Resolving Knee Injuries with Active Release Techniques (ART)
By: Dr. David Westmacott – Doctor of Chiropractic
Knee problems can be among the most frustrating and debilitating injuries to occur across a wide range of sporting activities. Not only are knee injuries extremely common, but as the pain and symptoms associated with the injury develop the athlete’s ability to train and compete quickly diminishes. Making matters worse, many sports injuries involving the knee are slow to respond to traditional types of care, keeping the athlete sidelined for weeks or even months at a time. This often causes an athlete to miss a large part of their competitive season, or even worse, to be unable to participate in an event they have spent months preparing for.
Fortunately, a new treatment technique known as Active Release Techniques (ART) is proving to be a very successful method to combat many common knee problems and get athletes back in the game quickly and effectively. But before we talk about why ART works so effectively, first we need to understand how the knee becomes injured in the first place.
How Do Knee Injuries Develop?
The knee joint is a type of hinge joint that allows the knee to bend forwards and backwards. For most athletic activities the knee is a critical region as it must act to both support the weight of the body, as well as flex and extend to generate the propulsive forces needed to move the body. To help with these tasks there is a complex set of muscles that surround the knee. It is essential that these muscles possess adequate strength, flexibility, and coordination as we rely on them to protect and stabilize the knee during virtually every athletic activity.
For example, with sports such as basketball or soccer, the muscles of the knee must contract during running, jumping, or to initiate rapid changes in direction. Similar demands on the knee can be seen within a wide variety of sports such as hockey, football, baseball, racket sports, and martial arts. These athletic motions require explosive muscle contractions at the knee, but also require finely tuned muscle balance and coordination to control the knee and prevent excessive strain during these movements.
For the knee to stay healthy and to retain optimal function it is absolutely critical that there is adequate strength, flexibility, and coordination of the surrounding muscles. However, maintaining proper function at the knee in itself is not enough. In fact, for the knee to stay injury free, proper function is needed at the other regions of the leg and trunk as well.
For example, in addition to problems occurring in the knee muscles themselves, knee injury can also be linked to problems at the adjacent joints, such as the foot, hip and pelvis. This is because the knee is directly connected to these structures through the tibia and femur, as well as through the surrounding muscles.
This interconnectedness is referred to as the kinetic chain. With this relationship we can think of the knee as one link in the kinetic chain, but each link can be affected by any of the other links. This can be a big problem for the knee because the adjacent foot and hip move differently than the knee. For example, both the hip and foot are designed to move in all 3 planes – front to back, side to side, and into rotation. The knee however, is designed to move primarily in only one plane – forward and backward. If even a minor problem such as excessive tightness, weakness, joint restriction, poor muscle balance, or faulty alignment exists in the hip or foot, it will often cause the knee to move excessively into a side-to-side or twisting direction.
This abnormal knee motion will not only result in excessive strain and overload to the bone and ligament components of the knee joint, but will place even further contractile demand on the muscles that surround the knee in an attempt to protect the knee and correct the abnormal movement. This does not necessarily mean that these adjacent areas (i.e. foot or hip) will themselves be painful. In fact, the knee is often the site that will first develop pain, even if the knee is not the primary cause of the problem!
This situation where pain develops in one area as a result of a problem in another adjacent region is referred to as “movement compensation”. Because of the repetitive, high force motions associated with sports, even minor movement compensations will be greatly magnified and will prevent the athlete from properly controlling the knee and generating the propulsive forces required for the athletic movements. As this occurs, instead of forces being transferred effectively through the muscles and joints of the kinetic chain, the forces become concentrated at the knee, which is the site of the movement compensation.
Due to the impact movement compensations have on knee injuries, it is critical that the entire kinetic chain is evaluated to ensure all areas are functioning properly, not just the area of pain. Failure to identify and correct these compensations will not only prolong the injury process, but will also lead to the injury reoccurring over and over again.
ART: Our Approach – A Better Solution (Kristian decide if there should just be a link here that circles back to the November 17th Post)
ART stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART treatment is highly successful in dealing with many knee injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By location and treating the soft-tissue adhesions with ART, it allows the practitioner to, 1) breakup restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.
You can think of an ART treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hand as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.
An additional benefit of ART is it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.
One of the best things about ART is how fast it can get results. In our experience, many knee conditions respond very well to ART treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments. These results are the main reason that many elite athletes and professional sports teams have ART practitioners on staff, and why ART is an integral part of the Ironman triathlon series.
To book an appointment to see if ART will be able to help with your injury, simply call our office at 403-278-1405.