3 REASONS WHY YOUR KNEE HURTS (AND HOW TO FIX THEM)

Pain can be a debilitating experience. It can cause us to take a break from activities we love, impair the way we regularly move, and even cause us to lose sleep depending on how severe the pain gets. When it comes to debilitating pain, it can spring up anywhere in the body. Arguably, though, one of the most annoying places pain can crop up is in a joint. Joint pain can be especially irritating because you may not feel pain at all in certain positions but then once you move after you’ve forgotten all about it, BAM! It sends you a nice, pesky reminder that it is indeed still there.



MY RULE OF THUMB

Fortunately, a good amount of joint pain can be addressed and corrected relatively fast! Throughout my personal training career, I have made countless observations that have lead me to develop a “rule of thumb.” This rule of thumb has enabled me to relieve a variety of painful joints experienced by some of my clients. That rule of thumb is “if it hurts, it’s too tight.” Meaning that if you suffer from joint pain it is usually caused by an overactive muscle. In my experience, I have yet to see an underactive muscle cause joint pain. Underactive muscles are simply too weak to cause the sort of pulling, tugging, rubbing, grinding, or snapping that usually leads to pain. With all of this in mind, let me note that my “rule of thumb” is not a hard and fast rule. Joints can experience a variety of injuries and pathologies. If you have torn ligaments, damaged cartilage, arthritis, or any other joint disease then my rule of thumb might not apply to you. Do not hesitate to speak with your doctor about any pain!



RECIPROCAL INHIBITION

Once you pinpoint where the pain is located, you can easily determine which muscle is likely to be tight by looking at the anatomy in that area. After verifying the tight muscle, your main objective is to make that tight muscle relax. This is where reciprocal inhibition comes in to play. Although pretty scientific and precise, the sheer speed of how fast reciprocal inhibition works to relieve pain may leave you thinking that this is some sort of miracle. The pain relief is literally instantaneous when performed correctly.


Reciprocal inhibition describes the neurological process of how muscles on one side of a joint relax to accommodate the contraction of the muscles on the opposite side of the joint. For example, let’s take the biceps and the triceps. If you’re performing a bicep curl, your tricep cannot simultaneously contract. For if it did, the curl would instantly be thwarted and there would cease to be movement at the elbow joint. The two muscles contracting together would result in a stalemate and your bicep would be disappointed at its inability to curl. Therefore, in order to fully contract your bicep, your tricep muscle must relax and allow your bicep to pull your tricep into a longer position. This automatic mechanism happens due to a reflex that is activated by the tension created in the muscle spindles. The stretch reflex inhibits the muscle to prevent it from working against the contracting muscle. In laymen's terms, a contracting muscle turns off the opposite muscle.



ANTAGONIST WORK FOR PAIN RELIEF AND REHABILITATION

Understanding reciprocal inhibition truly switches up the game when it comes to corrective exercise, rehabilitation, and pain relief. Too many times have I seen trainers and social media fitness gurus tell people to work out the problem muscle that is too tight. Unless specified by a medical professional for whatever reason, working out a painfully tight muscle is a TERRIBLE idea. Why would you want to make an already tight muscle tighter?! That does not make sense and, in my opinion, should be considered malpractice if suggested by a trainer or fitness professional. INSTEAD, we need to use reciprocal inhibition and what we know about your overactive/underactive muscles in order to fix the root cause of the problem.


For every painfully tight muscle, there is an equal and opposite muscle or groups of muscles that are significantly weak in comparison. The pain indicates that there is an imbalance in the way the agonist and antagonist muscles are pulling at the joint. If you have pain due to a tight muscle it’s because the opposite muscle is no longer capable of generating an adequate amount of force to counter the tight muscle’s pull.


With this information, one might dare to think that stretching the tight muscle is the best way to correct the problem. Although we may need to incorporate some (read very little) stretching to help expedite relief, stretching will only be a temporary fix. Our bodies are extremely smart. They will find the most effective and efficient way to perform a task. For all we know, that tight muscle is the most effective and efficient way to move for something you do daily and it could be the only thing protecting your joint from further injury or instability. The last thing that we want to do is weaken the one muscle that is somewhat functioning properly and protecting you from an all-out trip to Snapcity. Instead, strengthening the antagonist muscle (opposite muscle) will maximize the amount of stability your own body can create around a joint. This is why antagonist training and NOT stretching will be the best way to rehab your knee or any other joint for that matter.



KNEE PAIN

Knees are one of the most common joints to experience pain in. Although the knee is a relatively simple joint, the knee contains a good number of muscles that influence it. Certain muscles help to extend it, some help to flex it, and some even attempt to twist it by a small degree. Among all of the areas surrounding the knee though, there are three sites that are notorious for experiencing pain. All sites of which are located on the anterior aspect of the knee. From lateral to medial (left to right in the specific image below), these areas include the insertion sites of the IT Band, the patellar tendon, and sartorius. If your knee hurts in any of these approximate areas, there is a great chance that you can easily fix your knee and be pain-free immediately.



ILIOTIBIAL BAND (IT BAND)

The IT band is a long, strong band of connective tissue that attaches the iliac crest to the tibia (hints ilio-tibial). This thick band is influenced by two muscles, the gluteus maximus and the tensor fasciae latae (TFL). This may be the most complex site to have pain at simply because the two muscles can either work together to produce ABduction OR they can work separately to produce functions that are opposite in nature.

Glute max is responsible for hip extension while TFL assists other muscles to accomplish hip flexion. This means that glute max and TFL can also produce reciprocal inhibition in one another! However, this also, also means that if you workout either of these individual functions you may start to feel pain again in the knee since working either function will create tension in the IT band. A small predicament in regards to figuring out exactly which muscle is tight and which of the two is weakened but thankfully irrelevant when it comes to pain relief. Since we know that both the glute max and TFL can produce ABduction, we can knock them both out by using ADduction exercises. ADduction exercises will work the adductors and trigger reciprocal inhibition in both the glute max and TFL.


IT BAND REMEDY: Use your gym’s seated ADduction machine to work out the adductors. This machine will eliminate a lot of other variables and allow you to focus solely on your adductors. Keep a slow and controlled rhythm. Add a 2 to 3s pause at the squeeze (SQUEEZE HARD) to help trigger reciprocal inhibition and get a great adductor workout.


PATELLAR TENDON

The patellar tendon is the broad tendon that crosses over the patella in the knee and inserts on to the tibia bone. All four quad muscles converge into this thick tendon and pull on the tendon to produce knee extension. Pain in this area is the easiest to fix. Besides hip flexion, which is performed only by the rectus femoris amongst the quads, the quadriceps have one primary function: knee extension. Using the power of reciprocal inhibition, the biggest muscle group responsible for knee flexion is the hamstring complex. Performing hamstring curls will turn off the quadriceps and offer relief to the tendon area.


PATELLAR TENDON REMEDY: The most lengthen position the quads can be in is the shortest position your hamstrings are capable of achieving. The lying down hamstring curl is the most conducive exercise for this goal. The hamstrings are responsible for both hip extension and knee flexion. Unlike the seated curl, which puts your hips in a flexed position, the lying down hamstring curl allows you to execute both the major functions of the hamstrings. Keep a slow and controlled rhythm. Add a 2 to 3s pause at the squeeze (SQUEEZE HARD) to help trigger reciprocal inhibition and get a great hamstring workout. For more tips on how to best perform this exercise, check out my execution video here.


SARTORIUS

Sartorius is the longest muscle in the body. The dino sounding muscle attaches to the anterior superior iliac spine and crosses over the quad to attach to the medial aspect of the tibia. When contracted, sartorius can perform hip abduction, hip flexion, hip lateral rotation, and also slightly rotate the knee medially. Since it covers a wide assortment of movements you can do a variety of exercises to help this muscle relax. With that said, there is one movement that I tend to like the most. I call them "TFL Ankle Pull Aparts." This specific move allows you to utilize your TFL to pull sartorius in its longest position. It’s a strange move to explain so let me just show you.


SARTORIUS REMEDY:



CONCLUSION

Whether you are a personal trainer assisting clients or just someone who has a tweaked knee, understanding reciprocal inhibition is valuable knowledge to have. It's almost like a cheat code for the body. Overactive muscles that have become so tight that they are painful can quickly be dealt with by working the opposite muscle. Strengthening the antagonist muscle will give you instant relief and allow you to get back to the things that you love. If you're an avid gym-goer, you can also use this technique to knockout the painful muscles that are keeping you from attaining more gains. I'm not saying that reciprocal inhibition is the end all be all but I will say that it is a remarkable technique that blurs the lines between science and miracles.