We only have two of them and they are instrumental in just about everything we do in life! When our knees are acting up it can shut down our ability to remain active to any significant degree.
Walking with knee pain alone is enough to stop us in our tracks, but squatting, stooping, exercising, lifting our children and grandchildren, and going up and down stairs can be painful too. When knees are barking, we are listening.
Most people try to put off doing anything about it with the hopes that the knee pain will just go away with a little rest, a little less activity, and maybe some ibuprofen. Sound familiar?
There are so many structures in and around the knee joints and when these structures are brought past their limits they can break down and the body has a way of illuminating a “check engine light” in the form of pain and inflammation. Some kinks and random strains will go away, but as we age injuries can linger and cause a cascade of functional impairments that can haunt us for a lifetime. It is important to go to a trusted expert for an evaluation and not just mask the symptoms with medication.
One of my most cherished times in my career was when resident physicians came to me for a musculoskeletal and sports medicine rotation during their medical school training. I remember distinctly that my number one message to them was to avoid pulling the trigger on pain medication and muscle relaxers without giving careful thought and a thorough diagnostic process to determine the underlying condition as well as the cause of that condition.
Medication has its place, but real value comes from helping people understand why a particular bodily structure is breaking down and giving them credible solutions that can prevent a simple tendinitis from becoming a surgery later in life. For example, if someone has pain on the inside (medial) part of the knee because they are loading that knee incorrectly it would be prudent to change or modify the abnormal loading. Helping the person fix that issue now can prevent a total knee replacement later in life due to 30 years of abnormal loading because it wasn’t identified and addressed early.
As a board certified orthopedic clinical specialist and Doctor of Physical Therapy I have had thousands of patients over my career ask me “Can you give me some strengthening exercises for my knee?”
First of all, I have noticed that many people automatically assume that their problem is a strength issue and while it can be part of it there are so many more boxes that need to be checked. One of the primary reasons people don’t get better and can actually be harmed is because treatments are prescribed without really knowing what the underlying cause of the problem is. This is true for the knee and every other condition, disease, or dysfunction in the human body.
So, it is critical to have a thorough examination and in my practice it is mandatory. We don’t just start throwing exercises around. Exercise is often just one component of successful intervention. Healthcare professionals need to be able to see the forest and not just the trees for every injury or condition they encounter.
Let’s talk about some of the most common conditions that can cause knee pain:
1. Osteoarthritis and “Bone on Bone”
One of the most common cause of knee pain, osteoarthritis is the wearing down of the cartilage in the knee joint over time. It leads to stiffness, swelling, and pain, especially with movement. Characteristically, joints are particularly stiff in the morning for the first 20 -30 minutes out of bed or until people are up moving around for a bit.
My Expert Insight: Cortisone shots, gel shots, and joint replacements should not be the first nor are they the best solutions in many cases. I prefer my patients to engage in natural, non-invasive joint surface regenerative treatments (shockwave therapy, peptide therapy), hands-on, skilled muscular and capsular flexibility techniques, “effective” weight reduction strategies, (and I don’t mean simply telling a patient “you need to lose weight” and they walk out the door with no tangible help), manual therapy-joint mobility techniques, and anti-inflammatory nutritional practices.
2. Patellofemoral Pain Syndrome
Also known as “runner’s knee,” (but doesn’t have to be a runner) this condition is caused by improper alignment (or improper gliding) of the kneecap (patella) and can result from overuse, muscle imbalances, or biomechanical issues.
My Expert Insight: Commonly, we find tenderness on the outside edge of a person’s lower thigh (femur) where the kneecap often “rides and wears down” the bony surface. The muscles and tendons above and below the knee cap (the “guidewires”) may be involved or abnormal loading of the entire leg when the foot hits the ground (during walking, running, squatting, or negotiating stairs) and it certainly can be both. The “cause” needs to be identified and corrected.
3. Meniscus Tears
The menisci are c-shaped pieces of cartilage that cushion the knee joint. Tears in the meniscus, often due to twisting injuries or degeneration, cause pain, swelling, and difficulty moving the knee.
My Expert Insight: These are the “lingerers” !!! The meniscus is known to have poor blood supply and tears can take forever to heal. There are severe cases where the meniscus is torn so bad or it flips position inside the knee joint causing motion to be significantly blocked and painful. People can feel a “catching sensation” or the knee can “lock” at times. Getting up from a chair or out of the car after sitting for a period of time can be a problem and often takes several steps for a person to feel like they can walk somewhat “normally.” It is CRITICAL to know early if you have a meniscus tear because twisting, pivoting, and “torsion” at the knee joint must be STOPPED if there is any hope of minimizing the chance of having an invasive treatment approach.
4. Ligament Injuries (ACL, PCL, MCL, LCL)
Injuries to the knee’s ligaments (such as ACL or MCL tears) typically occur from sports injuries or trauma. These injuries can lead to instability, swelling, and severe knee pain.
My Expert Insight: Ligaments are the structures that basically hold our joints together. Our muscles are very important to the stability of our joints too but without intact ligaments, it is a much tougher task. Ligament replacements and reconstructions have mixed results especially when someone returns to a sport or job that demands maximum joint stability. Treatment choices have everything to do with specific goals of a patient with regards to timelines and functional demand. My overarching message, no matter the treatment choice, is “Don’t rush it.” Faster rehabilitation and quicker return to extreme functional demands is not better in the majority of cases. There are many factors involved and ALL must be addressed and optimized for maximum success. (strength, stability, psychological confidence and fear minimization, endurance, muscular and neurologic synchrony, skill training, nutrition, recovery, etc.)
5. Tendonitis (Patellar or Quadriceps Tendonitis)
Overuse of the knee joint, especially from jumping or running, can cause inflammation in the patellar or quadriceps tendon, resulting in pain at the front of the knee.
My Expert Insight: What I have seen with these injuries for many years is a lack of preparation for the demands of a person’s life and activity level. Whether it is a basketball athlete, volleyball player or someone who climbs a lot of stairs, or even someone who is overweight, our tendons only have so much capacity and in the absence of specialized strength and power optimization strategies they will breakdown!! I remember early in my career I produced a local tv show and I had an episode pertaining to youth athletes and plyometric training. Some parents and coaches were VERY concerned about younger athletes performing plyometric activity UNTIL I asked them the million-dollar question “What exactly do you think they are doing on the basketball court or the soccer field or in gymnastics?” Yes, there is no better representation of “plyometrics” than organized sport activities. You see, instead of fearing strength training and power training, it should be embraced to better prepare our tendons for “Game Day”!
6. Bursitis
The knee has small fluid-filled sacs called bursae that reduce friction. When these become inflamed (often from overuse or direct pressure), it leads to knee pain, swelling, and tenderness.
My Expert Insight: When it comes to the knee, two particular areas where bursae can “act up” are at the top of the kneecap (Suprapatellar Bursitis) and on the inside (medial aspect) of the knee. (Pes Anserine Bursitis). In the vast majority of people who have pain in these specific areas there is either an abnormal loading issue for various reasons or an unloaded or loaded repetitive knee motion and this needs to be delineated.
7. Iliotibial Band Syndrome (IT Band Syndrome)
Common in runners and cyclists, this condition occurs when the iliotibial band, a thick band of tissue running along the outside of the thigh, becomes tight and rubs against the outer knee, causing pain.
My Expert Insight: Oh no, not the IT Band!!! I have a 98% success rate in curing this issue which is typically a relentless pain with loading and can be caused during downhill running, short stride running or other impact activities involving faulty biomechanics. Shockwave therapy, technique modification, and a very specific and skilled Deep Transverse Friction technique is nearly unmatched by any other treatment approach in my experience.
8. Gout
Gout is a type of inflammatory arthritis caused by the buildup of uric acid crystals in the joints, including the knee. It leads to sudden and intense pain, redness, and swelling.
My Expert Insight: Ouch! This is painful and is often a matter of nutrition!!
Shockwave therapy can help in recovery and pain reduction !
9. Rheumatoid Arthritis
An autoimmune disease that can cause inflammation in several joints, including but not limited to the knees, hands, feet, rheumatoid arthritis can lead to chronic knee pain, swelling, and eventual joint damage.
My Expert Insight: #1 – See skilled providers that can help you determine if you have a Rheumatoid in the first place. There are tests for this. #2. – I recommend nutritional strategies and consideration of peptide therapy to help with this systemic condition and Shockwave therapy at lower intensities have been very successful at reducing pain and inflammation and improving function.
10. Baker’s Cyst
A Baker’s cyst is a fluid-filled swelling that develops behind the knee, often due to another knee condition like arthritis or a meniscus tear. It can cause pain and swelling in the knee and calf area.
My Expert Insight: I don’t have any ☺ These are ridiculous! Just make sure it’s what you truly have; I have seen people misdiagnosed with Baker’s Cyst just because they had pain and swelling in the back of the knee (Popliteal area)…there are several conditions that can cause these symptoms.
My Concluding Recommendations
Manage your body weight (Don’t just “try to lose weight) Hire an expert to help you.
Don’t do too much of any activity without adequate recovery time.
Seek and establish a relationship with an expert or a company that can help you prepare your body optimally and comprehensively for sports and other functionally demanding life activities.
Address pain, inflammation, injuries EARLY!
Rest, Ice, Compression, Elevation (RICE) is old school!
Very acutely, reducing pain and controlling inflammation may be helpful, but then get out of the way of your body’s natural healing capabilities!
Seek natural and regenerative methods (ie. Shockwave Therapy and Peptide Therapy) and get your nutrition in check to heal joint surfaces and soft tissues FIRST before ever resorting to shots, medications, and surgery!
If you would like to attend a Modern-Day Physical Therapy program or set up a Shockwave or Peptide Consultation, please send us your information or you can call or text 315.525.6860.