- Posted by Covent Garden Physio
- On 27th February 2019
- 0 Comments
- Knee pain, Knees, PFPS, Runner’s knee
People who suffer knee pain following an acute injury usually won’t hesitate to seek medical advice and treatment. However, when people suffer from chronic knee pain – which develops gradually and may only present intermittent symptoms – they’re more inclined to forego treatment and attempt to self-diagnose via Dr. Google.
Much of the advice you’ll find online for treating knee pain focuses on strength and strength alone, and I’ve even known of some health professionals to have this one-dimensional approach.
But knee pain is a multifaceted issue, caused or aggravated by the interaction of multiple structures from your hips down to your feet. Simply trying to strengthen your knees without understanding the structures at play is more likely to cause further irritation than resolve your symptoms.
How yours knees work, and what happens when they don’t
Your knees consist of two joints: one between your thigh bone (femur) and shinbone (tibia), called the tibiofemoral joint, and another between your thigh bone and your kneecap (patella), called the patellofemoral joint.
When you extend or bend your knees, your kneecap slides up and down through a groove at the base of your thigh bone. If your kneecap is not tracking correctly, movement through this groove is impeded, resulting in dysfunctional joint mechanics and pain.
There are a number of painful conditions caused by a misaligned kneecap:
- Patellofemoral pain syndrome (PFPS): also known as runner’s knee, this condition refers to misalignment of the kneecap resulting in friction between the kneecap and the thigh bone, which may become painful.
- Winking patella: a type of PFPS where rotation in the femur causes the kneecap to face inwards, which can lead to tension in the structures that pull the kneecap outwards and painful contact between the kneecap and the thigh bone.
- Patella alta: where the kneecap sits too high on the knee and points outwards, putting stress on the patella tendon which connects the kneecap to the shinbone and increasing risk of dislocation.
- Tipping patella: a downwards-pointing kneecap which can put pressure on the fatty pad which sits beneath your patella tendon, leading to aggravation and inflammation.
- Chondromalacial patella: if PFPS goes untreated, friction between the kneecap and thigh bone can start to damage the bones themselves, resulting in severe pain and potentially months of rehab.
There are also a number of painful conditions which can develop in the ligaments, cartilage, tendons and muscles in and around the knee joints – but there are simply too many too discuss here!
The delicate tug of war keeping your knee in position
A useful analogy to understand why your kneecap might become misaligned is to think of a tug of war between the structures pulling your knee towards the inside of your leg versus those pulling it to the outside.
If the structures on one side are weaker or tighter or slow to activate, they start to lose this tug of war and your kneecap gradually starts to shift into the wrong position.
For example, one of the structures which pulls your knee outwards is the iliotibial band, connective tissue which runs all the way from your hip to your knee, where it provides stability during movement. This tissue often becomes inflamed or tight through overuse, which you may have heard of as iliotibial band syndrome (ITBS).
On the other side, a structure pulling your knee inwards in the vastus medialis (VMO), one of your quadriceps muscles. If this muscle becomes weak or fatigued, your kneecap can lose stability and get tugged over by structures on the other side.
These are just two examples of the many structures involved in keeping your knee joints properly aligned. There are many, many more, extending all the way from your hips to your feet.
Weak glutes, a tilting pelvis, tight hamstrings, poor ankle balance, overpronating feet and more have all contributed to knee pain in patients that I’ve seen. Equally, these factors have been present without contributing to the pain at all.
This demonstrates why it’s impossible to self-diagnose knee pain or treat it with a simple prescription of “strengthening”. There are simply too many potential factors involved, many of which can overlap, to trust anything but a professional diagnosis.
Treating knee pain with strengthening alone can be more irritable than helpful
If you Google your symptoms, diagnose yourself with PFPS and start a tough regimen of leg exercises, you’re more likely to cause further damage to the knee than resolve your pain.
For example, squatting with a misaligned kneecap will only increase friction between the kneecap and the femur and accelerate the onset of a chondromalacial patella, turning what could have been a rehab of a few weeks into one that lasts for months.
Treating knee pain properly is a bit of a catch 22, as many of the strengthening exercises which will reduce the likelihood of pain reoccurring also aggravate the knee.
Rehabilitation is a delicate, two-part process where we first focus on restoring stability and alignment to the knee before moving on to strengthening exercises to lock everything in place.
Using techniques such as taping can help to provide additional stability during rehabilitation, while foam rollers can directly work on tight muscles without putting load on the knee.
Whatever it takes to restore pain-free movement to your knees, it’s far beyond the scope of what you can do yourself. No amount of online advice, including this blog, is a replacement for safe and effective physiotherapy.
BEx Sci MPhty MCSP Physiotherapist