Knee Pain

Lateral, Medial, and Posterior knee muscles

Knee Pain:

Knee pain is the most common musculoskeletal complaint that brings people to their doctor. With today's increasingly active society, the number of knee problems is increasing as well. Knee pain has a wide variety of specific causes and treatments.

Anatomy of the Knee:

The knee joint's main function is to bend and straighten. The knee, more than just a simple hinge, however, also twists and rotates. In order to perform all of these actions and to support the entire body while doing so, the knee relies on a number of structures including bones, ligaments, tendons, and cartilage.

The knee joint involves three (3) bones. The thighbone or femur comprises the top portion of the joint. One of the bones in the lower leg (calf area), the tibia, provides the bottom portion of the joint. The final bone of the knee is the patella (knee cap). The knee contains three (3) important groups of bursae. The prepatellar bursae lie in front of the patella. The anserine bursae are located on the inner side of the knee about two (2) inches below the joint. The infra-patellar bursae are located underneath the patella.

The kneecap or patella rides along the front of the femur. The remaining bone in the calf, the fibula, is not involved in the knee joint but is close to the outer portion of the joint. Ligaments are fibrous bands that connect bones to each other. The knee includes four (4) important ligaments, all four (4) of which connect the femur to the tibia. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide front and back (anterior and posterior) and rotational stability to the knee. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) located along the inner (medial) and outer (lateral) sides of the knee provide medial and lateral stability to the knee.

Tendons are fibrous bands similar to ligaments. Instead of connecting bones to other bones as ligaments do, tendons connect muscles to bones. The two (2) important tendons in the knee are: the quadriceps tendon connecting the quadriceps muscle, which lies on the front of the thigh to the patella; and the patellar tendon connecting the patella to the tibia (technically the patellar tendon is a ligament because it connects two (2) bones). The quadriceps and patellar tendons as well as the patella itself are sometimes called the extensor mechanism, and together with the quadriceps muscle, they facilitate leg extension (straightening). Cartilaginous structures called menisci (singular - meniscus) line the top of the tibia and lie between the tibia and the two (2) knuckles at the bottom of the femur (the femoral condyles). Menisci provide both space and cushion for the knee joint. Bursae (singular, bursa) are fluid-filled sacs that help to cushion the knee.

Diagnosis of Knee Problems:

In order to diagnose a kneee problem, the doctor will give you a physical examination. The doctor will then inspect the knee and press around the knee to see exactly where it is tender. In addition, the doctor may perform a number of maneuvers to stress the ligaments, tendons, and menisci of the knee and evaluate the integrity of each of these.

Types of Knee Pain:

The nerves that provide sensation to the knee come from the lower back and also provide hip, leg, and ankle sensation. Pain from a deeper injury (referred pain) can be passed along the nerve and felt on the surface. Knee pain, therefore, can arise from the knee itself or be referred from conditions of the hip, ankle, or lower back.

Sprained and Torn Collateral Ligaments:

All of the following sources of knee pain arise from the knee joint itself. In general, knee pain is either immediate (acute) or long-term (chronic).

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Like all ligaments, this ligament may be sprained or torn. A sprained ligament may be partially ruptured. A torn ligament is completely ruptured.

Symptoms of Medial Collateral Ligament Injury:

Severe MCL sprains or tears often produce a tearing or ripping sensation along the inner joint line of the knee. You may also notice knee instability and swelling. A force from the outer (lateral) knee to the inner (medial) knee is typically responsible for this injury in contrast to the more rarely injured LCL which is typically a result of an inner to outer force. In general, bruises occur at the point of impact. Sprained and torn ligaments occur opposite the point of impact.

Both MCL and LCL injuries are common in contact sports but can also result from twisting the knee with a planted foot such as in skiing.

Treatment of Medial Collateral Ligament Injury:

ART® is well accecpted as the best treatment for strains and sprains. After the doctor takes a relevant health history from you , a physical examination is performed. The doctor may suggest MRI or arthroscopy to further evaluate a torn ligament. The doctor may also recommend x-rays. The x-ray does not help in the diagnosis of ligament injuries, but it may help define the knee anatomy prior to arthroscopy.

Conservative treatment for a mild sprain consists of early rehabilitation with compression, ice, elevation, anti-inflammatory and pain control medications. You will also be educated to follow an appropriate exercise regimen including a stationary bike and leg-strengthening exercises. These treatments may be all you need. An exercise regimen should be under the supervision of a doctor or physical therapist because certain exercises are to be avoided.

Sprained and Torn Cruciate Ligaments:

An anterior cruciate ligament (ACL) injury is a common sports injury generally caused by a hard stop or a violent twisting of the knee. The posterior cruciate ligament (PCL) is stronger than the ACL and much less commonly torn. To tear the PCL, it requires strong forces, such as those produced when the dashboard strikes the knee in a car accident. Due to these severe forces, PCL injury is often associated with other ligament and bone injuries.

Symptoms of ACL and PCL Tears:

In contrast to sprains, tears often require surgical repair for best results. If you tear your ACL or PCL, you may hear a pop. You will also notice your knee give way or become unstable. You will feel pain that is bad enough that you might feel like vomiting. This will, almost always, be followed by marked knee swelling over the next couple of hours because the ACL and PCL bleed briskly when torn.

Surgical repair is recommended for athletes who demand optimal outcomes. Conservative treatment and knee braces may prove sufficient for those who do not demand quite so much from their knees.

Tendon Ruptures:

Both the quadriceps and patellar tendons may rupture partially or completely. Quadriceps tendon rupture typically occurs in recreational athletes older than forty (40) years. This is the injury President Clinton suffered while jogging. Patellar tendon rupture typically occurs in younger people who have had previous tendonitis or steroid injections to the knee.

Symptoms of a Rupture:

Rupture of either the quadriceps or patellar tendon causes pain -- especially when trying to kick or extend the knee. People with complete ruptures are unable to extend the knee. The patella is also often out of place either upward (with patellar tendon rupture) or downward (with quadriceps tendon rupture).

Treatment of a Rupture:

Tendon ruptures should be evaluated urgently. Tendon ruptures generally require surgical repair. A partial rupture may be treated with splinting alone.

Meniscal Injuries:

Injuries to the meniscus are typically traumatic injuries but can also be due to overuse. Often, a piece of the meniscus will tear off and float in the knee joint.

Symptoms of Meniscal Injuries:

Meniscal injuries may cause the knee to lock in a particular position, or the knee may either click or grind through its range of motion. Meniscal injuries may also cause the knee to give way. Swelling typically accompanies these symptoms although the swelling is much less severe than with an ACL injury.

Treatment of Meniscal Injuries:

Meniscal injuries often require arthroscopic surgical repair. A locking knee or a knee that "gives" should be evaluated for arthroscopic repair.

Knee Dislocation:

Dislocation of the knee is a true limb-threatening emergency. This is also a rare injury. Dislocation of the knee is caused by a particularly powerful blow to the knee. The lower leg becomes completely displaced with relation to the upper leg. This displacement stretches and frequently tears not only the ligaments of the knee but also arteries and nerves. Untreated arterial injuries leave the lower leg without a blood supply. In this case amputation may be required. Nerve injuries, on the other hand, may leave the lower leg viable but without strength or sensation.

Symptoms of Knee Dislocation:

Knee dislocations are severely painful and produce an obvious deformity of the knee. Many dislocations are reduced or put back into anatomic alignment spontaneously. As this occurs, many will report feeling a dull clunk.

Treatment of Knee Dislocation:

If the knee dislocation has not been put back into place (reduced), the doctor will immediately reduce the dislocation. Medical treatment, however, does not stop here. Whether a dislocation reduces by itself or is put back into place in the hospital, it requires further evaluation and care. After reduction, people with these injuries are observed in the hospital where usually a number of tests are conducted to ensure that no arterial or nerve injury has occurred. If such an injury is found, it must be repaired immediately in the operating room.

Dislocated Kneecap (Patella):

A dislocated kneecap is a common injury caused by direct trauma or forceful straightening of the leg. Such as an injury can happen when serving in volleyball or tennis. Patellar dislocation is more common in women, the obese, knock-kneed people, and in those with high-riding kneecaps.

Symptoms of Dislocated Kneecap:

If you have a dislocated kneecap, you will notice the patella is out of place, and may have difficulty flexing or extending your knee.

Treatment of Dislocated Kneecap:

The doctor will pop the patella back into place (reduce the dislocation). Even if the patella goes back into place by itself, however, it needs to be x-rayed for a fracture. After reducing the patella and ensuring the absence of a fracture, the doctor will treat these injuries by splinting the knee for three (3) weeks to allow the soft tissues around the patella to heal. Following healing, you will execute strengthening exercises to keep the patella in line.

Many types of pain are difficult to prevent, but you can do some general things to reduce the likelihood of sustaining a knee injury. Stay slim! Staying slim reduces the forces placed on the knee during both athletics and everyday walking and may, according to some medical research, reduce osteoarthritis. Keeping your weight down may also reduce the number of ligament and tendon injuries for similar reasons.

Keep limber! Keep fit! Many knee problems are due to tight or imbalanced musculature. Stretching and strengthening, therefore, also help to prevent knee pain. Stretching keeps your knee from being too tight and aids in preventing both Patellofemoral Syndrome and Iliotibial Band Syndrome. Strengthening exercises particularly of the quadriceps can help prevent knee injury. Straight leg raises and leg extensions are two (2) excellent exercises, but please see a book on exercise and training for more suggestions. Exercise wisely if you have chronic knee pain, do consider swimming or water exercises. In water, the force of buoyancy supports some of your weight so your knees are relieved of this weight. .If you don't have access to a pool or do not enjoy water activities, at least try to limit hard pounding and twisting activities such as basketball, tennis, or jogging. You may find that your aching knees will act up if you play basketball or tennis every day, but they will not act up if you limit your pounding sports to twice a week.

When playing volleyball or when laying carpet, protecting your knees may include kneepads. Wearing proper protection for the activity at hand can help avoid knee injuries. When driving, knee protection may include wearing a seatbelt to avoid the knee-versus-dashboard injuries as well as injuries to other parts of your body.

Whatever you do, respect and listen to your body. If it hurts, change what you are doing. If you are fatigued, consider stopping. Many injuries occur when people are tired. Protect your knee!

Iliotibial Band Syndrome:

A fibrous ligament called the Iliotibial Band extends from the outside of the pelvic bone to the outside of the tibia. When this band is tight, it may rub against the bottom outer portion of the femur (the lateral femoral epicondyle).

Distance runners typically suffer from this condition. These runners complain of outside knee pain usually at the lateral femoral epicondyle. Early on, the pain will typically come on ten to fifteen (10-15) minutes into a run and improve with rest.

Treatment of Iliotibial Band Syndrome:

The most important aspect of treating Iliotibial Band Syndrome is to stretch the Iliotibial Band. One way to do this is to place the right leg behind the left while standing with your left side about two to three (2-3) feet from a wall. Then, lean toward your left for twenty to thirty (20-30) seconds. Use the wall to help you support yourself. In addition to stretching the Iliotibial Band, PRICE therapy and NSAIDs may be of some help.

LVPRC, utilizing ART® protocols for injuries to the muscles, tendons, fascia, nerves, and surrounding soft tissues associated with Iliotibial Band Syndrome has proven to be the mot effective treatment of most knee injuries.

Traditional treatments address only one area, but ART® restores unimpeded motion and function to all soft tissues associated with Iliotibial Band Syndrome. ART® provides a means to diagnose and to treat the underlying causes of IBS. Iliotibial Band Syndrome, also known as Runner's Knee, is the term given to pain under and around the kneecap.

Most patients report that there is stiffness under the knee joint. Typical symptoms of IBS include numbness, tingling, burning, and aching under or around the knee. This is often related to tight hamstrings, and imbalances between the hamstrings and quadriceps.

Other physical structures that may be involved include:

The Psoas muscle for example is the primary hip flexor. When the Psoas muscle becomes shortened, Fibrotic, or weakened the quadriceps (Rectus Femoris) has to exert more force to make the hip flex. This is a major (and often undiagnosed) cause of unresolved knee pain. The posterior knee is also often involved, especially a small muscle called the Popliteus. This muscle is involved in the stability of rotation of the knee.

Synonyms and Keywords

Dislocated knee, anterior cruciate ligament, dislocated kneecap, ACL, posterior cruciate ligament, PCL, medial collateral ligament, MCL, lateral collateral ligament, LCL, patella, kneecap, arthroscopy, PRICE, RICE, osteoarthritis, rheumatoid arthritis, infectious arthritis, patellofemoral syndrome, chondromalacia patella, jumper's knee, Osgood-Schlatter disease, Iliotibial Band Syndrome, gout, bursitis, meniscal injuries, housemaid's knee, chronic knee pain, knee joint, knee pain, most minor toe, foot, or ankle problems go away on their own. Home treatment is usually all that is needed to relieve your pain, swelling, and stiffness.

There are thousands of reasons for knee injuries; sports injuries, work injuries, injuries at home, and even just the osteoarthritis brought on by wear and tear or the aging process can cause severe damage to the knee.