Wednesday, May 20, 2009

Knee pain

When I think about injuries that happen to the knee it reminds me of a quote that most of us used in our childhood. “It’s not my fault, they made me do it” Although injuries to the ACL, MCL, collateral ligaments and patellar tendon are well known, it is not as well known why they occur. Yes, it’s easy to deduce that when a 280lbs linebacker lands on the back of your knee and you hear a pop that that is what tore your ACL, but most ACL injuries and other knee injuries are not the result of one specific trauma. The knee is stuck between the foot and the hip and it can only react to what happens above it and below it. The motion of the foot dictates the motion of the tibia and fibula (the lower bones of the knee) and the hip joint motion dictates the motion at the femur (the upper bone of the knee).
Most knee injuries are the result of repetitive micro-trauma’s usually involving foot and hip joint dysfunction. As I described in the last newsletter, the heel must properly dorsiflex, and move down and in (pronate) to allow the tibia to rotate medially. If this motion does not happen properly then the muscles up the kinetic chain are not stimulated to contract and without muscular support, the ligaments of the knee must take on more of the load. Over time this can lead to a tear. Similarly, the hip joint motion must be within normal limits to have proper knee function. When the foot strikes the ground the hip should flex, internally rotate and adduct. This motion lengthens the powerful muscles of the buttock stimulating them to contract in order to stabilize the knee and then bring the tibia out of internal rotation and into external rotation. Like problems with the foot, problems with hip can cause the ligaments and tendons of the knee to take on extra loads which can cause tears.
The good thing about knee injuries is that if you can identify the area of greatest restriction or greatest mobility you can address the true cause of the pain. Dr. Colling has a series of functional diagnostic tests and treatments which are specifically designed to identify the body’s true area of weakness. He can provide effective treatment and exercise protocol’s to help prevent knee pain and to help recover from major knee injuries. It is interesting to note that, often knee pain issues can be treated successfully without treating the knee itself. So in many cases of knee pain, “it is not the knee’s fault, something else did make it hurt.”