Knee Injuries

We see patients in our office daily with arthritic knees - sometimes bilateral, other times affecting only one leg.  Some patients can point to an old football injury or car accident as the probable cause.  But, frequently, they can not tell us why their knee hurts, only that they have a new friend called "arthur" that causes their knee to swell and hurt.

Each day we are faced with patients whose musculoskeletal complaints may not appear spinal related.  Many times no mechanism of injury is retain from a consultation or examination.  Orthopedic tests are quite often absent of a positive finding other than maybe a little discomfort.  So what is the cause?  It is easy to figure out from a diagnostic view of the patient who sustained a direct injury to the knee from a fall, or car accident, or the athlete who received a traumatic blow to the knee.

In runners, the chief complaint is commonly lower leg pain.  This could be determined as tibial stress syndrome (shin splints), or perhaps strains of the soleus and gastrocnemius muscle.  The second most common complaint is of the knee-generalized soreness anywhere around the knee to advancing conditions like chondromalacia.  The foot is third, with conditions like plantar fascia, bunions, blisters, ankle sprains and strains.  fourth is the hip, followed by the upper leg and finally, low back conditions.  As we look at this list of most common areas of chief complaints, do you feel the order is correct?

When we analyze the gait cycle, we have a good understanding from previous articles and our own general knowledge that the foot is made up of three arches (medial, anterior, and lateral) and three distinct segments (forefoot, midfoot, and rearfoot).  Together when patients ambulate, they transition from some form of heel strike through mid-stance followed by toe-off.  We know all three arches work together for structual support of the foot.  If one arch is affected by misalignment, plastic deformation or wrong or ill fitting shoes, it will affect the normal movement pattern of the foot.  We know that, when the foot goes into its pronation pattern (rolling inward), the tibia medially rotates (turns in).  this medial rotation can be excessive as in hyper-pronation or restricted as in hyper-supination, or it can be an abnormal movement pattern through the foot asin a patient who just picks the foot up and sets it down and does not have heel-toe transition.  The stresses placed at the knee are excessive.

We also know that subluxation complexes of the of the spine and pelvis will affect posture and alignment (which can affect Q angles), while anteriority and posteriority of the hips affect the angulation of the femur.  When we think about the knee joint, it is a hinge joint.  It primarily functions in flexion and extension.  It has the simplest joint movement and one of the less stressful joint movement patterns.

When we think about a door hinge and how many times it swings back and forth, what usually causes a door hinge to start to fail?  It's not that it wears out.  It's usually the door, itself, starts to misalign or the house shifts and the door no longer closes properly causing angulated stresses on the door hinges.  This is no different that what our bodies do.  There is no doubt that "neurologically it is from above-down-inside-out" but, "biomechanically, it is from below-up".  Or to put it another way, "when the foot hits the ground everything changes."  These phases just point out that in our treatment of patient's knee conditions we must always look to what the real cause of the knee condition is and not just look at the knee itself for the treatment of the condition.  We must evaluate abnormal patterns in gait and posture, and we must help our patients with treatment plans that can include rehabilitation, specific chiropractic adjustments, or supportive measures like custom-made orthotics.