Knee Pain: A Complex Problem to Solve

It is not uncommon for a client to turn up at my door and state they have been told by friends, colleagues, team mates and sometimes other therapists that they have ‘Runners Knee’ and don’t know what to do about it.  ‘Jumpers Knee’, ‘ITB Syndrome’ and many other complaints present but all have one thing in common – a knee that is in pain!  Personally I think these name’s are misleading, non specific and not very useful in terms of identifying for the client what exactly the problem is and more importantly what the client needs to do to heal. 

‘Runners Knee’ is a generic name given to anterior knee pain, generally behind the knee cap but also in the areas surrounding the patella (knee cap).  It is often used to describe conditions such as Chondromalacia Patellae (wear of the cartilage behind the patella) and Patellofemoral Pain Syndrome.  ‘Jumpers Knee’ is generally used to described Patella Tendonitis, or inferior knee pain where the tendon between the patella and the Tibia has become inflamed. 

Don’t be fooled by the names, these conditions do not just affect runner and jumpers, but anyone who runs or jumps e.g. tennis players, squash players, basketball players, volleyball players and the list goes on.  The frustration for a lot of people is that although the condition the muscles around the knee, the pain can return time after time.

So how do we treat the pain if we do not know what is causing the overload.  Is it a clear case of overuse or is there a biomechanical or gait issue at play which means that the forces being put through the body are out of alignment putting too much pressure on the soft tissues affecting the knee joint and causing the pain?   Rest is of course part of the treatment, but generally people who rest alone find that when the pain subsides and they return to their sport or activity that the pain returns also.  One new client last week told me she was giving up running (she runs the marathon every year!) because she has had ‘runners knee’ since March and she feels it is something she will just have to live with as after 4 months of rest it is still niggling.  What a tragedy!  Before giving up, try to understand your specific problem and ensure that your rehabilitation plan is addressing all the soft tissues involved.
To help you understand the complexity of knee pain I have outlined some examples of where problems/restrictions in other parts of the body can lead to knee pain:
                        Ankle Mobility & Stability
o   If we take the actions of squatting, walking and running, all involve at some point the actions of dorsi-flexion of the ankle, followed by a flexion at the knee and flexion at the hip.  Now imagine you have tight calves and struggle to dorsi flex the ankle, how would your body compensate as you still need to be able to perform these actions?  One example of how this can impact your knees which I see quite frequently is that your knees will not only flex but they will track outwards allowing your body too move downwards even through your ankles do not want to allow this.  What this results in are forces being exerted through the knees and hips in a dysfunctional manner.  This in turn can lead to forces being exerted to a greater extent through the outer hip and knee muscles, patella tracking laterally and burning pain on the outside of the knee. 
Hip Mobility & Stability
o   I like to the think of the Hips as the main junction to movement in the body, whether movement is up the chain or down, if there is dysfunction at the hips the forces involved will not be distributed correctly through the body which can lead to problems.  In the case of the knee if there is a lack of stability from one side of the hip to the other, more force can be placed through one leg leading to overuse of one knee.  Now add running to this pattern and with every step you take you are adding greater load through a dysfunctional body building up more and more pressure onto the knees.  Lack of mobility in the hip can be equally destructive to the knees.  I see many clients with an anteriorly tilted pelvis who struggle to extend the hip and have weakened Glutes.  This constant overuse of the hip flexors and quads creates a constant stream of tension on the knee.  Sometimes this does not cause a problem but in clients who are very active this tension builds and builds until they start to feel pain in their knees or in the tendons surrounding the knee.  We can rehab the knee but if we do not correct the problems at the hip it will only even be a temporary solution.
And the list goes on……..
As you can see, there could me many reasons why you are experiencing knee pain and it may be that you are simply not targeting the whole problem when you are trying to heal your knee.  Consider getting assessed by a Sports Therapist, Physiotherapist or Soft Tissue Therapist to get some advice and treatment to help you heal as quickly as possible.


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