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Could one of these 4 things be causing your knee pain?

By Daniel Jordan - LifeForce Physiotherapist

Could one of these 4 things be causing your knee pain?

Knee pain is extremely common, in both highly active and relatively sedentary populations. It affects all age groups, both men and women, and knee surgeries make up a huge part of public health spending annually. So what is wrong with our knees, and what can we do to avoid knee conditions?

1 Tight Hamstrings

Can you touch your toes? No? Well, neither can most people. In today’s chair-bound society, 3 things are certain;

  1. You wish you’d bought shares in Google,
  2. You never seem to get as many Facebook likes as your friends do, and
  3. Unless you stretch regularly, you have tight hamstrings.

Patello-femoral pain syndrome, an extremely common knee condition responsible for 30% of all presentations to sport injury clinics, is known to be linked to tight hamstrings. Tightness in the rear compartment of your leg (hamstrings and calves), creates increased strain in the patello-femoral joint (the joint between your knee cap and your thigh bone) which can result in irritation of the joint.

The answer?

Stretching! Getting up and about during your work day for a stretch is definitely going to help reduce the likelihood of you having tight hamstrings, and it can also reduce the hamstrings’ input into your knee pain. Tight quadriceps muscles (the front of your thigh) can also increase strain on this joint, so you should probably stretch those too, while you're at it! Foam rolling is another great option.

2 Poor hip biomechanics

There are lots of different things that could lead to faulty hip biomechanics: weak gluteal and abdominnal muscles, tight calves, increased or reduced mobility at the ankle joint, among many other things. If your hips aren’t behaving correctly when you are standing,

walking, running, or jumping (among other physical activities), they can cause imbalances at your knee joints. This can result in patello-femoral conditions, arthritis, Osgood-Schlatter’s disease, patella or quadriceps tendinopathies, and more. 

The answer?

See your physio! We know, it seems like a self-advertisement, but, can you tell me whether your lack of talocrural dorsiflexion and subtalar inversion is causing a reduction of internal rotation at your hip and a resultant biomechanical stress at your knee? Most people couldn’t, but your physio might tell you just that (probably without bamboozling you with jargon like we just did!)/p>

3 Arthritis

One of the most misunderstood medical terms going around, in our opinion. Have you got an X-ray report or have you been told by your doctor that you have ‘degeneration’ in your joints? What a scary word that is. Let's talk about what ‘degeneration’ really means: wear and tear. As in, what happens when you use something lots. In a 2012 study, over 50% of people that underwent MRIs

on their knees showed evidence of osteophytes (abnormal bony growth) and cartilage damage, even though only roughly half of these people had any knee pain. Don’t get us wrong, MRI, X-ray, CT-scans etc are all very useful for diagnosing joint and tissue pathology, but sometimes, the pathology doesn’t line up with what we feel, or with the actual cause of our pain.

The answer?

Exercise! Studies have shown that regular exercise can help improve pain, physical function, wellbeing and general health in populations with arthritis. Often, being overweight can add to the strain on your joints, so if this is an issue for you, exercise can help with this too. Whether it is exercise at home, in a gym, in aquatic therapy, land-based classes or tai chi that takes your fancy, you really can’t beat exercise! The common mistake when starting a new exercise program is going too hard, too early, and after feeling some of the less desirable effects of exercise (muscle soreness, possible initial irritation of your pain), giving up. Avoid this mistake by chatting to your physio or other health professional, and most of all, make it fun!

4 Your spine

The pain you are feeling in your knee may not in fact originate there. It could be coming from your lumbar spine, specifically the nerves that exit your spinal cord via small gaps (called foramen) in between your lumbar vertebrae. If these nerves are compressed, by a disc bulge, or other narrowing of the foramen, you may feel referred pain into one or both legs.

This pain is often accompanied by back pain, or a sensation of pain shooting down your leg, but not in all cases – the pain may just be present in your knee without the back pain or shooting pain. There are specific tests that can uncover tell-tale signs that your pain could be originating from your lower back, and your physio will likely perform these tests early on in your treatment plan. 

The answer?

See your physio! This one seems like a no-brainer - if your knee pain is coming from your back, you should probably get it checked out by your physio. They may refer you to get scans done, depending on the severity of your symptoms, but often, a few sessions with your physio can help this type of knee pain a great deal.

Well there we have it. There are lots of reasons why your knee could be hurting, and we’ve just mentioned a few of the more common ones. This list is by no means exhaustive, so make an appointment to see your LifeForce physio to begin getting on top of that knee pain!  

References

Fransen, M., Nairn, L., Winstanley, J., Lam, P. and Edmonds, J. (2007). Physical activity for osteoarthritis management: A randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum, 57(3), pp.407-414.
Javaid, M., Kiran, A., Guermazi, A., Kwoh, C., Zaim, S., Carbone, L., Harris, T., McCulloch, C., Arden, N., Lane, N., Felson, D. and Nevitt, M. (2012). Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: The Health, Aging, and Body Composition Study. Arthritis & Rheumatism, 64(10), pp.3246-3255.
LaBella, C. (2004). Patellofemoral pain syndrome: evaluation and treatment. Primary Care: Clinics in Office Practice, 31(4), pp.977-1003.
White, L., Dolphin, P. and Dixon, J. (2008). Hamstring length in patellofemoral pain syndrome. Physiotherapy Research International, 13(4), pp.207-208.
Photo by David Castillo Dominici courtesy of freedigitalphotos . net.