Knee pain

Knee injuries are incredibly common. For some it can be a short lived tweak and for the unfortunate; a life long struggle. With so many types and sources of knee pain let's start with the basics of anatomy to help you better understand knee pain.

Your knee joint is formed between the end of your femur (thigh bone) and your tibia and fibula (shin bones). Those bone meet and are covered by thick and strong cartilage. The last bone in this equation is your patella (knee cap) which sits over top of the joint. With so much force and torque passing through your knee it's stabilized by some of the most well known ligaments in your body. Your ACL (anterior cruciate ligament) gives front to back and rotation stability, your PCL (posterior cruciate ligament) give back to front stability, your MCL and LCL (medial and lateral collateral ligaments) give side to side stability. Unlike other joints your knees gets some extra cushioning and stability from two C shaped cushions called mensisci. The main movements of your knee are bending which is powered by your hamstrings and straightening which is powered by your quadriceps.

 

Acute knee injuries

To affect the major stabilizers of the knee it takes a significant amount of force. These are pretty solid structures. A hard blow to the inside or outside of the knee while standing can severely stress the lateral and medial collateral ligaments. An intense over-straightening of the leg from a hard straight leg landing or a leg taggle into straight legs can damage the posterior cruciate ligament. The main stabilizer of your knee, your ACL is most commonly injured your knee is forced to bend and twist towards your midline. Menisci are most susceptible to twisting injuries.

As these injuries affect the major stabilizers of your knee on of the main symptoms beyond severe pain is a feeling of instability. Many patients will describe a feeling that their knee will give out. With the severity of these injuries sufferers also experience significant bruising, swelling and stiffening of their knee and greatly reduces their normal range of motion. Menisci don't provide the same level of stability as ligaments and when their acutely injured they often give a catching feeling rather than a give-way feeling.

Overuse knee injuries

Unlike acute injuries overuse injuries don't always have the same clear-cut cause and effect explanation. These injuries develop over days, weeks or even months. These injuries will rarely cause tearing of ligaments or any significant disruption of your menisci. Most patients can reflect on a change in their activities, footwear, etc in the last month a find a change that likely caused the issue. 'I just started running', 'I installed laminate floor', 'I helped my friend move', 'I bought some new shoes', etc. are sentences your chiropractor commonly hears as a possible cause of knee pain. There may also be difuse pain felt further up the thigh or down the shin.

Beyond simple overuse muscle strains the majority of overuse knee pain relate back to poor knee alignment and posture. Typically there is an imbalance in the strength or flexibility in muscles or tissues surrounding your knee that had left your knee very susceptible to injury if you introduced some new stresses on your knee like a new activity or new footwear. Knee pain sufferers in this category often describe pain under or around their knee cap, stiffness, difficulty with stairs or getting up from sitting for some time.

Knee arthritis

After 60 years of age the majority of knee pain results from arthritic changes in the knee and typically affects over 20% of the population. Simplified this means the cartilage of the knee has begun to break down and has lost some of it's cushioning and lubricating qualities. Because of the construction of our knee joint the inside half of our knee is most commonly affected by arthritis. Injuries earlier in life often predispose us to knee arthritis as well. Those suffering with arthritis in the knee can expect generalized knee pain with most activities and can expect swelling and increased pain or stiffness with wet weather.

Looking at this knee x-ray you can see a complete loss of space (circled in red) between the femur above and tibia below.

Who can chiropractors help with knee pain?

Chiropractors know joints and they know alignment. Injured knee joints need to regain their normal joint motion and imbalances need to be corrected to allow your knees to maintain proper alignment. Your chiropractor is well trained in diagnosing acute, overuse and arthritic knee pain. If needed in serious cases they can also directly refer you to get x-rays or special imaging of your knee or knees. Beyond just treating your knee pain at the site your chiropractor understands the affect your entire leg and pelvis can have on your knee since flat feet and weak hips and core can increase the likelihood of knee pain as well.

What can I do right now?

If you've reading this because you have a knee injury there are certainly steps you can take to help manage your knee pain. Start with a simple protocol called 'PRICE'. Start with P for Protection, avoid or limit things you know irritate your knee. R is for Rest since your body needs time to heal. I is for Ice, nature's anti-inflamatory and pain killer. C means Compress, lightly wrapping your knee from shin to thigh will help reduce swelling and give your more feedback on your knees posture. Finally E is for elevate. While you're resting keep your knee elevated and supported.

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