KNEE PAIN & MYOTHERAPY
The knee pain conditions covered in this article focus on chronic pain and overuse conditions. Intra-articular knee pain, involving the meniscus and ligaments, often the result of trauma (sports injury, accident), won’t be covered here.
ANTERIOR KNEE PAIN
Patellofemoral Pain
The most common type of knee pain, often afflicting runners and cyclists and people who are sedentary. Patellofemoral pain typically occurs when the lateral thigh muscles become dominant, causing a shift of the patella (kneecap) towards the outside of the thigh. This tracking problem causes the patella to move unevenly over the condyle joints, causing pain that is often felt underneath the kneecap. Patellofemoral pain can be hard for the individual to pinpoint, the classic sign of Patellofemoral pain is pain reproduced with direct pressure over the kneecap when slowly moving the kneecap laterally and medially.
Treatment for Patellofemoral pain includes strengthening of the medial thigh muscles if weak, releasing the surrounding muscles; in particular the lateral thigh muscles, and activity modification. Taping of the patella can be used to alleviate pain and allow the patella to track evenly.
Patella Tendon Pain
The patella tendon attaches the bottom of the kneecap to the top of the shinbone (tibia). Patella tendon pain is often the result of overuse of the patella tendon. Patella tendon pain often affects jumping athletes (basketball, football, ballet), as well as sedentary people with weak thigh muscles.
Patella tendinopathy commonly occurs alongside infrapatellar fat pad inflammation and/or infrapatellar bursitis.
Treatment for patella tendinopathy includes strengthening of the thigh muscles and avoiding kneeling and deep squat movements.
A similar presentation in younger people is often caused from Osgood Schlatter’s disease, which typically occurs in 12-14 year olds.
MEDIAL KNEE PAIN
Pes Anserine Bursitis
If we disregard intra-articular injuries, one of the most common causes of medial knee pain is Pes Anserine bursitis. The Pes Anserine, also called the ‘Goose Foot’ describes the appearance of the three tendons which conjoin over the associated bursa. The sartorius, gracilis and semitendinosus (medial hamstring) muscles make up the Pes Anserine and when overused, create excessive friction over the bursa leading to inflammation and pain.
Movements requiring excessive flexion and adduction can lead to this condition, including running, climbing stairs, kicking, squatting or side to side movements.
Bursitis treatment typically requires rest to settle the inflammation. Avoiding aggravating activities, along with taking non-steroidal anti-inflammatory drugs (NSAID), and ice for pain relief. Releasing tension in the muscles and once the pain has settled, strengthening.
Patellofemoral pain can also present as medial knee pain, therefore receiving a proper diagnosis is important.
Pes Anserine Tendons
Osteoarthritis
Although Osteoarthritis (OA) affects the articular joints, I have decided to add it into this article due to its prevalence. Osteoarthritis is a common chronic pain condition of the joints. OA in the knee occurs when the hyaline cartilage within the joint starts to break down, causing pain and swelling.
The hyaline cartilage in a healthy joint allows smooth, pain free movements, acting as a cushion between the bones. Over time, bones can begin to break down, forming bone spurs and fragments. Further deterioration of the cartilage is caused by inflammatory responses in the body. The final stage of OA is complete breakdown of the cartilage causing bone to rub against bone.
Risk factors for OA include age (45 years and above), obesity, overuse and joint injuries.
Osteoarthritis often causes brief morning stiffness, which returns at the end of the day. Pain caused by OA is usually a sharp ache or burning feeling, which intensifies with activity. Osteoarthritis does not usually cause swelling in the joints as seen with rheumatoid arthritis. It typically affects people over 45 years of age.
Treatment for OA of the knee can include monitoring weight, moderate exercise and physical therapy.