In this post, we are going to be talking about where does knee pain come from, is surgery the answer, and why range of motion and hip strength matters when it comes to knee pain.
The Concept of Victims and Culprits with Pain and Injuries
This is really not unique to knee pain, but it is a really important concept that I know physical therapists are very aware of. I also do think it's important for the patient or the active person to know about when you're facing a pain issue. While I'm talking about knee pain here in this post, keep in mind that this can apply whether you're having a headache, shoulder pain, back pain, etc.
Victims and culprits -- what do I mean by that?
When you come in for a physical therapy evaluation, it should be a THOROUGH evaluation. You may come in for knee pain, but you need to look at the whole body and how it's moving as a system because your knee pain could just be the victim. This means that you have pain there, but it might not be the cause of your issue.
The culprit is really elsewhere, meaning it's not in your knee. The problem that could then improve your knee pain is actually maybe in your back, in your hip, and/or your ankle. If you don't address the culprits (true causes), you're likely going to have that issue again.
Knee Replacements for Knee Pain -- Worth the hype?
Let's take a super common example -- a total joint replacement for the knee. Instead of pursuing conservative options for knee pain treatment, a patient may be advised to go straight to knee surgery, instead of physical therapy, and physical therapy can actually resolve your issue without surgery. However, if you haven't had a thorough examination by a physical therapist, into other areas, you may not be fully addressing the problem by getting a knee replacement.
My point, back to victims and culprits, is if you get a new knee, your pain may be gone, but if you haven't addressed the culprits, you may still have a problem.
How Joint Mobility and Range of Motion Can Affect Your Knee
It's important to look at the joints above and below the knee. For example, many patients may have an issue with a lack of mobility in their ankle. Lacking dorsiflexion, which is the ability to bring your toes towards your shin. The mobility of that joint is less or you could have the opposite problem and maybe you have a long history of multiple ankle sprains and you have an instability in your ankle, meaning your ability to kind of lock in that joint and hold it stable. This is why knowing what your past injuries are is a really important thing to explore when addressing your current problem.
If we go up and look at your hip, we can examine the stability and mobility. It's more often a lack of mobility in your hip, but that's not always true. But when you're talking about stability with your hip, you're usually also including your back or what we call your lumbo-pelvic hip complex, a long wordy term but basically it means how you're able to stabilize or keep it locked in, in your back where your pelvis and your hip and femur all meet together (this is definitely important for runners and hikers!).
When you come in for a physical therapy evaluation, and we figure what's going on, I come up with a game plan and I present this game plan to you -- not everybody will have to start at this point but the starting point is often your mobility.
Whether you are having knee pain and you are a high level athlete, whether you're having knee pain and you can barely get off the couch, your range of motion may be a factor and it needs to be the starting point. It can be easy for the higher level person to forget at times, but if you start having pain, it's a good idea to kind of check what your range of motion is.
If you're having a chronic osteoarthritis problem and you're contemplating a knee replacement, you need to optimize your knee range of motion. With arthritis you want to move less and less, and so it is common to lose range of motion. Well this you can improve upon! However, if you're destined for a knee replacement and it's inevitable, you're gonna set yourself up for a better outcome on the other end of the recovery process, if you try to improve and optimize your range of motion BEFORE surgery. And more often than not, when you improve range of motion, you do have some effect on decreasing your pain. So that's the second thing range of motion super simple, but I do think it's for both ends of the spectrum, the sedentary individual or the very active athlete.
How Hip Stability and Strength Affect Knee Pain
Your hip strength is a huge factor with knee pain. The best way to improve this is to start with some basic exercises. All of them are very foundational type exercises and are really simple. We start with open chain exercises, like leg lifts and clamshells, then move to closed chain exercises.
Working on balance and stability can be both concentric/eccentric exercises, but I also find that isometrics work really well. In any position, evaluating whether you're able to hold that position confidently without wobbling will help you figure out if more hip strength will be in your plan.
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