The knee is the largest joint in the body and probably the most vulnerable. Because of this, it is a great source of pain. It gets its stability from its boney design and its strong ligamentous structures. There are a variety of situations that can contribute to knee problems. My focus here will be on common causes of knee pain.
Some knee problems manifest slowly (degenerative) others immediately (trauma). Pain of a traumatic origin is felt at the time of the injury. The severity of the pain and the immediate disability of the knee do not always reflect the severity of the ligamentous injury. Minor and moderate sprains can actually hurt more than severe sprains.
A little background is helpful to understand joint problems. Our skeletal system is primarily held together with ligaments. A scientific name for this boney-ligamentous system is a Kinetic Chain. Because everything is connected, compensatory changes can occur throughout the body. What exactly do I mean by compensatory changes? A good example of this is a house that has foundation problems. If the foundation heaves up, cracks form in the wall that rests on that area of the foundation. Above that, doors and window may not open properly. Structures around the problem area compensate to accommodate the changes that have taken place. Our body is no different. When structural changes occur above or below the knee, the knee over time will become painful. If caught early appropriate chiropractic care is very effective at eliminating knee pain due to these types of structural changes. If you live in the Cincinnati area and are suffering with knee pain it is critical that you have a thorough examination to find out the cause of the problem. Like all joint problems, the earlier the treatment begins the better the outcome.
Common Causes of Knee Pain:
• Referred Pain – Pain that is felt at the knee but its origin is not the knee. Sometimes problems in the lumbosacral region, sacroiliac joints or the iliofemoral joint can refer pain to the knee. It is common for a senior citizen to complain of knee pain and after examination and x-rays it is revealed that it is actually a degenerated hip joint that is referring pain to the knee.
• Flat Feet (Pes planus) – A flattening of the medial arch will cause the foot to pronate (a bending inward of the ankle). This leads to compensatory changes in the lower leg bone. Meaning the lower leg bone (tibia) rotates to accommodate the flattened arch. It is this rotation that changes the mechanics in foot, ankle and knee. Left uncorrected, degenerative changes will occur in all these areas. If you have flat feet you should have this evaluated.
• Muscular imbalances (Runner’s Knee) – Muscular imbalances can happen anywhere in the body. Skeletal muscle has two primary purposes: Stabilizing joints and creating motion in joints. Muscles cause joints to flex and extend. The strength of the muscles that cause both motions needs to be balanced. If the muscles that cause flexion are much stronger than the ones that cause extension this can cause imbalances in the joint. This happens frequently with runners. The muscles in the back of their thighs (hamstrings) are much stronger (do to running) than the muscles in the front (quadriceps) of their thigh. These imbalances cause pain and much frustration to runners. If you feel you have this… have your knee(s) evaluated.
• Sacroiliac problems – The pelvis is actually made up of three bones (sacrum and two ilums or hip bones). These bones come together to form the sacroiliac joints. These joints actually allow motion to occur in the pelvis. As with all joints they are susceptible to injury and misalignment. If the joints become misaligned due to one ilium rocking backwards it will cause the leg on that side to be drawn up. This in turn increases the weight going down the leg. Now there will be asymmetrical loading of the knees. Our knees are designed to carry our body weight in a very specific way. If this is altered problems begin. Have you been told by a tailor that one hip is higher than the other? If so, you may have this type of problem. This needs to be evaluated and corrected.
• Degenerative Arthritis – The knee is a common site for degenerative arthritis. Typically the initial symptoms are aching and stiffness. Pain can occur while standing or stiffness after prolonged sitting. Both Osteoarthritis and rheumatoid arthritis can occur in the knees. Again, early intervention is important.
• Meniscus Tears – First of all what is a meniscus? Imagine two bones coming together to form a joint. However, the ends that come together to form the joint, do not match. This actually happens in the knee. The bottom of the thigh bone (femur) is rounded and the top of the lower leg bone (tibia) is flat. Imagine putting a ½” piece of clay on top of the flat surfaced tibia and then pushing the rounded end of the femur into the clay. The clay would mold itself to both the tibia and femur. Because of the clay the two surfaces match or are said to be congruent. In this example, the clay represents the meniscus. If the meniscus gets torn it can cause severe pain and make the knee lock. The location and severity of the tear will determine the appropriate treatment.
• Osgood-Schlatter Syndrome – Essentially this is an over-use-syndrome and is mostly observed in adolescent boys. The tendons that come off the lower end of the front thigh muscles or quadriceps converge into a common tendon that crosses the knee joint to attach to the top front of the lower leg bone (tibia) at the tibial tubercle. This is actually the site of the pain and the problem. It is this attachment that begins to pull away or avulse. This problem is aggravated by kneeling, squatting or jumping. This condition should be evaluated immediately.
• Kneecap or Patellar tracking problems (Chondromalacia Patellae) – Symptoms include a sensation of pain behind the kneecap. Grinding or crepitus. At times the knee may feel like it is going to give-away. The most common symptom is pain when walking downstairs. This is typically caused by a degenerative arthritis of the patellofemoral joint. Specifically, the back of the patellae. Like an old slot car that stayed on the track via a tang that actually slipped down into a groove/slot in the track. On the back of the kneecap there is tang that sticks out. As the knee bends this tang rides in a groove at the end of the femur or thigh bone allowing the muscles in the front of the thigh to efficiently create motion in the lower leg. If the patellar tang wears down, it can no longer track properly in the femur, causing instability and pain in the knee. If you are having any of the above symptoms you should have your knee(s) evaluated.