Knee Pain and the Kinetic Chain

“The knee tries to do what the ankle wants it to do, but does what the hip allows it to”. I am not sure of the origin of this phrase, but it remains a powerful truth in my mind! While there can be many sources for knee pain, altered biomechanics can certainly be a primary culprit in a cascading effect on any part of the musculoskeletal system, including the knee. The following is a non-exhaustive list of some of the manifestations of the dreaded knee pain.

• ACL injury
• Torn meniscus
• Knee bursitis
• Patellar tendinitis

• Loose body within knee
• Iliotibial band syndrome
• Dislocated kneecap

• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Pseudogout
• Septic arthritis.
• Chondromalacia patellae (patellofemoral pain syndrome)

Some of the above are the result of trauma, some from infection or poor diet considerations and others are from repetitive strain/stress/overuse. So, a “one size fits all” approach with say, an anti-inflammatory medication, exercises or “working through” the pain may not prove to be palliative.

A look at one’s history of the complaint, their activities (or lack of!), diet and family background are critical in finding the cause; examination and additional tests such as blood work, x-rays and MRI can provide further information that will enable the doctor to properly and expediently manage the case.
As a practitioner of manual medicine, via chiropractic care, the spine is not the only joint or tissue area that I address. According to a 2006 National Health Interview Survey, approximately 30 percent of adults reported experiencing some form of joint pain during the previous 30 days, and knee pain was a leading complaint.

When infection or other presentation (that needs a more critical care approach) is ruled out, my job is to sort out which structure(s) are the pain generators. It is important to consider the body’s kinetic chains that can fall victim to a sequence of events involving tissues along a line of tension that are necessary to complete a task (such as throwing a ball, completing a golf or tennis stroke, or simply walking). Think of the muscles and other tissues at the back of your foot and ankle. They don’t just stop there; they continue northward up the calf to the thigh and buttock and back. This is why just treating the area of pain may prove frustrating and, in a number of situations, futile. For example, if one is suffering with pain on the medial, or inside of the knee, it may be as a result of a direct trauma, or, possibly due to a deep buttock muscle group known as the external hip rotators being overly tightened and not allowing the femur (thigh bone) rotate properly, causing stress on the knee area. Also, hyper-pronation of the foot can lead to internal rotation or twisting of the lower leg bone named the tibia, and lead to significant stress on the medial meniscus of the knee joint. The iliotibial band on the lateral side of the knee may also be affected. The point is that there are connected “chains” that are only as strong as there weakest link. The problem sometimes is that our bodies are excellent at compensating for movement deficiencies (to a point) and convince us to ignore it until it becomes unbearable or activity preventing.
So, what do you do for your knee? As I have often stated in previous articles, there first is a need to take responsibility for the things you have control over and:

1. Assess the pain and recount what the possible mechanism of injury is to rule out need for meds or other crisis care (think gout, infection or torn ligaments).
2. Have a chiropractic examination to determine restrictions around the knee as well as along the kinetic chains involved, including up to the pelvis and spine. The surrounding fascia should be examined as well. Also, determine if there are any weak or inhibited muscles involved.
3. Fix the restrictions to diminish or resolve the pain, increase the range of motion and then engage (via electric stimulation or exercise if possible) any weak muscles to strengthen.

Now, as you get back to your regular activities, go slowly and “test the waters” so that you can perform the movements that you desire dialed back several notches (think slow moving Tai Chi versus all out Tai Kwan Do). As we reach that “onset of maturity” phase of our lives, it makes good sense to warm up with very slow golf or tennis swings or even sweeping and vacuuming motions to prepare your body for the impending increased demands even before any injury.  So, slow down before going all out, stretch and hydrate well and remember your kinetic chain…..it’s only as strong as your weakest link!

Disclaimer

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner.We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.