A real pain in the…knee?

Introduction
Knee pain can occur on many movements; squatting, jumping, running, or climbing stairs. It is reported that around 1 in 5 (22.7%) of the population experience anterior knee pain (pain at the front of the knee) annually (Dey et al. 2016), and rising to as many as 1 in 3 (35%) of regular amateur cyclists (Smith et al. 2018). Being involved with sports that involve regular squatting (CrossFit and Olympic Weightlifting), and working in Orthopaedics, I have seen how much knee pain can impact on someone’s activity levels. So how can we combat this and keep everyone’s
knees as healthy as possible?

“Knees are a victim never a cause”
These are the words uttered to me on my very first physiotherapy student placement. As physiotherapists we are taught to assess all of the joints and structures around the area of pain. So what my clinical educator meant by the above was that the knee is subject to the movement at the joints around it: the hip, and the ankle.

The knee is a joint that is made up of the femur (the thigh bone) and the tibia (shin bone). Above the knee the femur forms the hip with the pelvis. The quadriceps form the bulk of the front of the thigh, with the hamstrings at the back. The quadriceps form the patella tendon and attached to the front of the tibia. Both sets of muscles work across both joints. Below the knee the tibia forms the ankle with the fibula and the bones of the foot. The gastrocnemius (the large muscle of the calf) crosses both joints. When something is not moving well at one of these points, the knee gets caught in the middle.

Focus on the foot
The ankle is a hinge joint, which means the tibia glides across the bone in the foot (talus). When this becomes stiff, or moves less freely, it increase the forces on the quadriceps and the patella tendon. In other words, the knee takes the brunt!

Knee to Wall Test
This simple test can tell us a lot. Measuring 5” (12cm) from your big toe to the wall, keeping your heel on the floor, try to touch the wall with your knee cap. If you are unable to touch the wall without your heel raising this is a sign of a limitation in ankle mobility. This could have a knock on effect on your ability to squat, run or jump pain free. A sensation of tightness in the calf would suggest muscle tightness is the limiting factor, whilst a pinching sensation in the front of the ankle suggests the limitation lies in the ankle joint it’s self.

Look After Your Ankles!
A healthy ankle joint can be the key to keeping the rest of you moving well and ease the pressure on your knees. Try the knee to wall test.

If you feel your knee pain is getting in the way, get in touch and come and see one our physiotherapists at The Medical.

If you would like to book in with our physiotherapist Anthony Cusack, at The Medical Newport call 01633 223 888 or 03303 334 123 or contact info@themedical.co.uk

References:
Dey P, et al. A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties. BMC Musculoskeletal Disorders, 2016; 17:237.

Smith, B. et al. Incidence and Prevalence of Patellofemoral Pain: A Systematic Review and Meta-Analysis, PLoS One, 2018, 13:1