6 Principles Of Foam Rolling For Knee Pain


Over 25% of adults have troubles with their knees to the point where it affects their quality of life, and they cannot do things they would normally do. In this article, I will explain if a foam roller can help with knee pain and how to do it properly.

In general, foam rolling does help with knee pain because it addresses the biomechanical restriction in the muscles above and below the knee. Tight muscles pull on the knee and pressure the joint. Using a foam roller can reduce the tension and restore the full range of motion.

My goal is to give you a complete model of how to work on your sore knees and also be able to identify oversensitive tissues, so you can move more efficiently.

How Do You Use A Foam Roller For Knee Pain?

The most effective ways to use foam roller for knee pain are:

  • Roll on the muscles above and below your knee
  • Use PNF contract-relax technique while rolling
  • Change the length of the muscle while rolling
  • Use other exercises to fully reclaim range of motion
  • Use different tools to facilitate the change
  • Be consistent

Let’s look at those concepts one by one.

1. Roll On The Muscles Above And Below Your Knee

The discomfort of the knee typically results from the tension of the muscles that are above and below your knee.

This means look wider and focus your attention on everything else that is surrounding your knee, instead of looking only at the joint.

Our body works in a kinetic chain. It’s like a system, and when one part is in motion (or under tension) it will affect everything else.

Like a domino effect. One move creates the chain of moves.

And one of the most brilliant skills we have as humans is the ability to compensate. This means if we are moving with a restricted range of motion in one specific area, it will cause our body to adapt some weird position to buffer and compensate.

For example:

  • Walking with fallen arches can cause the knees to cave in. This leads to internal rotation of the hips which creates tension in the knees, hips and lower back.
  • Sitting all day cause lack of glute activation. Weak glutes lead to fatigue of the stabilization muscles that maintain our upright position (that’s why it’s more comfortable to slouch in the chair, rather than sit up straight).

That chain of reaction leads to muscle tension in a whole system, not just the single muscle unit.

And if the pattern is repeated for long enough, the tension will translate from one place to another and cause pressure in the joints.

So rolling on your quads may feel like you’re doing a good job. But looking at all the other muscles will give you the best bang for your buck.

What Muscles Do You Foam Roll For Knee Pain?

You should foam roll on the muscles that are below your knee (calves, shins) and the muscles that are above your knee (hamstrings, quadriceps, hip flexors, glutes, and lower back). This allows you to reduce the tension globally from all the areas and get better results that last.

Your first order of business is to identify trigger points (spots with noticeable muscle tension).

Muscle shouldn’t feel painful to compress. When you roll on your muscle and you feel no discomfort, this means there is nothing wrong with the tissue.

When you roll and you feel some type of pain, this means you found a trigger point. Your goal is to stay on that point until you feel the tension release.

Foam rolling hamstrings

  • Sit down on the box and place the lacrosse ball or a small dumbbell weight directly under your hamstring (see in the picture).
  • Shift the weight on the side that you want to mobilize. For better pressure, place your both hands on the thigh and press or lean down on the dumbbell.
  • Start by placing the dumbbell/ball close towards the hip and move down toward the knee. One inch at a time, every 20-30 seconds.
  • If you don’t feel any discomfort, this means the tissue is normal and you can move on one inch further.
  • If you feel the discomfort, it means that you want to spend some time on that spot until you release the tension.
  • For better results, add some flexion and extension of the knee. This will allow working on the muscle in the full range of motion (more on that later).

Foam rolling quads

  • Lay down on the ground and place the foam roller directly under your thigh.
  • As you can see in the picture, the leg that stays on the foam roller remains straight. Another leg is flexed and externally rotated to the side. This allows for better pressure on the spot you’re rolling.
  • Roll back and forth trying to find the spot where you feel discomfort and stay there until you feel tension is releasing.
  • Once you find the spot, don’t roll anymore. Just stay there on the spot and breathe.
  • Spend around 20-30 seconds on one spot before you move on.

Foam rolling calves

  • Lay down on the ground and place the foam roller directly under your calves (see in the picture).
  • For more pressure, you can (1) ask someone to gently press your leg on the roller, (2) you can place your other leg on the top of the leg that you mobilize (3) you can sit against the wall and brace your hips to the ground. This will create pressure from your hips on the leg.
  • Instead of rolling up and down, move side to side.
  • Stay on each position for 20-30 seconds and move on one inch at a time.

Foam rolling glutes

  • Sit down on the ground and place the foam roller or a medicine ball directly under your glutes (see in the picture).
  • Use your arms for the balance and position yourself towards the side that you mobilize.
  • For better pressure, lean back, cross your leg, and place it on top of the knee (see picture).
  • Spend some time rolling back and forth to find the trigger point.
  • Spend 20-30 seconds on each spot and move on.
  • For better results, and some flexion and extension. This will allow the muscle to express the full range of motion as you mobilizing it (more on that later).

Can you foam roll your knee cap?

You should not use a foam roller on your knee cap because it can cause pain. A foam rolling is just another soft tissue work and it should be used only on the muscles to release the tension and using it directly on your joint can cause unnecessary discomfort.

2. Use PNF Contract-Relax Technique While Foam Rolling

PNF stands for proprioceptive neuromuscular facilitation and is basically the connection between muscle and the brain (source).

In general, PNF represents a wide range of methods and is described as the most effective stretching technique to increase the range of motion.

However, you don’t have to be an expert in physiotherapy to use that technique. You can easily use foam rolling stretches for knee pain together with PNF stretching.

The simplest PNF technique is called contract-relax.

Contract-relax technique

The contract-relax technique is about the active engagement of the muscle while doing stretching or foam rolling. Is divided into two phases.

The contract phase is when you engage (contract) the muscle that you plan to work on while holding the stretch or while being on the foam roller.

For example:

  • Peak squeezing your butt for 5 seconds while sitting on the foam roller.
  • Full extension of the leg and peak squeezing your quadriceps before stretching it.
  • Peak contraction of the entire leg before stretching the hamstring.

The peak contraction sends the signals to the muscle and inhibits the tension of that muscle. It’s like a light switch for muscle tension.

Lower tensions allow to desensitize the trigger point and increase the range of motion (source).

The relax phase is when you completely relax the muscle. After intermittent contraction, there is a partial inhibition of the neurons in the GTO (Golgi tendon organ) sensory receptors and leads to reduced muscle tension.

For example:

  • Lay down flat on the floor and contract all of the muscles in your body for 3-4 seconds. Include your legs, arms, chest, and face. Once you release the tensions, notice how your body immediately starts to feel relaxed.

After your build the tension, the relax phase allows reclaim the normal range of motion and stretch further, comparing to regular static stretch.

Doing regular cycles of contract-relax (5 seconds ON, 10 seconds OFF) not only allows for a better range of motion but also desensitizes the painful trigger points while you’re on the foam roller.

This means if you can’t handle the discomfort from the roller, using the contract-relax part will reduce the pain. So you can continue with foam rolling.

To learn more about that mechanisms, check out my article foam rolling and why it hurts.

How to use contract-relax for knee pain

  • Place the foam roller under the muscle that you want to work on.
  • Get yourself comfortable, spread your legs and use your arms for stability.
  • Spend some time to find the sensitive spot (trigger point).
  • Once you find the trigger point, peak squeezes the muscle you are rolling on.
  • If you cannot contract the single muscle, peak squeeze the whole area (leg or butt).
  • Hold the peak squeeze for 5 seconds while holding your breathe.
  • Release.
  • Relax for 10 seconds, stay on one spot and breathe normally.
  • Repeat the cycle 5-10 times until you feel the trigger point is getting less sensitive.

After you use contract-relax, now is the time to add movement to the muscle.

3. Change The Length Of The Muscles While Rolling

Change the length of the muscle is just a fancy name for moving the leg while your work on it.

In fact, the most effective way to foam roll the soft tissue is by adding the movement of the muscle.

For example:

  • Foam rolling your quads in a straight leg position will feel different than foam rolling the same leg but flexed at the knee. Because the muscle changed the length-tension relationship, it opens up the new fibers from different angles.
  • Foam rolling your hip flexors with a straight spine position will feel differently to foam rolling with a flexed hip position where your knees are close to your chest.
  • Foam rolling calves with dorsiflexion will feel differently than in plantarflexion.

Muscles are dynamic tissues that change the length during the movement.

Using a foam roller while adding the muscle movement allows you to tap into the muscle at various lengths and find all the hidden corners and the trigger points.

It smokes out the real problem that can be missed if you only spend time in one position.

That change in excursion of the muscle allows for better access to the muscle fibers and to find the blind spots.

You can squeaky clean all the tissues, in all ranges of motion.

This simple addition changes the entire dynamics of the foam rolling and can reduce knee pain much more efficiently.

Foam rolling quads

  • As you lay down on the roller, add simple flexion and extension of your knee.
  • Do it slowly with full control.
  • To go one step further, you can stop and hold your leg while having a flexed knee and add some rotation side to side on the roller.
  • For best results, squeeze your butt as you flex your knee. Squeezing your butt will externally rotate your hips, change the angle of your quads and give you another new angle to mobilize.

It’s pretty cool, right?

Foam rolling hamstrings

  • As you sit down on the box with a ball or dumbbell under your hamstrings, add simple flexion and extension of your knee (this is what I was referring to in the first principle).
  • As you extend your knee, you can lean on toward your straight leg for better pressure.
  • Once you find the trigger point, continue to adding flexion and extension until you release the tension.

Foam rolling glutes

  • As you sit down on the roller under your glutes, start by straightening your leg forward, followed by bringing it back (see picture).
  • As you extend your leg, squeeze you’re but for 5 seconds on, and release. Adding the contract-relax technique helps to desensitize tissues even better.

Foam rolling your muscles from different angles helps to really restore the full capacity of your tissues, which allows for better knee mobility.

4. Use Other Exercises To Fully Reclaim ROM

Foam rolling for knee pain is effective but you can go one step further by adding other tried and tested methods to restore full range of motion.

The best way is to combine foam rolling with stretching and joint distraction.

A simple home-based stretching routine has been proven to significantly reduce knee pain (source). You just need to know what you’re doing.

TIP: When you’re adding stretching to your foam rolling routine always make sure that you warm up first. For foam rolling, warm-up is not necessary. However, to get the most benefits from stretching you should spend 5-10 minutes moving around.

Foam rolling with stretching for knee pain

There are several good stretches that can be used to increase range of motion and reduce knee pain. Some of them include quadriceps stretch, calf stretch, and hamstring stretch.

Hamstring stretch

  • Lay down on the floor
  • You can find a spot with a pillar or a door frame (see picture).
  • If you don’t have a spot with a door frame, you can use a strap or a towel.
  • Bring one leg up towards the ceiling and place it against the pilar. This will allow for passive pressure (almost like a partner stretch).
  • For better tensions, move forward close to the pilar.
  • If you don’t have a pillar, use a strap or towel. Wrap your foot around it and pull it towards your chest.
  • Hold the stretch for 1-2 minutes.

Calf stretch

  • Find the step or some attachment that you can anchor your foot against (see picture)
  • Find some stable object to hold on to (fence, wall, or some door frame)
  • Place one foot on the step.
  • Ball of the foot stay on step, but try to reach your heel down to touch the floor.
  • The supporting leg stays completely flat on the floor.
  • Once you load up the leg with tension, lean forward until you feel the stretch.
  • For best results, thrust your hips forward and peak squeeze your butt.
  • Hold the stretch for 1-2 minutes.

Quadriceps stretch

  • Start from going down on the floor into the box position with both hands and legs on the floor.
  • Bring one leg forward and place your foot flat close to your chest.
  • Anchor the leg behind you against the wall, couch, or bench.
  • Use a soft mat or a pillow for the knee that stays on the floor for better comfort
  • Once you find stability, straight up your torso and push your hips forward
  • Use an additional chair or bench to hold yourself.
  • Hold the stretch for 1-2 minutes.

Foam rolling with joint distraction for knee pain

Joint distraction with using the elastic band is a popular method that can improve muscular function, range of motion, as well as reduce the DOMS (source). 

The band used for this technique is a thick resistance rubber band, also called “monster bands”.

The banded distraction creates additional vector force that is pulling the joint from the angle that you want to work on. This simple method can significantly increase your range of motion in that joint.

There are several ways to use an elastic band to create a joint distraction. For sore knees, the best way is to combine it with a quadriceps stretch.

Here’s how it works.

Banded joint distraction for a quadriceps stretch

  • Create a loop and attach the band against a stable pole
  • Place your leg in the loop, put your knee on the floor and position the band as high towards the hip as possible
  • The opposite leg is at a 90-degree angle with a foot flat on the ground (see picture)
  • The further you step back, the more tension you create from the band.
  • You can place some comfy mat under the knee.
  • Hold to some static object for better balance, or get yourself a chair.
  • As you hold the stretch, squeeze your butt and push your hips forward.
  • Hold the position for 1-2 minutes.

Integration of all three methods can enhance joint range of motion and reduce knee discomfort, much more efficiently than using foam rolling alone.

5. Use Different Tools To Facilitate The Change

Foam rolling is not only about the foam roller. You can add many other available tools to create local pressure on the soft tissue or get full access to some hidden corners where foam roller doesn’t go.

Some of the large muscle groups like quads, and glutes are fine with using the foam roller.

But for the hamstrings or lower back, you be better of using things like a massage ball or double lacrosse ball.

They have a much smaller diameter and can penetrate the soft tissue area more precisely.

Massage ball

Having a handy massage ball is an excellent way to target many little corners of the tissue, especially in small or sensitive areas.

Depending on the diameter, you can also use a massage ball for the large muscle groups. As you pin the ball it will feel more robust, comparing to the foam roller.

  • Great for feet, shins, hamstrings and hip flexors

Peanut ball

The peanut ball is a specifically designed duoball for spine mobilization. It works better than a foam roller because of its shape that allows for precise access to the vertebrae discs. The foam roller is flat and can only reach so many corners.

  • Great for hamstrings, lower back, quads, and shins

Related article: 9 Easy Ways To Roll Out Sore Muscles Without a Roller

6. Be Consistent

At this point, non of the tools will work if you won’t do the work. Compliance is everything.

Doesn’t matter if you’re dieting, exercising, or doing foam rolling. You cannot spend a weekend in the gym and expect to be fit for the rest of your life.

You cannot go for 2 weeks juice cleanse and expect to lose all the excess weight.

And you cannot foam roll for one day and get rid of the knee pain forever. This has to be done on a daily basis.

It’s not about the length, but the width. You don’t have to spend all afternoon in the gym on the foam roller. You can get a lot of work done in just 10 minutes per day.

And if you’re consistent, the change can be remarkable.

Here are some guidelines:

  • Stretching and joint distraction (with band) can be done before your workout. They activate sympathetic response and fire you up for the workout (5-10 minutes).
  • Use foam rolling after the workout and/or in the evening as a part of your down-regulating routine (10 minutes)
  • Focus on 1-2 muscles per day only. No need to cover everything in one day.
  • For foam rolling, stay until you make a change, or until you stop seeing the change

Conclusion

A sore knee is one of the most common complaints I hear from people.

Sadly, people usually don’t care about their mobility, until they cannot do things they love to do anymore.

Using a foam roller and other helpful soft tissue methods is an easy solution for simple self-maintenance practice that can mobilize at several positions from different angles and can significantly reduce the problem.

Use those tools and get ahead of the game.

Michal Sieroslawski

Michal is an exercise physiologist (MSc), nutrition coach, Ashtanga teacher, and fitness blogger. He shares his successes and failures to help busy men and women squash down 20, 50, or even 100 pounds of fat without leaving their home.

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