Author: Bryan Lang, PT, DPT, MHA, CSCS, Cert.DN: Doctor of Physical Therapy, Business Owner, Associate Professor, and Blog Contributor. Explores common client questions, helps find solutions for every day functional health concerns, and interprets difficult theories in healthcare rehabilitation. Committed to life-long learning and education. Learn more about Bryan on Google+.
Knee pain is a common problem that I see in the physical therapy clinic. The knee is an incredibly important joint for our ability to ambulate in life and, because it is a load bearing joint, (meaning it supports your body weight as you walking) it is susceptible to injury. Let's go through a couple of scenarios.
Scenario 1: “I recently started increasing my running to train for an upcoming marathon. I've also added more hills to my program. I started getting getting pain into the front of my knee. Sometimes it's just at the end of my runs, but sometimes I feel it even going downhill. I think it's getting worse.”
Answer 1: This woman was 28 years old and in good health. She reported no traumatic injuries to her knee before this event. She did not have a history of back or hip pain either. After performing an examination and listening to her story, it was clear that this was an issue called patellar tendonitis. Patellar tendonitis occurs when the tendon that attaches your quadriceps (the muscles in the front of your thigh) to the shin bone becomes over-worked. This woman started increasing her running, which led to micro-tears in her patellar tendon. Normally, these small tears will heal on their own, but she continued to increase her running to train for the marathon. Her patellar tendon was never able to fully heal. She feels more pain running down hills because it places the largest strain on this area. Your quadriceps is extremely important in controlling how hard you land and how much your knee bends during downhill running. When the quadriceps has to pull hard to control this motion, your patellar tendon get's pulled hard too, and the tears can increase. Furthermore, she was likely more susceptible to this injury secondary to having tight quads and weak hip and core control. So even though her pain was in her knee, her treatment consisted of hip and core strengthening because the knee takes the load that the hips and spine cannot control. After physical therapy and some activity modification, the patient was able to complete her marathon without knee pain.
Scenario 2: “I started getting pain on the inside of my knee and I've also noticed some swelling. The funny thing is that I don't remember doing anything to injure it! I've had some knee pain off and on. I've even had pain that was similar to this, but it it went away on it's own and it was not nearly this bad. I don't know what's going on!”
Answer 2: This patient is a lot harder to treat as there are many things that can cause pain on the inside of the knee (even the back can cause it!). This is where subjective and objective tests are really important to figure out the problem. Subjectively, this man was 55 and slightly overweight. He reported no history of back or hip pain, and that he had not started anything new in his life that would cause more wear on his knees, but it he did own a construction company and was up and down on his knees all day. Objectively, he did have intra-articular swelling (swelling within the joint), pain to touch on the inside of his knee, and pain with a little “click” on a special test for meniscus damage. After putting this all together, it was apparent that this man tore his medial meniscus in his knee. These tears are known to happen insidiously (gradually without one specific cause) in the 5th and 6th decade of life. It is also known that small meniscal tears do as well with physical therapy treatment alone than with surgery and physical therapy treatment after! After 8 weeks of rehabilitation, the patient had no complaints of pain, and was actually performing more general exercise training outside of physical therapy to help decrease his weight.
With each of these examples, there was a little more to the story about what I tested and issues that I discovered that were not included in an effort to preserve brevity. If you have any knee pain, please feel free to message us on Facebook, or call into the clinic to talk. We can get you back to a pain free lifestyle.