The knee joint consists of three bones the femur (thighbone), tibia and patella (kneecap).
Soft tissue ligaments (patellar tendon, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), lateral and medial collateral ligaments , muscles including hamstring tendons, patellar tendon, patellar ligament, cartilage and the meniscus) all assist in stabilising the knee to enable it to function correctly.
The knee joint operates as a hinge joint meaning flexion and extension are the only movements typical of the joint.
Knee Changes During Growth
During growth we see many different changes to the knee, one of the key changes is the position of the femur and the tibia.
The first developmental change you may notice is bowed legs (usually from 0 – 2 years of age). Bowed legs are seen when the knees extend out or away from the midline of the body.
The next normal phase of development occurs when the knees move towards the midline commonly referred to as knock knees (usually seen between the ages of 2 – 7 years of age).
Then at the age of approximately 7 years the knees tend to straighten up and form their final shape. Sometimes, children develop outside these levels of normality.
If you are concerned about your child’s development or gait, book an appointment with one of our podiatrists.
Growing pains occur as children grow. This is because the bones grow first and the muscles need to catch up.
Osgood Schlatters Disease is an example of a growth disorder of the knee, it usually occurs between the ages of 10 – 15 years in active children, pain is felt below the knee on the tibia (shin bone) where the patella tendon attaches.
Pain is a common reason why we see a doctor. Usually, podiatrists start seeing children during early development for complications associated with growth and gait.
Highly active young athletes can develop knee pain, which usually presents in the front of the knee due to poor tracking of the patella (kneecap), commonly referred to as patellofemoral pain syndrome.
Osgood Schlatters Disease, is another condition effecting the young athlete (10 – 15 years), this occurs at the apophysis of the tibia over the tibial growth plate just below the knee.
Children’s knee pain commonly stems from bone growth, muscle imbalances, poor biomechanics and even muscle tightness in the hip and legs.
This can result in increased stresses on the knee joint, increasing load on the medial collateral ligament, posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), lateral collateral ligament, and creating meniscal trauma or ACL injury. This stress commonly increases the risk of knee injuries and knee pain.
As we age into our early 20’s, our growth plates are fused, and on into our 30’s and 40’s bone growth is complete and muscle tightness is largely driven by poor biomechanics, history of trauma and age related changes. History of knee trauma will largely affect joint integrity.
Trauma can involve previous sporting injuries, motor vehicle accidents , work injuries and knee surgery.
Abnormal biomechanics can result in knee trauma further developing into osteoarthritis which is a decay of the bones and loss of joint integrity due to wear and tear or trauma. Because of the changes in the bone, the knee joint will become unstable and increase the level of fluid in the joint.
Knee joint instability will also result in ligament, tendon and muscular tightness. This tightness will cause most of your pain which is commonly exacerbated through moving up and down stairs and walking on unstable surfaces. Changes in temperature can bring on arthritic pain particularly in the knees.
Conditions Affecting The Knee
When you suspect knee problems it is worth having it medically reviewed by a podiatrist, health professional or doctor, to gain the right advice and health information to avoid surgery.
The following knee problems causing knee pain include:
Conditions Affecting The Knee
Arthritis is a debilitating condition that can cause knee problems and severe knee pain. Arthritis results in the decay of bones, reduced and uneven wear of cartilage and directly effects the integrity of the joint, bringing on symptoms of joint stiffness and causing knee pain and knee swelling. This group includes common conditions like osteoarthritis, rheumatoid arthritis, gouty arthritis (where uric acid crystals form in the joint causing erosion), psoriatic arthritis to less common conditions like juvenile arthritis and septic arthritis.
Osteoarthritis is the most common form of arthritis resulting from increased activities and general wear and tear of joints. This form of arthritis can commonly be managed through reduced activities, managing and preventing sports injuries, protecting ligament injuries, strengthening and toning of selected muscle groups and the use of aids assist in daily activities. Weight loss can reduce pain associated with knee osteoarthritis in obese people.
Book an appointment with a podiatrist at Erica Dash Podiatry for gait and biomechanical assistance if you are suffering from knee osteoarthritis.
Rheumatoid arthritis is an autoimmune condition where pannus (granulation tissue) infiltrates the joint space which will cause damage to cartilage, tendons, ligaments and bone. The symptoms of the joint will often present with stiffness and swelling.
Treatment commonly involves antimetabolic medication to manage associated problems. Some doctors recommend fish oil for treatment of symptoms such as stiffness, however contraindications may exist with other medication.
Arthritic conditions will be chronic in nature and present with muscular pain in the early stages and advance into the joint as the condition progresses and cartilage deteriorates. Knee pain will be localised to the knee joint and will impact soft tissue around the knee resulting in tighter and weaker muscles.
Treatment options can involve physical therapy, particularly dry needling to manage muscular tightness, focal shockwave therapy to remove fluid from the joint and orthotic therapy to assist with knee stabilization.
It is important to remember to have your orthotic correctly fitted by a Podiatrist from Erica Dash Podiatry otherwise you can risk having the orthotic overcorrecting your gait and this will lead to tighter muscles in the hip, gluteals, inner thigh and foot (this will cause more pain elsewhere). Surgery is a solution of last resort.
B. Runners Knee
Runners knee is a common soft tissue injury affecting the outside (lateral side) of the knee. It is the result of tightness in tissue in the distal area of the iliotibial band, dysfunction of vastus lateralis and tightness in the gluteal region. Runner’s knee responds quickly to dry needling therapy as dry needling quickly reduces muscular tightness and will typically enable you to return to your normal activity within a couple of days.
This can commonly resolved through rest, addressing biomechanics and performing regular stretching and massages of the lateral sections of the upper leg.
C. Bakers Cyst
This is a swelling of fluid behind the knee. This does not necessarily cause pain and can be diagnosed through ultrasound or on x ray. It commonly appears from an arthritic knee or trauma to soft tissue around the knee.
To assist the pain associated with a bakers cyst, joint exercises, stretching and strengthening can be prescribed. Sometimes your podiatrist may suggest a course of dry needling to correct muscle imbalances.
D. Muscle Weakness
One of the common causes of knee pain is muscle weakness. This can arise through changes in muscle function, trauma, abnormal biomechanics, reduced activity and reduced nerve supply. Pain associated with knee osteoarthritis is often a result of the quadriceps muscle group weakening.
To assist the pain associated with muscle weakness, a muscle strengthening program is suggested.
E. Muscle Tightness
Muscle tightness can cause knee pain in the older population, active people and growing children. Symptoms can be varied from pain behind the knee, pain at either side of the knee, or pain at the front of the knee.
If muscle tightness is not resolved cartilage will often break down creating arthritic complications and knee injuries and resulting in chronic knee pain.
F. Knee Bursitis
A bursa is a fluid filled sac that is designed to reduce friction and cushion surrounding tissue. A bursa can, at times get inflamed creating pain and swelling in the local area.
The area that is commonly affected is just below the knee cap. A bursa can be irritated through repetitive trauma commonly associated with sports and kneeling, friction and inflammatory conditions.
G. Patellar Tendinitis
The patella tendon attaches the patella to the tibia (shin bone). The patella tendon becomes inflamed when the site experiences overuse and trauma. This can be relieved through a visit to your doctor or podiatrist.
H. Patella Femoral Pain
Patellofemoral pain arises when the patella (kneecap) does not track correctly through its position in the thigh bone, resulting in bone on bone friction, joint swelling and chronic knee pain. It is particularly painful when walking down stairs and hills.
With this condition, people commonly see tightness in the outer thigh, weaknesses in the inner thigh, problems with biomechanics like flat feet, genu recurvatum (backward bending knees) and genu valgum (bow legs).
When patellofemoral pain conditions become chronic, osteoarthritis and effusion will be evident on x rays with reduced cartilage. This condition can be diagnosed through distracting the knee cap and eliciting pain.
Managing Chronic Knee Pain
Managing knee pain is crucial in maintaining the quality of the knee joint and your quality of life.
If you find that the pain does not resolve it is important to gain professional advice from a Podiatrist, Physiotherapist or Doctor and be wary of non medically trained assistants like those found at ‘The Good Feet Store’ or general retailers.
Having your knee medically reviewed by a health professional is important for longevity.
At Erica Dash Podiatry we can assist in treating knee pain by prescribing various muscle strengthening programs, stretching and implementing coping strategies to minimize risk factors.
Risk Factors To Knee Injury Involve:
a. Genu Recurvatum (where the knee hyper extends or bends backwards)
b. Genu Valgum (knock knees)
c. Genu Varum (bowed legs)
These variants to biomechanics will further load ligaments and muscles and increase knee stresses.
How Do I Know If My Knee Pain Is Serious?
Pain is an indicator that the knee is under stress. Pain that does not resolve within a week is a good indicator to see a doctor or allied health professional.
What Can Erica Dash Do For My Knee Pain?
As allied health workers we aim to provide a sustainable alternative to surgery.
Our years of experience may allow you to achieve a non-surgical result.
These therapies include but not limited to (see below):
As you would be aware, knee pain at times can be disabling and reduces your quality of life if not addressed in a timely manner.
At Erica Dash Podiatry we can assist with managing your knee pain effectively through correctly fitted orthotics. These orthotics are casted to your feet and modifications made according to your prescription. These are then fitted to your shoes while you wait.
Dry needling can assist in managing your knee pain. Knee pain is commonly the result of muscles being very tight.
This muscle imbalance will cause tracking issues of the kneecap and create knee pain or even further knee injury.
Dry needling is the use of needles (similar to acupuncture) of varying lengths targeting specific trigger points within a muscle belly. The presence of the needle ‘turns off’ the muscle cells resetting and lengthening the muscle.
Shockwave therapy is the use of acoustic waves to treat ailments. The shockwave assists in reigniting your natural healing potential.
With two types of treatment options, focal shockwave dealing with bone and joint changes and radial shockwave dealing with muscular, connective tissue and fascia. The team at Erica Dash Podiatry can offer a successful treatment.
Knee strengthening will improve muscle tone around the knee joint. These exercises have been medically reviewed to improve joint stability, reduce tired muscles and reduce knee pain.
- Bridging will assist in building stronger core and gluteal muscles. You perform this by laying on your back with your knees bent and feet flat on the ground. Raise your buttock off the ground and squeeze your buttocks when you reach the top and hold for 30 seconds. Slowly drop your buttock to the ground. REPEAT.
- One leg standing. This is best performed in a doorway as balance is key. Standing in the doorway, stand on one leg. Hold for 20 seconds. Repeat on the other side. The difficulty of this exercise can increase by bending the weightbearing leg slowly.
- Lunges. Are performed by placing one foot 1m in front of the other . Bend the front knee forward while the back knee bends down. Squeeze the buttock while bending the back knee. Move the back foot to a similar position in front of the other foot. Bend the knees as previously and REPEAT. This exercise assists in strengthening the quads as wells as the gluts.
- Butterfly stretch. Sit on your buttocks with your soles of the feet touching and your knees pointing away. Using your elbows or hands push your knees down towards the ground. Hold for 30 seconds. REPEAT.
Shockwave is a great alternative to treatments such as dry needling if you’re needle phobic and not keen on dry needling. We also have effective treatment offers for kids.