Every Knee Must Bend..but it doesn’t have to hurt
Knee pain is a common diagnosis that I see in the physical therapy clinic. Many are traumatic injuries such as a fall which results in a torn ligament or meniscus. For the majority of clients, the pain is progressive over time and there is no specific injury. Generally, these clients present with pain that is in the front (anterior) of their knees and is worse with things like transitioning from sit to stand, climbing or descending stairs and walking down hills.
On every evaluation, I always ask for a prior injury history. This is not only limited to a prior knee injury, which can give us a lot of information. Having a history of back pain or surgery, can tell me if we need to look at core related dysfunctions that may contribute to the pain. If you had an ankle sprain as a teenager, you may have limitations in your ankle as well as at your hip that have led to compensations at the knee.
I’ll assess your static posture. No one is completely symmetrical, but knowing if you have more weight in one leg, if your foot does not have 3 points of contact, if one hip is higher or if you have changes in your spinal curves can provide valuable information to determining where added pressures may be in your knees, and guide us toward what exercises will help.
How do you move? What does your gait look like? I will both watch you walk, and will breakdown the movements that happen at the pelvis, spine, ribs and head because these are directly correlated to what happens at the ankle…and of course since the knee sits between the hip/pelvis and foot, what is happening above or below may affect what is happening at that joint. And then I’ll look at gross movement patterns: can you touch your toes, lean backwards, twist, stand on one leg, squat, kneel..and get up from kneeling..as well as your shoulder mobility. Our body moves in all these patterns throughout each day. While we may not address them all in treatment, they all provide valuable feedback for what is happening at your knees and knowing which patterns create the sensation of pain and which do not, will help guide the exercises given.
Palpation and muscle testing are next in my evaluation. Is there significant tension in the muscles that surround the knee, hip, ankle, and core? Can you meet resistance with a movement pattern effectivelyand without pain? Is it equal on both sides and if not, can you meet resistance with core testing. .) If you couldn’t hold a single leg stand with centered alignment, and you could hold alignment in kneeling, we will look to your ankle mobility. If you couldn’t hold a centered position in ½ kneel we will look at your hip. Hint..core comes up a lot with injuries and most of us need our core to be more efficient. If something is off on both sides, check in with how your core is first. Then build from there.
There are tests that we use to see if you have a ligament or meniscal injury. The biggest piece of information we get is from your history and how you got injured. Putting the movement screen together with the history provides us great information to determine if you need further workup such as an MRI or an x-ray. In most non-traumatic cases, imaging is not required. If you’re unable to weight bear or have other signs of a fracture/break, an x-ray would be appropriate. There are times when the mechanism of injury suggests a ligament, meniscal or muscle/tendon tear, but the tests are questionable. In this case, an MRI may be helpful.
If you have had non-specific knee pain for a while without new injury; If you have pain with squatting, kneeling or getting up from a chair; if you are a cheerleader (or any athlete), if your knees ‘cave in’ when you perform a squat pattern and then hurt after, physical therapy can help. It’s important to figure out what muscles/bones need to move better for you so that you are not just stretching or strengthening random movements.
If you are not having pain, but you know you’re not moving well from sit to stand or from the floor, working with a strength coach who does corrective movement can make a world of difference in helping to not only prevent pain or injury down the road, but also to allow you to continue to do more fun things that make you happy.
Moving well is a lifelong journey. Working with someone can make that journey so much better.