What is knee pain?
Knee pain is either caused by disease or injury. The resultant pain can restrict range of motion and can quickly degrade strength in the knee and leg by non-use. The most common disease to affect the knee is osteoarthritis – which is a wearing down of cartilage in the knee. Osteoarthritis commonly results in pain and swelling in the joint.
Knee injuries can occur by way of direct or sudden forces at the knee that strains the knee past its usual range of motion; like in an accident, during sports or in a fall. These accidents often cause tears in the knee cartilage or ligaments that support the knee.
There are numerous diagnoses that explain for knee pain, e.g. patella tendonitis, chondromalacia patellae, IT Band syndrome, meniscus tear, ligamentous tears/laxity. Although differing in severity and presentation, they all result in one common thing: faulty biomechanics from weakened hip and quad muscles. All these pain sources can be helped with good knee therapy.
How does faulty biomechanics contribute to knee disease and pain?
Non-traumatic knee pain tends to progress over time, and usually does not prompt the patient to seek immediate medical care for it. As a result of the pain, the body and brain shuts down usage of that limb and starts favoring the other stronger, healthier leg. The quads, glutes and peritibial muscles of the painful leg injury start to atrophy and surely enough, you start to see the biomechanical pattern above. A person with good mechanics and strength would look very neutral – there would be a direct vector line from foot contact on the ground through the hip join. A person with poor mechanics and poor hip and quad strength would demonstrate what us PT’s call “knee valgus” – the tendency for the knee to collapse inward because of weak hip abductor muscles, weak quads and excessive foot pronation. Faulty mechanics like these during daily activities will cause the knee pain to get worse regardless of its diagnosis. Knee pain begets more favoring of the leg … which begets more knee pain … and the cycle continues.
The same could also be said for “bow-legged” postures – where the knees seem to cave outward. Folks that present like this tend to have a larger probability of having meniscus thinning or tearing, and also higher probabilities of hip joint degeneration because of excessive forces translating up into it.
Those who are all too familiar with this may have tried the following interventions: rest; knee brace/strap; ice; IT Band foam rolling. Though this might help a bit in the short-term, the knee pain would most likely continue because you’re not stopping the cycle.
How is Knee Pain Diagnosed?
Your physical therapist will determine the anatomical source for your knee pain and formulate a theory of how the damage occurred. At times you may have already seen a physician and had gotten imaging done such as an X-Ray and an MRI, but imaging is not an absolute need for your PT to evaluate you.
The following information would be useful in helping your PT determine what is wrong with your knee:
- Location of your knee pain
- Whether you twisted your knee recently
- Whether you heard or felt a tearing sensation in the knee
- If you have felt symptoms like locking or catching of the knee joint during movement
- Any difficulty or inability in walking up and down stairs
- Any difficulty with keeping the knee bent for prolonged periods of time, like in sitting
- Pain with sudden movements, bending or straightening
Your physical therapist will perform tests to assess the severity of your knee condition. This may involve measuring range of motion and strength testing, but also should include some provocative manual tests that elicit your pain. This way, your therapist is able to determine the exact anatomical structure that is damaged and may be able to tell whether you would need to be referred out to an orthopedic surgeon.
Another crucial part of the evaluation is watch your movement in doing daily activities. This may include a gait/walk or run analysis. We may also want to watch how your perform a squat or a hop to see where in the movement chain are you dysfunctional in.
So How Can PT Help?
The following is a better recipe for getting rid of the pain: supportive shoes or sometimes even orthotics (over-the-counter or prescribed by a podiatrist), quadriceps strengthening, gluteus medius and maximus strengthening, peritibial muscle strengthening, biomechanics retraining, manual knee therapy on the IT Band.
For severe cases if osteoarthritis, sometimes hylouronic acid injections, also known as synvisc, may help lubricate and cushion the knee joint. It is recommended that the patient goes through adjunct physical therapy along with injections, so they can benefit from biomechanics counseling. Yes, some knee injuries are severe enough that they eventually do need surgical intervention. Even othertimes the pain is a result of something serious like a total knee replacement. But oftentimes moderately severe knee pain can be helped by biomechanics retraining and strength training by a good physical therapist.
Can Knee Pain be prevented?
Here are some common treatments and suggestions we perform at the clinic to help our Stride Strong patients with their knee pain:
1) Strengthen your butt muscles
ACL (anterior cruciate ligament) tears typically happen during sports when gluteal muscles are weak. Weakness is usually worsened by inactivity and sedentary lifestyles, which is common in our society. Gluteal muscles provide stability so the knee joint doesn’t get strained during motion.
2) Stretch the muscles around your knee
Hamstrings and inner thigh muscles, called the hip adductors, tend to overcompensate for weak gluteal muscles. Over time, these muscles can get tight. Typically, hip flexors and quad muscles can also get tight through guarding from knee pain. Stretching these muscles will free up the knee cap better for ease of movement.
3) Strengthen your core muscles
Much the same as strengthening your gluteal muscles, strengthening your core will also help prevent knee pain because it also provides a stable base for your knee to move from. Strengthening your trunk and core muscles can also affect the posture and movement of the knees. You can experiment this on yourself right now: Arch your back and see how your knees and thighs roll inward. Flatten your low back and watch how your knees turn outward. Strengthening the core will instead keep your back at a neutral spine posture to help minimize knee aberrant motion and helps with maintaining best positions for the thighs and knees.
4) Maintain a healthy weight
Sedentary behaviors and being overweight increases likelihood of osteoarthritis by up to 5 times. Research shows that reducing your weight by 11lb can result in 50% decrease risk for knee arthritis. Excess body weight adds strain and pressure to knee joints. Change that fat into muscle today!
5) Change your footwear
Wearing high-heeled shoes increase knee joint compressive forces by 23%. Wearing high-heels also positions your knee and foot in valgus position and places your foot into a pronated position. One wrong move while wearing heels, and you’ve got a recipe for knee pain. Instead, wear lower-heeled shoes and remember to change up workout shoewear every 400-500 miles. This way, you’ll give your knees continued support and cushion, in a much better posture.
Contact one of our clinics in Beaverton or Hillsboro for knee therapy today!
By Alice Holland, DPT.
Alice’s Google + page.
Doctor of Physical Therapy, Director at Stride Strong Physical Therapy