client should follow with regular stretching, i.e., lunges. I cannot impress upon you enough that releasing the hip flexors can miraculously end knee pain. I can’t guarantee it, but who wouldn’t choose a few massages over a major surgery? In the words of my old teacher, Jim Hackett, “Soft tissue work is always worth a try.”

If you are suffering, please find a good massage therapist who knows how to work with hip flexors in the region we used to call the triple attachment area when I was at CSMT. That’s the front of the hip where the origins of rectus femoris, tensor fascia latae, and sartorius are in proximity. Psoas is also a hip flexor, and some therapists work with it as well. I find that I don’t often need to go there.

So remember: knee pain, hip flexors.

I’d love to hear your experiences and comments.