Introduction to Knee Pain
Knee pain can occur in the front, back or sides of the knee, and may be accompanied by pain spreading into the thigh or the lower leg.
Knee pain affects patients of all ages and has many different causes. It can come on from a specific injury, such as whilst playing sport or from a fall, or can occur more gradually with no obvious initial cause.
Common conditions that are associated with knee pain include osteoarthritis, patellofemoral pain and ligament injuries.
In almost all cases, knee pain responds well to conservative treatment and does not need surgery.
Chiropractors are trained to determine the likely cause and diagnosis of your knee pain and advise you on the best way to manage it.
Knee pain can be related to a specific diagnosis, such as a ligament strain, but it can also occur without damage to a specific structure.
This is often related to an imbalance in the function of the muscles in the knee, hip, ankle or foot and can often be managed very successfully with home exercises.
Types of Knee Pain
Traumatic Knee Pain
Traumatic knee pain is pain that has been caused by a specific injury or fall.
The severity of the injury can vary significantly, from a mild ligament sprain or strain that should settle in 1-2 weeks, to a fracture, so it is important that these injuries are assessed properly so that they can be managed correctly.
Indicators that you should attend A&E or a minor injuries unit after a traumatic injury are:
- An inability to put weight through the affected leg for 2 consecutive steps
- An inability to bend the knee to 90°
- Worsening of knee pain within 5-7 days of initial injury
- Significant swelling shortly after injury
- Being aged 55 years or older
Examples of common traumatic knee injuries include
- Cruciate ligament tears
- Medial collateral ligament tears
- Tibial plateau fracture
- Dislocation
Having traumatic knee pain does not always mean you need surgery.
More and more it is being realised that the body is very quick to adapt to and repair injuries, and many traumatic knee problems respond better to correct rehabilitation rather than immobilisation or surgery.
Non-traumatic knee pain
Knee pain in the absence of clear injury is classed as non-traumatic. Often non-traumatic knee pain comes on gradually.
None traumatic knee pain is much more common than traumatic knee pain and usually responds well to conservative management.
There are still some situations where non-traumatic knee pain may require rapid attention, so it is advised to contact your GP or 111, if you have any of the following symptoms:
- Sudden onset of swelling, redness and heat in the knee
- Any associated fever or flu-like symptoms
- Sudden onset of inability to bear weight on the affected leg
As long as none of the above symptoms are present, then seeing a chiropractor, or other manual therapist, about your knee pain is totally safe.
Examples of common non-traumatic knee problems include:
- Osteoarthritis
- Patellofemoral pain syndrome (PFPS)
- Hyper/hypomobility
Most often, non-traumatic knee pain involves more than one structure, or is not associated with obvious damage, and so does not require a diagnostic label.
Do I need an x-ray or a scan?
Most knee pain does not require an x-ray or a scan. Unless you have any the symptoms indicated above, it is unlikely that they will be required.
Having an x-ray to look for things like arthritis is usually not advised unless symptoms have persisted despite trying other forms as treatment such as pain killers, manual therapy and a targeted and sustained exercise programme.
The number of false positives found on scans is very high.
A recent study found abnormalities on MRI scans in 97% of a group of 115 asymptomatic adults.
Unless there is an indication of a more sinister cause to your knee pain, or it is not improving despite treatment, x-rays and scans are usually not needed.
What Will a Chiropractor Do?
Correct diagnosis of your knee pain requires a detailed understanding of your condition and your medical history.
After going through this with you, a chiropractor will provide a thorough neuro-orthopaedic examination. This will help reveal the exact cause of your knee pain, as well as revealing the underlying factors that might have predisposed you to the problem.
All GCC registered chiropractors complete a 5-year full time degree, including a year of supervised practice in order to ensure they can do this effectively.
The physical examination of your knee will also extend to looking at the movement and muscular control of your foot, ankle and hip, as issues in these areas can sometimes have a knock-on effect on the knee joint.
Once your chiropractor has done all of this, they will explain their findings to you and advise what your best options are for managing it.
They will take in to account your preferences regarding treatment, your goals and the best evidence to tailor your treatment plan to your needs.
What are the treatment options for knee pain?
Once your chiropractor determines what the likely cause of your knee pain is, and that it is suitable for manual therapy, there are lots of options available!
Soft tissue techniques such as massage and trigger point release, dry needling (a form of medical acupuncture), mobilisation of the joints in the knee, hip, foot or ankle and kinesio-taping are all brilliant options for knee pain.
However, the one element of treatment that is essential for almost all knee pain is a gradual and targeted programme of home exercises.
The type of exercises, their difficulty, and how far they are progressed will depend on your goals.
You need to do much more work to run a marathon than you do to be able to climb the stairs or walk to the shop, but exercises really are the lynch pin to helping knee problems recover and preventing them from recurring.
If conservative treatment options such as manual therapy and exercises are not successful in getting your knee pain under control, then the next step is to look at more invasive treatments.
This is the point that imaging may be a good idea and usually involves referral to an orthopaedic surgeon.
As long as there are no obvious structural changes, such as a ligament tear or rupture, the first line of invasive treatment is often an injection.
In most cases and injection would consist of a corticosteroid (a highly potent anti-inflammatory) and a local anaesthetic.
If this is also unsuccessful then there are surgical options available – the type of surgery used varies depending on what is causing your knee pain.
Conclusion
Broadly speaking, there are two types of knee pain: traumatic and non-traumatic.
Both usually respond to conservative management, but thorough assessment is essential to determine the correct course of action.
Chiropractors are trained to examine and treat knee problems, and can refer you to other specialists if conservative treatment or further investigation is necessary.
Most people with knee pain get better, and few require surgery.
