The knee is a very complex joint, with many pain sensitive structures. It is notoriously difficult to examine and identify the cause of the symptoms. The joint has to cope with many minor accessory movements to allow for adaptation and shock absorption during gait. The compromise for this is stability.
The knee has four main ligaments, the medial and lateral collateral ligaments and the anterior and posterior cruciate ligaments. The most commonly sprained ligament is the medial collateral ligament on the inside of the knee, as this takes the force of an impact from the outside of the knee. The cruciate ligaments are inside the joint capsule and when completely torn require surgical repair. Strength and proprioceptive training after a ligament injury helps re-educate the knee to reduce any instability.
The menisci are more commonly know as the 'cartilage' of the knee. They help cushion the joint and provide a larger surface area for the femur to articulate with. The medial meniscus is the most frequently torn, and the lack of blood supply make them difficult to heal. Tears cause more problems if they fold over or if material becomes loose in the joint causing locking. Tears can eventually be worn away, or if presenting an everyday problem surgery can be considered.
Bursae are fluid filled sacs that reduce friction between different surfaces in the body - usually between muscles or muscle and bone. Around the knee there are at least fourteen bursae, and any one of them can become inflamed from hypertonic muscles, trauma or even infection. Inflamed bursae can mimic many other conditions of the knee, and can be relieved by drainage techniques and reducing the tonicity of the muscles around them.
Patella (Knee Cap)
The back surface of the patella is V-shaped and it slides up and down a V-shaped groove in the femur. The quadriceps attach to it, and because of the angle of the knee, 3 of these muscles pull the patella slightly inwards and only one pulls it slightly outwards. If these muscles are imbalanced, or the Q-angle of the knee is increased, this causes wear and inflammation to the back of the knee cap resulting in a burning pain behind the knee. It often comes on after walking or running for some distance, or from being seated for long periods. This condition is readily treated by addressing the tonicity of the muscles involved and giving strengthing exercises to the quadricep pulling the patella inwards. The problem may also be caused by hip or foot dysfunction affecting the Q-angle of the knee.
Superior Tibiofibular Joint
This joint is a small joint very close to the knee that may mimic knee pain or affect the functioning of the knee. This may be due to a dysfunction of the foot causing restriction of the fibula. This can be very easily treated by articulation and manipulation, addressing any foot dysfunction and treating any resultant muscular dysfunction.
Hitchin Osteopathic Clinic, Old Park Dental Surgery, 72 Old Park Road, Hitchin, Hertfordshire SG5 2JT 01462 432609