The knee joint, the largest joint in the body, is one of the most frequently injured joints because it is the middle of a series of long and powerful levers (the leg), with big muscles and it undergoes large movements and heavy loads.
Common Knee Pain Causes
Knee pain and knee pain symptoms are often related to the age of the person presenting with them. Certain diagnoses are seen at particular times in a person’s life as their activity and their body tissues change, leading to different types of knee joint pain.
Older Children/Young Adolescents
During this phase of their life, young people are becoming more and more active and their size and power are increasing. This places increased stresses on their joints, particularly in parts of the skeleton where the bone growth plates are.
- Osgood-Schlatter Disease: The main strong knee muscles, the quadriceps, pull on the tendon at the front of the knee just below the kneecap. This tendon inserts into the bone at the bony lump on the shin bone just below the knee joint at the front. This is called the tibial tuberosity, and too much pulling on that can cause inflammation of the growth plate and so knee joint pain. This knee pain diagnosis is most common in sporty adolescents and can significantly impede their activity. Reduction in activity is one of the core approaches to Osgood Schlatter.
- Anterior Knee Pain: Anterior knee pain is pain at the front of the knee, often attributed to kneecap problems although the cause in most cases is not clear. It is a “diagnosis of exclusion”, in other words all the potentially more serious diagnoses need to be ruled out first. Muscle weakness, tight joints, abnormal leg alignment, overuse and abnormal movement patterns may all contribute to this problem.
Osteopaths are particularly well suited to assessing and treating young people with these kinds of problems as they include the whole person in their assessment. Reviewing the patient’s personal and psychosocial aspects is crucial in getting them onside for taking the steps they need to take so they can get better.
Young Adults to Middle Age
In this part of life many people are working but many also participate in energetic activities and sports. Because of the forces involved we see a different set of problems on average.
- Ligament injuries. Football in particular can cause knee ligament damage – medial collateral ligament damage or anterior cruciate ligament rupture are the most common. After any immobilisation period or surgery, an osteopath can assess the person’s knee and guide them from early rehabilitation right up through sports-specific work and back to their chosen activity.
- Meniscal Tears. This is the medical term for what most people call ‘cartilage injuries’, although these cartilages are the flexible, C-shaped structures that sit on each side of the knee joint and help deal with the forces going through the knee. In traumatic injuries, such as in sport, they can develop meniscal tears of different shapes and types. In some cases these tears will either require repair or surgical removal.
While cartilage problems can occur in older adults due to use over many years, the typical complaint of a patient over 65 with knee pain is related to osteoarthritis in the knee joint itself. This process, which occurs in everyone to some degree as we get older, does not always result in pain or symptoms. It may be due to very heavy activity in the past, a fracture of the knee at some point or be inherited to some degree.
Starting initially with an occasional mild ache after activity, knee osteoarthritis does not always progress significantly, but in some cases it can become disabling and require total knee replacement.
Knee Pain Treatment
An osteopath will assess the person’s social and psychological states and their views and attitudes about their knee pain problem. From that and the physical examination they will adopt a holistic approach to the issue, working to rebalance the body into better functional alignment.
Osteopathic treatments include muscle strengthening exercises, improving joint ranges, stretching, manipulation, soft-tissue techniques, muscle energy techniques, massage, education and advice. Osteopathic techniques are mostly very gentle yet effective and your osteopath will encourage you to keep going with a programme to maintain yourself in the best physical condition.