Chiropractor Chandler AZ
Knee injuries, including meniscus and ligament tears, patellar tendonitis, bursitis and arthritis, affect student athletes and older adults alike. While some types of injury such as an acute meniscus tear or advanced osteoarthritic damage may require surgery, many of these conditions can be treated non-invasively using techniques such as electrotherapy, extracorporeal shockwave treatment, Class IV cold laser, Graston technique and physiotherapy.
Most knee injuries typically reflect some type of biomechanical abnormality that has predisposed the person to joint damage. For example, patellar tendonitis, which is an inflammation of the patellar tendon at the top of the kneecap, often results from what is known as a “tracking problem.”
It is not uncommon for individuals to develop an imbalance between the lateral and medial quadriceps: the large muscles in the front of the upper leg that do most of the work when you walk or run. Most often, the lateral muscles become very tight while the medial muscles, particularly the vastus medialis obliques that extend upwards on the inside of the legs from the knee, shut down.
Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. These patients usually have loss of muscle and reduced function of the vastus medialis, and an imbalance between the vastus medialis and lateralis (inside and outside of the quadriceps muscle).
This muscle imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease strain on the knee. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least three months before considering other treatment options.
In other words, these very important knee-stabilizing muscles on the medial side of the leg stop working. If you are having pain around the kneecap, put your fingers on the muscle on the inside of the leg just above the kneecap. Does it feel soft? Now feel the muscle on the opposite (lateral side). If it feels tight, you have probably isolated the underlying cause of your knee pain.
Women are particularly prone to this problem because the Q-angle, the angle from the hip to the knee, is very wide. As with many knee problems, the best and most permanent fix is physiotherapy exercises to get the VMOs working again, and make them stronger.
At the same time, it is often necessary to release tension on the outside of the leg. Extracorporeal shockwave therapy is a perfect modality for this. This treatment uses the same basic technology as lithotripsy designed to break up kidney stones, except that in this case, the percussive instrument is applied directly to the skin instead of transmitting the shockwaves through water.
Extracorporeal shockwave therapy is especially effective at breaking up fascial adhesions within the iliotibial band: a thin band of fascia that extends down the lateral side of the leg between the hip and knee. ESWT is also good for releasing tightness in the lateral quadriceps, to balance muscle tone between those and the medial quadriceps muscles. More on Graston Technique for Knee Pain.
Even problems inside of the knee structure, such as ligament and meniscus tears, can have biomechanical causes. We’re not talking about the “terrible triad” that so often affects football players: that one usually comes from the defensive line. But when these injuries result from chronic soreness in athletes participating in running and cycling events, the source of the problem is most often within the athlete’s body.
The VMOs shutting down can certainly contribute; so can overpronation, defined as excessive rolling in of the ankles. Runners with low arches (or in some cases no observable arches) are prone to this problem. During their gait cycles, the ankles roll in more than the five degrees that is considered normal. When a person runs, he or she lands with three times the body weight of walking. So it’s no surprise that days, weeks, or even years of compensating for poor running mechanics can damage the internal structures of the knee.
The medial meniscus is a C-shaped piece of cartilage inside the knee that stabilizes the joint, particularly when a person “cuts” or turns in a different direction. The knee joint is unusual in that while most of its action is hinging, it can rotate slightly to the inside. When you are standing in one place, you will notice that this happens, so that the soleus (the major calf muscle used when you are standing as opposed to walking or running) doesn’t have to work as hard to keep you erect. The knee is essentially locked in place.
Stay with us here. The fact that the knee can rotate slightly makes it easier to move and to stand for extended periods of time. It also makes the knee more susceptible to injury. Persons who have low arches or flat feet, particularly those who decide to train for long-distance running events with unsupportive footwear, will often start to feel pain on the inside of the knee after a long run. This pain is not something to ignore. It could be a warning sign from the meniscus. An athlete might have a small tear in the meniscus and not even notice it until that tear catches during a turn. At that point, the meniscus becomes ruptured and requires surgical repair.
Caught early, meniscus problems can be treated proactively, with physiotherapy and if necessary orthotic shoe inserts. Tightness that develops within knee ligaments is easy to address with Graston technique. This is a non-invasive technique that uses specially designed stainless steel tools to slide across the skin and break up scar tissue. It is not unusual for persons with chronic knee pain to have a build-up of scar tissue inside the knee that limits the joint’s mobility. Breaking up the scar tissue jump-starts the healing process and allows healthy collagen to aggregate in its place.
Bursitis is an inflammation of a fluid filled sack inside of the joint. We have dozens of bursa throughout the body. One that seems to cause a lot of people problems is located underneath the lateral epicondyle: a bony protrusion on the outside of the knee.
Earlier we talked about the iliotibial band: a band of fascia running between the outside of the hip and knee. At the knee, the IT band inserts just below the lateral epicondyle. When it becomes tight, the fascia itself can become irritated and painful. Even worse, it can irritate the bursa right below it. The bursa sac is highly innervated. When a bursa becomes inflamed, it can produce a deep ache or a shooting pain that feels like an electric jolt. Bursitis can be hard to control, since the very act of walking (or running) makes it worse.
In this case, ice is your best friend. Ice the outside of the knee multiple times per day to get the swelling compressing the bursa to subside. Class IV cold laser can make a tremendous difference as well, in reducing down time from this type of injury.
Class IV cold laser, also known as low level light therapy or LLLT, takes advantage of an “optical window” that enables the laser beam’s wavelengths and frequencies to penetrate below the skin and turn off inflammatory factors that perpetuate this type of injury. At the same time, different wavelengths and frequencies speed up the delivery of adenosine triphosphate to the injured area. Also known as ATP, this substance is fuel for your soft tissue. By speeding up ATP delivery to the injured area, cold laser speeds up the healing process.
Cold laser can also be effective in reducing inflammation from various forms of arthritis. Arthritis is a term used to describe close to 100 medical conditions that cause swelling in joints. The most common form of arthritis is osteoarthritis, which is a gradual wearing down of cartilage inside the joint. When this occurs, joint spaces narrow and bone spurs can develop within the joint. More on class IV cold laser for knee pain.
However, cold laser can reduce the swelling from osteoarthritis that causes pain and limits mobility. With any type of arthritis, it’s very important to keep moving to slow down disease progression. Cold laser treatments can make it easier to walk, and keep you active in recreational activities such as golf and hiking.
Active exercises are going to help teach the neuromuscular and proprioceptive systems in the brain to work together again. These are standing balance exercises. These exercises are going to help keep the foot and knee in a neutral position, prevent internal rotation, and engage the hip muscles.
I compare this stage of treatment to building the base of a pyramid. You have to have a solid and strong foundation to build upon it. If you skip steps or fail to master each level, you will not have a strong foundation. This will catch up with you later when you stop improving.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises. In these exercises, the knee muscles tense up without moving or changing lengths. It allows the muscles to gain strength to prevent future knee injuries. An example is a 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 the surface, the more effort and stabilization is required of all the lower extremity muscles, increasing strength gain.
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 examples of knee exercises.
Some types of arthritis, such as rheumatoid arthritis, are autoimmune conditions. Hallmarks of rheumatoid arthritis are symptoms that are bilateral and that wax and wane. While early morning stiffness from osteoarthritis typically subsides within about 30 minutes, stiffness from rheumatoid arthritis lasts much longer.
Any type of arthritis with underlying immune system causes must be medically managed by a rheumatologist. These conditions require medication therapy, without which they can progress quickly and result in severe disability. However, even with pharmacotherapy some individuals still experience flares. In these instances, cold laser can be an option for reducing inflammation and making the condition less uncomfortable.
Finally, some individuals who have undergone knee replacement therapy can experience intermittent knee pain. Causes can include weakness in the VMOs (see above) or changes in biomechanics that sometimes cause pain on the opposite side. Physiotherapy can reduce muscle imbalances that contribute to pain and lack of mobility while electrotherapy (Russian protocol) and cold laser can reduce the pain and inflammation.
Our office often treats many patients with knee pain after knee replacement surgeries. Some patients do not recover after surgery like they expected or develop pain and decreased flexibility months or years after surgery. These patients require a specialized plan to identify the limiting problem and restore proper function.
If you are experiencing knee pain, we encourage you to call our Chandler, Arizona office at (480) 812-1800 to schedule an evaluation. We will work with you on a customized plan to reduce the pain, so that you can return to doing the things you love, including pickleball, hiking, running and golf. We look forward to hearing from you soon.