Knee and calf pain can occur due to many different causes. There is upper calf pain, lower calf pain, shin pain, knee pain, and much more. Before we can understand the how and why of knee and calf pain, we need to understand the knee and calf.
The knee and calf are made up of multiple regions which includes the knee and lower leg as well as the foot and ankle joint. There are large bones and muscles (in the thigh) and smaller bones and muscles (in the lower leg and foot). The knee and calf work towards moving our body forwards or back, up or down, and left or right. The knee bends and rotates as well as stabilizes the hips using muscles, bones, ligaments, and capsules. All of these are susceptible to injury.
The knee is a large synovial joint and functions together as a modified hinge joint. The structure permits bearing of tremendous loads and also provides mobility for locomotor activities (running, walking, etc.). There are multiple ligaments and capsules which stabilize the joints of the knee and lower leg. These assist with shock absorbtion but can be susceptible to wear and tear or degeneration.
The potential of torque on the knee joint is large. This joint is a major weight bearing joint and is positioned between the two longest bony levers in the body. The torque can increase with poor foot biomechanics. The compressive forces are reported to be greater than three times body weight when the knee/leg is engaged in stance phase of gait (four times with stair climbing/running) and one-half of body weight while walking. The compression forces are greater with knee flexion during weight bearing and even more so depending on the surface (e.g. concrete, asphalt, grass, track, dirt, etc.)
Common types of pain include:
Common locations of pain include:
Types of Injuries
Most of the injuries that we treat in our clinic are associated with repetitive strain injuries. Our initial goal is to assess the region and type of pain, the biomechanics and gait, and the history of the injury. In most cases, the injury is actually a tear in either the muscle or the tendon of the knee and/or calf. Sometimes there is a lot of tearing and sometimes there is just a little tearing (microtears) that adds up over time. This tearing leads to inflammation (tendonitis), weakness, soreness, swelling, bleeding and eventually scarring (adhesion / fibrosis). The key to fixing knee and calf pain, though, is to reduce or eliminate all of the above symptoms plus the adhesions and fibrosis that comes from the tearing process.
The formation of adhesions and fibrosis (or scar tissue) is the body’s response to healing a tear. What actually occurs is that the spread of sticky fibrin, which is the sticky substance you feel when you bleed, seeps throughout the layers of the muscle and leads to scar tissue formation. The scar tissue and adhesions that forms are made up of collagen. This creates a strong bond and binds the injured tissue back together.
What goes wrong?
The scar tissue that binds injured tissue back together also binds the healthy tissue together. This causes decreased circulation and tightening of the muscle resulting in inflammation and lack of oxygen to tissues, creating biochemical changes, increasing fibroblasts and resulting in fibrosis and adhesions. More and more fibrosis and adhesions develop within the muscles causing the muscle to become less elastic (like a rubber band) and more leathery (like a belt). The more leathery the muscle becomes the more stress is placed at the tendon (where muscles inserts into bone). Too much load or force can create tearing of the tendon!
Different grades of tearing
There are different grades of tears that occur in the muscle and tendon. The most common is a Type I muscle strain or ‘Repetitive Strain’. This basically consists of micro-tears. The other grades of tearing are Type II and Type III, which can result in complete rupture of the muscles and ultimately require surgery.
How do you determine the degree/grade of tear?
There are many things involved in determining the grade or type of tear that has occurred. In general, the degree of tearing can be based on the extent of bleeding that will create swelling and bruising on the surface. It is important to note that the degree of tearing is NOT based on the level of pain!!!
Treatments – What are your options?
There are many forms of treatments for knee and calf pain. They can include:
ART and Graston Technique address the scar tissue (adhesions and fibrosis) and works to make the leathery muscle fibers more elastic again. It is the most effective way to breakdown scar tissue.
How does ART and Graston Technique work?
The doctor locates the scar tissue and traps the scar tissue with hand/thumb or Graston tool while the patient actively lengthens the involved muscle. The trapped scar tissue is held back as the muscle moves through. ART and Graston technique is so effective because it makes the muscle elastic again and gets to the root of the problem by increasing circulation to the injured muscle and tendon.
Overview of Ideal Treatment Plan
While ART and Graston Technique is not a cure-all, removal of scar tissue is a key to a majority of cases. It addresses all hindrances to healing such as faulty mechanics of gait, footwear, poor biomechanics, hobbies (running, cycling, etc.), and allows proper rest and recovery. Most importantly, ART and Graston technique addresses the scar tissue.
Other types of treatment
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