Your knobbly knee cap cannot sit happily in it’s correct resting place if its being pulled out of alignment by tight thigh muscles. The resulting knee pain is known as Patello Femoral Pain Syndrome (PFPS) which is worsened by tightening of the quads due to prolonged sitting or overuse of these very strong muscles from too much stair climbing or running, Squatting and Dancing without adequate lengthening of the tired muscle at the end of the activity. The only muscles that straighten your knee (which we call knee extension) are the quads so you can see how key they are in the health of the joint. Ideally the quads would be strong but also not too tight, so lengthened as well. Most importantly, the knee is prevented from buckling when standing,
PFPS is the most common cause of knee pain which is often diagnosed on examination by pushing the patella into the femur along with palpating of the thigh muscle to feel the permanent state of tension there. Women are 2.5 times more likely to experience it that men and it sometimes takes years to treat. Tension in the quads pulls the patella off track causing pain which generally comes on gradually – it’s no surprise if you turn up at the GP with knee pain and get sent home with a list of quad strengthening exercises to do at home, especially if the pain is at the front of the knee (anterior pain).
It can be difficult to describe to the physician exactly where the pain is because it occurs all around the knee cap and sometimes at the back of it (peripatetic). Pain is worse when squatting, climbing or descending stairs and when kneeling and sometimes when sitting for long periods (this is known as the “movie” or “theatre” sign. Other reported symptoms are that the knee no longer bends to it’s full range, and sometimes produces sharp pain during activities or after sitting. It is often accompanied by a tight IT band (outer thigh) which you will notice in Yoga when you perform the windshield wiper move (wide feet when sitting or lying and swinging the knees from side to side).
It’s obviously very important to know the cause of this patella misalignment because if it’s from overuse, you may want to change up your activities – switch from running to swimming for instance or incorporate a more effective routine after the activity to lengthen the quads or the exact opposite… If the pain is at the very front of you knee (you will be able to pin point this area specifically) and you are exercising more rigorously, the cause is more likely to be Jumpers Knee / Runner’s Knee. I experienced this when I first opened my Zumba Classes in 2011 and the pain is hideous! It is very common in those who jump (as I was doing all of a sudden) and is worse if you are overweight as there is more stress put on the joint. Weirdly a small tight rolled band is applied to the front of the knee whilst exercising and it gives almost instant relief.
If you are not strengthening the quad enough (prolonged sitting as we age is often a cause) and this is the obvious cause of your PFPS, then incorporating some strengthening activities will be of benefit. This is the more common solution as we age.
HOW TO RELEASE THE QUADS WHILST LYING ON YOUR BACK.
Your quads (the four front of thigh muscles) are responsible for straightening your leg they are the strongest muscles in the human body. The biggest of the quads, the Rectus Femoris is also responsible for hip Flexion (along with other muscles).
Start by sitting up and feeling the status of your quad. Is it springy or bouncy or is it tight?
Now lie down on your back, We are going to be working on the left leg first. Bend the Right leg, foot flat on the floor and this will give you some stability and support in the hips. We are going to contract the Rec Fem in particular in the first of a three part movement.
- Inhale: Exhale and lift your Left knee in toward your chest, stopping when the knee is above the hip joint and the leg is in an L shape. Now the big thigh muscle is contrated and we are going to slowly release it. Picture it’s point of origin, the anterior inferior iliac spine of the pelvis and the upper margin of the acetabulum and it’s insertion point in the tendon that runs over the top of the patella, ending just below the knee cap.
- Inhale: Exhale and slowly and as smoothly as you can, with all your awareness in the Hip Joint and the front of the thigh, bring the leg back to the starting point. Think “length in the front of the hip” and as your heel touches the floor, lengthen out in the back of the knee and imagine someone is gently pulling your leg long along the mat.
- Repeat these two steps 3 – 5 times
- Inhale: Exhale and flex the leg as before so that the knee ends up above the hip joint.
- Inhale: Exhale begin to straighten the leg but ONLY PART WAY then pause.
- Inhale: Exhale, re-contract the muscle by bringing the knee back toward the chest, stopping when it is aligned with the hip.
- Inhale: Exhale, release the leg a little further this time, but not all the way down to straight just yet.
- Inhale: Exhale and reconstruct the leg back up toward the chest, stopping when it’s in line with the hip joint.
- Inhale: Exhale and slowly release all the way back down this time so that the leg is long along the mat. Fully relax the leg. Focus on getting the leg as straight as you can, opening up in the front of the hip joint and feeling the release.
- Now we are going to perform the same flow but with the leg in external rotation. So inhale: exhale and bring the knee out to the side as you flex it and draw it toward you. Pause. Feel the contraction in the Vastus Lateralis (the outer thigh muscle). It originates in the greater trochanter of the femur (thigh bone). It loops around the shaft of the thigh bone and inserts into the quadriceps tendon in the outer aspect. It also inserts into the back of the Petlog at the lateral patella retanaculum.
- Inhale: Exhale and as slowly and smoothly as you can, watching for shaking and skips in the movement, bring the leg back to the starting point, long and straight along the mat.
- Inhale: Exhale and bring the leg into a bend again, still with the knee pointing out to the side. Hold, feeling the contraction in the outer thigh.
- Inhale: Exhale and release the leg about half way down. Hold
- Inhale: Exhale, bring the knee back in toward the chest, stopping when it is above the hip joint.
- Inhale: Exhale and slowly release the leg about two thirds of the way down. Hold
- Inhale: Exhale, re-contract, bringing the knee into a bend again.
- Inhale: Exhale and slowly release the leg all the way down, allowing the leg to fully straighten. Relax fully.
- Repeat the external rotation contraction and release 3 – 5 times (stage 10 – 17)
- Now we are going to repeat this flow with Internal leg rotation. So…Inhale: Exhale and draw the leg toward your chest, until it aligns with your hip joint, then turn the knee in toward the midline, foot out to the left to increase the internal rotation of the leg in the hip socket. Hold and picture the muscle you are tightening now, the Vastus Medialis. It spirals over the top of your thigh, originating in the outside of the thigh bone, the femur and inserts in to the quadriceps tendon and the inserts on the inside of the tibia
- Repeat the same leg movements where you release the leg fully (slowly and smoothly) picturing in your mind the lengthening out of the Vastus Medialis then re-contract and release half way, then re-contract and release two thirds of the way, then lastly, fully lengthening the leg long along the mat and fully letting go.
- At the end of this sequence, release both legs long along the mat and compare both sides, especially noting any leg length discrepancy, any difference in the turn out of the feet, the distance between the backs of the thigh and the mat, Feel along the tops of the thighs and notice the difference in tension in the quads. Look for bouncyness and springyness!
- Now repeat the whole sequence on the Right Leg
- Now sit up again and palpate the muscle again on both legs to investigate it’s springiness compared to when you started the Somatic Flow.
You will need a bolster or a pile of pillows as a make shift bolster for this exercise.
- Sitting up, place the bolster under your Left Knee, then lie back down, ensuring that the leg is lying very relaxed over the bolster. The Right leg is long along the mat, relaxed and released.
- Inhale: Exhale, straighten the leg. Hold. Breathing normally.
- Inhale: Exhale, slowly release the leg back down over the bolster with control, noticing any jerks or tremors.
- Repeat 2 more times.
- We are going to add an external rotation to the movement now. Inhale: Exhale and as you straighten the Leg this time, turn the foot and the leg outward.
- Inhale: Exhale and bend the knee back over the bolster as slowly and smoothly as you can.
- Repeat 2 more times.
- Now we add the internal hip rotation at the hip. Inhale: Exhale and as you straight the leg, turn the toes and the leg inward and then slowly release the leg back down over the bolster with slow controlled movement.
- Repeat a further 2 times.
- Bring the bolster out from behind the knee and compare both sides of the leg, noticing any difference in the sensations of the thigh muscles in particular. You can also feel for the release by palpating the muscles. Be in the experience of both legs as you lie with them both long along the mat.
- Repeat all three leg positions with the bolster under the Right leg this time.
- Finally, compare both legs one last time, examining any release in the thigh muscles in particular. You may also notice later a great deal more comfort in the knee joint.
HOW TO RELEASE YOUR QUADS IN SIDE LYING
You may need a Yoga strap for this.
In our Dance Class we might stretch the quads in one of two ways – standing with one leg back, toes tucked under, knee bent and the other leg in front, also bent, tailbone tucked under or holding on the to front of the foot as we draw the leg behind us. Apart from being difficult to balance in this position, the effect can be lessened because the tendency is to anteriorly tilt the pelvis which compromises the stretch on the quad. In this following flow, we are taking lumbar extension (low back bending) out of the equation in order to experience a greater range of movement and therefore stretch the quad more effectively.
- Lying on your Right hand side, propped up on your R elbow or some cushions, bring the right knee in line with the hip and the ankle in line with the knee. If you can’t reach the front of your Left ankle with your Left hand, you may need a strap for the rest of this movement pattern designed to most effectively release the quad.
- In this position, the R hemi-pelvis is jammed forwards which helps bring the stretch on the front of the left quad into the correct place at the thigh. Try an experiment to prove this for yourself. Straighten the underside leg and see how much further back you can pull your foot. This is the position you are adopt when you are doing a standing quad stretch. However, what is really happening here is not that you are able to lengthen the quad further but that you are able to tilt the pelvis backwards (into an anterior tilt position) by over arching your lumbar spine. Effectively the quad itself is stretched less.
- Now bring the bottom leg back to the original position and you will experience the stretch in the right place at the front of the thigh.
- We are going to do a Pandiculation in this position to see if we can genuinely increase the range of movement of the thigh bone by lengthening the quad.. Inhale, Exhale and press the front of the ankle or top of foot (whatever you’ve got hold of) into your hand. At the same time, use your top hand to bring the leg further behind you, whilst the leg is pressing into the hand to resist the movement. Your quads are now contracting.
- Inhale, Exhale and slowly let your hand win, noticing how far back the knee travels behind you now as the quad releases further.
- Repeat 2 more times.
- Very gently release the leg, without letting it ping at the knee joint.
- Sit up and feel the quad on both legs to compare the difference, then roll on to the Left hand side and Repeat
- Sit up at the end and palpate both quads to feel the difference between where you started and where you finished up at the end of the movements.