Muscles and Trigger Points. In knees that
haven't suffered actual injuries such as torn ligaments and ripped
or ground-away cartilage, pain commonly comes from muscles and the surrounding
connective tissue (fascia). This is especially true when the muscle
becomes tight or shortened and is no longer able to relax to its full
When muscle fibers become chronically shortened, the result is a
tender nodule in the muscle, usually in the middle of the muscle
or at its attachments.
These tender areas or Trigger Points (TrPs)
are named for their astonishing ability to "trigger" or refer pain to distant areas, far
from the actual origin. A muscle with TrPs is shortened and weakened.
Historically, "just tension" or "pain of muscular origin" hasn't been
taken very seriously, but it can be brutal, every bit as bad
as the pain of heart attack or broken bones.
Restoring strength and healing the pain involves gently easing away
the TrPs and returning the muscle to its proper resting length.
Pain and Weakness. Why would a shortened muscle be weak?
Because a muscle's strength depends on its ability to contract, to shorten.
If a muscle is already contracted due to TrPs, there isn't as much
muscle left to do the work required of it. Physiologically, the sarcomeres
are too close together. Overstretching is just as bad. Physiologically, the sarcomeres
are too far apart to allow the muscle to contract effectively.
In either of these situations, the remaining normal fibers must work even
harder to accomplish the same motions. Our bodies attempt to compensate
by recruiting other muscles. Muscles trying to do jobs for which they were never intended
are easily strained and can also begin to hurt and weaken.
If this domino pattern of muscle overload and strain continues,
a host of other problems will eventually arise.
When muscles weaken due to TrPs, a common interpretation is that
the weak muscles need strengthening exercises, such as weighted knee
extensions to "strengthen the quads."
This exercise has its place, but if the problem is actually
TrPs and shortening, exercises that contract the fibers
even more will only make the problem worse.
Knee pain should always be evaluated by your doctor, but
if no structural damage is found, check for shortened muscles.
Test muscle length with the Range-of-Motion (ROM) tests.
Look for a therapist who is familiar with
range-of-motion testing and who deals directly with muscles and fascia.
Proper Treatment. The most
qualified professional to treat knee pain is a Myofascial Trigger
Point Therapist. You may find one near you through the directory at
However, it is often possible to treat your own muscular pain.
ROM tests and pain patterns help identify and isolate the shortened muscle.
TrPs can then be treated by yourself or a partner using gentle pressure from fingers, knuckles,
or other tools. Always follow treatment with gentle stretching to help
return the muscle to its proper resting length.