WONDERING WHAT'S CAUSING YOUR KNEE PAIN
AND HOW YOU CAN FIX IT?
The knee joint is one of the more common areas of pain and dysfunction. Particularly in the running population.
It is estimated that close to 25% of the population will experience a limitation to mobility and function of their knee over their lifetime and those rates increase dramatically for those who are active, over the age of 65yrs or female.
One of the main contributing factors to this is the loads undertaken at the knee when active. During walking it is estimated that this is 2-3 times your body weight and running it ranges between 5-8 times.
So what actually allows it to do this?
Let’s have a quick look at the anatomy of the knee.
The knee joint is formed through the joining of the tibia, patella and femur contains two major joints.
The Patellofemoral joint (joining of the small bone at the front of the knee and the thigh bone) and the Tibiofemoral joint (joining of the shin and thigh bones).
Supporting these joints are four major ligaments, four bursae, three hamstring tendons, two meniscus and the quadriceps and patella tendons; all aimed at helping to allow movement and absorb load.
The main mechanisms of the knee are flexion and extension, with the capacity to withstand a small degree medial and lateral rotation.
Now these movements may seem insignificant, however are crucial for a majority of our recreational activities such as running, lunging, jumping, squatting & sitting.
So why does my knee get sore?
Common causes of knee pain can typically be classed into two main categories. Acute (short term, rapid onset) presentations and chronic (overuse, progressive) injury.
Acute
These present from a more highly loading mechanism such as high speed change of direction or landing, or can be associated with rapid growth and traction during boney development.
These include Injury to:
ACL, PCL, MCL, LCL (Ligaments of the knee)
Meniscus
Growth plate below tibial tuberosity (Osgoods Schlatters)
Chronic
Here the trend is more related to repetitive overload, degeneration and compensation of the structures of the knee.
These include:
Patellofemoral joint pain
Osteoarthritis (OA)
Iliotibial band syndrome (ITBS)
Bursitis
Baker’s cyst
Hoffa’s fat pad syndrome
So, what causes the knee pain?
Some of the major risk factors for knee pain include:
Deconditioning of stabilising musculature
More specifically of the quadriceps, hamstring, calves and glutes. In a high majority of presentations this is a major consideration as weakness is often associated with:
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Overstride
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Increased vertical oscillation
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Poor control of hip adduction & knee valgus
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Contralateral pelvic drop
Which are all risk factors for knee pain in themselves!
Other prominent risk factors include:
Increased Weight
Age (25% of those over 65 report symptoms of Osteoarthritis)
Sex (Female’s unfortunately are at greater risk with 1 in 5 females experiencing patelofemroal pain)
Spike in loading/ training errors
Direct impact
How can a podiatrist resolve knee pain?
Assess & modify
This is not about stopping you doing what you love. Moreso around stepping back, taking a deep breath and evaluating what has led to the point of your knee becoming sore. Here, we can make minor adjustments such as reducing intensity through sessions short term, tweaking your running schedule or diagnosing dysfunctional movement patterns that are contributing to pain.
Strength & conditioning
This involves addressing the underlying deficits in conditioning of the major structures surrounding the knee. Most commonly this can involve the quadriceps, hamstrings, calves, glutes and adductors/abductors. We use specific movement assessments and screening to evaluate which areas are deconditioned and contributing to increased work at the knee then put in place a graduated and progressive rehabilitation program to address them.
Orthotics
Here we can help address significant contributing biomechanical factors that are contributing to increased loading or compression at the knee. Particularly if symptoms are consistent, prolonged or impacting your ability to undertake activity. We use orthotics to create a more structured and comfortable environment to facilitate rehabilitation and activity and there is strong evidence for the use of orthotics as an effective treatment for sufferers of patello-femoral pain.
Footwear
Specific characteristics of shoes can help reduce but also contribute to knee loads. Therefore we can often pick specific traits that will help to decrease symptoms. For example, lower pitch & stack height (thinner, flatter) footwear has been shown to remove loads from the front of the knee and increase the demands on the calf complex.
Plan return to activity
Once we have got symptoms to settle and you are within your specific strength markers we can then begin the fun stuff. Getting you back doing more of the things that previously caused issues. We do this through creating a plan forward towards your goals while implementing the strategies above to keep you out there!
If you are managing ongoing knee pain or needing some specific information tailored to you and your situation, please feel free to book an appointment with on of our rehab professionals via the "BOOK ONLINE" button below or give us a call on 0403669817