We only realise how much we use our knees, when they start to hurt us every time we use them. We have to move our knees every time we, pick something up, walk, go up or down the stairs, or when we stand up.
Knees are important!
Every other week I assess the posture of somebody suffering from low back pain (which I do for all my clients), only to see a major compensation pattern from an old knee issue. As they stand in front of me, it becomes obvious to me that they are avoiding putting pressure on their “dodgy knee”. This leads to a slight twisting of their posture which puts undue stress through the hips and back.
Over the years as physio technician and Osteopath, I have lost count of the numbers of times, that I have assessed and treated an acute or chronic knee problem. You only need to look at the number of knee replacements that the NHS does to see how common knee problems are.
My assessment process of the knee involves me asking lots of questions in what is called a case history. I ask about past injuries and whether the knee is stable or not, as well as asking questions to figure out what makes the knee/s hurt. After the case-history I then assess how they carry themselves when they walk, in other words whether their gait is compensatory or not. After this I see how well they can move their knee, how much potential it has to move, followed by some orthopaedic tests. Knee pain can be caused by many different acute or repetitive strains or compressions leading to a multitude of common diagnoses such as…..
– Quadriceps muscle strain
The quadriceps are 4 muscles at the front of the thigh, which straighten the knee when they contract. There are 3 different levels of muscle tearing:
Grade 1: a fully functioning injury, where a small number of muscle fibres are torn resulting in some pain.
Grade 2: a moderate loss of function occurs, as a significant number of muscle fibres are torn.
Grade 3: all muscle fibres are ruptured, resulting in major loss of function.
– Meniscal tear
Characterised by the knee constantly clicking and giving way at times. Meniscal tears of the knee are surprisingly common and don’t always need surgical correction.
– Knee osteoarthritis
Osteo means bone.
Arth means joint
Itis means inflammation.
There are various stages of arthritis, each with different characteristics. It is often not until the late stages of degeneration that the knee starts to cause pain, this is characterised by the inability of the extend at all.
– Iliotibial Band Friction Syndrome (ITBS)
The IT Band runs along the outside of the thigh and connect to the outside of the knee. Sometimes this tough band of connective tissue can rub on the bone on the outside of the knee and cause inflammation. This is a common condition that endurance runners can suffer with.
– Chondromalacia Patella (Runner’s knee)
When the kneecap and the underlying femur has wear and tear, where the cartilage has worn away. It is aggregated with the repetitive impact of running, hence why it is commonly called runners knee.
– Bursitis
Bursa are fluid filled sacs that help to absorb shock and prevent friction. When inflamed they swell up, usually after a trauma or repetitive activity such as running. The pain is very specifically located at one place and is usually tender to touch.
– Osgood-Schlatter Disease
This is a condition that effects active teenagers. It is where the periosteum (outer shell of bone) at front of the shin bone becomes irritated due to the thigh muscles constantly pulling on it. Over time the outer shell of bone, starts to develop extra bone on it. In some serious cases a bit of bone gets pulled from the shin bone, in what is called an avulsion fracture.
– Bakers cyst
Usually post traumatic, it is an injury characterised by a bump appearing at the back of the knee. It can be sharp and painful if it irritates a nerve in a nearby muscle.
– Knee joint swelling
Commonly referred to as having water on the knee. The knee swells up and becomes painful due to the body responding to some form of damage through inflaming.
I am rarely flummoxed by what it is that is causing a knee problem. Having diagnosed hundreds of different knee conditions that cause knee pain. If I am unsure or feel I cannot help I refer people to the doctors. So rest assured that you will be in the right hands, even if those hands are an orthopaedic consultants hands.
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How I treat knee problems……
I have found that knees that are tight respond best to the following treatment methodology.
– Traction of the joint
– Gentle joint capsule stretches
– Functional Range Release (great for meniscal problems)
– lymphatic drainage (if the joint is swollen)
Before I prescribe any exercises I see how the joint responds to the following, research-backed treatment methods:
– Rhythmic PNF
– Reactive Neuromuscular Training
– Isometric Agonist Antagonistic activation
