In our office we treat quite a number of knee problems. Most people with knee pain have not had a true trauma to the knee but had symptoms when they were children that may have been ignored or poorly managed. Most people do not know that foot problems create knee problems. They do not also understand that the knee is merely a conduit or pulley that allows us to walk. The kneecap is the pivot point that the muscles use to transmit force from your feet to your core. If this mechanism is not firing or coordinated properly, the result is knee pain, meniscus tears, clicking or grinding at the kneecap as well as shin pain and even lower back pain. We inherit our body style and if we have low or flat feet which tend to transmit these forces less efficiently in combination with feet that turn or toe out (overpronated), you have the recipe of knee pain, shin pain, plantar fascitis, kneecap tracking problems and back problems.
In our health care system, most people visit their primary care doctor who will usually have you visit an orthopedic doctor (surgeon). Their primary interest is knowing who is a surgical candidate and who is not. There interest is not getting your out of pain. I often see patients with chronic knee pain visiting physical therapy where heat, muscle stim, some light massage to the knee and then they are asked to lift weights with the knee. Many people do not get improvement this way and often, they exacerbate simply because they have problems tolerating gravity with their current structural integrity and are then being asked to tolerate more weight.
You can make better choices because knowledge is power. The better physician will look at what is surrounding the knee such as your core muscles (lower back, hip flexors, gluts, abs) and see what they are doing first. In our office, anyone with knee pain will have their pelvis and their feet checked first. The reason is (we get almost all our patients with knee pain free of it by getting to the source) that if you are asymmetrically built (remember this is an inherited trait and typically appears around the age of 3 and by the age of 6 it is well set), your body will respond to these forces and the myofascia in your core will tighten in response and literally glue it into improper motion. This will cause you to recruit other muscles because of a lack of leverage and torque the hips. Since we stabilize and fire from the core first, one of the places you recruit into is the legs which causes tight legs. Many people attempt to self manage this with exercise, yoga, foam rollers and pilates which all appear on the surface to help, however there is one large problem… You cannot train a torqued core which will create chronic neck and back as well as knee pain. These methods all have some benefit however, you need to have a stable core to train, which takes stress off the knees and improves mechanical firing patterns which will keep you looser without doing all these maintenence methods. This is why visiting the orthopedic and then having therapies thrown at the problem is a lesson in futility for the long term, even though it may offer short term relief.
How do we fix and manage this better
We should screen all children for asymmetry and those who have flat feet should be educated in the importance of shoe inserts or orthotics. This will improve the way they walk. A chiropractor who understands the myofascial system (some have special training in the diagnosis and treatment of this, especially those who are involved in sports medicine) can be a terrific asset in your quest for cost effective management for yourself and your family members.
Before you embark on trying to do exercise, a visit to the chiropractor to correct any joint and myofascial problems in the core can lead to a much more successful training experience. Those who train with a torqued core will get foot, calf, hip and shoulder pain and will find that without the exercise, they continue to tighten. You can break this cycle by getting the core right.
Once the core is functioning properly, in our office, we look at the calves, shins, posterior knee since adhesions in these areas brought on by years of poor body mechanics will also adversely affect the firing pattern of the leg. We then test and retest because firing patterns can be physically challenged and poor patterns are really obvious to both the doctor and the patient. Chiropractors are also trained and skilled in manipulation of the spine and extremities which is essential for the best outcomes. This is why we are in demand at major sporting events.
Finally, foot orthotics whether they are custom or off the shelf will improve your gait and should be part of the management of these types of problems.
You will notice that knee management is secondary, not primary. This is because the knee is a conduit and develops problems because of the foot and the core, and usually not because of the knee itself. Sports simply increase the forces on the region if structurally it is unsound. Proper management in most knee problems even if an injury occurred should include strengthening and improving core stability, shoe inserts and checking stability of the kinetic chain (the series of joints comprising the ankle, knee and hip). Once you can tolerate increased forces via testing and have improved stability, you should quickly rehab over a period of 2-6 weeks.
This is quite different from what most people are advised to do however, this makes mechanical sense. I often tell patients who have growing children to think outside the box when the pediatrician describes leg pain with terms like growing pains and osgood schlatters (a really bad case of shin splints). These children need a good biomechanical workup and the chiropractor can often be a better place to start. If you did not improve or if the doctor suspects there is knee damage which may not be amenable to rehab, the doctor will send you out for testing (MRI) and then make a surgical referral to an orthopedist.
If you have knee pain and have tried the other options I have outlined here, you are likely frustrated by the lack of results. Here is an approach that is effective, tried and true and methods like active evaluation (challenging areas that are not working properly to find the source of the problem treat, test and retest) which is the future of musculoskeletal medicine. My hope is that the information in this blog post will help you make better decisions regarding your knees and other problems in the musculoskeletal system.