Chronic or acute knee pain can be due to a variety of issues. Let’s look at some of the causes and symptoms as well as potential treatment. If you have pain that is progressing or failing to resolve it’s sensible to seek advice regarding the best way to treat the problem – whether that’s a physical or medical approach.
Causes of poor knee health
Knees are made of sturdy stuff which, by design, deals with the whole weight of the body in movement really well. The way the knee handles movement is very clever and when the knee is injured it can say more about the neighbouring structures, or even further afield: often the knee is literally stuck in the middle and taking the pressure from elsewhere.
Direct trauma, whether recent or in the past, can cause in ongoing problems, if injury doesn’t resolve well it can be the result of issues around neighbouring structures; the back, hip or foot-ankle can have a surprising impact on how the knee works. Dysfunction can also develop from a lack of functional movement; like all joints, knees work best if they are used to their full capacity in healthy weight-bearing movement using the full ranges. With all this in mind, helping to resolve knee pain is often a process unique to the individual. Addressing the specific symptomatic area is important, however, taking into consideration the body’s bigger picture can be essential, especially in more chronic issues.
Basic test to check for dysfunction in the knee
If you have pain doing any of the following, or if you struggle with balance, stiffness or your joint range does not allow you to do the movement, it’s potentially time to seek help to resolve the pain and/or improve your function.
- Off-weight bearing (i.e. sitting or lying down) can you fully bend and straighten your knee to its end of range?
- Can you do a shallow single-leg squat?
- Can you do a normal squat on 2 feet?
- Can you do a deep squat?
- Can you lunge?
These are simple movements that the body should be able to handle without issue, whether you are a teenager or older adult. Enabling confident ability in basic movement can have a powerful impact on the whole body’s biomechanics, including that of the knee. Achieving and maintaining body health can be the difference between staying active and pain free, and having an ongoing or even disabling problem that impacts day-to-day tasks.
Good joint function is driven by what you ask your body to do and the opportunities you provide for it – the answers to dysfunction can be simple and specific time-efficient tools you can do yourself, independently, with some initial direction.
How I can help with knee pain & dysfunction
For problems with joints, ligaments, muscles and tendons, in the knee or surrounding structures, osteopathy (including hands-on treatment and movement strategies) can be powerful in helping with pain and dysfunction, and understanding the initial cause(s).
The goal of treatment is to help to resolve symptoms such as pain as quickly as possible. It is also to provide you with a good understanding of the problem and why it developed, as well as physical and behavioural strategies to help avoid recurrence.
Your response to treatment is key and your progress will be at the forefront of the care you receive. Treatment involves:
- Whole body assessment in movement and at rest to get as much information as possible about what is contributing to the issue. This is done after taking a full medical history to make sure you are in the right place for the right kind of treatment, or establish if you need a referral for other specialist advice, tests or scans.
- I may use hands-on treatment in the area where you feel symptoms as well as further afield. Knees are often impacted by dysfunction as far away as the hip or upper back: the whole body is included in addressing the problem.
- Strategic movement behaviour and analysis is often key in helping to resolve musculo-skeletal problems causing knee pain, so that the whole body works to take pressure off the problem area.
- Understanding good whole-body function can make a huge difference to the choices you make about how you use your body, so education and understanding are often a significant part of treatment so that you can maintain good body health into the future.
Conditions of the knee
Osteoarthritis
This describes ‘wearing’ of joint surfaces, it’s a common condition that is variable from person to person, some people experience no symptoms or mild pain, and for others it can be more severe. Symptoms associated with arthritis often respond well to treatment. Advice and movement/behaviour modification can also be useful in preventing the condition from deteriorating. The goal of treatment is to avoid further joint destruction, help with pain and inflammation of the joint and surrounding tissues, and address identifiable underlying bio-mechanical factors, which may have contributed to the problem.
Tendinitis
This is inflammation of a tendon and is common in athletes although anyone can experience tendon problems. In the knee this often involves the patella tendon at the front. Treatment involves assessing why the tendon is experiencing excess pressure during walking, running, or whichever activity is causing symptoms. Commonly, there is a bio-mechanical compromise in either the way the knee is being used or the way it is dealing with pressure from other neighbouring structures, such as the hip, foot-ankle or even the back. The goal of treatment is to reduce the pressure on the tendon by changing how the joints in the whole movement chain adjust to physical force, to decrease pain and improve your physical function, so that movement and exercise are no longer problematic.
Bursitis
The bursa is a thin, lubricated cushioning structure that softens friction between bones and tendons/ligaments/surrounding soft tissues during movement. When there is excess pressure on a bursa it can become inflamed, resulting in bursitis. This can be very painful but often responds well to treatment that alters movement patterns to take pressure off the knee and it’s associated structures.
Chondromalacia Patella
The patella is your kneecap, this condition describes when the cartilage under the knee cap is damaged as it glides over the end of the thigh bone (femur). Runners and young athletes, especially adolescents during growth spurts, can be prone to this, although anyone can experience it. It can be due to state of the surrounding muscles and joint function and often the foot/ankle or hip function can be involved in the cause of the problem. The goal of treatment would be to investigate the biomechanics of the whole lower limb in relation to the pelvis and back and find out if the problem has occurred due to a compromised movement pattern.
Baker’s Cyst
Also known as a popliteal cyst. This is caused when excess joint fluid (synovial fluid that naturally occurs in joints for lubrication) is pushed into one of the small soft tissue sacks behind the knee, forming a lump. It can be the result of injury or different types of arthritis, and can cause tightening, swelling and/or pain at the back of the knee. A Baker’s Cyst can resolve itself, it can also burst causing pain – the body naturally gets rid of the fluid leaked. If it’s caused by injury, treating the injury can help to resolve it. If doesn’t go away and causes pain, your doctor can drain the cyst.
Rheumatoid Arthritis
This is an auto-immune condition that can affect multiple joints causing painful inflammation fatigue and flu-like symptoms. It can affect the knee but usually affects the small joints in the hands and feet first. Exercise and nutrition can help but it’s very important to see a Rheumatologist for specialist diagnostic blood tests and appropriate treatment/medication to avoid joint destruction or even organ damage – the earlier treatment starts the better the prognosis.
Meniscus Tear
Each knee has an inner and an outer meniscus. These cartilage pads between the thigh and lower leg bones provide effective rubbery padding. Menisci can be damaged, torn or ruptured due to impact injury especially involving twisting or turning. The wearing of the joint with age or dysfunctional joint mechanics can also predispose injury. A minor tear can cause pain and swelling that resolves within 2-3 weeks. A moderate or severe tear may affect how far you can bend your knee and cause sharp pain on twisting or squatting, and cause clicking or popping, locking, catching or a feeling of instability. Some people experience very little pain. If symptoms don’t respond to conservative hands-on or movement therapy, MRI scans or x-rays may be necessary to investigate whether surgery is required.
Torn Ligament
The cruciate and collateral ligaments make up the 4 major knee ligaments of the knee. These, especially the ACL (anterior cruciate ligament), are infamously torn or ruptured during sporting injuries while skiing, playing football etc. where there is a twisting motion under force. Like meniscus injuries, this can cause pain, stiffness, swelling and instability, and may require surgery depending on the level of damage and how that affects your needs.
Osteosarcoma
A rare kind of bone cancer, which can occur at any age but usually affects teenagers and young adults. The most common sites are arms or legs – particularly the knee joint. Initial signs can be bone pain at night and swelling. This is a rare condition and many other factors can cause knee pain; seek advice if you are concerned. This type of condition cannot be addressed with conservative treatment so it’s important to receive the right investigations. If you have symptoms similar to what is described above, see your GP.
