Knee Pain: Getting to the Root of the Problem with Miller Sports & Wellness

Knee Pain: Getting to the Root of the Problem

Is knee pain keeping you sidelined?

Did you know that a thorough clinical exam has been shown to be more accurate than MRI for properly diagnosing meniscus (Cartilage) injuries in the knee? Furthermore, MRI shows meniscus (cartilage) damage in 24% of patients that are pain-free! Does this make you question what really is causing your knee pain? It should.

Although we’ve said it before, I’ll say it again. Understanding the underlying cause of your injury is equally important to knowing the actual diagnosis. Understanding your entire health history and injury history ensures adequate and high-quality treatment. Be sure your provider has given a thorough exam, is not only relying on MRI or other imaging, and that your treatment addresses the underlying problem not just the pain itself.

Starter Guide to Knee Pain

Here is a starter guide to knee pain, most likely causes, and what to watch for.

Treatments

Treatments vary by condition, but as a general guide:

  • Active Release Technique and Instrument-Assisted Soft Tissue Mobilization (IASTM) are 2 of the best techniques for many of these injuries. There are plenty of others, but these are a great starting place.
  • Rest, Ice Massage, and anti-inflammatory cream at home may help control symptoms.
  • Proper rehab and correcting movement patterns is a key to preventing recurrence.
  • Additional, specific treatment options for some conditions are listed below.

Pain Location

Front of the Knee (Anterior)
  • Most Common condition categories:
    • Patellar Tracking Disorders/Cartilage irritation (aka “The knee cap doesn’t glide where it should”) causing irritation of any number of tissues/structures around the knee.
    • Degenerative Changes – breakdown and irritation of cartilage, bone, and/or ligaments. Maybe the result of a previous injury, or more commonly due to improper mechanics.
    • Tendinosis – inflammation or tissue thickening of tendons (attaching muscles to bone).
  • Who: Most Commonly related to overuse. Runners, jumpers, activities requiring excessive starting/stopping, stair climbing, jumping or impact.
  • What to look for:
      • Swelling – may indicate irritation/inflammation of a bursa (fluid-filled sac).
      • Popping/Clicking – may indicate damage/degeneration of the meniscus (Knee cartilage) or the presence of a plica, a band of tissue under the knee cap which can friction causing noise and sometimes pain.
  • Underlying Causes: Improper Mechanics. See knee mechanics article here. Overuse. Improper training regimen/progressions.
  • Diagnosis: Clinical Exam
  • Treatment Options: usually responds to properly prescribed homecare, rehab and conservative methods (ART, IATSM, etc)
Inside of the Knee (Medial)
  • Most common condition categories:
    • Medial Meniscus – cartilage within the knee may be degenerating, irritated, frayed or torn.
    • Ligament Damage – Specifically MCL or the Medial Longitudinal Ligament.
    • Tendinosis – Sartorius, Gracilis, Semitendinosus most commonly.
    • Bursitis – Pes Anserine Bursa protects the three tendons listed above from rubbing on the underlying bone.
  • Who: Soccer, Football, Basketball, Tennis and Racquetball players. People suffering from weak hips, improper hip mechanics and/or feet causing the knee to “fall” inward during walking, running, stair climbing, etc.
  • What to look for:
    • Swelling – may indicate irritation/inflammation of a bursa (fluid-filled sac) or the MCL.
    • Popping/Clicking – may indicate damage/degeneration of the meniscus (Knee cartilage).
    • Feeling unstable/giving away – may indicate ligament damage, loose bodies, muscle weakness or meniscus injury.
    • Pain unchanged by knee movement or that cannot be reproduced. Rarely, a problem in the lower abdomen can refer pain here.
  • Underlying Causes: Trauma/Injury where the knee is forced inward (sometimes with rotation). Improper Mechanics. See knee mechanics article here. Overuse – most notably with weak hips, weak feet, and poor mechanics.
  • Diagnosis: Clinical Exam, possible MRI.
  • Treatment Options: Possible surgical intervention for Meniscus or MCL damage. Meniscus tears are categorized by a number of factors. Surgical intervention is required for some types of tears however, many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.
Outside of the Knee (Lateral)
  • Most Common condition categories:
    • Lateral Meniscus – cartilage within the knee may be degenerating, irritated, frayed or torn.
    • Ligament Damage – Specifically LCL or the Lateral Longitudinal Ligament.
    • Tendinosis – Iliotibial Band (ITB), Biceps Femoris (one of the hamstring muscles), Popliteus (small muscle behind the knee).
    • Bursitis – protecting the ITB from the underlying bone.
  • Who: Runners, Contact Sport athletes.
  • What to look for:
    • Swelling – may indicate irritation/inflammation of the bursa or the LCL.
    • Popping/Clicking – may indicate damage/degeneration of the meniscus.
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury.
  • Underlying CausesTrauma/Injury where the knee is forced outward (sometimes with rotation) Improper Mechanics. See knee mechanics article here. Overuse – most notably with weak hips, weak feet, and poor mechanics.
  • Diagnosis: Clinical Exam, possible MRI.
  • Treatment Options: Possible surgical intervention for Meniscus or LCL injuries. Meniscus tears are again categorized by a number of factors. Surgical intervention is required for some types of tears, however many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.
Back of the Knee (Posterior)
  • Most Common condition categories:
    • Medial or Lateral Meniscus- degeneration, irritation, fraying or tearing usually in the back aspect of the cartilage.
    • Tendinopathy- Hamstring, Gastrocnemius (Calf muscle). May indicate irritation, inflammation, thickening or tearing in one of these primary muscles.
    • Capsule involvement- irritation or contraction of the capsule surrounding the knee joint.
    • Radiculopathy or referred pain from the low back, a pinched nerve or disc-related injury.
  • Who: Runners, Contact Sport athletes
  • What to look for:
    • Swelling – may indicate a cyst which can be related to meniscus tears or damage to the Anterior Cruciate Ligament  (ACL) or Posterior Cruciate Ligaments (PCL)
    • Popping/Clicking or Locking – may indicate damage/degeneration of the meniscus or may indicate a “loose body” in the joint; these range from calcium deposits to chunks of bone which have broken away due to injury.
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury.
    • Pain unchanged by knee movement or that cannot be reproduced. Pain may be coming from the low back, hip or another area.
  • Underlying CausesTrauma/Injury where the knee is forced backward (sometimes with rotation), improper warm up prior to an activity. Overuse and occasionally poor mechanics.
  • Diagnosis: Clinical Exam, possible MRI.
  • Treatment Options: Possible surgical intervention for meniscus, depending on classification or location of injury. Chiropractic manipulation, McKenzie technique, rehab or additional techniques may be needed if the cause is related to low back concerns.

Final Notes

Hopefully, this has helped you understand the basics of knee pain and concerns. As always, be sure to understand the underlying causes of your injury, proper diagnosis, and appropriate treatment options. We’re happy to help you with your knee pain, simply contact our office to set up an appointment.

Updated blog, originally posted 2015 | Feb | 17

About the Author
Dr. Therese Miller, D.C., believes passionately about changing the expectations of patients toward their healthcare. Providing a fusion of chiropractic medicine, corrective exercise and manual therapies, she currently holds additional training in 9 techniques. Since 2013, she has held the prestigious "Elite Provider" certification through Active Release Techniques® and is working to complete her Diplomate in Rehab. Dr. Miller has built Miller Sports & Wellness as a leading resource for athletes and patients looking for long-term, pain-free living.
  1. Sports Injury treatment Reply

    It’s truelly good.

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