Apart from spinal conditions, knee pain is one of the most common ailments of the musculoskeletal system. There is a large range of problems that can affect the knee, as the knee joint is one of the most-used joints in the body with our walking, running, sitting and bending.
The most common complaints relate to ‘wear and tear’ or osteoarthritis and although a condition such as osteoarthritis is not curable, the symptoms can be reduced and the progression of the problem can be slowed down and helped thanks to our unique approach to treatment.
The knee is a complex joint that relies heavily on ligaments and muscles for stability.
The knee is a major weight bearing joint and is composed of:
- The tibio-femoral joint (between the thigh and lower leg)
- The patello-femoral joint (between the knee cap and the thigh),
- Muscles and ligaments, which gives active and passive stability to the knee.
- Two ring shaped cartilage discs in the knee, called the menisci (one meniscus).
1. Patello-Femoral Syndrome (Lateral Patella Tracking)
Patello-Femoral syndrome usually involves knee pain that is felt under the knee cap or around the knee. It is described as aching or stiffness in the knee and is aggravated with going up or down stairs, sitting for prolonged periods, and crouching down. The condition refers to misalignment or maltracking of the knee cap (patella) on the femur and can be caused by tight muscles on the outer portion of the knee, weak muscles on the inner portion of the knee, or poor biomechanical factors either higher or lower along the mechanical chain (i.e. foot, hip dysfunction).
2. Iliotibial band syndrome (ITB)
The iliotibial band (ITB) is a section of thickened fascia that runs along from the hip down to the outside of the knee. ITB Syndrome may be due to repetitive bending/flexion-extension of the knee. It may also be a product of muscular imbalance. In either case the area on the outside of the knee may undergo inflammation or irritation from the band rubbing along the femoral condyle (knobby outcropping of bone). Symptoms of ITB Syndrome include pain localized to the lateral aspect of the knee or it can travel up towards the outside of the hip. Although it is commonly associated with running and cycling athletes it is also present in the general population.
3. Jumper’s Knee (Patellar Tendinopathy)
Jumper’s knee or Patellar Tendinopathy is often seen as an overuse injury from repetitive loading of the extensor muscles (quadriceps) in the knee. It is common in sports that involve jumping and quick movements such as volleyball, basketball or soccer. Symptoms include a dull ache in the front of the knee often accompanied by stiffness and swelling.
4. Knee Osteoarthritis
Osteoarthritis (OA) is the most common form of knee arthritis. OA is usually a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people. The joint may become stiff and swollen, making it difficult to bend or straighten the knee.
Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing, or kneeling.
The pain may often cause a feeling of weakness in the knee, resulting in a “locking” or “buckling.”
Many people report that changes in the weather also affect the degree of pain from arthritis.
5. Bakers Cyst/Popliteal Cyst
Bakers Cyst is a swelling on the back of the knee caused by the build-up of fluid inside sacs called bursae between the two heads of the gastrocnemius (calf muscle). The patients may have swelling, redness and tenderness behind the knee or no symptoms at all depending on the severity. Common causes of Baker’s cyst include arthritis, infection, torn knee cartilage and other knee injuries.
Quite often when we examine the knee and view the imaging such as X-rays and MRI the knee may appear to have significant findings such as tears in cartilage and degeneration. The funny thing is the findings may not match the severity of the pain and swelling. It appears that if a knee has strong muscles, elasticity in the ligaments and tendons and knee cap that articulates really with the front of femur then there may be very little symptoms considering the severity of the findings.
Specific knee-based mobilisation techniques are applied to areas of restricted movement in the knee and surrounding joints, to increase movement, improve the function and reduce pain. The biggest emphasis is restoring the mechanics of the patella-femoral joint to reduce lateral patella tracking issues. We also apply deep soft tissue massage and active release method within the patient’s tolerance. We also check the hip, spine, pelvis and ankle for any contributing or compensatory changes and correct those if they are found.
When appropriate we introduce exercises to improve strength, endurance and stability. We also work on improving your balance and your sense of joint position (proprioception). This will help in preventing further injuries.