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Do you suffer from knee problems?
Clicks, cracks, swelling, aches and pain – our knees can cause a multitude of symptoms...
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Our knees are the largest joint in our bodies and are probably the most complex; unfortunately they are also one of the most commonly injured joints.
There are actually two joints – the main knee joint between the thigh bone and the top of the shin (the Tibio-Femoral joint) and the joint between the thigh bone and the kneecap (the Patello-Femoral joint). The knee then is a very clever but complex arrangement of (….wait for it) four bones, articular Cartilage, two Menisci, ten main Ligaments, two Fat Pads, thirteen Bursae, a joint capsule and thirteen Muscles (….phew!). Many will comment that with such complexity it is no wonder that we get problems with our knees - I have often wondered with knees how they ever work at all!!
Any one of these structures can be damaged and can lead to pain in the knee. There are specific injuries and conditions that affect not just the knee joint (such as muscle strains and osteoarthritis) which I intend to cover in separate topics.
For the purpose of this topic I wanted to talk about a problem specific to the knee joint: ironically considering what I’ve just said, although this can be one of the most common causes for patients presenting with knee pain, it is actually quite simple and will normally respond extremely well to treatment.
Patello-Femoral Pain Syndrome (PFPS)
This used to be known as Chondromalacia Patella or Anterior Knee Pain and is a very common cause of knee pain in adolescents and adults, particularly those involved with sports.
In a healthy knee the Quadriceps Muscles at the front of the thigh blend evenly into the Patella (kneecap,) so that as we bend and straighten the lower leg the Patella glides over the end of the Femur (thigh bone.) To aid the stability of this gliding movement the undersurface of the Patella has a ridge which runs in an effective groove formed by the Femur.
Due to effects on the knee from insufficient stretching, poor training technique, biomechanical issues and wear and tear, for example, the Quadriceps muscles can become imbalanced. Frequently we see that the muscles on the outer side of the thigh have become stronger and tighter than the muscles on the inside. This unfortunately will have the effect of pulling the Patella slightly to one side and can therefore aggravate the joint cartilage.
The resulting inflammation from this process will cause reaction in the local soft-tissues and increase the local blood supply thus causing pain. The pain will classically be somewhere over the front of the knee and may seem to be more to one side. The pain is often described as an intense ache which can be sharper on activities such as up/downhill or stairs, frequently it will become bad enough for that person to feel they need to stop sport or activity completely. The pain often seems a bit out of proportion to what can be seen – rarely does the knee actually look swollen with this condition.
What can I do about it?!
- Local ice packing: Put the ice pack on for 5mins, off for 10, back on for 5. Repeat every 2-3 hours ideally.
- Reduce the duration and intensity of activity you normally do but don’t stop completely.
- Increase your Quad stretching: When you have warmed up, stretch and hold for at least 15 seconds, repeat 4-5 times. Ideally 2-3 times per day (use the technique described in my article on Low Back Pain!).
Specific treatment of PFPS
There is a lot that we can advise you on as Osteopaths, such as stretching technique and other ways to help reduce the inflammation and pain and how to adapt your exercise / training schedule.
The most important single thing I feel though is to have your posture and biomechanics assessed and to get the hands on treatment needed to address the issues found. Without changing these issues you may well be able to self-manage the problem for a time but almost certainly it will never clear fully.
What else can go wrong with our knees?
Well, unfortunately a lot! Common problems would include Ligament Sprains, Meniscal Tears, Cartilage Tears, inflamed Fat Pads and Bursitis. From middle age Osteoarthritis is all too common as well. Less commonly the knee may be affected by Rheumatoid arthritis and similar inflammatory conditions, Infection, Gout, Pseudogout and some Tumours.
Due to the complexity of the knee early intervention is the recommended rule of thumb – get attention to any new pain quickly and the end result is likely to be better.
I think it is also worth mentioning how much techniques have improved to aid in diagnosis of more complex knee problems. In addition to the traditional X-Ray, scans such as MRI and Ultrasound can be used to great effect as can the use of Arthroscopy where a small camera is inserted into the joint. Arthroscopy is also used to treat certain injuries of the knee.
In conclusion
There are so many things that can affect the knee and cause problems. Many of these things are relatively simple to sort out so don’t ignore knee pain – get it looked at.
Remember that problems with your feet, back and pelvis will affect the knee in some way and often they can be the sole cause of your problems!
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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