Knee Problems

Knee Pain Osteopathic Treatment

Penarth Osteopaths treatments for your knee pain can help reduce swelling and pain allowing for increased mobility and your knee to fully recover from injury.

The knee is a complex joint that is prone to injury as at is affected by strains from the hip and back as well as from the foot and ankle.

This means that when looking at any knee problem a full examination of the whole of the lower extremity is necessary.

Anterior knee pain or pain around the knee cap is most often caused by the knee cap being pulled to one side or the other because of an imbalance in the muscles of the thigh.

This usually can be corrected through the prescription of exercises and specific stretching to reduce the strain upon the knee itself as well as treatment of other surrounding joints that may have an affect upon the knee’s function.

Osteopathic treatment of the knee has been shown to be effective and involves soft tissue work (massage), articulation to help reduce the soft tissue irritation and exercises to help restore the correct bio-mechanical function of the joint. 

Some treatment will also be done upon the surrounding joints such as the hip or ankle in order to allow the body to compensate properly.

To book an appointment to examine your knee and movement issues, contact Penarth Osteopathic Practice today


References:

Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE: Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebocontrolled trials. BMC Musculoskelet Disord 2007, 8: 51.
Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W: Manipulative therapy for lower extremity conditions: expansion of literature review. J Manipulative Physiol Ther 2009, 32: 53-71.
Fransen M, McConnell S: Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2008, CD004376.
Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL: Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med 2006, 166: 2533-2538.
National Institute for Health and Clinical Excellence. Osteoarthritis: National clinical guideline for care and management in adults. Clinical guideline 59. 2008.


Information on Knees

Knee injuries are common and can affect up to 33% of teenagers or young adults at some time and over 50% of athletes suffer from some form of knee pain at any one time.

The incidence of knee pain goes up as you get older as the incidence of osteoarthritis increases and the tissues around the joint become weaker. 

The most common areas to become injured are the ligaments and cartilage; however you can also get damage to the bone itself or the tendons. 

Knee pain can also be caused by a mis-alignment of the knee cap or sometimes can even be caused by another joint such as the hip or the lower back which can then refer pain to the knee itself. 

As such a correct diagnosis at an early stage is essential as most forms of knee pain can be resolved at home or with treatment but some may require surgical intervention.

About knee injuries

There are many different structures inside and outside your knee.

These include; muscles, ligaments, which connect your bones together, articular cartilage, which covers the end of your shin bone and thigh bone in your knee joint and two fibrous half-moon shaped discs called menisci.

The menisci are made from cartilage and have multiple functions such as acting as a cushion in the joint and dividing the upper half of the joint from the lower half of the joint where different ranges of movement occur.

Injury to your knee may damage any one of these structures.

Bursitis

A bursa is a fluid filled sac that sits around joints to help prevent tendons rubbing against bone and cushions the surrounding structures.  They can become irritated and inflamed from repetitive movements or tightness through the muscles or tendons above them.  They can also in rare cases become infected.  When a bursa becomes irritated the body produces an increased amount of fluid and causes the sac to swell and become painful.  The medical name given to different bursae become swollen is often linked to jobs that put increased strain upon that one particular bursa; for example ‘Baker’s Cyst’, ‘Clergyman’s Knee’ and ‘Housemaid’s Knee’.

Iliotibial band syndrome

The iliotibial band or ITB is a tendon that runs down the side of the thigh and attaches onto the outside of the knee and blends into the fascial (connective tissue) covering of the lateral (outermost) tibia and fibula.  Tightness through the ITB can cause the pain at the side of the knee where it attaches on to the bone, but can also cause pain and discomfort at the hip where the tendon originates.  It is often caused by an overuse of one muscle group or an imbalance of muscle tension through the hip, knee or thigh.  If it becomes inflamed and swollen one of the best treatments is ice and gentle stretching as well as temporarily stopping the activity that causes the problem in the first place.

Knee ligament injuries

Your knee ligaments help to keep your knee stable, but up to 80% of the total knee strength comes from the quadriceps muscles.

The medial collateral and lateral collateral ligaments are located on the inside and outside respectively of your knee joint, and limit the amount of sideways movement that occurs. You can strain your medial collateral ligament if you twist your leg while it’s straightened or from an impact from the side. These movements often occur during sporting activity, for example, when running in a straight line suddenly changing direction and twisting through the knee or being impacted on the outside of the knee when you are weight bearing on the leg.  Usually damage to the lateral collateral ligament isn’t isolated; there is often injury to other structures at the same time from the injury.

Your anterior cruciate ligament and posterior cruciate ligament form a cross inside your knee and help prevent backwards and forwards motions of the upper leg in the knee joint.  Anterior cruciate ligament injuries are one of the most serious types of knee injury as they can leave the knee painful and unstable and as such more prone to resulting osteoarthritis.  They can heal but normally require considerable rehabilitation or even surgery in those who have greater athletic demands.

Osgood-Schlatter Disease

This is a developmental problem that mainly initially occurs in teenager boys and sometimes in girls, where a painful lump appears at the front of the knee where the patella tendon inserts onto the bone of the shin.  The pain usually comes and goes with activity and so is more common in those who are active in sports. It is usually a self-limiting condition  so apart from a residual lump on the front of the knee is most likely to resolve itself over time.

Osteoarthritis

This commonly occurs in those over the age of 60 but can also occur with someone who has had a serious previous injury or a very active lifestyle.  Osteoarthritis is also more common in those who are overweight, as the increased weight causes more damage to the menisci upon movement.  The cartilage in the joint is not pain sensitive but as it wears away it can cause irritation to the surrounding structures or from loose bits of cartilage floating around in the joint.  Eventually if left untreated the cartilage can wear away completely and then you get bone rubbing on bone which is very painful, can cause cysts in the bone and will more than likely require surgical intervention and a knee replacement.

Patella mal-tracking

In this condition the knee cap moves in and out of its normal alignment on movement of the knee.  This is because of an increase or decrease in strength through the muscles of the thigh pulling the knee cap.  This deviation can cause swelling and pain at the front of the knee, but can also if left untreated results in pain under the knee cap itself as the cartilage gets irritated and worn.  This condition is often more common in teenage girls but can be seen in any athletic population where a training imbalance has occurred.

Meniscal injuries

The menisci themselves can be prone to injury as they are only partially attached within the knee. You can damage them if you play a sport that involves twisting your upper leg while your foot is planted on the floor. As you get older your meniscus may degenerate and become slightly thinner or develop micro tears which will increase the chance of damage following a minor injury.  Following a meniscal injury, depending upon its severity, you may require surgery to help the healing process.

Symptoms of knee injuries

You may feel or hear a popping or snapping sensation at the time of the injury. You may also find that you can’t stand properly on the affected leg, or put your full weight on it.

The symptoms for most injuries will be similar, no matter which structure has been damaged. These may include:

If you have any of these symptoms, visit your us or your GP for advice.

Causes of knee injuries

You may injure your knee if:

Your knee is forcefully moved beyond its usual range of movement, for example if you have a fall or land awkwardly

You play a sport that combines running, jumping and stopping with quick changes of direction, such as football

You have a condition such as arthritis or gout, which can affect your joints

You are very overweight, which can put pressure on your knees

You are involved in an accident and the front of your knees hit something pushing them backwards – this can cause damage to the posterior cruciate ligament damage

You wear unsuitable footwear that doesn’t match the shape of your feet or have poor training methods and flexibility; these factors can lead to overuse injuries of your knee

Pain

Clicking

Locking of the Joint

Swelling

Instability – you may feel like your knee is giving way.

Diagnosis of knee injuries

When you come in for an appointment we will ask about your symptoms and examine you.

This may include feeling for fluid in your knee joint by pressing gently around your kneecap. 

We will also ask you to describe exactly how your injury happened as the cause of most injuries give a very good clue as to what structures have become injured. 

We will also ask where your pain is and what type of pain it is.

We may also ask you to walk, sit or squat so we can test for injury to your knee ligaments or soft tissues.

We will also bend and flex your knee and move your leg into different positions.

There are combinations of orthopaedic tests that we know which can help diagnose damage to particular structures which we use on a regular basis. 

To make this assessment easier it is advisable to bring a pair of shorts so we can easily see and feel the knee itself during the examination.

If after the initial examination we find something that requires further investigations or we are unsure we can refer you back to your doctor so that he can organise further tests in a hospital or clinic.

These may include an MRI or ultrasound scan, and occasionally an X-ray. These tests can help to diagnose more complicated or severe injuries.

Treatment of knee injuries

There are different types of treatment that can be done depending on the type and severity of the damage to your knee. 

From an Osteopathic point of view it is all about restoring proper function to the knee and allowing the body to heal itself. 

This can be done by correcting imbalances in the muscle strengths around the knee, or stimulating ligaments and tendons to recover. 

It’s vitally important to be patient when recovering from a knee injury as they can take some time to fully repair itself, so you may not be able to do all the things you are used to doing.

It’s not just about the knee, either.  Osteopaths will also take a look at other joints in your body, such as your feet, hips and spine to make sure that the function of these joints is efficient and not putting strain on your knees in the first place. 

Sometimes the best way to treat a knee is to treat another joint instead!

Self help

You should follow the PRICE procedure to manage any type of soft tissue injury to the knee. PRICE stands for the following.

Protection

    Protect your injury from further harm.

Rest.

    Rest the injury for the first two to three days and only then reintroduce movement so you don’t lose too much muscle strength.

Ice.

    Apply a cold compress such as ice wrapped in a thin cloth to help reduce swelling and bruising. Do this for 10 minutes every one to two hours. Don’t apply ice directly to your skin as it can burn your skin.

Compression

    Compress the joint by bandaging it to support the injury and help decrease swelling. A tubigrip stocking is best and can be bought from most pharmacies.  However remember to NOT leave this on while you sleep as it can lead to the formation of DVT’s (deep vein thrombosis – blood clots that can block blood vessels.)

Elevation

    Elevate your knee by resting it on cushions and keeping it above your heart if you can.  When supporting the knee provide support along the whole length of the leg as it will be more comfortable.

There are certain things you should not do in the first three days after your injury so you don’t damage your knee further. These can be remembered as HARM.

Heat.

    This includes having a hot bath or using a heat pack as the heat will increase the amount of inflammation with the joint and relax the muscles that are supporting the joint, so when you come to move again the knee may be more unstable. The way to remember this is to think of inflammation as a source of heat in your body, so if you put heat on something inflammed, it will just become more inflammed.

Alcohol.

    Drinking alcohol can increase bleeding and swelling in the affected area as well as reduce your awareness of the amount of pain you are in, and so allow you to cause more harm without releasing it

Running or other forms of exercise.

    Exercising on an injury only increases the amount of damage that has already occurred and will prevent the overall healing process

Massaging the injured knee.

    This can increase the amount of swelling or bleeding in the knee as massage causes a small degree of damage to the muscles when performed, which also causes inflammation

If you’re having difficulty bearing weight on your knee, you may need to use crutches or wear a brace to make sure that you keep weight off the affected knee.

Medicines

You can buy over-the-counter painkillers such as paracetamol to treat mild and moderate pain. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help to reduce inflammation and swelling, as well as relieve pain.

NSAIDs are available as gels, creams and sprays that you can put directly onto your skin and gently massage in, as well as tablets or capsules that you take by mouth.

If you take the latter, always take them with food (as they can irritate the stomach and cause ulcers in some people) and stop taking them if you have any resultant stomach irritation. 

They can also increase the risk of bleeding, so they are not suitable in some people for that reason, and also with asthmatics as they can also trigger attacks in some people.

Your doctor may prescribe stronger painkillers if your pain is severe.

Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.

Osteopathy and Knees

If your injury is more severe or complex we will develop a programme of rehabilitation exercises to gradually strengthen your knee and stretch your muscles. These exercises will vary depending on the type of injury you have and how severe it is. We may also use various osteopathic techniques to help speed up the healing of your knee.

Braces or strapping to support your knee are occasionally used during rehabilitation, usually when an injury has been severe.

Treatment is necessary as abnormal function at the knee can lead to stresses and strains affecting the lumbar spine and the hip on the same side as you may walk with a limp or avoid fully weight-bearing through the injured knee.

Surgery

For some types of knee injury, we may recommend that you get an MRI in order to discern the degree of damage that has occurred.  If necessary you may then require surgery to repair the injury to your knee – especially if other forms of treatment haven’t worked. Your doctor will then need to refer you to an orthopaedic surgeon for these assessments.

Prevention of knee injuries

There are some precautions you can take to try to reduce the risk of damaging your knee.

Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.

Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury.  We also advise stretching your muscles after cooling down in order to return the muscles to their resting length and to prevent muscle shortening over a period of time.

Wear correct footwear. There are many different models of trainers available, but the best is one that matches the shape of your feet. If you’re not sure, it’s a good idea to go to a specialist sports shop and ask for advice.

headache and recovery

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