Treating the boss- Knee Pain

01 Sep Treating the boss- Knee Pain

Today, I saw my boss as a patient for her longstanding knee pain in both of her knees following previous injuries.  An X-ray had cleared her for any bony involvement or degenerative changes, so if her knees seemed OK on X-ray, why all the pain?  During her physical examination, I found a wonderful demonstration of why we need to look at the big picture and the pain isn’t always coming from where we think it is! I always liken it to stepping on a dog’s tail, it barks from one end but the problem is the tail!

On examination, she had good movement in her knees, kneecaps were moving as they should and there was no obvious issue with the knee joint itself.

When I examined further into her single leg stability, mostly focusing on what was happening around her hip and pelvis, this is where I found the problem.  Often with a weakness in the gluteals (particularly gluteus medius) you may have difficulty stabilising your unsupported side on single leg weight bearing.  This can cause poor mechanics lower down in the leg or lower back and hip pain as the other muscles have to work harder for you to move, which can in turn lead to pain and dysfunction.

Furthermore, she was also overpronating her forefeet, causing biomechanical issues around the knee on both sides which caused incredible tightness and pain in the tibialis posterior muscle.

With issues like this, we have to approach it in multiple ways, short term and long term management. 

Manual therapies to help provide relief from the pain and to reduce tension in some of the muscles that are tight, but also strengthening exercises and improving biomechanics and movement throughout.  If we don’t strengthen the underlying weakness, the problem will continue to recur as you are not treating the cause of the problem just the effect!

As is nicely demonstrated in this case, pain is often the surface of the issue and not always coming from where you feel it!