We see a lot of people come through the clinic complaining of knee pain. Sometimes they twisted on it funny while running or playing basketball. Sometimes they slipped on ice while walking the dog. Sometimes they have no clue how it started and are annoyed they don’t even have a great story to tell.
In comes your local physiotherapist to help put the pieces together!
It’s not too difficult to figure out where the pain is coming from or what structures are specifically involved. Whether it be the muscles, tendons, ligaments, meniscus, etc. A good history, some clinical test, and some poking around can help give the problem a name.
In my experience, less people care about the name and more about what they need to do to get back to work, sport, and a normal life!
What is often even more important to me and ultimately important to my patient’s recovery and full functional restoration is the “why” the pain started in the first place. If we can figure out the “why”, we can fix the current problem and help prevent future problems too.
This is where the real detective work begins.
When treating knee pain, it is crucial to look at other joints nearby that may be contributing to the problem even if they are not painful themselves.
Aside from an assessment of the knee itself, it’s important to look at:
- The foot – A flat or pronated foot can cause the normal alignment of the knee to be shifted towards the midline of the body. Whereas as a high arch or supinated foot can cause the alignment to be shifted away from the midline. Corrective orthotics may be necessary to rectify this problem.
- The ankle – Restricted joint mobility in the ankle may alter the way you squat or go up and down stairs. If the mechanics of your ankle are altered, your knee may be forced to move differently in order to get the job done.Knee to wall test: stand at a wall in a stride stance with the ankle you are measuring closer to the wall. While keeping your foot flat on the ground try to bend your knee so that it is moving forward to touch the wall. Measure the furthest distance your foot can be placed away from the wall that you are still able to bend your knee and touch the wall. Compare both sides to see if there is a difference.
- The hip and core – Weak hip and back muscles lead to poor control of the pelvis which may also cause a shift in the knee alignment. It is not at all uncommon that the cure to your knee pain may be a solid core stability program.
Click here for a free plank program to get you started!
- Balance -Poor balance on one or both legs can be problematic when performing activities such as running when you are constantly only on one leg or the other. Can you stand on one foot for 10 seconds without shifting from side to side or flailing your arms. Advanced: can you do it with your eyes closed? Is there a difference between your good and bad leg?
These are the common culprits for pain that didn’t come with a great story. Of course it is important to also know about the knee itself and what impairments are present. We need to know about swelling, tenderness, range of motion, strength, and stability.
Here is one of the best exercises to help manage this type of knee pain:
Eccentric Step Down:
- Stand on a step with both feet shoulder width apart
- Make sure your feet are facing forward and are not rotated outwards.
- Keep the foot of the affected leg flat on the step, while you slowly step down with the opposite leg.
- Go as slow as you can, it makes it harder.
- Only lightly touch your heel to the ground and then bring it back on the step.
- Make sure you keep your knee in neutral alignment the whole time you are stepping down and on the way back up too. Tip: Neutral alignment is when the center of the knee cap is directly above your second toe.
- Make sure you keep your pelvis level as well. Tip: Keep your hands on the bony part of the top of your pelvis so you can make sure they are level while you move.
- Try this in front of a mirror so you can see what your knee is doing.
If you are considering going to therapy for your knee pain, some treatment options may include:
- Manual Therapy (joint mobilization/soft tissue release)
- Stretching (see 5 Quick Tips for Better Stretching)
- Core stability (see 21 Day Plank Challenge)
- Taping – I prefer Kinesiology Tape for knees.
- Ice/Heat (see How to know when to ICE vs. HEAT an injury)
- Ultrasound (see How does Therapeutic Ultrasound work?)
If you have knee pain and you are wondering why you have “bad knees”, you may need to dig deeper to find out the root of the problem. An old ankle, hip, or back injury could have caused your knee pain today. There is always a reason.
As always, visit your local physiotherapist for some expert guidance to help you get back to doing what you love.