The Bees Knees

It seems like summertime and all the activities we enjoy this time of year can really take a toll on our knees. The clinic has been full of sore knees recently! Hiking, golfing, gardening, biking, hilly walks, tennis. All these activities put more load and different forces through our knees.  Knees can present with a variety of problems that may come from several sources in our body. I’ll discuss here some of the most common and what are some red flags to watch out for.

One major complaint we see is the problem of giving way or buckling at the knee. This often occurs in weight bearing, while walking or doing stairs.   According to Medical News Today, 11.8 % of people aged 36-94 reported at least one episode of knee buckling in the past 3 months. This may affect people of all ages and all levels of fitness. There are many potential causes for this issue.

The knee consists of the femur (thigh bone), the tibia (shin bone) and the patella (kneecap). There are muscular attachments at the knee that also cross the ankle and the hip joints. Joint forces from both the ankle and the hip, therefore, can affect the knee. There are tendons (connect muscles to bone), ligaments (connect bone to bone), cartilage lining the joint surfaces and a meniscus that acts as a shock absorber. It is possible to damage any of these structures or more than one at one time!

Some of the common causes of knee pain:

Patellar Tracking – the patella that runs along the front of the knee joint can get off track. Muscle imbalances in the hip, knee or ankle can affect the patella and how it moves along the front of the knee. If this happens it can be a sharp, shooting pain along the front of the knee, grinding or a popping sensation. Muscle imbalances from the hip and how they pull on the kneecap, is one of the most common sources of knee pain.

Mensicus – a meniscus is a piece of cartilage within the knee joint that helps to deepen the socket as well as provide shock absorption. Forceful twisting motions, degeneration, or trauma can lead to a tear in the meniscus. This interferes with the normal motion of the knee and can cause sharp pain, clicking, locking or giving way. Baker’s cysts – a pocket of swelling at the back of the knee is a common sign associated with a meniscus injury.

Ligaments – there are four main ligaments that stabilize the knee. The most commonly injured are the ACL (anterior cruciate ligament) and the MCL (medial collateral ligament). This is typically due to trauma, but may also be sprained due to overuse and poor joint mechanics of the lower leg. When a ligament is injured, the knee can feel unstable, weak and painful.

Osteoarthritis (OA) – this is a condition in which the cartilage between the joint degenerates. The lack of cushion in the joint can lead to pain, swelling, stiffness and decreased mobility. The knee is one of the most commonly affected joints. According to the Arthritis Foundation, more that 27 million people in the US have osteoarthritis. Factors that may increase the risk of developing OA of the knee are age, weight, genetics, repetitive stress injuries, and other illnesses (ie. metabolic disorders). Studies have shown that the symptoms of knee pain are weakly associated with radiographic findings of OA. This means that even though an X-ray may show you have OA of the knee, it doesn’t mean that is the main source of your pain.

There are other structures that can manifest as knee or leg pain but have more cause for concern:

Femoral neuropathy – the femoral nerve exits from the spinal cord in the lower back and innervates muscles along the front of the thigh. This can affect the strength in the quadriceps muscle and cause the knee to feel weak and possibly give way, or buckle. If there is associated pain, burning, tingling or numbness in parts of your thigh or lower leg, this may be a sign of a neurological dysfunction or a source coming from your back.

Deep vein thrombosis – a DVT is a serious condition that occurs when a blood clot forms within a vein. They commonly form in the thigh or lower leg but may develop in other parts of the body. This blockage can cause pain, swelling and tightness in the leg and is typically worse while walking. One is at risk of developing a DVT after surgery or prolonged periods of sitting (ie. a long flight). If you have insidious onset calf or leg pain, heat, redness and tightness in the leg, contact your doctor right away.

Rheumatoid arthritis (RA) – this is autoimmune disorder that affects the lining of your joints. Unlike the degenerative process of osteoarthritis, RA can lead to bone erosion and chronic inflammation of the joints. Typically presents in both sides of the body and in multiple joints. Common symptoms may be fatigue, joint pain, swelling, redness and loss of joint range of motion. It may also be associated with a fever, numbness, tingling and a general feeling of malaise.

The practitioners at Bragg Creek Physiotherapy are equipped with the tools to help you find the source of your knee pain. The physiotherapists, athletic therapist and massage therapist would love to help get you moving again before the snow flies! If you are struggling with an injury or are unsure what your symptoms may mean – we would love to help get you heading in the right direction.

Jennifer Gordon (BSc.PT, AFCI, GunnIMS)