Besides spinal conditions, knee pain and disability is one of the most common ailments of the musculoskeletal system. Problems with the knee can be classified into three categories: 1) poor mechanics or overuse of the knee joint, 2) traumatic injury from events such as sports and falls, and 3) problems due to arthritic changes in the joint. 4) faulty foot mechanics due to foot pain.
Patella Femoral Syndrome ( Knee Cap Pain )
Poor mechanics of the knee joint and the associated stress upon the soft tissues of the knee is by far the most common cause of non-traumatic pain. The most common part of the knee affected by this is the patella or knee-cap. Often the patella does not move smoothly or does not move sufficiently on the femur during bending of the knee causing abnormal stresses upon the tendons cartilage and ligaments. This condition is often called chondromalacia patella or CMP though a better term is patella femoral syndrome. The problem usually originates when there are imbalances in the quadriceps muscles of the thigh which attach to and move the patella.
The associated pain is experienced during activity, especially stair climbing, running, jumping and after getting up from prolonged sitting. Women are more predisposed to this problem for anatomical reasons and also the use of high heels.
Repetitive Knee Strain – Overuse Injury
Imbalances in other muscle groups that attach to the knee can also lead to pain and dysfunction. As an example, the muscles on the inside of the thigh when strained and tight can cause pain on the medial or inside side of the knee.
Lower back problems especially in the sacroiliac joints, are one of the main reasons for imbalances in the muscles associated with knee movement and subsequent knee problems. Foot problems that cause gait abnormalities such as pronation, are another cause of mechanical knee pain.
The main treatment for mechanical or overuse injuries to the knee is to re-establish proper balance of the muscles, restore proper movement to the patella and other joints of the knee, and correct any subluxations of the sacroiliac joints and foot problems. In certain cases, a brace is used to help with the alignment of the patella or to stabilise the joint. Chiropractors are ideally trained to provide the proper diagnosis and management of these problems.
Traumatic injuries often occur during sports that involve running and jumping, such as football and basketball, and with activities such as skiing. When the knee is stretched or twisted beyond the strength of the ligaments that hold the joint together, tearing of these tissues can occur causing a sprain. The muscles that move the knee can also be torn during injury causing a strain or pull of the muscle. As with a sprain, a muscle strain can vary from a minor injury that requires little care to a severe injury requiring surgery. The knee also contains two special “cartilages” – the menisci – between the tibia and the femur that provide for smooth movement and cushioning. These cartilages can also be torn during trauma and often require surgical repair or removal if damaged severely. Traumatic knee injuries can cause severe pain and swelling and require immediate evaluation and attention. In most cases a qualified chiropractor can manage these conditions, though there are some injuries that do need the expertise of an orthopaedic surgeon. In any case, it is important to stabilise the injured joint and ice if possible until you can get the injury evaluated. Please see the section on sports injuries for additional information regarding this topic.
If poor mechanics or traumatic injuries are not corrected at an early age, the tissues of the knee joint especially the cartilage will eventually begin to wear out. As a result the bones rub upon one another and changes such as bone spurs can occur. This painful condition is known as degenerative joint disease or osteoarthritis and is often progressive with age. Common treatment often involves medications such as NSAIDS (non-steroidal anti-inflammatory drugs) though conservative treatment such as chiropractic can be helpful in alleviating some of the pain. There is some evidence that nutritional substances such as Glucosamine and Chondroitin can be helpful in the long term management. People can often help themselves by keeping their weight down, doing exercises especially in the pool, and wearing cushioned shoes or insoles