If you are reading this blog chances are you are experiencing knee pain, swollen knee, knee tendonitis, knee bursitis , knee pain while bending, knee joint popping, knee joint grinding, or knee joint buckling? If so, there is a great chance that you may have had an injury to your knee that needs to be addressed, was not addressed fully or completely. These problems do not necessarily result from sports or an accident and can be as a result of our sedentary lifestyle. The knee joint is the largest joint in the body and one of the most complex ones. In my practice, I see many knee surgeries that fail and encountering a double, bilateral ( meaning both sides) knee surgeries is not uncommon!
What Does the Knee Joint Look Like?
The picture above is the right knee x-ray with the small bone on the left side of the picture being the Fibula. Let’s explore the knee joint a little bit here.
The knee joint is a joint where four bones come together. The top of the joint is made up of the femur (thigh) bone of your leg. The bottom of the knee joint is made up of two bones. These two bones are the Tibia (shin) bone and the Fibula. The final bone that makes up the knee joint is the patella (knee cap). Between these three bones is a shock-absorbing cushion called the meniscus.
The meniscus is formed to two c-shaped segments that make up the lateral (outside) and the medial (inside) meniscus. In addition to the bones and the meniscus, there are four crucial ligaments that support and stabilize the knee joint.
The anterior cruciate ligament (in the front) and the posterior cruciate ligament (in the back) are two ligaments that can be found on the inside of the knee joint. They cross in the middle to keep the knee joint from moving too far forward or backward.
Hugging each side of the knee on the outside is the Lateral Collateral Ligament and on the inside part of the knee, you will find the Medial Collateral Ligament. These two ligaments stabilize and help keep the knee joint from moving too much from side to side. There are also several small sacks called Bursa which are filled with a fluid and they help the knee joints move smoothly by cushioning this joint. Of course, just as in all joints, there are muscle attachments to the knee joint via the associated tendons.
What Causes Knee Pain?
I won’t be talking about cases when someone is born with knee joint abnormalities but I intend to go over the basic knee joint causes that are caused by us one way or another.
Knee joint pain is a common extremity joint problem or injury in men and women of all ages. Chances are when you picture a knee joint injury, you probably visualize a fall or an injury in an athlete such as a runner, soccer player, basketball player or football player. These people do suffer from knee injuries but you don’t have to be active to have knee issues. Since I mentioned runners, I would like to refer to the video below that tells you what to look for in running shoes.
When you sit for more than 20 minutes, your body starts adapting to the knee joint in this seated bent position. Your ligaments and tendons attached to the bones in your knee tighten up or stretch out to keep your knee in this position. When you stand up to walk after some time of sitting, your body takes some time for the ligaments and tendons to adjust to the new position causing irregular movement. This can result in ‘misalignment’ of your knee. A ‘misaligned’ joint forces your body to have extra strain on the joint. It can cause the joint to pull on the muscles of the knee unevenly and unevenly wear the cartilage that cushions the bones in the knee. This ‘misalignment’ of your knee causes pain due to the wear and tear over time and results in Osteoarthritis which is is the most common form of arthritis in the knee and fully unrelated to age! If age has anything to do with osteoarthritis then why is it that not all of your joints look old?!!! Duh!!!
In these two videos, I show a couple of things you can do to better stabilize and work out your knee joint and you will notice that the second video is actually for the hip area. The reason for that is because as mentioned above, the thigh bone is one of the bones that make up the knee joint and therefore any issues and instabilities there lead to knee issues as well.
With a fall or a direct injury to the knee, you can end up suffering from a knee sprain or strain. A knee sprain has to do with the actual joint itself and may include even a partial tear to one of the ligaments in the knee joint. A knee strain is an injury to one of the muscles or muscle tendons that connect to the knee. A fall or a direct injury to the knee is also likely to result in misalignments to the knee joint.
What Treatments Are Available for My Knee Joint Pain?
I interviewed Dr. Adam Schulte, a Family Physician with focus on Sports Medicine in one of my FB Live events at my office in Irvine where he gave a synopsis on the medical approach to knee injury and treatment.
In my practice, not only the knee joint but the whole body alignment is assessed and looked at. Why? Because any misalignment especially at the nearby joints lead to its pain and ‘malfunction’ sooner or later. It is one thing to get rid of the pain but to make sure the pain does not come back or its chances of return are minimized, the whole body needs to be taken into account.
Depending on the acuteness of the pain or injury, I may or may not adjust the knee joint itself right away. Ultrasound, Cold Laser of the knee joint, and muscle stimulation of the involved muscles connected to the knee joint are initial approach to calming down the joint and injury. An additional treatment for knee pain is Cold Laser. Cold laser is a pain-free treatment that creates energy deep in the knee tissue to promote blood flow into the area and to encourage healing. It works to increase the speed, quality, and strength of the knee tissue. You will be excited to know that cold laser treatments also decrease knee pain.
No matter what, I tape the knee joint either for stability or for assistance in movement. In this video you will see me taping the knee joint with the general approach to stabilize it in an athlete who is going to participate in her sport with injury prevention in mind. I prefer taping over a brace because the joint is to move in order to be helped! Bracing limits all movements in all ranges of movement within that joint and can impact the muscle strength as well as the motor or movement mapping in the brain. I have talked about Brain-based neurology and posture on my website which I suggest you refer to here.
Active Release Technique or ART is my Functional Rehab. of choice when it comes to all joint injuries including the knee joint. I have written a blog that describes what ART is all about. When muscles are injured, they will cause limits in function and motion of the knee joint. An injured muscle is not able to function normally when it is injured. This leaves its main function to be performed by other muscles which have their own main function to perform. The task is shifted and given to other muscles. As you can imagine, this overworks these muscles that have stepped up to help and result in them becoming tight and sore. ART assists in bringing back the function back to the dedicated muscle or muscle groups so the ‘job’ is done by the correct ‘workers’.
Rehabilitation of the knee joint does not stop with the joint movement without any pain. It involves strengthening the injured joint, strength stabilizing the surrounding muscles, then coordinating movement of the injured joint within what is referred to as the kinematic chain- the chain of muscle-bone-joint-tendon-fascia involved in a movement. In my practice, I quickly implement the Brain assessment in the re-exam to see how the lack or limited mobility impacted the Motor map of the brain! Read about this here. We want to make sure the correct command for action and movement comes from the Brain.
The most recent modality I have implemented in all movement related cases in my practice is DNS or Dynamic Neuromuscular Stabilization and did a blog on that.
Adjusting the knee joint is certainly part of the treatment but the point at which I implement it varies from case to case.
How Do I Prevent Knee Injury?
Obviously, the focus is to avoid situations that clearly will cause injuries. No, I am not saying stay at home and don’t move!! In fact, the body is much more equipped to handle injuries due to activities than lack of! I absolutely suggest you subscribe to my YouTube channel to view short videos that alert you on different ways you can injure yourself and also how to self-treat.
If you are an office worker, it is important to take micro breaks from sitting. These microbreaks will give your joints a much-needed rest from being in one pos