Common Causes of Knee Pain
Osteoarthritis is a degenerative process in the knee joint, the cartilage gradually wears away and changes occur in the adjacent bones. It is associated with aging and most typically begins in people age 50 or older. It can occur in younger people who have had an injury to the knee or neighbouring joints. The much less common Rheumatoid arthritis also advances the degenerative process.
There are a number of ligaments which “rope” the various bones involved in the knee joint together to provide stability. Traumatic injury to the knee can damage or tear one or more of these ligaments.
Tendons are the fibrous ends of muscles which attach to bones. If excessive or repetitive forces act on tendons, they can become injured or ruptured.
The meniscus is a layer of cartilage which sits on top of the tibia (main bone of the lower leg). It acts as a “cup” for the femur (thigh bone) to sit in. Knee injury can cause tears in the meniscus.
Bursae are fluid filled sacs found under tendons to aid in the mechanics of movement; they prevent friction between the tendons. These can become irritated and inflamed.
In some people the folds of the knee joint capsule become inflamed, thicken and then catch in the joint when the knee is fully extended.
Patella-Femoral Syndrome / Chondromalacia Patella
The retro surface of the knee cap can rub and grind on the femur if poor balance between the thigh muscles pulls the knee cap out of its groove on the femur.
Ilio-Tibial Band Syndrome
This long fibrous flat tendon can irritate the bone underneath it, when it is too tight.
Osteochondritis, Ossgood-Schlatters, and SUFE syndromes
These conditions can occur during teenage growth spurts. Parts of the soft bones at this time, are susceptible to injury from excessive stresses. Young athletes and sports people need to be examined if they experience persistent knee pain.
With a better understanding of your problem, reduction of pain and a strategy to rehabilitate and maintain knee health, you could find yourself on an ever increasing cycle toward pain free knees.
As osteopaths, we are very familiar with these “labels” and they can be useful to describe the nature of the dysfunction which is apparent in the patient’s knee, however, we treat people, not conditions.
In order to treat and manage a patient, a deeper level of understanding of the tissue causing the pain is required. We are led to the “local” dysfunction by the patient’s case history and orthopaedic testing of structures in the knee.
Knowing when and how the problem started informs us to examine other parts of the body. The efficiency of the overall posture and the overall mechanics of the leg, ankle, feet, and hips are all assessed. A good explanation of what we think has gone wrong locally, and how that fits into the overall view of the patient’s posture, usually helps put the patient’s mind at ease.
Restore function and structure
In the short term, our treatment is focussed on restoring function of the tissues implicated in the dysfunction of the knee. Our attention is then directed more globally to contributing factors present in other locations of the body. All through the course of treatment patients are advised about how to stay active without causing further injury or aggravating their symptoms.
Treatment will involve manipulation of the target soft tissues and joints. We aim to encourage tissues to behave appropriately which may involve using techniques to encourage tissue relaxation, lengthening, strengthening, mobilisation, and improved quality of movement. Sometimes it may be necessary to use strapping or taping in the short term to support or reinforce certain muscles, tendons and ligaments.
With chronic knee problems, it is sometimes necessary to encourage a healing crisis in tissues. This involves using vigorous techniques to kick start a natural healing process.
In the mid to long term, you will be asked to follow a personalised exercise program to complement the treatment. The exercise is specific to the individual and what has caused their tissues to become injured.
Will I need surgery?
If there is locking, severe instability, evidence of loose bodies within the joint or severe degeneration of the joint, then surgery may be indicated. We will recommend referral to an orthopaedic specialist for further investigation if any of the above is suspected or if your knee fails to respond to treatment:
If surgery is indicated, the informed decision which you make will be based on the potential benefits versus the risks. We will be available to talk through any concerns you have regarding surgery, and can assist with the very important post-op rehabilitation.