Knee Pain

Monday, September 24, 2018

A very common reason why someone would come to our office needing help is for knee pain.

The “punching bag” of the leg:

Many years ago one of my lecturers and mentors told me that the knee was the “punching bag” of the leg. What he meant by this is that the knee takes a beating when there are any issues present in the leg. He wasn’t talking about traumatic knee pain, like a twist or a fall, but rather the knee pain that builds over time.

Let me explain. The hip is a very mobile ball and socket joint and the foot and ankle have many plains of movement. These structures have the ability to use their varied ranges of motion to compensate around problems that may develop. The knee however is just a hinge working almost exclusively in one plain (flexion / extension) and thus can’t really compensate to the unbalanced forces of faulty hip and or foot / ankle movement. Thus even though the problem may be present in the hip, ankle or foot the knee shows up the stress and pain first. I will usually assess your foot, ankle and hip before I look at your painful knee to get all the information I need.

Common Causes (a brief list):

  • Anterior (front) knee pain is often caused by a tracking issue in the knee cap. Just like with your car’s wheel alignment, your knee cap can be pulled out of its ideal tracking. Most commonly we find that the muscle on the inner thigh (V.M.O.) gets weak and this allows the knee cap to be pulled toward the outside of the knee. This will eventually cause a rubbing of the knee cap cartilage onto the thigh bone. Over time the resulting inflammation causes pain.
  • Medial (inner) knee pain can arise from constant stress upon the medial knee ligament, cartilage and joint capsule from fallen arches of your foot. Your hip can also be the culprit when there is weakness in the external rotators of your hip which allows the thigh to roll inwards twisting your medial knee joint.
  • Lateral (outer) knee pain can be caused by weak foot muscles. A weak foot tends to roll outwards to the little toes and doesn’t use your big toe to drive your body forwards. This transfers too much force up your lateral leg. Tight hip muscles (buttocks and outer hip flexor) make the lateral connective tissue band (ITB) very tight. This too can cause lateral knee pain.
  • Posterior (back) knee pain can be caused by damaged hamstrings or calf muscles and they both cross the back of the knee.
  • I must also mention that referred pain from other areas can arrive in your knee. For example the quadriceps (anterior thigh) and hamstrings can refer pain to the knee. An arthritic hip often refers pain to the knee.

Pain killers and anti-inflammatories help the symptoms but won’t fix the cause of these problems. The cause needs to be accurately identified and properly treated for long term success.

I hope that this gives you a better understanding about hip pain and strategies to help manage it.

Get Well, Stay Well.


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