Repetitive Strain Injury/Knee problem


QUESTION: Hello - 3 weeks ago, I noticed a tender spot and bruise like feeling above my knee cap, slightly to the right of centre on my right leg (so towards outside edge).  About a week or so after that I noticed swelling/puffiness above the whole of the knee cap and an achey feeling in my knee, slightly up the front of my thigh and sort of sciatic ache - no major pain as such.

I tried to think what I may have done, no direct injury, maybe repetitive - I have been seated at a desk much more than usual the last few months and I first noticed the bruise feeling when I crossed my legs and the left leg pressed on this tender area.  I have also been power walking/gentle aerobics a little bit in my house, in hindsight with out good shoes and not a resistant floor.
Also been kneeling and stepping up and down with gardening and decorating and helping a friend move house.

I have been dealing with a stiff shoulder with restricted movement for a year, having myofascial release for it and it is working well, I believe this is a RSI type situation from emotional tension and posture etc  I have no other joint or muscles problems.

I was not sure what to do to help with the bruise feeling not showing a bruise and then the swelling - I started to rest and elevate the knee and apply ice a couple of times a day last week and the background ache seemed less noticeble.

Today the puffiness is much better and I have not been sitting but after sitting and going up and down stairs the ache began again and I checked my knee, the tender area seems tender again (the same bruised feeling) and as before I can feel a sort of knot/grisly area, not quite a lump, in the area of tenderness and when pressed this pain tends to create a dull ache around the knee and somewhat up my quad muscles.  I should say that as well as icing last week I gently stretched the quad muscles as this seemed to somehow help.

The tender grisly feeling seems to be coming and going, although I cant be certain but definately felt better for a while.

Do you have any advice on what I might have done?  I am happy to continue to treat at home, just wasnt sure what timeline to expect and what signs of healing to look out for. As I said, there is not pain as such,I can still do all activities, just the puffiness which seems to be subsiding and the tender area and subtle ache - the knee feels vulnerable as such but not giving way.  The fact it is coming and going a bit and vague made me concerned it might turn into a chronic thing or maybe the timeline is a reasonable one?

Many thanks

I am 43 female and not a sports person, not overweight

ANSWER: Hi Sarah,

I agree with you that the odds are high that you have a repetitive strain injury. The source of the problem is your quadriceps muscles on the front of your thigh.  The "quads" contract when you go to straighten your leg after sitting or kneeling, and of course, while you are walking.  

The analogy I use is: if you pull your hair your scalp will hurt, but you don't need to massage your scalp, use medications, or have brain surgery to eliminate the pain, you only need to release your hair.  It's exactly the same with muscles and joint pain.  The muscle merges into a tendon, and the tendon crosses over a joint before it inserts into the bone.  When the muscle is tight it will pull on the tendon and the insertion point (at the joint) will hurt.  

I suggest you go to and read about repetitive strain injuries, including the sections titled "Muscles and Pain" and "What's Happening Exactly."  This will explain a lot about what is happening and why you are feeling the pain.  The good news is that you can easily self-treat your quadriceps muscles. If you go to you can read about each of the muscles that cause knee pain, and a lot of other common aches and pains.  You'll see a list called "The Julstro Protocol" which is the order of treatment that works the best to release the tension put on the pelvis and knees, you'll see it on the thread just mentioned.

The odds are very good that you'll eliminate this problem by self-treating each of the muscles listed in the Julstro Protocol.  You can either go to a good Trigger Point massage therapist, or you can successfully do them yourself.  You'll read how to learn the self-treatments as you read the thread.

Wishing you well,
    Julie Donnelly

---------- FOLLOW-UP ----------

QUESTION: Thank you so much Julie, everything you have said here and in the link you sent makes total sense to me.  I don't have your book to reference the self treatment directly, perhaps I will go to my Myofascial release therapist and get her to work on the muscles groups for me.  I feel relieved to hear that there are simple and natural ways to approach this issue.

I will let you know how things go.

Hi Sarah,

I'm glad you're going to your Myofascial Release therapist, I suggest you ask her to work on the muscles I mentioned, in the order given on the thread. You, or she, may be interested in the "Treat Yourself to Pain-Free Living" ebook as it will explain how to do self-treatments throughout the entire body.  This is good information for a therapist to have handy to share with his/her clients.

Wishing you well,
    Julie Donnelly

Repetitive Strain Injury

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Julie Donnelly, LMT


I can accept questions that relate to chronic or acute pain caused by muscle spasms and contractions. Repetitive Strain Injury is actually Cumulative Trauma to muscles. Releasing the spasm &/or contraction will relieve the strain that is felt at the insertion point on the bone. I am the co-developer of the unique safe-stretching program "Focused Flexibility Training," which combines easy instruction for self-treating spasms throughout your body with proven yoga stretches. I have recently authored two new books: "The 15 Minute Back Pain Solution," and "The Secret to Your Best Golf Game EVER!


Since 1989 I have been working with endurance athletes and individuals suffering from chronic pain conditions. I have authored seven self-treatment books and three self-treatment DVDs and I have developed the Julstro System for the treatment of carpal tunnel syndrome, Trigger Finger, and other Hand/Wrist pain. I am a national and international presenter at conventions, seminars, and workshops. Principle topics are "Work Shouldn't Hurt," and "The Pain Free Athlete." In 2005 and 2006 I was the massage therapist for ultracyclists competing in the Race Across America (RAAM) 3000+ mile race from San Diego, CA to Atlantic City, NJ. I've taught the Julstro techniques to physical therapists at the Cleveland Clinic, to massage therapists in areas around the USA, and I've taught Julstro self-treatment clinics to dancers at Juilliard School of Performing Arts (NYC),the sprinting team at NC State, and I am working closely with several Olympic-hopeful. We have successfully eliminated the repetitive strain injuries that could keep them out of the Olympic Games, and the best part is they know how to do the self-treatments so they can stay pain-free and flexible.

Triathlete Magazine, Endurance Magazine, multiple national and international trade journals.

Swedish Institute of Allied Health, NY, NY - Initial education in massage therapy Licensed NYS Massage Therapist since 1989. SUNY Empire State College, Saratoga Springs, NY - B.Sc. degree in Interdisciplinary Health Education I was an Associate Professor helping to develop the massage training program for SUNY Rockland Community College

Past/Present Clients
Privacy prevents me from filling in this section without prior consent from my clients. Life Experience: I have been specializing in the treatment of chronic pain and sports injuries since receiving my NY massage license in 1989. A personal bout with carpal tunnel syndrome was the catalyst to my developing a self-treatment that heals the symptoms of carpal tunnel syndrome quickly and without surgery. My work with endurance athletes was the inspiration to teach people how to self-treat so they could stop pains even during a race or heavy training day. Both of these situations ultimately became the products that are sold on my websites: and I currently treat people in my offices in Sarasota, FL, Cary, NC, or Pearl River, NY

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