Knee pain can interfere with work, sports, housework or just getting out and seeing people. This makes sore knees a source of great frustration. Sometimes it even makes people question who they are if they can’t carry on doing the things they love.
“If I could change on thing about myself, I would: Have better knees. Mine are shot because of injuries. You’re only as good as your legs, whether you’re an athlete or an actor.”
William Petersen, Actor
Looking at the anatomy, our poor old knees are stuck between a rock and a hard place. Below them, every time the foot lands on the ground it sends a shock wave upwards. And above, the hips and pelvis are often quite wobbly, and may not control forces from the upper body very well. Even worse- knees are stuck at the end of two long bones, which exposes them to high forces of leverage. On the other hand, knees are equipped with strong ligaments and some of the most powerful muscles in the body. And there are many ways in which an osteopath to help with knee pain.
Here is a brief summary of some of the common knee problems. There are many other possible causes of knee pain, and a clinician will try to hone these out while taking your case history and examination.
Pain on the outside of the knee, ITB syndrome
This is a common problem that affects the front or outside of the knee among runners. It often occurs when people are ramping up their training or are new to running. Strangely, running downhill can be worse, while running uphill is a blessed relief. It normally responds well to some osteopathy, training advice and appropriate exercises.
Pain at the front of the knee, Patellofemoral pain
Pain at the front of the knee is often related to the patella (knee cap). People may feel it while going up or down stairs, getting out of a chair or walking downhill. The patella sits in a groove at the end of the femur and acts like a runner for the strong muscles in front of the thigh. It can take a hell of a beating- just walking downstairs places 6 times your body weight on the patella! Normally it handles these very well, but certain muscle imbalances can place too much compression of parts of the patella. People may feel a vague ache around the knee cap after running or walking. It might just creep on without any specific injury. Patellofemoral pain responds well to corrective exercises based on a good analysis of your particular movement patterns. We may have to stretch some areas such as the calf muscles and strengthen others such as the hips and quadriceps.
Clicks and pops in the knee are quite common. If they aren’t painful its probably best not to get too worried about them. Clicking noises may occur due to friction between different moving surfaces in the joint. In younger bodies this often happens in people who are quite flexible, and they should probably work on building strength around the hips and core. With an older knee the cartilage under the patella can become roughened, so it may grind or crackle on bending. In other people a painful click may indicate a problem with their meniscus.
Meniscus : “torn cartilage”
When people say “cartilage” in the knee, they often mean the meniscus. These are two C-shaped pieces of cartilage between the tibia and the femur, which help guide movement and improve stability. If the knee doesn’t move well the meniscus can get pinched or squashed. Over time they may become rough or develop tears which interfere with smooth movement. Meniscus problems can be tricky to treat. They don’t have a good blood supply so they heal slowly. Although an osteopath can help with improving your movement, to take strain off a meniscus, and give it a chance to heal, there isn’t a lot we can do directly to it. So if it is not responding to rest and exercise it may be best to consider injections or keyhole surgery.
One of the key symptoms of meniscus damage is that the knee joint may become “locked” in one position. Another is clicking or popping noises when turning or twisting the knee. So while taking the case history I often ask “Any locking, popping or clicking?” I remember once in a dance class the teacher saying there were three components of hip hop dance: locking, popping and boogaloo. In clinic, part of me always wants to ask “Any locking, popping, …boogaloo?” But so far I’ve resisted the urge!
Swollen knee: bursitis
A bursa is a fluid-filled sac, its function is to reduce rubbing at points of friction. There are lots of bursae around the knee and if they become overloaded, they swell up. Housemaids knee is one example of this, at the front of the knee. A Baker’s cyst is another, at the back, where the swelling can make it difficult to bend the knee. Any swelling needs to be checked to make sure its not something more serious. When we are sure it’s safe we look at why the bursa became inflamed, and how we can make your knee more resilient.
Assuming there are no developmental problems, knee problems in a younger person are normally related to overuse or injury.
Sudden injury can include tearing or bruising to the muscles, tendons, ligaments, meniscus or even the bones themselves. Depending on how serious these are, these injuries should respond to rest, osteopathy, and rehabilitation. Surgery is normally only considered as a last resort.
Overuse problems can come from the wrong training methods (going too hard, too soon?) or faulty movement patterns. The most common faulty movement patterns that affect the knees occur at the foot and ankle, or at the hip. I like to take people through exercises that “wake up” the foot, so the brain can receive all that juicy information about position, balance and terrain underfoot. And there are lots of exercises we can do to strengthen or improve movement around the hip area.
Arthritis and the aging knee
Problems in the older knee tend to be an accumulation of different factors. There is already a history of injuries and the tissues are now losing their natural ability to heal. So a minor bump or strain can cause an unreasonably large response. And sometimes problems appear for no apparent reason at all.
The combination of inflammation and loss of cartilage is known as osteoarthritis, which seems to strike fear into the heart of many people. But arthritis is just a word, not a death sentence. Anyone above the age of 30 has arthritis to some extent. Advanced arthritis may need surgery but many cases respond well to good management including lifestyle advice and exercise. The important thing is to stay active. Exercise keeps the muscles strong, the joints lubricated and the nerves firing important information to the brain. The next important thing is to learn your limits and how to work within them without aggravating your symptoms. There will be good days and bad days but if you can do these two things most of the time you should be able to keep up your work, your hobbies and the life you want to lead.
If you would like to see how I can help with your knee problems please give me a call on 520714 and make an appointment.