Knee Pain - Finding the cause and building strong knees

Knee pain is a common complaint at Kelowna Manual Therapy Centre. This article deals with knee pain that gradually increases, rather than knee pain that is caused by an acute injury.  Treating knee pain must involve taking a thorough history as well as physical examination.  A Thorough history-taking and physical examination will help determine whether the knee pain is the primary problem or the ‘victim’. In other words, a manual therapist will look for the root of the problem.  The knee pain can be the source of the problem, or caused by problems in the lower back, pelvis, hip and/or foot and ankle.

Commonly, non-acute knee pain is brought about by about by stresses transferred from other areas.  For example, tightness and weakness around the hip can cause a lack of control and an increased angulation of the knee with bending.  This is termed “Valgus collapse”.  This is one of the most common causes of knee pain seen with ‘overuse’ injuries.

PIC: Poor knee control as a result of hip muscle tightness and/or weakness

Another example is tightness in the calf muscles or stiffness in the ankle joint will put an increase in stress on the knee by causing an increase in twisting forces on the knee.  Excessive pronation can also contribute to increased knee stress.

Manual Physical Therapy treatment will use a combination of manipulation, mobilization, IMS dry needling, soft tissue work, stretching and strengthening to help restore normal mechanics.  Orthotics can be used if it is determined that increased foot pronation is contributing to the knee pain.  A specific therapeutic exercise program will be taught to reinforce correct movement patterns.

The therapeutic rehabilitation program will follow one or more of the following principles:

• Correct knee, lumbar, pelvis, and hip alignment with exercises. This involves good control of the ankle, knee, hip, pelvis and lumbar spine with movement.  Movement patterns that mimic the activities that were painful are focused on as part of the rehabilitation.  Rehabilitation exercises must be kept pain free.
• Initially, exercises will be used to minimize ‘sheer’ stress on the knee. If the knee remains centered over the foot rather than allowed to move forward this will reduce stress on the knee.  As the exercise program progresses increased loading will be used.  There are a varieity of methods used to increase that load i.e. moving from both legs to one leg, adding weight, adding speed, adding unstable surfaces, etc.
• An emphasis on eccentric (muscle and tendons working and lengthening) exercises are used for sports that require this type of loading i.e. downhill trail running.  Eccentric exercises are useful to prevent and treat knee tendinopathy.
• Attention to the type of activities and training previously discussed here.