Adductor hamstring muscle pain and I have knee pain and feel like it might give way

Rear view of leg: Take careful noted of the red
muscle that runs up the side of the leg

"I have a question for the PGDipRehab PGDipSportMed- department- a year and half ago I got a very bad IT problem that took months of physiotherapy (strengthening, stability and tensioning etc) and eventually a meeting with a Dr who gave me one exercise of straight legged tensioning with foot tilted in.

Now- even though I do a lot of hip flexor stretches, and trying to keep the IT band stretched and stretching in general, I have a sensation of weakness in the ligament or tendon that is attached

from the quad to the top of the knee cap, it does not hurt at all, but sometimes it feels like it could give way. Bearing in mind I have no pain. It feels like it is on the tendon or muscle that the kneecap is attached to - just wondering if you have any suggestions?"

(name withheld)
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Gary:

This topic continues to be extremely popular with over 100,000 views of this article alone (to May 2013), so I have done a quick update as follows:

Although this injury appears to be affecting a slightly different area to what I am about to describe, the majority of cases that fit this description of persistent niggling knee pain with apparent instability may be due to a condition affecting the tendons of medial hamstring muscles where they slide around the bony inside border of the knee and insert into the tibia and help form the knee joint capsule (Refer diagrams).

You can see from the diagrams how tightness and inflammation of these tendons can indirectly cause pain in the front of the knee, including the kneecap and patella tendon. It is an area that is easily irritated because of the way the tendons wrap around the tibia and easily confused with conditions such chondromalacia and patellar tendonitis - and even cartilage damage. This explains why so much physiotherapy and surgery for knee pain is wasted time and effort. Knee pain of this kind is more common in women than men, possibly because of their having softer collagen and more stretchy ligaments.

It is also worth noting that pain abut the lower leg and knee may not be all that is amiss: If you look at the upper diagram of the rear of the leg, deep, firm palpation of the muscle that is outlined in red may elicit considerable pain.  This will need to be addressed because dysfunction, including spasm of this muscle will directly affect knee function, stability and pain.

Front view of knee

Treatment for this problem is usually a doddle but it does take time: Massage the inside and front of the knee where the affected tendons and fascia slide, insert into the tibia and form the knee joint capsule. Look for areas that are tender and swollen. It is common on women for the insertion point on the tibia to be visibly swollen and may even look like a fluid sack.

Massage each of the affected areas firmly but gently for several minutes using a quality massage wax or oil. It is best that this be done by a trained and experienced massage therapist.

Do not repeat the massage for another 5-7 days. Do not massage, other than very gently in between but exercise as per normal. Repeat the massage at least 4-6 times or more, or for as long as it takes, until there is no pain or residual swelling.

If recovery is poor, or the problem persists, then I recommend that you arrange to consult with me either in person or via Skype.

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The most frequent cause of knee pain in walkers

I have written about this topic some time ago; but the cases continue to roll in, so its time for an update.

I could not count the number of times a walker has come to see me for help with their sore knees following a long hike in the hills, or following an event like the Oxfam Trailwalker 100km.  They may hobble up the path to my office and describe suffering a tightness and diffuse pain in one, or both knees.  It is typical that their knees have been troubling them for several weeks or months and they have had many physiotherapy treatments without relief.

Although they may be complaining of knee pain and although they may have had a diagnosis of, say, wear under the knee cap, or the kneecap not tracking correctly, these often turn out to be "red herrings".  

Swelling and pain affecting the lower inside of the knee

More often than not we will find swelling and pain around about the lower inside of the knee, skirting around to the back of the joint.  The knee joint itself, may be fine.  This kind of injury is most common in walkers but also found in distance runners and cyclists.

The cause of this pain is excessive rubbing of the tendons of the inner thigh at the point where they wrap around the inside of the knee bone.  There may also be pain and swelling at the point of attachment of the tendons to the tibia just below and to the inside of the knee.  In some people, especially women, this may appear as a swollen and soggy mass just below and to the inside and rear of the knee.  

It is quite surprising just how swollen and painful this region can be and even more surprising how long it can go without prior detection.

Knee pain of this kind is more common in women than men, possibly because of their having softer collagen.

Walking seems to be particularly conducive to this injury, although it is present in runners and walkers.  The repetitive straightening of the knee may inflame the inner knee tendons and they consequently swell.  With this swelling, the tendons rub more than ever, causing further swelling.  Its a vicious cycle.  As time passes there is progressive scarring and thickening of the tendons and surrounding tissues.  Rest, on its own, gives little more than temporary relief.

Treatment of knee pain

Treatment consists of deep tissue massage of the inside and front of the knee where the affected tendons slide and where they insert into the tibia and form the knee joint capsule. This must be done by a trained and experienced therapist.

It may also be helpful to give dietary supplements such as vitamin C, zinc, magnesium, manganese and silica which aid tissue healing.

Look for areas that are tender and swollen and concentrate on massaging these. Where there is visible swelling, the massage technique used is "effleurage" to shift the fluid out and towards the heart.

Massage the affected areas firmly but gently for several minutes using a quality massage oil.  Stay within pain limits - you are not setting out to hurt - only to heal.  Repeat the therapy at seven day intervals for as many sessions it takes to be completely recovered. Do not massage hard in between: Stick to gentle effleurage which will assist healing.  

Exercise as per normal, using pain and discomfort to guide just how much to do at a time. While there may be pain when touching the massaged areas, there will be improved function, such as being able walk more freely.  There is usually marked relief by about the fourth session and complete recovery by about eight or nine sessions (weeks).

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