Anyone remotely athletic usually has some degree of knee pain…why? Well, putting aside traumatic injuries, there are a couple of reasons the knee is so susceptible to general non-traumatic or over-use pathologies.
- The knee is a the largest moving joint (surface area) in the body and
- It is located between the two longest levers in the body (femur and tibia)…the combination creates a great deal of potential torque through the knee-joint and caught in the middle of it is the knee cap (patella).
- The knee is really well designed to move forward and backward, but rotation and sideward motions create a real issue for your knee due to the leverage and torque noted above.
Now you are probably thinking…”That makes sense for basketball players who are pivoting and changing direction all the time…but I just walk for exercise…or jog…I’m just moving straight ahead…why do I have knee pain if the knee is designed to move straight ahead?”
The answer is all about biomechanics…my field of expertise. Even though you are moving forward there are subtle sideward and rotational movements that occur in your knee…this puts a lot of stress on the structures designed to control, decelerate and limit those motions (plica, pes anserine, IT band, the patellar tendon and the entire patella femoral joint).
You’ve probably heard the term pronation; well pronation doesn’t stop at your feet. Pronation in the foot is translated into rotation of the tibia and to make matters worse the femur starts rotating the opposite direction during the stance phase of gait. Now picture all those structures I listed above being pulled in both directions and you can understand why your knee hurts when all you do is walk for exercise.
Common Treatment of Knee pain:
Self-treatment: anti-inflammatory medications, ice, rest, knee sleeves, sports creams…these will all help your knee “feel” better…but will not treat the cause of your knee pain… so often times your symptoms will recur. There are a couple of things you can do to address the cause of your knee pain all yourself!! First of all, improve your walking/running surface. The more flat and level the less of those pesky accessory motions affecting your knee. Secondly, better shoes. Some biomechanical issues can be addressed with shoes alone; not a specific brand but a general type of shoe. How can you know what kind of shoe you should wear? You should receive a biomechanical evaluation…and I do that for only $20!!
Physician treatments: stronger anti-inflammatory medications, injections, more expensive braces and hopefully a physical therapy consult.
Physical therapy treatments: Modalities (ultrasound, ice, heat, LASER, electric stimulation), exercises and manual therapy (massage, myofascial release, trigger point needling, etc). You already know the modalities by themselves won’t do much better than what you could do for yourself. Please don’t ask me why every physical therapy student is taught to treat knee pain with exercises…mainly quadriceps strengthening and hamstring stretching…both those muscle groups work largely in the forward plane of movement. The knee ALREADY moves really well in that plane. The bottom line is that the body doesn’t have very many muscles that are even well designed to control lower extremity movement in sideward or rotational plane of motion and believe it or not, you probably don’t need any more strengthening of those muscles…you know why? Because they are really strong already!!! You know why? Because your biomechanics make them work extra ALL THE TIME (every single step). Because they work more than they should…and probably have for years…the muscle itself may be short circuited a bit and have fibrotic knots and ropes running throughout it. If that’s the case…those muscles would benefit from manual therapy (myofascial release) and combined with modalities and exercise you can have your dynamic pronation stabilizing muscles firing on all cylinders before you know it!! Once you combine that with a better walking surface and shoe…you may actually have resolved your knee pain!!
However, often times a shoe is not a great enough correction…or maybe you don’t want to spend the rest of your life confined to walking and running on a treadmill. In either case, please contact me…read my testimonials!! For only $20 I will do a biomechanical assessment on you and let you know if your mechanics can be improved with shoes alone…and what type of shoes you should wear. I’ll also let you know if I feel a custom orthotic would help your mechanics (please read why my orthotics are unique)…and the average cost of the custom orthotics I hand make is typically only another $80!!!
LTC Tony Bare (ret), DPT, ATC, OCS
Colorado Springs, CO