Knee pain is a common complaint and may result from various causes such as injury, inflammation, arthritis, or imbalanced biomechanical function.
Many types of knee pain respond well to self-care measures, physical therapy and exercise (1).
As osteopaths, we aim to identify the structural contributing factors to your knee symptoms. We consider the knee as well as the structures above and below it.
Osteopaths consider the whole person – as it goes in the old folk song indeed is true, “the ankle bone’s connected to the shin bone, the shin bone’s connected to the knee bone, the knee bone’s connected to the thigh bone, the thigh bone’s connected to the hip bone, the hip bone’s connected to the back bone”! (2)
Once the contributing factors are identified, treatment may involve hands on work to rebalance alignment and improve range of motion, Low Level Laser Therapy to influence pain and inflammation, and exercise advice to address muscle flexibility and control.
While there are numerous causes of knee pain, three common culprits are:
- Patello-femoral pain
- Chronic degenerative meniscal tears
- Osteoarthritis (3)
Patello-femoral pain syndrome
Patello-femoral pain syndrome is a blanket term for pain around or under the kneecap, and can also be called Patellar tracking dysfunction, Runner’s knee or Jumper’s knee. Pain occurs at the front of the knee where the kneecap meets with the thigh bone, and symptoms can range from a dull ache to a pinch felt behind or around the kneecap.
The pain is caused by irritation, which can lead to inflammation or swelling of any of the structures which make up the patello-femoral joint including cartilage, tendons and ligaments. Furthermore, imbalances in the structural alignment of the legs, and tight or weak muscles influencing the knee can alter the alignment and movement of the patella and lead to irritation, bringing about symptoms.
Once the contributing structural factors are identified, treatment may involve hands on work to rebalance alignment and improve range of motion, and exercise advice to address muscle flexibility and control.
Chronic degenerative meniscal tear
The knee joint contains two pieces of cartilage that act as rubbery cushions within the joint and are called the medial and lateral meniscus. These structures can be damaged or torn by traumatic injuries, or through the process of ageing, gradually deteriorate over time and become thinner and prone to fraying and degenerative tears. Symptomatically this typically presents with a puffy or swollen knee, pain or a twinge felt deep inside the joint, and possibly a clicking, popping or locking sensation. These symptoms may inhibit your physical activity and depending on the extent and severity of the problem, may take a variable time to resolve, and may recur over the course of months or years. The current approach to managing mensical tears is through conservative treatment including management of inflammation, physical therapy and exercise. In our experience at Balmain Osteopaths we have found Low Level Laser Therapy to be an effective tool for managing the inflammation and pain associated with a flare up of a meniscal tear, which may be complemented by hands on treatment and supported by exercise in order to return patients to their regular activities.
Most often osteoarthritis (OA) affects people over the age of 50 however it can also occur in younger individuals, especially if there is a history of knee trauma which can predispose the joint to wear and tear. Classic symptoms are knee stiffness and decreased mobility, swelling and aching pain, which is typically worse in the morning or after periods of inactivity.
Whilst OA is commonly classified as a degenerative problem of ageing, an underlying driver of the process is now understood to be chronic lowgrade inflammation of the joint. OA is not one single disease but is an outcome of chronic joint inflammation combined with the predisposing factors of age, joint trauma, altered biomechanics, and obesity (4).
At Balmain Osteopaths our focus is to improve symptoms and function within the patients’ tissues capacity for change. Our experience has shown us that we may able to influence altered biomechanics through hands on osteopathic care, and to reduce the pain of chronic joint inflammation by applying Low Level Laser Therapy to the knee joint.
The treatment of OA of the knee is by no means a quick fix, but requires time, effort and commitment to treatment and management advice. In some cases your knee may require surgical repair, however this depends on the cause, and in many cases should be considered a last resort when conservative treatments have been unsuccessful. The British Medical Journal favors conservative management and recommends against arthroscopic (keyhole) surgery in patients with degenerative knee disease (5), and knee replacement is reserved for patients with severe disease after non- operative management has been unsuccessful (6, 7).
- Mayo Clinic. (2019). Knee Pain. Retrieved from https://www.mayoclinic.org/diseases-conditions/knee-pain/symptoms-causes/syc-20350849
- Wikipedia. (2019). Dem Bones. Retrieved from https://en.wikipedia.org/wiki/Dem_Bones
- Harvard Health. (2019). Oh, my aching knees. Retrieved from https://www.health.harvard.edu/pain/oh-my-aching-knees
- Sokolove, J. & Lepus, CM. (2013). Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskeletal Dis. Apr; 5(2): 77-94
- Siemieniuk, RAC. Harris, IA. Agoritas, T. Poolman, RW. Brignardello-Petersen, R. Van de Velde, S. Buchbinder, R. Englund, M. Lytvyn, L. Quinlan, C. Helsingen, L. Knutsen, G. Olsen, NH. Macdonald, H. Hailey, L. Wilson, HM. Lydiatt, A. & Kristiansen, A. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guildeline. BMJ 2017;357;j1982
- McGrory, B. Weber, K. Lynott, JA. Richmond, JC. Davis, CM. Yates, A. Kamath, AF, Dasa, V. Brown, GA. Gerlinger, TL. Villanueva, T. Piva, S. Hebl, J. Jevsevar, D. Shea, KG. Bozic, KJ. Shaffer, W. Cummins, D. Murray, JN. Donnelly, P. Patel, N. Brenton, B. Shores, P. Woznica, A, Linksey, E. & Sevarino, K. (2016). The American Academy of Orthopaedic Surgeons evidence- based clinical practice guideline on surgical management of osteoarthritis of the knee. J Bone Joint Surg Am 2016;98:688-92.
- Skou, ST. Roos, EM. Laursen, MB. Rathleff, MS. Arendt-Nielsen, L. Simonsen, O. & Rasumussen, S. (2015). A randomized, controlled trial of total knee replacement. N Engl J Med 2015;373:1597-606