Knee pain can be caused by various factors, not always originating from the knee.

Common causes of pain

• local causes- Trauma and overuse
• Dysfunction of lower limb
• Referred pain from lower back, pelvis and hip.

The knee joint is a complex joint that relies heavily on ligaments and muscles for stability.

When pain is perceived as coming for the knee all the anatomical components need to be examined in addition to the joint, i.e. low back, pelvis, hip and ankle/foot.

Ligaments are usually injured due to direct trauma to the knee and the amount of ligament injury caused is described as 1^st, 2^nd or 3^rd degree sprain.

1^st degree sprain- some tearing/overstretch of the fibres, no joint instability, mild pain, minimal swelling.

2^nd degree sprain- separation/tearing of fibres causing moderate instability and moderate to sever pain, swelling and stiffness.

3^rd degree sprain- total rupture, gross instability, serve pain, swelling, usually requires length immobilisation and/or surgery.

Ligament injury will usually involve a certain amount of swelling directly over the ligament.

Most common causes of ligament sprain are:

Posterior cruciate ligament- football tackles
Anterior cruciate ligament- sudden slowing down i.e. sport
Collaterals- injury from the side of the knee while foot in planted on the ground.

Treatment of the sprain depends on the degree of injury. Chiropractors can treat 1^st and 2^nd degree sprains but 3^rd degree sprains often require surgical repair.

Grade one sprains are often weight bearing within one week whereas a grade two sprain commonly takes 3-6 weeks before person can return to normal activities.

Cartilage Dysfunction

Chondromalacia patella describes inflammation/irritation of the knee joint together with destruction of the cartilage that lies underneath the knee cap. Pain is usually at the front of the knee and is worse on going up and down steps and having the knee bent for long periods of time. There is often associated grating of the joint. Its causative factors include; patella malalignment, increased activity such as running, direct trauma i.e. fall onto bent knee, repetitive trauma i.e. kneeling, weak muscles and flat feet.

Treatment- Rest and use of cold packs, muscle rehabilitation, adjusting of the pelvis, hips, knee and feet and prescribing of formthotics if required. If patients have not responded with conservative treatment within 6 months then they may be referred for surgery.

Osgood Schlatters

This is a common condition found in adolescence as the muscles are stronger than the bones prior to bone fusion. It is caused by overuse of the knee resulting in inflammation. Usually affects active individuals i.e. runners and those playing on hard surfaces.
Symptoms – Pain and tenderness over the tibial tubercle, pain on full knee bending, redness and heat and a hard swelling at the site.

Treatment- If there is no separation, with rest and use of modalities to reduce the swelling, this condition is self-limiting with no long term after effects.

Degenerative Joint Disease

The knee is a very common site for wear and tear arthritis. Usually in the over 40 year olds and presents as swelling, joint line pain, decreased range of movement, grating of the joint, muscle wasting, increased muscle tone possible limp and feeling of giving way. The diagnosis is aided with an x-ray.

Treatment- reducing the joint inflammation, restoring any abnormal biomechanics i.e. form flat feet, adjusting of the low back, pelvis, hip, knee and feet, soft tissue of the involved muscles and advice on non-weight bearing exercises such as cycling and swimming.

Early chiropractic intervention can help to reduce the progression and severity of the arthritis.

Flat Feet

The feet have two arches one on the inside and one of the outside of the foot allowing for correct propulsion. We are used to wearing shoes on even surfaces and therefore the arches of the feet do not get used for shock absorbance.
This results in the muscles weakening and eventual dropping of the arches. This causes the knees to become mildly “knock kneed”, putting more pressure on the inside joint of the joint of the knee (one of the causative factors of arthritis and cartilage problems)

Treatment- An assessment by the chiropractor will determine if the arches have dropped. If they have, this can be addressed by exercises to strengthen the muscles and use of arch support.

Referred pain from the low back, pelvis, hip, knee pain can also be referred form the low back, usually from the joint irritation from the second and third lumbar vertebrae, from irritation of the sacro-illiac joints of the pelvis and from the hip.

There are orthopaedic tests that the chiropractor will perform in order to determine the origins of the knee pain. There may well be multiple causes of the knee pain.

Knee pain is often difficult to pin point the origin of and can be difficult to treat as often the patient is unable to rest it sufficiently. However with correct treatment the most common of the knee complaints can be treated, by the chiropractor and the patient.