Knee pain is very distressing and greatly debilitating. There are so many degrees and causes of knee pain and so much public awareness due to the high incidence in sporting arenas. This public awareness often creates people thinking the trauma in their knee is far greater than the actual pathology. Sportspeople will always fear the worst anticipating that a reconstruction and months away from sport has occurred and our older generation will fear their knee has worn out to the point of soon replacement!
Despite the high incidence of knee trauma from falls and collisions most knee pain is due to altered joint and muscle mechanics particularly of the patellofemoral (knee cap) joint. The patella (kneecap) slides up and down on the shiny cartilage surface of the femur (thigh bone) and is enveloped by the powerful muscles of the thigh (quadriceps). The main action of the patella is to increase the leverage of the quadriceps muscles and hence enhance power and range of knee extension.
If the patella is not sliding evenly in this groove, pain particularly when the quadriceps are contracting (e.g squatting, walking up and down stairs, running) is highly likely to occur. This is usually a gradual occurrence and explains why people may experience episodes of swelling after these activities. The patellofemoral joint is reliant on symmetrical flexibility and strength of the quadriceps muscles. If the muscles on the outer thigh are tighter and stronger than the inner thigh the patella will be pulled toward the outside of the joint surface. This is a very common occurrence as the muscles of the outer thigh and buttocks are used whenever we weightbear and gradually become tighter and tighter. If this tension is not released (particularly by stretching) the patella will continue to be pulled off centre increasing the likelihood of patella tendonitis, bursitis and ultimately arthritis of the patellofemoral joint.
Further contributing factors to the patella maltracking (moving off centre) include:
- Wasting of inner thigh muscles (often after previous injury)
- Feet rolling inward due to unsupported arches and poor footwear
- Wider hips (especially females) increase the angle of thigh muscles
- Legs bowing inward (knock knees) increase the angle of thigh muscles
Osteopaths will determine the cause of your knee pain and most importantly help you correct the mechanics of your knee and patellofemoral joints so that you can move around with confidence and comfort. If need be, an osteopath will refer you for further medical assessment.