Common causes of knee pain
Knee pain is very common. In this short piece I will talk about a few most common causes. Next month we will discuss how Pilates and improving your pelvic stability can help.
Knee joint line pain
Due to 'poor design' of the angles of the femur (thigh bone) and the way our muscles work in the leg, weight passing through the knee joint is usually uneven, with more through the medial (inside) side. With the natural effects of aging, or with deconditioning of our leg muscles, this can cause more wear and tear in this part of the knee and joint irritation (see osteoarthritis). If there is minimal arthritic changes to the knee cartilage that lines and cushions the joint, then this type of pain can easily be rectified with re-alignment of the knee. This occurs with an exercise program to stretch tight inside muscles and strengthen the hip and thigh muscles. Footwear adaptations and orthotics can help here too.
Osteoarthritis is a very normal adaptation of a joint to aging. Unfortunately however, it can be quite painful and debilitating. Knees, hips and lower spines, our big weight-bearing 'busy' joints tend to suffer most. Cartilage which lines each bony surface in our joints becomes brittle, with decreasing collagen as we get older. With constant movement and weight passing through the joint, this cartilage can start to erode, taking away the joint's protective lining. In response to this, the bone cells in the immediate area begin to proliferate or multiply, causing uneven and rough joint surfaces and bone 'spurring'. This is very common in the knee, particularly the inside of the joint (see knee joint line pain). Treatment here again will focus on an exercise program for the hip and knee to strengthen the muscular support for the joint. If really bad and quality of life comes into question, a partial or total knee replacement can be done by your friendly orthopaedic surgeon. This is followed by lots of the same exercises for rehabilitation after (with your friendly physiotherapist)!
Patello-femoral tracking problems
The knee cap or patella floats about on the front of your knee joint and is a major cause of knee pain. It does so through falling into poor alignment due to muscular imbalance in those muscles attaching onto it. This usually happens insidiously, or gradually. Typically, muscles to the inside of the patella are weak and the ones to the outside too strong, pulling the knee cap off centre. This creates much pain, noise and sometimes swelling under and around the knee cap. There are other factors typically involved too, such as weak hip muscles and/or poor mechanics at the foot and ankle such as over-pronation (flat feet). Fixing all of these factors are necessary again here with a big emphasis on strengthening exercises to re-align the patella back to its happy place. Sports taping and braces can help early on to assist facilitation of the correct muscular activations.
Menisci are the disc like structures inside the knee that give this hard working joint more shock absorption. There are 2 in your knee – a medial and lateral meniscus. These types of injuries are typically thought of as a sportsman's injury with twisting and falling – football, soccer, skiing, basketball. However menisci can become torn gradually over time due to poor joint alignment or mechanics (see knee joint line pain). Pain felt with these injuries can be quite short, sharp and irritating, and often sporadic with absolutely no pain between episodes. The knee can sometimes 'lock' or feel stuck. Management of meniscal tears is usually key hole (arthroscopic) surgery to trim and vacuum out the flapping piece (much like a trimming a finger nail). Recovery is fast and outcomes good.
Under this heading fall the big ones, again often associated with the sportsmen and women, and of course, the ski season! Cruciate ligament tears, medial ligament tears. These are very dramatic, with instantaneous pain and swelling. They occur when the knee goes one way (with the foot usually fixed firmly on the ground) while the weight of your body goes the other. After consultation with your friendly physiotherapist or orthopaedic surgeon, and with consideration of your desire to return to sport, surgery is typically the only option. Some will forego the surgery to reconstruct the knee and also therefore forego the ability to return to sport. The knee may feel OK for walking, but would not like a sudden change of direction. This is due to the knee's instability with usually 2 of the 4 ligaments holding the joint gone. After a total knee reconstruction, there is a very long and difficult rehabilitation process for regaining movement, balance and muscular strength about the knee and hip.
As a masseur friend recently said to me, the knee is the poor child left in the middle of its parents' messy divorce. I couldn't agree more. By this she meant that the knee cops a lot of wear and tear and unfavourable biomechanical stresses from an unstable or weak hip/pelvic region above and poor foot mechanics below (such as over-pronation, stiff foot and ankle joints).
Pilates, core stability and hip stability exercise such as at The Fix Program can build the strength and stability at the knee to better support its structures. Manual therapy and a podiatrist visit for orthotics may also be treatment options alongside your exercises to optimise the mechanics of the knee.
Next month we will talk about the top 5 exercises for knees and knee pain.