Knee Pain Treatment Brighton | Myofascial Release & Soft Tissue Therapy That Works
Knee pain is one of the most common musculoskeletal complaints affecting the British population, with the important implications in quality of life, mobility, and healthcare costs.
This comes to no surprise in the world of soft tissue therapy since the knee joint is quite vulnerable to injury due to its anatomical characteristics and the role it plays.
What seems to make knee pain particularly challenging is its tendency to become chronic when left unaddressed, with many people experiencing symptoms for months or years before seeking effective treatment.
This would be a problem with any joint but what makes knee pain even more problematic than the rest is the fact that it supports the weight of pretty much our entire body, we can’t take a step without it!
With knee pain falling into the category of “musculoskeletal condition”, our health system isn’t very effective at providing a conservative solution or clear treatment pathway for people experiencing knee pain, unless surgery it’s required.
This leaves people in limbo, often leading to complications and/or decreased quality of life.
At INSIDE we aim to close this gap in the medical system and provide specialised treatment for people experiencing muskuloskeletal pain, in this case knee pain.
When we look at a joint like the knee, there are some instances in which conservative treatment, like soft tissue therapy, or exercise rehabilitation is not enough or effective, this is the case in:
- Structural damage scenarios: Complete ligament tears (such as ACL or MCL ruptures), significant meniscus tears, or advanced cartilage degeneration may require surgical intervention when the joint’s structural integrity is compromised beyond what conservative methods can restore.
- Advanced osteoarthritis: When knee osteoarthritis progresses to bone-on-bone contact with severe pain and mobility limitations, total knee replacement may be necessary as conservative treatments can no longer provide adequate relief or function.
- Mechanical obstructions: Loose bodies in the joint, locked meniscus tears, or significant bone spurs that cause catching or locking sensations often require surgical removal to restore proper joint mechanics.
- Unstable fractures: Fractures around the knee joint that affect joint alignment or stability typically require surgical fixation rather than conservative management alone.
On the other hand, a great number of knee pain presentations are not severe, are caused by imbalances within the soft tissue component of the musculoskeletal system and could be addressed by a well trained skilful soft tissue therapist in a few sessions.
We’re often an accidental find or a last resource for people experiencing knee pain, although there’s a raise in awareness about the benefits of soft tissue therapy and things are changing, with more and more people seeking our help much sooner.
When is knee pain treatable and why
We’ve seen above some instances where knee pain is not successfully treatable with soft tissue therapy alone.
Let’s now look at the opposite scenario, when knee pain is treatable.
Considering the place where the knee sits in the body and the forces to what it’s exposed, its complex anatomy and delicate uniaxial system -mostly limiting its movement to one plane sagittal plane (Blackburn and Craig, 1980) making it vulnerable against any misalignment- , as well as its highly impact-absorbing properties (Hoshino and Wallace, 1987) it’s not a surprise that the knee is found to be one of the most vulnerable and injured structures.
Whilst gravity and ground reaction are static forces, the biokinetics and structural balance of the human body can’t be calculated into a single number; its complexity and impact in injury prevention and rehabilitation cause it to be a hot topic still open to investigation and discussion amongst body therapists.
Let’s have a look at how the soft tissue can directly be the underlying cause for knee pain
Fascia
When discussing balance or biokinetics, the word “fascia” necessarily emerges.
Fascia is defined as ‘a connective soft tissue system in our body that forms a whole-body continuous three-dimensional matrix of structural support’ (Fascial Research Congress 2012). Strain in one area of the fascial ‘silken body suit’ can be transmitted to elsewhere in the body (Fairweather and S. Mari, 2015).
Not only that, research suggests that muscle tissue belongs within that fascial webbing (Schleip et al., 2012), meaning that there is no discontinuity between muscles as previously thought.
The anatomy trains concept of Myers follows the grain of muscle and fascia to see what links with what and stablishes 7 traceable meridians of myofascia through which stability, strain, tension, fixation, resilience and postural compensation are distributed (Myers, 2015).
This means that restrictions in a certain area or specific muscle would affect the whole respective myofascial meridian and, at the same time, affect the whole tensegrity system, in the same way as if we pulled a puppet string;
this would cause imbalance in the system, and imbalance is a predisposing factor for knee pain.
Restrictions reflect in individual patterns different for each person, so the source or underlying cause for the knee pain changes in each individual.
It’s the job of the therapist to use their knowledge and skill to assess and treat the myofascial system where it needs it.
This can be no easy task, so bear with us!
Trigger Points
Another word that emerges when thinking about possible causes for structural imbalance is “Trigger Point”. Necessary mention here to Dr Travell, who left a legacy in body therapy with her extensive work on Trigger Points (TrPs).
Defined as a “hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band” (Travell and Simons, 1993).
Independently of the reason why they develop or how, which is an entirely separate topic for research, trigger points develop in the muscle tissue and therefore they are deeply embedded within the fascia webbing, causing restrictions.
For example, research suggests a higher prevalence of TrPs in muscles like Gluteus Medius (Gme) and Quadratus Lumborum (QL) in individuals presenting with PFS in relation with those with no history of PFS (Roach et al.,2013).
TrPs can also directly give rise to characteristic referred pain – trigger points in muscles like Quadriceps Femoris, Sartorius or Gluteus Minumus can cause referred pain in the knee- (Travell and Simons, 1983) and therefore are an important element to take into account when looking at pain or structural imbalances affecting the distribution of biomechanical forces.
It’s well known by soft tissue therapists that correcting imbalance and misalignment by addressing key fascial restrictions and trigger points can effectively treat knee pain, although there’s not much research found to prove this to be true.
Strength training
If muscle imbalance is considered to be a primary possible etiological cause for knee pain, then we also need to look at resistance training (RT) recommended as one of the most effective methods to improve muscle mass, strength, and power (Kraemer and Ratamess, 2004).
Research on runners shows weaker hip abduction and late activation of Gluteus Medius in runners presenting with patellofemoral pain syndrome in relation to those running pain free (Willson et al., 2011; ) (Ferber et al. 2011).
Our own study
At Inside we carried out a small randomised, control trial on the matter a few years ago.
Data from our study suggests that carrying out a 6 weekly massage therapy intervention utilising a standardised soft tissue therapy had a positive outcome on PFS (Patellofemoral pain syndrome – or unlocalised pain at the front of the knee) pain levels and that the positive effects are greater when massage is combined with a strengthening program
How can soft tissue therapy treat knee pain
Putting all previous points together with our experience in clinic over the years treating clients with knee pain, we can confidently say that in our experience soft tissue release is an effective treatment method for knee pain presentations (in many instances and not always).
This means that soft tissue has reliably shown to reduce and resolve knee pain in multiple clients over the years.
What to Expect in a Session with Us
At INSIDE, our sessions are personalised and designed to address the root causes of the pain with soft tissue therapy. Here’s what a typical session involves:
Initial Assessment
We begin with a comprehensive assessment to understand each specific knee pain presentation, history, movement patterns, and individual factors that may be contributing to the condition. This helps us identify fascial restrictions, trigger points, and muscle imbalances that could be affecting the knee.
Hands-On Treatment
Using a combination of mainly myofascial release and trigger point therapy, we assess and address the entire fascial web, which may include working on areas like the hips, thighs, and lower back that influence knee mechanics.
Targeted Soft Tissue Techniques
Our approach adapts to each unique presentation. We may focus on releasing tight fascia in key muscles such as Quadriceps Femoris, Gluteus Medius, or Sartorius, and deactivating trigger points that could be causing referred pain or structural imbalances affecting the knee joint.
Integration with Strengthening (When Appropriate)
Based on our research findings showing that soft tissue therapy combined with resistance training produces superior results in the treatment of knee pain, we may recommend complementary strengthening exercises to address muscle imbalances.
Treatment Plan
Even though results can often be quick, most people often require work over a course of treatments, usually 3/4 to 6 treatments. In particular, our PFS study showed positive outcomes with a 6 week intervention.
Each session is approximately 60 minutes and focuses on restoring balance to your myofascial system, reducing pain, and improving function. As a result of this work, and due to the deep connection between the myofascial system and the nervous system, clients’ general feeling of wellbeing and general health also improves, which is a in itself a great reason to give this treatment method a proper go and use it as part of self care habits.
References:
A lot of the information on this post has been extracted from a research that I carried out a few years ago as part of my training:
A randomized, control trial, comparing the Jing Hip and pelvis clinical massage protocol versus the same protocol plus strengthening exercises in the treatment of patellofemoral pain in runners
(link to it below)
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.