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A General Overview of the Knee

The knees are the shock absorbers of the body.  As upright animals, our knees take the brunt of the forceful shock damage with every stride we take. The faster the pace, the more force is created.

The knee is comprised of two very large broad bones (the distal femur and the proximal tibia) as well as the head of the fibula is off to the outside of the knee, which is not apart of the “proper” knee joint, but acts as an attachment for many muscles that aid in the stabilization of the knee joint.  On the front of the knee, there is also the knee cap (patella) that is buried in the tough fibers of the tendon for the quadriceps.  Internally, there are 2 ligaments that aid in holding the interior of the joint together, the Anterior Cruciate ligament (ACL) and Posterior Cruciate ligament. (PCL)  Anyone who plays or watches sports knows these ligaments quite well.  The front and sides of the knee are surrounded in their own tough ligaments, as the knee itself is very susceptible to damage, considering the forces the surrounding muscles can generate as well as the forcible impacts the bones receive on a regular basis.  As a built-in precaution from said injuries, we have a spongy soft meniscus in between the tibia and femur.  This meniscus acts as both a shock cushion and an anti-slip layer between the bones.

Where does knee pain come from?

Knee pain is very tricky to isolate and diagnose.  Pain in this joint typically follows many years of inactivity, or some kind of sudden trauma.  Very rarely is there a time when a knee simply starts hurting with no causative event.  Knee injuries are typically related to very few types of movements and highly likely to one type of action; inactivity.

How can traumatic injuries cause knee pain?

Let’s start with how the knee is suppose to move.  The knee is meant to move forward and backward, as such, it is very strong in both of those directions. Traumatic injuries can occur very easily when the knee is struck from the side.  This type of injury typically requires surgery to resolve as the structures that are broken, are not easily healed. Think back to the last time you went skiing on water or snow, jumped on a trampoline, or spent a long boating trip; how did your knees feel the day after?

If your foot slides forward and the thigh suddenly stops, this places an extreme amount of stress on the ACL within the knee in a “jarring-like” motion, as its job is to stop the tibia from sliding forward.  The inverse applies to the PCL, in that its job is to stop the tibia from sliding backwards.  Any sudden movements of the foot, with sudden stopping of the body (like sliding or slipping and catching yourself) may cause substantial damage to these ligaments, which will cause pain.

How does inactivity cause knee pain?

Frequent damage to the knee is related to activity, but the most common cause of the pain, is decades of inactivity.  The knee is a very strong joint.  As humans, we’ve adapted to be upright long distance runners.  This is how humans hunted long before firearms were invented.  We are not fast runners (you won’t see a human compete with a cheetah) but we have the anatomy and biomechanical design to run very long distances at a very moderate pace.  This is where the structure of the knee becomes very important.

The quadriceps is one of the most important joints when it comes to proper knee health.  The purpose of this muscle group is to pull the tibia (shin) forward in a kicking motion.  This muscle gets used a lot with forceful leg activity, and as a result, is one of the largest muscle groups of the body.  The patella (knee cap) is embedded within the tendon of this large group of muscles, and it directly allows for optimal bending and movement of the leg.  If the muscles of the quadriceps weaken, this pattern of movement gets sloppy.  As the movement of the knee becomes less optimal and less frequent, the joint does not maintain a strong level of stability.

This lack of stability won’t be immediately noticeable, but it causes increased wearing of the joint, leading to Osteoarthritis later in life.

The other problem with knee instability is that it is “insidious” or very slowly progressing (squatting wrong for example).  The problem won’t be overly noticeable until there is a sudden demand for the knee to be stable (like in a fall) and it won’t be, which is likely to lead to a traumatic bone fracture.

The last, and most important part of maintaining proper knee health is that a weak and/or sore knee will directly cause low back pain.

If you have one “bad” knee, you will continually use it less, due to pain.  As you compensate for the “worse” knee, the other knee and hip will have to take more of the weight of the body, and as a result, the lower spine now has to bear more weight than it was suppose to.  This will cause premature wearing of the joints of the spine and pelvis, as well as add a remarkable amount of strain to the muscles of the lower spine.  As these muscles get tighter, the spine loses its ability to be flexible, which will cause more pain over time.

How can chiropractic treatment help this?

Determining the source of the pain is imperative.  The knee may be strained due to poor foot and ankle mobility, poor muscular control from the pelvis to the floor, or from a progressing lower back injury.  Each treatment option will vary depending on the case and the patient.  Some cases require nutritional consultation to remove excessive weight, thus lightening the load bearing on the knee, while others are complex muscular imbalances from the lower back to the calf.  Chiropractic adjustments restore proper joint mobility while the muscular treatments maintain that mobility and ensure stability of the joint.

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