What Causes Knee Pain?
Knee pain causes can be either acute or sudden in their onset. An example of an acute, sudden injury could be a ligamentous tear or cartilage tear playing sport. Other knee problems may be chronic and develop over a long period of time. An example of chronic knee pain would include osteoarthritis which comes on gradually over a number of years.
Podiatrists often see chronic overuse type injuries where the pain has developed gradually over a number of months or even years.
Some common examples of knee pain treated and managed by a podiatrist can include:
- Patellofemoral Pain Syndrome – Excessive pronation of the feet can cause the knees to rotate internally which moves both legs into more of a ‘knock-kneed’ position. This can cause the knee cap tendon to pull in the wrong direction. The knee cap then tracks over areas of the knee joint that it should not normally do, and eventually this can result in injury and pain. The pain is often felt with bent-knee activity, like squatting and walking upstairs.
- Iliotibial Band Syndrome – A band of thick tissue which runs down the outside of the thigh, and which crosses the outer side of the knee joint, is the iliotibial band. Excessive foot pronation and subsequent inner leg rotation can can lead to irritation and inflammation around the outside of the kneecap. Pain is usually felt on the outer edge of the knee joint.
- Osgood Schlatter’s Disease – this commonly affects teenagers, and is an inflammation of the growth plate of the tibia (lower leg bone), which is situated just below the kneecap.
- Chondromalacia Patella – this is a form of wear and tear of the cartilage behind the kneecap which can occur with abnormal tracking and alignment of the kneecap or patella.
Runner’s knee is another common term used to describe a number of common knee problems causing pain around the kneecap or patella. The term “runner’s knee” is sometimes used to describe iliotibial band syndrome, chondromalacia patella, patellofemoral pain and knee malalignment issues.
The name suggests running is a common cause of runner’s knee and this is true. However, many other sports and activities can bring on knee pain including simple walking, hiking, netball, football, basketball, soccer, cycling and jumping activities. Climbing up and down stairs can also aggravate or bring on symptoms.
What Are Some Common Symptoms Of Knee Pain?
Knee pain sufferer’s may experience a dull, aching pain in the vicinity of the kneecap. Sometimes pain will occur behind the kneecap. In the case of runner’ knee, the name suggests running is a common cause of runner’s knee and this is true. However, many other sports and activities can bring on knee pain including simple walking, hiking, squatting, netball, football, basketball, soccer, cycling and jumping activities.
Climbing up and down stairs is another common activity that can aggravate the knees and bring on symptoms. Even standing up from a seated position may cause discomfort. Some may even feel instability in the knee. Iliotibial band syndrome commonly causes pain along the outside of the knee.
Knee swelling or grinding are also common symptoms that can occur.
How Do Knee Overuse Injuries Occur?
Various factors can cause overuse injuries to the legs, including poorly fitted footwear, inappropriate training programs and inadequate training surfaces (eg. bitumen or soft sand).
Another major cause of knee pain, which can often be overlooked, is abnormal alignment of the foot and lower leg.
Excessively Pronated Feet ( aka ‘Flat Feet’) – commonly known as ‘flat feet’, this can lead to excessive internal rotation of the lower leg at the same time that the upper leg is rotating in the opposite direction with forces produced during walking or running. The knee is the area that therefore must absorb these twisting forces, and thus injuries due to excessive strain or force can be the end result. Excessively pronated feet can result in a ‘knock-kneed’ position, which can contribute to various muscles exerting their forces in abnormal directions.
Abnormally High-Ached Feet – high arched-supinated feet, or feet which roll out excessively, do not allow normal knee flexion during walking. This foot type is often accompanied with a forefoot valgus which can also alter mechanics and forces on the ankle and the knee joint. Neutralising these abnormal foot and leg mechanics can help to reduce damaging forces on the knee joint.
How Is Knee Pain Treated?
Knee pain treatment for overuse conditions generally responds well to conservative treatment if treated early. In fact, a research article was published in late June 2017 concluding:
“The addition of foot targeted exercises and foot orthoses for 12 weeks was more effective than knee targeted exercises alone in individuals with patellofemoral pain.” Here’s the link to the study: https://doi.org/10.1016/j.jsams.2017.05.019
If knee pain is disregarded, symptoms and treatment can last for several months and may lead to the need for possible surgery. Conservative treatment often involves:
Training or activity modification.
Your training or activity schedule will be discussed and modified so that a successful and effective treatment can be administered.
R.I.C.E. Rest, Ice, Compression and Elevation.
As with any acute injury the RICE principle is paramount. It is necessary in the early stages of treatment to help fight the inflammation. Anti-inflammatory medication may also be suggested.
These allow the foot, leg and knee to function in a position which reduces the damaging forces placed on the knee and its surrounding structures. Forces are redistributed throughout the leg and stability is improved.
Appropriate strengthening and stretching of muscles around the knee may be advised by your Podiatrist.
Your podiatrists may suggest taping, bracing or further assistance from a physiotherapist.
Footwear Assessment and Advice
Appropriate footwear is crucial and should be appropriate for the sport or activity level.
Where Can I Get Help for Knee Pain?
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