Why do I have knee pain?
Knee pain is challenging and can prevent you from living an active healthy lifestyle. We use our knees for many things: climbing stairs, kneeling down to put the leash on our dog, lifting our children or going for a long run. Day to day tasks require knee mobility but when there is pain or stiffness it can put a wrench in our plans. Our goal at Break Free is to empower you with knowledge around knee injuries to help find out if physiotherapy is right for you.
We get a lot of questions at our clinic around knee pain. But the most common question around knee injuries is finding the source of the problem.
The story below is very common.
You’ve tried various things to help your knee pain but they do not provide relief. That includes ice, heat, rest, stretching, massage, medicinal rubs – but nothing changes the pain. As time passes, there is no improvement at all. With periodic use of your knee, it becomes more than an annoyance. You’ve modified your household tasks which take longer than usual. With more use of your knee, the pain becomes more constant and the intensity increases over time. Your function is limited and your knee pain becomes debilitating. Your irritability rises and caring for others becomes harder. Eventually you or someone close to you convinces you to seek help from a physician. You see a doctor who prescribes medication for your pain. The medication takes your pain away temporarily or dulls the intensity. Anxiety around your injury begins to build. You search for resources online for a quick fix. Self-diagnosing begins, using your Google search bar to find short clips on Youtube or Instagram on how to fix knee pain. You apply some of these exercises but there’s no change. Frustration builds further.
Does this sound like you?
Each injury is different and requires a detailed analysis to ensure you are receiving precise care for the exact problem. I do not fault anyone if they are looking for an answer online because it sometimes works! But I’ve also seen the opposite happen, where pain worsens from the recommended exercises.
I wanted to impart some knowledge around knee injuries with my experience as a clinician. On our own, navigating the healthcare system is very challenging when we are unsure about the source of injuries. In North America, this is an overuse of medical imaging. On top of that, our healthcare system is under pressure and waitlists for magnetic resonance imaging (MRI) run from 8 months to 1 year. Even then, many injuries do not warrant a surgical consult. So many people are stuck in limbo, swimming in a large sea of options, not knowing where to go for help.
Physiotherapists can help
Physiotherapists are trained in the anatomy of the body, well enough to use special orthopedic tests to determine what structure might be the culprit of your pain. They use their hands to perform manual tests to determine the source of the problem. Physiotherapists are trained to understand when something is not right. Using manual tests can narrow down the source of the problem without having to wait for an MRI.
As for treatment, physiotherapists use movement as medicine and are trained to provide the appropriate exercises for your knee injury. By completing a thorough assessment, they can determine the triggers of your knee pain and help you find modifications on how to avoid these painful positions. If your knee is acutely painful, they can decrease pain using acupuncture or dry needling. But ultimately, determining the source of the injury and providing the appropriate stretching and strengthening exercises will help you get back on your feet. To give you more information around what could be causing the pain, here are some common reasons why knee pain occurs.
Muscular Imbalances
Strength changes around the hip, knee and ankle can cause knee pain! When your hip, knee and ankle muscles are weak, it can change the tracking of the knee resulting in a buildup of pressure either at the front or inner aspect of the knee. This includes increased pressure at the knee cap, knee joint, the menisci and ligaments.
The Mystery Injury
Have you experienced an injury that suddenly snuck up on you? You wake up feeling knee pain unsure of how it started. There is no bruising or swelling. You are generally healthy and you can’t recall an event where you hurt your knee. Enter the mystery injury.
At Break Free Physiotherapy we have seen this presentation many times. To help us narrow down the cause, we use an evidence-based method called Mechanical Diagnosis Therapy (MDT). MDT is a methodology that uses repeated movements to determine a diagnosis and care pathway. By completing a repeated movement assessment we are able to find the source of injuries when they are not obvious.
The big question is where could the problem be stemming from? One of the possible sources could be your lower back.
Lower back? But I don’t have back pain, my knee hurts!
It’s a common myth that lower back pain must be present for it to be related to your knee. For example, there are research studies showing patients with lumbar spine disc herniations that do not have back pain. Therefore, back pain alone cannot help us determine whether knee pain is related to the lower back.
So how do you determine if it’s coming from the back?
There are a series of questions your physiotherapist can ask to narrow down whether we need to focus more on your back and knee. If your knee is suspected, physiotherapists may use repeated lower back movements first to see if your knee pain decreases or improves range of motion. Your physiotherapist can also see if changing your back position changes your knee pain. Another method used to determine if your back is related is dry needling. By performing dry needling in the lumbar spine region, we can see if there is a change with your knee pain afterwards. The big question is why does moving your back or placing an acupuncture needle in your back decrease your knee pain?
Nerves, nerves, nerves
Nerves are a highspeed information network made of tissue that is connected to your spine and brain. These nerves exit your lower back and travel towards your knee. There are certain postures or positions that can increase pressure on the nerves. This can alter the signal from your brain to nerves resulting in multiples changes such as:
Range of motion loss in the lower back or knee
Weakness of muscles surrounding the knee, hip or ankle
Tingling, loss of sensation and lack of limb awareness (proprioception)
These symptoms can vary from person to person. To help you find out if your knee problem is related to your back, here are some questions to ask yourself:
Does your knee pain feel better when you change your posture?
Does your knee hurt when you are sitting, bending forward, turning or sitting still?
Do you have or have had tingling down the same leg as your knee pain?
Has your back become stiff since your knee pain started?
If you answered yes to any of these questions, this increases the likelihood of lumbar spine referred knee pain.
Other common reports from clients with spinally source knee pain are:
No consistency with pain patterns
The same activity will feel good one day and terrible the next
Intensity of pain fluctuates
Your leg doesn’t feel right, it feels as though it is hard to get your muscles to activate
If this sounds like you and you want to get to the bottom of your injury, book with one of our physiotherapists here.
What are the chances that my knee injury is related to my back?
25%
Twenty-five percent of patients who report knee pain could have range of motion loss, strength deficits and even pain with knee movements from a back injury. In this study from 2019, some bright physiotherapists screened the lower back for extremity problems. They found that 25% of people with knee pain found change in their symptoms with lower back movements.
We want to ensure that screening the lower back is our first priority at Break Free, because it allows us to cut the problem at the root. It’s like pulling out the same weed that keeps coming back because you haven’t dug out the root. The weed continues to spread as time elapses. The same goes for a knee problem that has started as a spinal problem, without treating the root cause, it comes back.
The question is how do we find it and how do we keep it away?
Find the source!
Your physiotherapist who is trained in mechanical diagnosis therapy will be able to find the source of the problem using something called repeated movements. A repeated movement exam is the scientific method in its simplest form.
Test – apply intervention – retest!
We test a baseline such as a weak muscle or painful movement, repeat a movement in your lower back, then retest the initial baseline for improvement. This information allows us to prescribe you a precise exercise to solve the problem. Your physiotherapist may alternatively use dry needling instead of movement depending on your presentation. Once your lower back is clear, your physiotherapist will move to your knee if there is remaining pain.
Could my knee itself, still be the problem?
Yes, absolutely!
You may have an underlying knee problem. Compensation overtime can result in the development of knee pain. Here are other reasons why your knee hurts.
Tendons
Tendons are the insertion of the muscle to bone. An example of a common knee tendon injury is the patellar tendon. This tendon attaches the knee cap to the lower leg and provides a leverage point for your thigh muscle known as the quadricep. If you have pain in the front of your knee, you could be dealing with patellar tendinitis. Tendinitis occurs with repetitive overuse resulting in inflammation of the tendon. Tendon inflammation can also occur from trauma. Some examples of trauma are car accidents, impact with other players during sport or a quick stretch of muscle by force.
Muscular Strain
A muscular strain happens at the belly of a muscle. This can be caused by direct impact or a forced overstretch of the muscle. This leads to tearing or bruising of the muscle belly leading to pain with stretch and contraction. The most common areas for muscular strain near the knee are the quadriceps, hamstrings and calf muscles. The best treatment for this type of injury is rest, followed by a graduated strengthening program from your physiotherapist.
Joint
Your knee joint may be stiff! This can be related to inactivity or an old injury that may need movement to make it feel better. The right movement is generally the best medicine for a stiff joint due to inactivity.
The surface between your knee cap and your femur is also considered a joint. Patellofemoral pain syndrome is a common condition where the cartilage under the knee cap is irritated due to poor tracking. When we bend our knees, the knee cap glides along a groove at the front of the knee joint. Proper stretches and strengthening exercises can help with this problem.
Meniscus
Does your knee feel like it suddenly gives way? Do you experience locking of the knee? The meniscus is a shock absorbing disc in your knee, helping lubricate the joint with movement. A plant and twist injury of the knee can result in irritation or damage to this area. There are special tests your physiotherapist may perform to determine if your meniscus is the culprit of your knee pain. Most injuries of the meniscus do well with a good stretching and strengthening program.
Ligaments
You may have heard about the anterior cruciate ligament (ACL), posterior collateral ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL) which are thick fibrous tissues that connect bone to bone! Ligaments hold the knee joint in place to prevent shear forces forward, backwards and side-to-side. These are more commonly injured when playing sports. Manual testing can determine if a ligament is the source of your knee pain.
What’s your next move?
Being in pain can be extremely frustrating! Perhaps this is your first knee injury and unsure what to do. Maybe you’ve sought help from other professionals but have yet to find an answer? Or perhaps you are too busy and can’t be bothered with this problem any longer.
Understanding your injury is the key to overcoming it. How your knee responds to certain movements can shed light on your mystery injury and alleviate your frustration. It will save you the time scouring the internet, trying to figure it out yourself. Book with one of our skilled physiotherapists to find out where your injury is coming from and Break Free from pain!
Corey Kim
Co-Owner and Physiotherapist
Hey, my name is Corey, and I’m a co-owner of Break Free Physiotherapy and Wellness. I was born in Seoul, South Korea but grew up in London, Ontario. I finished both my Bachelor of Arts in Kinesiology and Master of Physical Therapy degrees at Western University. I’m passionate about helping people find pain relief through movement and believe in self-empowerment by sharing knowledge of the human body and its ability to heal. [full bio]
