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Osteopathy and Knee Pain

Knee pain is very common in both the exercising and non-exercising population. It occurs for many reasons and can be related to age as well as activity. It can be very debilitating, sometimes leading to significant changes in lifestyle and outlook. But what is it? Why does it happen? Most importantly what can be done about it?

First, one common type of knee pain is Patellofemoral Pain Syndrome (PFPS). The PF refers to the relationship between the kneecap (patella) and the bottom of the thigh bone (femur). In its simplest terms, the kneecap has a central ridge that sits and glides in a grove made by two ridges (trochlea) on either side of the end of the thigh bone. This gliding mechanism may be disturbed. The disturbance can come from muscle imbalance around the kneecap where one side might be stronger causing slight misalignment issues. Repetitive movements can, over time, put strain on other related tissues in the area, like cartilate, ligaments, a fat pad and fluid-filled sacks called bursae.

The disturbance can also come from the way the ankles and feet move as well as the control exerted by the gluteal muscles of the bottom. It is because of the influence exerted from above and below that the knee is often known as a floating joint.

There is also a significant area of cartilage within the knee joint as well as on the back of the kneecap. This can become frayed with age but that does not always necessarily cause pain. In many instances the loss of cartilage creates a pressure point on the bone below and this can get irritated, a bit like a bruise and repetitive loading when walking or exercising can lead to pain.

Giving way is a phenomenon experienced with degenerative changes in the knee. The above mentioned condition, where the weight, if put through an area of inflammed bone, can cause the knee to give way. Also, tears in 'C' shaped meniscal cartilages, which are designed to deeped the joint, can also cause locking or giving way.

Patellofemoral pain sysndrome

This is the name given to the general condition of pain in the knee that is not necessarily identifiable using images or ultrasound. It relates to the phenomenon mentioned above where the mechanics of the kneecap become altered cause pain in other soft tissue structures in the area. Some of this pain can cause the knee to 'grind' or 'click'. For the majority of cases this does not mean that the joint is wearing away or being damaged. Fluid dynamics behind the kneecap can produce this noise and though it can sound disturbing, it is no cause for alarm. In cases of extreme knee osteoarthritis a similar phenomenon can be experienced. This is different in its feel and its cause.

Generally PFPS can occur due to one of the following:

  • overtraining: increasing the amount of training/a you are doing too quickly

  • muscle imbalance at the knee, on the front and back of the thigh

  • tension in the muscles of the lower leg (shin)

  • muscle weakness at the hip

  • the way the foot interacts with the ground/surface

  • trauma, like a trip and fall.

Osteopathic treatment of knee pain

The osteopath will look both at the local area of the knee as well as the control from above and the mechanics of the feet and ankles below. Some time will be spent on the area of pain and this can include soft tissue mobilisation, joint mobilisation and local musclar development. But the qualty of thje movement in the ankle will be assessed and worked on the quality of muscular strength and coordination from above will also be addressed.

Even in an arthritic knee, good quality muscle tone and control are essential and can help to delay the need for a replacement or at the very least can prepare the knee for such an intervention and for the rehab after.

Treatment of knee pain takes a bit of patience and time but also belief that there is, in all likelihood, no damage to the knee, even if the noises emanating from it may imply otherwise.

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