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Knee pain

I am recapping (please excuse the pun) on the subject of knee pain as I so frequently have patients coming in for treatment of symptoms relating to the knee.

The knee is the largest and most complicated joint in the body which consists of many structures which, if damaged by anything from an acute traumatic event to general wear and tear over time, can require quite a bit of rehabilitation to correct.

Here are some of the more common knee problems:

  • Osteoarthritis – essentially this is wear and tear of the knee which can be treated effectively, especially if the treatment is started early. You may find that your knee is aching or painful after certain activities such as climbing stairs with stiffness present particularly in the mornings or after rest. Pain may be experienced within the joint, all around it or in one place. There are many causes for osteoarthritis of the knee including pelvic torsion that results in more pressure being put onto one knee than the other or it may be due to secondary to osteoarthritis of the spine.
  • Referred pain – knee pain may be referred from compression of the nerves supplying the knee at various levels down their course to the knee from the low back. It may also be referred from trigger points in muscles further up or down the leg.
  • Biomechanical issues - such as kneecap lateral tracking (moving towards the outside) occur as a result of many issues including dropping of the foot arches, knock knees, lack of tone of the quad muscles nearer the inside of the leg(s), leg length differences or pelvic torsions.
  • Chondromalacia patella - is related to the above issue where the underside of the knee cap becomes irritated as it passes along the groove at the base of the femur (thigh bone) often due to mal-tracking.  Going up stairs or deep knees bends can be painful.
  • Bursa inflammation – Bursa are like tyres filled with viscous fluid-like material which act as pads between muscles, tendons and bones around the knee. These can become irritated and inflamed, most commonly causing pain just above or below the kneecap.
  • Children - Osgood Schlatter’s disease, where the quadriceps muscle at the front of the thigh pulls at the surface of the bone where its tendon attaches just below the knee.  This often results in a painful, visible lump.  Never ignore persistent knee pain in a child as there are serious diseases which need to be excluded.
  • Sports injuries
    • Cruciate ligament tears/collateral ligament tears – the cruciate ligaments are found within the knee joint. Tears can occur when excessive force is applied to the knee joint with the anterior cruciate being affected the most often. Other structures such as the joint capsule and the collateral ligaments on the inside and outside of the knee are also commonly damaged.  If there is a major tear there will be sudden and painful swelling in the knee at time of injury and the knee will feel unstable.
    • Meniscal/cartilage tears – the meniscus/cartilage is found lining the ends of the tibia and femur (shin and thigh bones that meet in the knee). Damage often occurs to these structures when the knee is over-rotated.

My job as an Osteopath is to assess the joints and muscles of the knee, hips, back and feet holistically focusing on everything so that the cause of your knee pain can be determined. The problem will then be treated with soft tissue massage, articulation, stretching and manipulation and dry needling (modern acupuncture) as appropriate. Advice may also be given on effective exercises and hydrotherapy (hot and cold packs) and medication. If need be, you will be referred for further medical assessment.

 

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