The knee is one of the most commonly injured joints in the body. known by runners, tennis players, and weightlifters alike, the knee can really hamper your favorite activity. But, is the need the real problem? Or is it the victim? The answer is it can be both. But ask your physiotherapist and they’re likely to tell you its more the latter. As a general rule: without direct trauma or a specific event that caused injury, look elsewhere. If your knee pain comes on gradually, look elsewhere. Where should you look? Great question. In this blog we’ll go through the 3 most common places where the culprit could be lying. Before we begin lets clarify. The pain and/or damaged structure is coming from the knee itself. That’s where you feel it, that’s where the injury is present. The argument is the knee was “hung out to dry” by a weakness or tightness in another area of the body.
The Foot/Ankle The first area we are going to look at is the foot and ankle - responsible for contacting the ground and providing a stable base for the leg. Generally, we want nice neutral joint position in the body. We tend to run into issues when joints are consistently working away from neutral. In the ankle, away from neutral is pronation and supination. Now, these are completely normal movements in the body! In fact, the ankle is designed to go through pronation and supination as we walk, squat, jump, and move. We run into trouble when we spend all our time in over-pronation (arch flat to the ground) or over-supination (arch lifted away from ground). During over-pronation and over-supination, the leg has to adapt to the foot, altering pressures on the knee. Using pronation as an example: Instead of the knee, couldn’t the pain be in the foot? Absolutely. We see just as many foot and ankle injuries in this scenario as we do knee. It’s much easier to catch and often you end up treating the right area sooner. But if the knee is the victim and the ankle the culprit, it can delay the right treatment.
The Hip The second area that can leave the knee high and dry is the hip – responsible for controlling the pelvis above and the knee below. The hips can be both tight/restricted and weak, and both situations can lead to knee varus (A) and knee valgus (B). In knee varus, the knees move outwards, setting up over the lateral (outside) of the foot. In knee valgus, the knees move inwards and set up over the inside of the foot. In both situations, the knee will have to adapt to the preference of the hip. You may start to see how knee varus go along with over-supination, and knee valgus with over-pronation. The job of your physiotherapist: which one is the ring leader and which ones are following along. Accurate diagnosis leads to more effective treatment.
The Core The final area we will look at is the core. When you have core weakness, it is not uncommon for your knee pain to come with a side of low back pain, hip pain, and the famous ITB pain. With core weakness we tend to see lateral shifting when walking or squatting, decreased stability through the leg, and leg preference during movements. Weakness in the core tends to exacerbate the problem at hand.
What to do if you have knee pain? If pain comes on after activity start with some reactive treatment. Stretching of the lower body, especially the quads, foam rolling, and local ice can help reduce pain. If the problem continues to re-occur, come visit a Pivot therapist so you can get to the root of the issue. The further the culprit is from the pain, the longer it takes to treat (generally!). Small problems are quick solutions, and we want you out there enjoying your summer activities!
References Barton, C. J., Levinger, P., Crossley, K. M., Webster, K. E., & Menz, H. B. (2011). The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clinical Biomechanics, 27(7), 702–705. https://doi.org/10.1016/j.clinbiomech.2012.02.005 Crossley, K. M., Stefanik, J. J., Selfe, J., Collins, N. J., Davis, I. S., Powers, C. M., McConnell, J., Vicenzino, B., Bazett‐Jones, D. M., & Esculier, J. F. (2016). Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 50(14), 842–850. https://doi.org/10.1136/bjsports-2016-096384 Powers, C. M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective. Journal of Orthopaedic & Sports Physical Therapy, 33(11), 639–646. https://doi.org/10.2519/jospt.2003.33.11.639 Powers, C. M. (2010). The influence of abnormal hip mechanics on knee injury: A biomechanical perspective. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 42–51. https://doi.org/10.2519/jospt.2010.3337 Willson, J. D., Dougherty, C. P., Ireland, M. L., & Davis, I. M. (2005). Core stability and its relationship to lower extremity function and injury. Journal of the American Academy of Orthopaedic Surgeons, 13(5), 316–325. https://doi.org/10.5435/00124635-200509000-00005
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