The knee is made up of three bones, several muscles, 2 menisci, and 4 ligaments. Any of these, when injured, can cause pain in the knee. There are also things like arthritis and normal wear and tear on the joint that can also cause pain in the knee, which tend to, but not always, affect older people.
The conditions that I will be discussing in this section are in regards to the menisci and the ligaments, as most of the other conditions are discussed in a general sense in other articles.
There are 2 different types of ligaments in the knee, one set is the collateral ligaments and the other set is the cruciate ligaments. The collateral ligaments are very close to the surface of the knee and are located on the inside and outside of the knee. These ligaments, when injured, are treated the same way as any other type of sprain. As for the cruciate ligaments in the knee, they are very deep in the knee and are actually behind the patella (knee cap), so they are not able to be worked on directly like the collateral ligaments are.
The menisci are like cushion pads in the knee that help absorb shock while we walk, or run. These are located between the femur (thigh bone) and the tibia (the larger of 2 shin bones). Again, much like the cruciate ligaments, they are not able to be directly touched by the human hand, to be able to help them heal. Thus, for both of these types of injuries, massage isn’t able to help the injury directly, rather it is used to help with the rehabilitation of the knee itself.
Any of these structures can be injured with a direct blow to any part of the knee, or if there is an overly exaggerated twist of the knee. Depending on the severity of the injury, and if you need to have surgery to repair the knee, it can take anywhere from 3 weeks up to 4 months, possibly longer, depending on if you are doing rehab, or how healthy your body is, to heal. Sadly, these injuries don’t even fully heal, so if you go back to doing the same activity that you were doing to cause the injury in the first place, there could be an easier chance that you could re-injure yourself, as the stability of the knee isn’t what it used to be.
If it is suspected that you have either one of these injuries, you will have to go to the doctor and wait for their approval for a massage. The reason is, there is the chance that an effusion, (abnormal build-up of fluid in or around the joint) or hemarthrosis (bleeding into the joint), may be present in the knee, and the doctor needs to assess this first. Plus depending on the injury, you will need braces, crutches, surgery, or all of the above, to keep you from injuring the knee even further.
Once you have the okay to start your rehabilitation, you can come for a massage. Positioning stays the same no matter what structure is injured, you can be in either a face-up or face-down position, with the injured knee being elevated to help with draining the leg, and keeping it in a comfortable position, as the knee may hurt if it is in a flattened position. Depending on the stage of the healing process you are in, ice will be used on the injured leg, to further help with bringing down the swelling at the beginning stages. Later the therapist can either apply hot or cold on the leg, as well as sometimes switching between the two, to make a manual pump in the muscles. While this hydrotherapy is being used, lymphatic drainage and treatment of trigger points and muscle tightness in compensating structures are worked on. In the early stages of the injury, lymphatic drainage is only used above the knee, to help with bringing down the swelling, whereas, in later stages, the whole leg can have this technique done, if there is swelling below the knee.
After the muscles are worked on, and lymphatic drainage has been completed, the massage therapist will do some joint play of the patella, and the hip, in later stages, to keep the joints from seizing. All of this joint play is to be done with no pain present. If you start to feel any pain with it, you have to let your therapist know so they stop this technique immediately.
Lastly, the therapist will go through a passive relaxed, pain-free, range of motion for the knee. This will help decrease the protective muscle spasms, and keep the joints healthy, as it isn’t a good thing to not move a joint at all. Plus this will help you gain back any of the limited range of motion you have from the injury itself, usually happening in your ability to straighten the knee.
You will have to attend a type of strengthening program for your knee, to help decrease your chances of re-injuring yourself again. This can be done with a Physiotherapist, who you will more than likely be seeing at the same time as you are coming for a massage, or with a personal trainer who has training in rehabilitation plans. You will still have to be careful doing certain activities as well, even after you have reached the 4-month mark, these include running, jumping or contact sports, as any of these can cause you to injure yourself again, even after a year of healing. Braces are usually recommended if you are want to participate in the above activities. You will also have to be careful if you have a meniscal tear, as you can feel your knee locking, or even buckling during certain activities after the initial injury.