Knees are needed

Knee pain is a common issue that affects people of all ages. The knee is a hinge joint providing our body with flexibility, support, and a wide range of motion for our legs.(1) This weight-bearing joint is exposed to significant stress as we perform our usual routines. It also serves a large role during activities such as walking, sports, and exercise.

The knee is one of the largest joints in the body and made up of a series of bones, ligaments, cartilage, and tendons. The knee is a team player who works with the hip, ankle, and foot to function. The knee’s proper movement allows 135 degrees of knee flexion. This range of motion gives you the ability to kick a soccer ball and perform other activities you love.

But how does the knee work? What does it do in the body, and is it susceptible to injury? What does it mean if someone has knee pain? Is knee pain treatable? To answer these questions, it is important to understand the structures inside the knee and how they move and protect the joint.

Knee anatomy

The knee joint consists of several bones: the kneecap (patella), the shin bone (tibia), and the thigh bone (femur).

Between the bones are two rubbery, C-shaped cartilage called the meniscus that sit on the tibia to cushions and protect the bones.2 The meniscus transfers and absorbs internal and external forces on the joint. This function lets us jump on trampolines, walk downstairs, and apply our body weight onto the knee without pain. Athletes are especially prone to injuring the meniscus when too much force is applied to the joint.

Another type of cartilage lines the bones of the knee where they connect. This slippery cartilage, called articular cartilage,2, allows for smooth movements of the bones of the knee joint. Articular cartilage protects bone surfaces from rubbing and grating on each other. This soft tissue structure prevents wearing down or degeneration of bony surfaces.

Within and surrounding the knee are several important ligaments connecting bone to bone and tendons connecting muscle to bone. Muscles span from the hip, butt, and pelvis and attach to the knee to stabilize and support knee function. The kneecap is a sesamoid bone attached on the bottom to the patellar ligament and the top by the quadricep tendon. When the quadricep muscle contracts it serves as a pulley giving the knee a mechanical advantage.

Is the knee prone to injury?

Normal aging, repetitive activity, traumas, and sudden movement can cause a knee injury. This is due to the knee’s role in lower extremity (leg) movements and the combination of bone surfaces together.

Not all knee pain feels the same, either. Some pain is described as dull and achy, sharp, burning, pulling, tight, or sore. Symptoms can also be felt deep in the joint or on the surface of the skin.

Some injuries and conditions that occur at the knee are:

• Arthritis
• Fracture
• Tendinitis
• Bursitis
• Torn cartilage
• Dislocated kneecap
• Sprained ligaments
• Meniscus tears
• Muscle tears
• Patellofemoral pain syndrome

Problems in the knee can result from trauma or a medical condition.(3) A knee injury can also exist without pain. You may have symptoms of a knee condition such as clicking, popping, and locking of the knee. You may notice your knee has decreased overall movement, or specific movements that cause discomfort.

Knee pain may not involve the entire knee, either. Some individuals report having knee pain on one side of the knee. Knee pain can occur in the front, on the back, on the inner or outer sides, or deep within the knee joint. Sometimes pain can prevent proper movement and functioning, such as weight-bearing, on the knee.(4) The location of the pain is an important characteristic regarding knee pain treatment.(4,5,6)

Who is at risk for developing knee pain?
Several risk factors increase the likelihood of developing a knee injury. These include increasing age,(4,5) being overweight, certain diseases like gout or autoimmune conditions, previous history of injury, lack of exercise, and more.(3)

When should I see a doctor?

You should make an appointment with a musculoskeletal specialist if you have:

• Difficulty or loss of ability to walk comfortably on the affected side
• Injury that causes knee deformity
• Swelling of the joint or the calf area
• Knee pain that persists longer than several days
• Difficulty or loss of ability to bend the knee
• Any other unusual symptoms prompting immediate medical attention

How is knee pain treated?

Knee pain and knee injuries are best diagnosed with a proper evaluation and assessment. A doctor of chiropractic or physical therapist are musculoskeletal specialists and the right person to assess the most common knee conditions. If the doctor needs more information, he or she may include imaging such as x-rays to visualize bones and joint spaces or an MRI to visualize soft tissues like ligaments and muscles for possible injury. Many knee diagnoses are based on medical history and physical examination alone.

Treatment options will depend on the severity, duration, and frequency of the pain and the cause of the condition. Some people seek treatment for knee conditions even without dysfunction to improve movement and quality of life.(7,8)

Conservative care can be very effective in treating different forms of knee pain. Thankfully, there are many options available to a person. Conservative care may include specific stretches for muscles and tendons of the knee, joint mobilization, specific exercises to strengthen the surrounding muscles and tendons, hands-on soft tissue work into the muscles and fascia, changes in exercise routine or modifications at work or home, home exercise, and stretching programs, and more.

Schedule an evaluation

If you’re experiencing knee pain, it may go away on its own in a few days. However, if the pain does not go away or it keeps returning, then it’s time to call and make an appointment for a proper evaluation. Let’s get you back to living your best life.

References

1. Zeller, J.M., Lynm, C., and Glass, R.M. (2007). Knee Pain. JAMA. 2007;297(15):1740.
2. Netter, Frank H. Atlas of Human Anatomy. 1906-1991. Philadelphia, PA: Saunders/Elsevier, 2014.
3. “Causes and tips for coping with chronic knee pain.” (2018). Medical News Today. Retrieved March 2021 from https://www.medicalnewstoday.com/articles/311308.
4. Farrokhi, S., Chen, Y. F., Piva, S. R., Fitzgerald, G. K., Jeong, J. H., & Kwoh, C. K. (2016). The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults With Chronic Knee Pain: Data From the Osteoarthritis Initiative. The Clinical Journal of Pain, 32(6), 463–470.
5. Foroughi, N., Smith, R.M., Lange, A.K., Baker, M.K., Fiatarone Singh, M.A., Vanwanseele, B. (2010). Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis. Knee. Jun;17(3):210-6.
6. Farrokhi, S., Piva, S.R., Gil, A.B., Oddis, C.V., Brooks, M.M., Fitzgerald, G.K. (2013). Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis. Arthritis Care Res (Hoboken). Apr;65(4):544-51.
7. Rubin, B.R. (2005). Management of Osteoarthritic Knee Pain. J Am Osteopath Assoc;105:S23–S28.
8. Frese, T., et al. (2013). Knee Pain as the Reason for Encounter in General Practice. International Scholarly Research Notices Hindawi. Retrieved March 2021 from https://www.hindawi.com/journals/isrn/2013/930825.

Adapted from The Chiropractic Success Academy.