Knee Pain

When we think of knee pain most times, trauma and degeneration are at the forefront of reasons why a person’s knee might hurt. There are a number of factors that we need to think about when considering knee pain. The hip and feet significantly influence mechanics of the knee. In addition, a person's posture will affect how the knee is moved. Please read the following article and learn how we as active individuals in our daily lives, can create our knee pain.

Consider this patient; a female in her 40’s with a 20 year history of working, taking care of children, being the center of the family. She may have gained weight and has been off and on exercising since she had children. Her idea was to shift focus onto herself and begin exercising. So she starts a walking or running program as part of a local shoe store’s promotion and/or from research she had done online. She did her homework about exercise and stretching, but about three weeks in her knees started hurting. This problem is no different for men or women and it is a consistent issue that we see regularly at Kulp Physical Therapy and Massage.

When people start exercising, most of us look towards good sneakers, particular stretches that we've read about or viewed online, and maybe even seeking out advice from more knowledgeable people and programs that promote health and wellness. People don't think about their usage patterns that their bodies have gotten used to and have compensated to the type of activities they have been performing. Kulp Physical Therapy and Massage is promoting the concept of exercises that work on aligning the body, recruiting the right muscle groups and developing more precise movement patterns that will promote health while reducing arthritis, repetitive injury and pain.

One of the most common dysfunctions is a weakness of the hip resulting from compensated recruitment of the Iliopsoas, Tensor Fascia Lata and hanging on the ligaments of the hip. This usually occurs from prolonged standing, sitting or muscular overuse. The result will be a pelvis forward, sway back posture with poor recruitment of hip extensors, lateral rotators and abductors which help stabilize the hip. The hip will slide anterior or superiorly, the femur will medially rotate and adduct. This will cause increased pressure and torque on the medial knee components and incorrect patellar sliding on the femur. The foot will also tend to pronate, stretching out its medial and plantar components. Some of the ensuing responses of the body to these positions may be hip and knee arthritis, medial collateral ligament and medial meniscus wear and tear, patellar – femoral pain and misalignment, prepatellar, infra patellar, supra patellar and pes anserine bursitis, ITB syndrome, plantar fasciitis and back pain. In addition the muscles around the hip and knee can develop their own pain.

Janet Travell found and documented the myofascial trigger point’s referral pattern of muscles throughout the hip and knee. (1). Note the referral patterns below.

Travell showed that the myofascial trigger point when active or latent will cause a loss of range of motion, weakness of the muscle, lack of coordination of the agonist and antagonist muscle movements, joint compression as well as neural compression.(1)

Kulp Physical Therapy and Massage will utilize exercises that will first develop the right recruitment patterns and then strengthen the muscles to promote correct alignment in the hip and knee joints. There will be less muscular strain, muscle soreness and myofascial trigger points. Kulp Physical Therapy and Massage will evaluate and treat each muscle, eliminating the trigger point and movement dysfunction.

When the knee joint is irritated, Kulp Physical Therapy and Massage will decrease inflammation and pain through the use of manual joint and tissue techniques, modalities of ultrasound and electrical stimulation, (including the use of phonophoresis and iontophoresis), and thermotherapy techniques. In addition, Kulp Physical Therapy and Massage will develop a home exercise program that the patient will utilize to help themselves.

Bursitis and ITB symptoms can be particularly difficult for the patient and require a skilled approach to reduce the stressors on the tissues. First we start by educating the patient on what they're doing that is contributing to this dysfunction. Then we develop a low grade exercise program at the back of the knee to get the tissues moving without irritability. Then we strengthen the knee joint complex and develop improved control through proprioceptive exercises. When the foot is involved, physical therapy can treat the symptoms appropriately and advise what type of orthotics or shoe gear will help the patient. Kulp Physical Therapy and Massage also promotes referrals to specialists in Orthopedics and Podiatry as well as utilizing the patient's Primary Care Physician in the care of their symptoms.

Trauma is treated with the appropriate staging of the disorder. Stage I rehabilitation requires rest and reduction of acute symptoms. Stage II progresses the patient through exercises and activities that get the tissues ready to accept increased stress and movement. In Stage III, Kulp Physical Therapy and Massage works on finalizing the patient's exercise program and returning them to full work and recreational activities.

Kulp Physical Therapy and Massage has two nationally certified manual therapists to help your knee pain patients.

Take a few moments to inquire how Kulp Physical Therapy and Massage can help your patient feel better. Doug or Janelle can also come to your office or clinic and give an in-service about how physical therapy treats knee pain. Please contact us at 585-742-8270 or email us at kulptherapy@frontier.com if you’re interested.

(1)Travell JG, Simons DG. Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 1. Baltimore. Williams and Wilkins. 1993.