Knee pain is one of the most common issues we see here in the Vail Valley, especially with our multitude of active people, skiers, bikers, runners, and other fitness devotees. A lot of knee pain comes from trauma such as ligament tears and sprains, meniscus tears or other impact traumas. But, frequently knee pain is diagnosed as “overuse” or repetitive stress. Common diagnoses that fall into these categories are tendinitis, bursitis, patellofemoral pain syndrome, IT Band syndrome, or just knee pain.
The knee is a joint that’s motion and stress are highly influenced by the surrounding joints, muscles, and other tissues. So frequently one of these other areas is actually not working properly, and asymptomatic and its extra stress is given to the knee. Think of 3 guys carrying heavy furniture. If one guy is not pulling his weight, who gets hurt? The guy who is not doing his job or the other guys who have to lift more?
This becomes an issue in treatment, because frequently knee pain can be non-specific and testing does not give us a conclusive answer of what tissue may be the problem. And even when a specific tissue is irritated local treatment may settle down the problem, but pain and inflammation may return when activity is ramped up again. The goal of therapy should be to figure out and correct the areas that may be leading to this extra stress.
Here are 5 areas that should be considered that may affect your knee pain.
- Your Hips: Your hips are the joint just above your knees. They are important stabilizers of your thigh bone (femur) which ends in the top part of your knee joint. If you have altered hip mobility or stability this can alter the angles that your knee is placed in when you load it up and bend it such as in squatting, stairs, walking, and running. Frequently we see a situation called valgus collapse. This is a situation where when you squat, rather than bending in a straight line your knee “collapse” inward and may “kiss” each other in extreme cases.
This movement pattern places abnormal stress on your knees, and may be leading to pain. Altering hip function through mobility activities or neuromuscular training may be able to change this movement pattern.
- Your Ankle: Your main ankle joint (talocrural joint) allows the movement of pointing your toes and pulling your toes up to you. It is also the 1st joint below your knee. If you don’t have enough dorsiflexion, which is pulling your ankle up toward you, then when you are required to bend forward in squatting and striding your leg may have to go into valgus collapse to compensate. To test this get down on one knee in a lunge posture. Keep your knee over your toes and bend forward at the ankle. Your knee should stay straight over your toes and go 4 to 5 inches past your toes.
If you aren’t going that far, then you need to either stretch your calf or get your ankle mobilized to return this normal mobility.
- Your Feet: Two areas of your feet can influence your knee. One is over pronating feet which are frequently known as flat feet and a stiff Great Toe. If your feet are pronating too much then this again can lead to valgus collapse. Sometimes flat feet are structural and little can be changed, but some of the time the can be a result of long term valgus collapse causing your feet to over pronate. Neuromuscular training of the limb and arch of the foot can be helpful in these cases and orthotics will change how the foot is oriented and may change your knee pain also. In the case of a stiff Great Toe, if your toe is not extending as you walk or run, again your foot may need to compensate rolling you into valgus collapse. Stretching or mobilizing your toe may alleviate this.
- Your Muscles: So far we have talked about the various joints that surround your knee. Multiple muscles also attach and influence the knee. Many times muscles, because of damage or improper use develop trigger points. Trigger points are areas of muscle dysfunction, frequently felt as knots or tight areas. They also can refer pain. Trigger points in the hip, thigh and calf frequently refer to the knee. These can be treated with deep tissue work, dry needling, or self massage techniques such as theracanes or foam rolling.
- Your Brain: All pain, no matter where it is experienced in your body, is actually being experienced in your brain. Signals from your body are sent to your brain, and it interprets what is going on. When your brain feels something is unsafe it sends pain signals to get you to do something about it.
These signals, when appropriate are extremely helpful and protect our body. Sometimes though, especially in long term or chronic pain, these become counter productive. Recent pain research is showing that the brain sometimes can begin interpreting input incorrectly and it reacts as if safe things are unsafe and give us the experience of pain. Research is also suggesting that these reactions may be influenced by experience not only actual input. So if your knee actually had a lot of pain with running for example, every time you rest and start to feel better then start to run again, your brain may be wired to feel this is not safe and give you pain reactions even if the tissue is healed and running is safe. This can be a difficult thing to overcome, as the pain is real and not “all in your head”. And there may be nothing obviously wrong with your body upon examination. If there is chronic pain it may need to be looked into more deeply. But things such as safely increasing activity and working on lowering nervous system sensitivity have been shown to modulate chronic pain.
Many of these factors overlap and most can be corrected with applying the correct actions, whether mobilizing a joint, training the whole limb in proper movements, or working trigger points. The key is to evaluate the whole limb and and movement patterns, otherwise you are guessing at the issue. If you have questions about knee pain or movement patterns drop us a line or call us at in Avon, Colorado at 970-949-9966 or Eagle, Colorado at 970-328-5230.