Knee pain is a common symptom in our patients and can be caused by a number of factors.
Common Knee Problems
The most common knee conditions that we see in our clinic are:
- Patella tendinopathy. (Pain around the knee cap)
- ITB Syndrome (Lateral knee pain)
- Patella Tracking Disorder (Clicking as the patellar moves out of its normal groove)
- Ligament strains (Occurs at collateral ligaments and cruciate ligament)
- Meniscal Tears (These can occur due to sport or aging from an awkward twist)
Anatomy of the Knee
What are the bones of the knee?
We have four main bones that make up the knee.
- Above the knee there is the Femur which is the longest and strongest bone in your body;
- Below the knee there is the Tibia which you can touch;
- and the Fibula which is smaller and on the outside of the lower knee;
- Finally there is the Patella which is also known as the knee cap.
What muscles straighten the knee?
Above the knee there is the quadriceps muscles. These are a group of four muscles found at the thigh. When these muscles contract they help the leg straighten.
What muscles bend the knee?
Located at the back of the knee is the hamstrings muscles, which include three muscles that help to bend the knee... the semitendinosus, semimembranosus, and biceps femoris muscles
Common Treatment Options for Knee Pain
The most common treatment options for addressing knee problems are usually:
-
Corticosteroid injections
-
Imaging (MRI’s / X-rays)
Why Steroid Injections may not be the First Treatment Option...
Corticosteroid injections are commonly used as a conservative measure for patients that have knee pain. However recent studies have raised concerns that these injections may cause chondrotoxicity, which is damage to the cartilage of our knees (1).
A 2020 study of 49,000 patients who received a corticosteroid injections due to their knee pain (no osteoarthritis present), demonstrated a correlation towards knee replacement at 5 years (1). It was also noted that there was a correlation between increased dosage of corticosteroid and reduced time until patients received knee replacements (1). This demonstrating that corticosteroid injections may not be as benign of a treatment as previously thought.
Why Imaging can Paint a Confusing Picture of the Knee...
Many MRI ‘abnormalities’ can be normal.
Almost 20 percent of people below 40 years old without pain or injury in their knees have abnormal findings on MRI. At 50 years old, this number jumps to 50 percent.
The changes seen on MRI’s in people without knee pain include meniscal teras, bone spurs, cartilage lesions and bone bruising.
How can this play out in the real world?
If you're over 50 years of age and a runner, there's a 20 percent chance that you have a meniscus tear. Tears can’t be dated on MRI’s. This means that tears found on MRI can simply be an age-appropriate finding; not something that needs to develop fear in patients.
This often means that there is no reason for a change in lifestyle.
Does this mean I shouldn’t get imaging of my knee?
Modern imaging is an incredible technological leap and does have its place in patients who have experienced trauma or failure of rehabilitation. Routine imaging can lead to scary false positives.
The bone on bone diagnosis....
Words are powerful. Just hearing bone-on-bone can make you grimace reflexively.
This statement projects ongoing pain and disability, and can bring about the nocebo effect in patients (3), which refers to negative thinking that has a detrimental affect on your health.
These thoughts can make people afraid of exercise and movement. Words matter!
A more Positive Approach to Knee Pain...
The findings on the MRI are one part of the story and often don’t tell the whole picture.
Considerations for knee pain need to be:
- Pelvic alignment
- Tissue Sensitivity
- Ability to load the joint
Our bodies will compensate to reduce painful or weak areas by recruiting muscle from other areas of our body. This can lead for problems if there is prolonged compensation.
The pelvis is our foundation and this may twist to prevent loading a sore knee. There can then be a flow on affect to your core strength. A cycle is created that needs to be addressed.
Step One to Getting Back on Track
Move well and move often.
Exercise has been shown to be as good as knee arthroscopy (surgery) for moderate to severe osteoarthritis (4). Gaining confidence in your knee comes with appropriate exercise prescription. Preserving your knee means using it in the right way so you can continue to enjoy the things you love.
At Stafford Chiropractic & Wellbeing Centre, we treat your body as a whole (holistic approach) and assess for areas of nerve pressure than can lead to muscle guarding or weakness.
We understand that the function of your spine and pelvis can cause compensations at your knee. We aim to improve the function of the structures that support the knee (muscles and ligaments) and what we are supported by (spine and pelvis).
What treatment is provided?
- Chiropractic adjustments to balance the spine and pelvis;
- Mobilisation to help reduce pain by providing new brain stimulus to improve your confidence;
- Muscle activation of the surrounding knees structures to balance compensations;
- Cold laser treatment to reduce inflammation and promote tissue repair;
- Exercise prescription that encourages you to move more.
There is hope for knee pain! We would love to help you regain confidence about your knee and continue moving forwards into your future!
If you have any questions on this topic, please give us a call on (07) 3356 9552.
Written by Dr Ben Lowe, Chiropractor
References:
- pubmed.ncbi.nlm.nih.gov/35802374/
- www.howardluksmd.com/sometimes-our-joints-just-hurt-and-its-ok-not-to-know-why/fbclid=IwAR1VpBoOHNCPNsTd0ISR6NVmKtOuyJ6kzGL34gLyL6qaQ11ZLx9rRX3k2Mw
- Effectiveness of manual therapies: the UK evidence report - PubMed (nih.gov)
- Why have knee surgery that's 'no better than placebo'? - Health & Wellbeing(abc.net.au)
DISCLAIMER: All content is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition.