MotionPlus Monthly: Is knee pain, purely from the knee?

If you have read some of my blogs you will know that there are multiple diagnoses for knee pain, let me rattle off a couple, jumpers knee, runners knee, patellar tracking issues, ACL ruptures just to name a couple. "Touch wood", hopefully, neither of these of these ever happen, as the rehabilitation time can vary.  

The structure of the knee

The knee structure is a modified hinge joint consisting of four bones, the distal femur (thigh bone), the tibia (shin bone), the fibula (calf bone) and the patella (knee cap). These bones consist of multiple muscle attaching via their tendons, furthermore, it has multiple ligaments, bursas and a bit of cartilage (meniscus) that helps the knee articulate. This joint is a stable joint and allows for limited ranges of movement (R.O.M). 

As discussed earlier there are many bones, ligaments tendons and a meniscus that provides the knee with support. Furthermore, multiple different diagnoses associated with knee pain. However, when diagnosing knee pain, ideally your therapist should be looking further aboard, what is happening in the hip what is happening in the ankle.

The joint by joint approach

The concept of a joint by joint model as shown to the side.  This model discusses how joints work in unison to provide either stability or mobility to the areas below and above, as this helps with locomotion.

For example, if the ankle is made for mobility, and the next joint in the body's chain is the knee, which must be a stable joint to accommodate the mobility of the ankle. Therefore the hip will accommodate the knee.

Here is an example. If a person who plays netball or  a person that runs hurts their ankle, typically the first thing reaction is to reach the brown strapping tape, a brace or Kinesio tape. This tape stabilises the ankle structure, as these products are made to offer support to the ankle joint. However, the brain which is in charge doesn't understand this intervention as this is a foreign structure and now becomes confused for a couple of reasons. 1) There is damage at the ankle, 2) the ankle has somehow increased its stability. The brain in reacts to this, will find the mobility which has been loss via the ankle injury elsewhere, which means somewhere along the body chain the body will find its mobility. Therefore, the knee joint becomes mobile, thus predispose itself the body to injury.

What should your therapist be thinking?

The approach mention above is a great way to in not just treating the symptom, but targeting the predisposing factors ( what susceptibility a person to injury) and maintaining factors (the influence that is keeping a person from healing). These are an important factor because the body is a self-healing machines, structures, the mechanism . For example: if someone stubs their toe it heals by itself. Therefore, if some hurts  the body is going to try repair itself. However, what happens if it keeps trying to heal itself, but the actual issue is elsewhere? Then its a case of looking further aboard what are the joints below and above doing? Furthermore, what is the corresponding muscle that interacts with those joints doing?

MotionPlus Mobility and Movement

Mobilise and strengthening tools that are needed are; a kettlebell, lacrosse ball, foam roller, tennis ball and a light and a medium resistant band.

All of these muscles and tendons in the picture are fair game to mobilise and strengthen, for the benefit of the knee.

BARE in mind, when I talk about mobilisation I are going to use the 2-minute rule. Mobilising the areas of interest for 2 minutes before moving on to the next area. 

How might this be done.  Either sit on one of these mobilisation devices or lay on them. The most important thing is to include movement. Example, if the lacrosse ball in underneath the calf muscle, place a little bit of more weight on the ball, from either the other leg or have a friend place a little bit of weight on this ball. Next move the foot up and down, side to side. This is just one example of what can be done

Other exercises that can help, 

Clams 

• Lie on your side, with legs stacked and knees bent at a 45-degree angle.
• Rest your head on your lower arm, and use your top arm to steady your frame. Be sure that your hipbones are stacked on top of one another, as there is a tendency for the top hip to rock backward.
• Engage your abdominals by pulling your belly button in, as this will help to stabilise your spine and pelvis.
• Keeping your feet touching, raise your upper knee as high as you can without shifting your hips or pelvis. Don’t move your lower leg off the floor.
• Pause, and then return your upper leg to the starting position on the ground

Form check: It’s important to make sure you’re opening your hip throughout the move rather than rotating your torso elevate your knee.

Fire Hydrants

• Start on all fours with your hands under your shoulders and your knees under your hips. This is your starting position.
• Keeping your hips level and your core engaged (see below for more on that), raise your right knee out to the side as high as you can, and hold for 1 second.
• Lower your right leg to return to the starting position, and repeat for a total of 15 reps. Then switch sides and repeat the sequence.

Form check: It’s important to make sure you’re opening your hip throughout the move rather than rotating your torso to elevate your knee. Keep both arms straight, and try not to rock or tilt your hips.

Banded Good Mornings. 

• Set up similar to a Back Squat with a stance between hip- and shoulder-width. Place the bar across your back in the high- or low-bar position. Grip the bar tightly, pull the bar into your body, take a deep breath in and tighten your core.
• Break at your hips to initiate the movement. Continue pushing your hips back until your torso is at about 15 degrees above parallel. Your shins should remain vertical and your knees should be slightly bent at the bottom of the movement.

Form check: One of the worst mistakes is trying to go to parallel or even lower. Instead, stop at about 15 degrees above parallel. Do not try the straight-leg version of the Good Morning.  Until you have mastered the a bend leg good morning. 

Wrap up

In conclusion this is not medical advice, this is a taster to help understanding how the body works, and if pain continues seek medical advice. better yet if these isn't a problem there,  why not mobilise and move to try prevent injury!

For further details why not click below and read one of my other posts