Knee pain is a very common complaint in both athletes and those who are less active.
- Common causes of acute knee pain can be trauma, repetitive strain, or wear and tear.
- Common causes of traumatic knee pain are ligament sprains, or tears; which can be mild, moderate or severe, or meniscus tears.
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The commonly injured ligaments are the medial collateral (MCL) or lateral collateral ligaments (LCL), which are located on the inside and outside of the knee, respectively, and the anterior and posterior cruciate ligaments, which are located deep inside the knee, and prevent the femur and tibia from sliding forward or backwards in relation to each other.
The medial collateral ligament is usually injured when the knee gets a blow to the outside, causing the inside of the knee to gap open in which case the ligament will stretch or tear. Conversely, the lateral collateral ligament is usually injured in trauma the bends the knee outward.
The posterior cruciate is typically injured by a force that hyperextends the knee (being bent backwards), while the anterior cruciate ligament is typically injured when landing on your foot with a slightly bent knee as you are decelerating or changing direction while running during a sport.
Between the femur (thigh bone) and tibia (shin bone) are the medial and lateral meniscus, which are fibrocartilage (flexible cartilage) that acts as a washer to make the bones fit together better. These menisci are often torn with sudden twisting, or repeated squatting, although a lot of people don’t know what cause set it off.
With meniscal tears, people often experience locking and pinching pain along the joint line or a feeling of the knee giving out.
Medial and lateral collateral ligament injuries and meniscal injuries, may be treated with PRICE protocol (protect, rest, ice, compression, elevation) in the early stages. Cold laser therapy can reduce inflammation and pain and speed up the healing process. In chronic injuries, shockwave therapy will stimulate the injured ligaments to heal.
One of the most common repetitive strain injuries of the knee is patellar malalignment syndrome, which causes anterior knee pain, especially with walking stairs or sitting with your knees bent for a long period as in seeing a movie – the so called “movie sign.”
Patellar malalignment syndrome causes knee pain because the patella (knee cap) gets pulled too far to the outside of the knee and therefore the cartilage under the knee cap gets worn excessively, causing pain. The malalignment typically occurs because of two main problems:
- The foot is over-pronating (aka fallen arches, flat feet) and this causes the knee to bend inward too far, meaning the leg is no longer straight and the kneecap will be allowed to move too far laterally.
- The lateral quad muscles are stronger than the medial quad muscles; therefore they pull the patella too far to the outside.
If this problem is not treated early, arthritis will develop on the underside of the kneecap.
Treatment of patellar malalignment knee pain can often be relieved with cold laser therapy and other modalities to reduce inflammation and speed healing, combined with strengthening the medial quad and foot orthotics to prevent the foot from rolling in so much – both help the patella to track properly. The combination of treatments helps to heal the injury and prevent the pain from returning.
The patellar tendon is the tendon below your kneecap that holds the kneecap to your shinbone (tibia). This is commonly injured in people who do a lot of jumping, hence the common term ‘jumpers’ knee.
As with most tendons they can become inflamed [tendinitis] although biopsy studies show that most of the time when they hurt there are no inflammatory cells, but instead the tendon is breaking down like a frayed rope.
In acute cases, cold laser therapy can provide relief by reducing inflammation and speeding healing, but in chronic situations, shockwave therapy is often the best treatment option as it relieves pain by regenerating the damaged tendon.
Bursitis is an inflamed, swollen, painful bursa. A bursa is a sac with fluid in it that allows tendons to easily slide on each other. When it gets injured, often by direct trauma, it gets inflamed and swollen and very painful.
In order to relieve the pain and swelling, the PRICE protocol should be followed at home (protect, rest, ice, compression, elevation). Cold laser therapy can reduce inflammation, decrease pain and speed healing in acute cases. In chronic cases where the pain has been there for months, shockwave therapy is usually the best treatment.
Arthritis is the classic wear and tear injury. It is caused by breakdown of the cartilage that covers the ends of bones in a joint. The cartilage is normally smooth and allows the bones to slide on each other easily. When cartilage is injured, it cracks and degenerates. Years of repeated minor injuries, or poor biomechanics, cause significant thinning and roughening, which causes grinding and pain.
Cold laser therapy is usually very effective for arthritis pain, as it goes deep into the joint and relieves pain, reduces inflammation, and stimulates enough healing that the pain can be greatly reduced, or even resolved.
If the arthritis is in the lower limb, and is the result of wear and tear due to abnormal biomechanics, foot orthotics designed to restore proper biomechanics and reduce impact, will help relieve pain and slow or prevent worsening degeneration.