If you suffer from knee pain, particularly lateral knee pain or pain on the front of your knee, around your kneecap (patella), pain when you go down stairs, pain after you run or do any kind of impact sport, this little trick could be a lifesaver.

The Quads

Quadricep in latin means 4 heads. The quads are 4 long muscles on the front of your leg that extend your knee. They all come together to form a common tendon that attaches and encompasses the knee cap (the patellar tendon). So if you have any pain in the front of your knee, or around your knee cap the culprit is probably a tight quad. Most sports overuse the quadriceps, particularly the lateral quadriceps. Running, dance, biking (if you aren't maintaining proper knee alignment pointing over the middle toe), and any high impact sports that involve the legs tend to overuse the lateral quadricep and underuse the medial quadricep. The exceptions are yoga, a good Pilates or Barre class (one that keeps the legs in parallel rather than in turn-out), swimming, ice skating, horseback riding. Knee pain, particularly lateral knee pain can be due to the imbalance of the lateral v. medial quadriceps.

VMO: The Universal Knee Cure

Vastus Medialis Obliquus

The medial quadricep is responsible for pulling the knee cap medially at the end range of knee extension. Because many sports use the legs without fully straightening the knee, the medial quadricep may become atrophied or under utilized and basically "turn off". VMO is an acronym for the vastus medialis obliquus which is the small oblique fibers of the medial quadricep that are right above the knee cap. These fibers are particularly responsible for pulling the knee cap medially at end range of extension and maintaining proper "patellar tracking".

There are many medical terms for the imbalance of the quad group; patellar femoral syndrome, patellar tracking problems etc. IT band syndrome is another diagnosis that also causes lateral knee pain (see below for more info about the IT band). All of these issues are due to the imbalance of the lateral and medial muscles of the knee.

Releasing the lateral quad (and the IT Band) followed by strengthening the medial quad (VMO) can help with these chronic overuse issues.

The IT Band

The iliotibial band emerges from the Tensor Fascia Lata (TFL) in the front of the hip, and the gluteus maximus in the back. It forms a long, connective tissue band that acts as a lateral stabilizer of the knee and hip. When it becomes too tight and overused it can create inflammation and pain in the lateral knee. Thus "IT Band Syndrome".

IT Band compensates for a Weak Gluteus Medius

Often the root of IT Band overuse is that the IT Band compensates for a weak gluteus medius. The gluteus medius is also a lateral stabilizer of the hip and holds the pelvis level while standing one foot, (or walking). If the gluteus medius "turns off" the IT Band does the work of the gluteus medius, but overtime the IT Band will shorten and get cranky from overuse. So part of the rehabilitation process should be strengthening the gluteus medius. There are many ways to do this, but I have chosen Single Leg Bridge since it mimics gait.

So guess what you can do? Roll it out! Oh but it will hurt! The more tight it is the more it will hurt. Again, like child birth, you need to look pain straight in the eye and go into it. Its the only way out!

Don't Cry

Rolling out your IT band can be very painful. Use a soft roller (MELT roller). I prefer these rollers for myofascial release. Start by rolling slowly up and down the lateral thigh going all the way from the top of the hip to right above the knee joint. Never roll over a bone. Next add "cross fiber" release by rolling your thigh side to side slowly as you roll up and down. You want to do a 3-dimensional release to get at the "web-like" structure of the fascia. If you can handle it, try also bending and straightening the knee while you roll up and down. This is a killer!

There are 3 main trigger points on the IT band. In Chinese medicine, this is Gall Bladder Channel or GB for short. You want to focus on GB 31, 32, and particularly GB 33 if you have lateral knee pain and IT Band Syndrome. GB 33 will be excruciating if you are suffering from IT Band overuse. But as they say, no pain no gain. If it doesn't hurt you haven't found the trigger point!