Chiropractor Chandler AZ

Carson Robertson
Google Plus

Knee Pain Injuries Without Swelling or Trauma

Most times people do not have a single incident such as a slip or fall which causes knee pain. Their pain began slowly over weeks or months. Many times there is no swelling or any single painful spot. Damage to the muscles, tendons, and ligaments that surround and stabilize the knee is the most common source of pain with trauma.

Many of us like to point to a single incident that produces or started our injuries, such as falling off a swing or a bike 10 years ago. Acute trauma can predispose people to future injuries. However, most of our soft tissue damage is the result of chronic repetitive stress injuries which are an accumulation of small amounts of trauma and stress over months and years.

Muscles and tendons not only allow movement but they also absorb pounding forces when we walk, stand, or squat. Over time, the repetitive activities cause micro damage in the soft tissues, which increases over time.

The small micro tears, or micro trauma, eventually lead to larger knee injuries. This leads to multiple spots of tenderness and tissue remodeling in the muscles, tendons, and ligaments around the knee.

knee model patella labeled
The Anatomy of the Knee Joint

The large femur sits atop the tibia, much like two pillars stacked on top of each other. The smaller fibula bone is on the outside of the tibia in the lower leg. The fibula provides some weight bearing, but not nearly as much as the tibia does. At the end of the femur are two large condyles with rounded edges that allow for the rocking or hinging motion associated with knee movement.

In between the femur and the tibia are fibrocartilage shock absorbers, or meniscus. Several large stabilizing ligaments on the inside and outside of the knee prevent excessive forward and backwards movements. These stabilizing ligaments include the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL).

The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded in muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.

The knee is a complex joint that is surrounded by a ligament joint capsule and lined with a synovial membrane that produces synovial fluid, which helps lubricate the knee. The lubrication reduces friction and damage to the internal components of the knee. Bursa are fluid-filled sacs that help reduce friction as muscles and tendons glide across the bursa.

knee model lateral view labeled
Tissue Damage Over Years

With every step, the pounding forces of our body weight against the ground are rippled throughout the lower legs. Depending on the ankle and knee positions, those forces can travel through the knee and into the quadriceps or hamstrings. All of the muscles, tendons, and ligaments around the knee end up absorbing these forces.

Everybody has their own unique walking gait, which is why not everyone develops the same knee pain. The way you walk causes increased stress and strain to be delivered to certain points along your knee. If this happens to send more forces to the patella tendon or patella ligament, then you are more likely to develop patellar tendonitis.

If your walk causes excessive strain to be placed on the upper gastrocnemius, or calf muscles, you may develop pain along these muscles and tendons behind the knee. Likewise, pain behind the knee can be the result of popliteus muscle sprains.

Chondromalacia patella is caused when excessive forces damage the hyaline cartilage between the patella and femur. Patella femoral syndrome is when the hyaline cartilage damage is mostly to the patella surface instead of the patella.

Sprains and strains to the supportive ligaments, muscles, and tendons can cause an incredible amount of knee pain. Small tears throughout these tissues result in chronic dull and sharp pain across the knee with increased activity, bending, or squatting. The small sprains and strains are aggravated every time the tissue is overworked. With rest, the pain decreases but will increase whenever the tissue is overwhelmed.

knee model posterior labeled
Home Treatments

At home the first step is always PRICE: protect, rest, ice, compress, and elevate. Reduce the stress and strain to the knee. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs) as recommended by your doctor can help reduce pain and inflammation. Ice helps block the knee pain and reduce inflammation.

Medical Treatments

NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options, as well. Pain management is not usually required unless stronger medications or joint injections are involved in treatment.

MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss.

Conservative Treatments

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

quadriceps muscle anterior 2 labeled

Iliotibial band Syndrome is common in runners who develop the injury because of weakness and poor stabilization of the leg and hip muscles. Specific knee exercises are given to increase strength and endurance. Proprioception exercises help teach the muscles how to work together again to stabilize the knee during walking or running.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

Improve Movements to Eliminate Knee Pain

The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and during recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, an exercise ball, and BOSU balls can be performed on the floor. The more unstable of the surface, the more effort and stabilization is required of all the lower extremity muscles.

GT therapy

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.

Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.