SHIFNAL CHIROPRACTIC CLINIC

Shifnal Chiropractic Clinic

01952 460 947

Knee Pain

The knee appears to be a fairly simple joint, but there are a lot of things that can go wrong with it!  Here, we aim to discuss how the cartilage, menisci, ligaments, muscles and joints can all have an impact on the overall function of the joint and how helpful Chiropractic can be in resolving problems with these structures.

At first glance, the knee is a wonderfully straight-forward joint.  It does nothing more than hinge your leg in the middle, so that you can walk normally, right? Unfortunately, no.  The knee is also one of the primary shock absorbers in your leg (along with the foot) and it is also part of the system which allows your ankle to move about as freely as it does.  Also, the actual bony structure of the knee provides very little support against other movements such as twisting, so it is forced to rely on the ligaments and muscles that surround it for stability.

Let’s start with the bones.  There are 4 bones which form the overall knee complex – your femur (thighbone), patella (knee cap), tibia and fibula (the two bones of the lower leg).  The main knee joint is between the tibia and femur, and is relatively flat.  The patella then sits in a tendon over this joint, and the fibula articulates with the tibia.  Pain in this area relating to these joints is usually from either the joint between the fibula and the tibia, where a lack of movement can cause pain and inflammation, or between the patella and the rest of the knee joint.  This can either be because the patella is not sitting correctly in its groove, or because the muscle tendon which it sits in has become so tight that it is causing the patella to be rammed too hard into the groove.

Moving on to the soft tissue then, there are a lot of muscles associated with the joint.  I will only try to cover a few of the more relevant ones here, otherwise I think we’ll all be fast asleep and/or totally lost in meaningless Latin names!  The main muscle down the front of your leg is the quadriceps, and the tendon which attaches this muscle to the bone actually crosses right over the knee joint and attaches onto the tibia just below your knee.  It’s in this tendon that the patella bone or knee cap sits.  The most common problem with this muscle that causes knee pain is either a strain or over-tightness causing the patella to be misaligned.  A strain of the hamstrings, a group of muscles down the back of your leg, can also cause pain in the knee.  But my number one finding with muscle-related knee pain is at a point called the pes anserine.  This is a single point just below your knee, on the front and towards the middle side, into which a whole bunch of muscles go.  So you have lots of powerful muscles, performing lots of necessary functions around an inherently unstable joint, all coming into one tiny little area.  Perhaps you can see why it is so often involved in muscular problems of the knee?!

In addition to the many muscles around the joint, there are lots of ligaments both at the front, the back, on both sides and even right in the middle of the joint.  These are commonly injured during sports – at some point or other, I’m sure we’ve all heard of a footballer for example who has “done” their cruciate ligament?  Well, that’s one of the ones in the middle of the joint.  Generally, ligaments are injured in the knee during collisions in sports, or when the person tries to twist on the knee with the foot planted on the ground, such as when trying to make a rapid change in direction while running.  Sometimes the damage can come from a build up of many small traumas, resulting in an overuse injury.  Generally, the pain is caused by inflammation around either many microtears, a full tear or total rupture of the ligaments.  Careful management is then needed to help the knee heal and recover its full function; otherwise it will be extremely prone to developing the same injury repeatedly because there is a weak spot at the original injury site.

Finally, there are two structures within the knee called the menisci.  These are thick, rubbery pads within the knee joint, in addition to the usual thin layer of joint cartilage, which act as shock absorbers.  This is usually the “cartilage” referred to when there has been damage in the knee joint, as it can be torn when there is a rotational force through the knee – for example a tennis player who twists to reach an awkward shot.  Once torn, it is very difficult to get these structures to heal again, as they have an extremely poor blood supply.  It is therefore often necessary to resort to surgery to repair the damage.  Once this has been done, careful rehabilitation of the knee joint is needed to make sure the structures around the knee are not going to suffer from the altered mechanics once the injury has been repaired.

Apart from malfunctions in these structures, either through overuse or specific injury, another extremely common problem with the knee is osteoarthritis.  Being one of the main shock absorbing structures for the leg means that every time you take a step, the knee is absorbing the stress from that impact.  If you then start taking into account activities such as running, that impact becomes much higher.  And if you think you’re ok because you don’t do much walking or running – let’s say you drive a lorry for a living and spend all your time on the road – then think again, because every time you use the clutch or accelerator pedal, that tiny movement through your knee adds to the overall wear and tear of the joint.  But it’s not the end of the world!  Most of the time, our knees last us pretty well throughout our life, and even if they do start to cause a problem then there are things we can do to manage it.  As with any osteoarthritic complaint, Chiropractic would aim to work with your core oasteoarthritis treatment from your GP to open out the space in the joint as much as possible to give it as much chance to move as it can get, as well as working with the muscles around the area to reduce any tension that is adding to your overall discomfort.

Treatment of knee complaints is often fairly focussed on strength and stability of the joint.  This means that once the initial recovery stage is well under way, your Chiropractor will start asking you to do various stretches to maintain good muscle length, strengthening exercises to give you the support you need around the joint and control exercises to make sure you are able to use the knee joint in the best way possible.  The combination of these techniques with adjustments to maximise the joints ability to move and soft tissue work to help with the muscle tension will give your knee the best chance of recovering from the initial injury and, perhaps more importantly, preventing further injury in the future.

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5 Dyas Close, Shifnal
TF11 9BQ

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