by Dr. Andrew Gorecki, DPT, Owner of Superior Physical Therapy
If you’re out there struggling with knee pain, and you’re looking for a natural solution, and you want to avoid injections medications and surgery this article from the Pain-free Living Series will help you.
I’ve spent 16 years of my life studying how the body moves, including the bones, joints, nerves, muscles, and bio-mechanics. So I want to simplify all that for you and describe what the knee is designed to do.
All joints in the body are where two bones come together to create a space. That space is designed for movement. Different joints like to do certain movements, and they don’t like to do other movements. The first movement the knee is designed to do is to bend and extend – about 140 degrees of bending and extending. It’s very comfortable with those movements.
The second movement the knee can do is move side to side. The knee can move side to side about 15 to 20 degrees depending on an individual’s body type. That’s much less movement than bending and extending. 140 degrees versus 15 to 20 degrees. So the knee doesn’t like to move side to side as much as it likes bending and extending.
The third movement the knee can do is to rotate in and out. But it can only rotate about five degrees. So we know that it doesn’t like to rotate very much.
The knee is two bones that come together, the femur which comes from the hip and the lower leg bone, called the tibia, which comes up from the foot and ankle. The bones are interconnected by muscle and cartilage, so what the lower leg bone does the upper leg bone has to do. The movements of the foot and ankle exert influence on the knee. The hip joint also affects the knee, causing it to move.
So if I have a patient who is struggling with knee pain, I always assess how well the foot, ankle and hip are moving. I like to use a phrase, “the knee is stuck in the middle with nowhere to go”. It’s stuck in the middle between the foot and ankle, and the hip.
The body is designed to heal itself naturally, but you have to create the right environment for healing to take place. The right environment includes sleep, nutrition and the physical environment. The physical environment we’re concerned with here is the condition and movement of the hip-knee-foot/ankle group. Everything needs to be in good condition and moving properly. If not, the knee is being subjected to constant stress and possible injury.
Before we cover how to improve the physical environment for the knee, let’s talk about the two most common knee diagnoses that people associate (incorrectly, we will see) with knee pain.
Number one is osteoarthritis. Arthritis is sometimes also called joint space narrowing, joint degeneration, cartilage wearing out, and bone on bone. That last one is one I hear a lot.
Arthritis of the knee, or any the joint for that matter, has been shown to be a natural aging process – one that doesn’t need to include pain. It’s pretty hard to find anybody over the age of 50 without arthritis in their knee. The question becomes whether or not they have pain.
Arthritis is essentially the aging of the bones. Think of your skin. Your skin at twenty-five years old and your skin at seventy-five look much different. It becomes wrinkly and less elastic, maybe not as thick as it once was, and a little bit more sensitive. The same things are happening with our bones. Natural aging processes are going on and the joint space is narrowing. It’s happening in all of our joints as we age. It’s the reason we shrink – our spine is actually losing joint space in the disc area. What many people don’t realize, is that they can have arthritis, or joint space narrowing, and not have pain.
The second most common knee diagnosis is a meniscus tear. The meniscus is a lot like a cartilage ring that goes around the knee joint on top of the tibia bone (the lower leg bone). The purpose of the meniscus is to make the knee joint more stable. Some people like to refer to the meniscus as a shock absorber. I would say that there’s not a lot of evidence to support that. In fact, there’s a lot of evidence to support that the femur (the top leg bone) and meniscus don’t actually touch at all. There’s space in between the bones and meniscus, and that’s a good thing. There isn’t a substance on the earth that can be slammed into itself ten thousand times a day and survive. That’s how often your femur and meniscus would come together when you’re walking, with about a thousand pounds of force, if there wasn’t a space! If our bones and cartilage were hitting each other, they would have been completely destroyed a long time ago. Our femur and meniscus don’t touch in the knee. There’s a space in between, and it’s our muscles’ and our soft tissue’s jobs to keep that joint space open and transmit the energy elsewhere.
It’s natural for us to have some minor tearing of the meniscus. On the other end of the spectrum, we can have a meniscus tear that’s so bad a small piece of it gets caught inside the joint and stops the knee from moving. Those cases are definitely a surgical situation, when the knee is locked up and cannot move because of the meniscus tear. But for everybody else, there’s a lot of hope for a natural approach to healing meniscus tears.
Let’s talk about why osteoarthritis or a meniscus tear are probably not the cause of your pain. There are others, but let’s look at two particular studies. The first is called the “Asymptomatic Imaging Study”. In this study, thousands of people without knee pain had an MRI of their knee. 76 percent of those people who were over the age of 63 had evidence of osteoarthritis in their knees. But only 13 percent of those people reported having pain. The conclusion the scientists came to was that osteoarthritis is not a direct cause of knee pain.
A second study looked at meniscus tears. It was a systematic review published by the British Medical Journal in 2017. The study compared people who had surgery for their meniscus tear with people who had only physical therapy. They found no difference in outcomes for the two groups. The conclusion from the study is that people should not have surgery for a meniscus tear, which is far riskier than physical therapy. Physical therapy should always be the first step in treating a meniscus tear.
What’s the real cause of your pain if these studies indicate that it’s not arthritis or a meniscus tear? Remember how the knee is stuck in the middle of the foot/ankle and the hip with nowhere to go? The motion of the foot/ankle affects the knee. And the motion of the hip affects the knee. If neither of these two areas are moving properly, too much stress is placed on the knee causing pain. Here’s how:
When we’re walking, our foot hits the ground and flattens out like a pancake. This motion moves the tibia (lower leg bone) and it turns it inward 30 degrees. This motion transfers up to the knee and says to the knee, “Hey knee, you’ve got to turn in 30 degrees.” But the knee says, “Wait a minute. I can only turn 5 degrees! But, I’ve got the hip upstairs, and I can tell the femur to turn the hip 30 degrees.” This is no problem for the hip, because it is designed to move up to 60 degrees.
That’s a scenario where everybody’s doing what they’re supposed to do. But it’s really common in our culture of sitting all day (many of us sit for 10 hours a day or more) for the hip muscles to get a little stiff. Now imagine when we start to walk what happens if the hip is too stiff to turn. When the foot hits the ground and flattens out like a pancake, the lower leg bone turns 30 degrees. When the knee, following suite, has turned its full 5 degrees, it calls on the hip to turn as well, but the hip is too stiff to turn all the way. Now you’ve got a knee that’s forced to rotate more than it’s designed to, and pain is the result. That is a classic example of how the knee can be painful (it may have arthritis or a meniscus tear), but the real cause is actually the hip’s inability to move properly.
If you’re in this scenario and your knee’s hurting you, the first thing you’re going to do is go to the doctor. What commonly happens next is your doctor orders an X-ray or MRI. That image shows that you have arthritis. But as we’ve seen, that is probably not the cause of your pain. We first need to look at your foot and ankle and your hip to see if they’re helping out the knee as much as they should be. And that is my recommendation. Get your foot/ankle and your hip looked at first before you go down the path of picking on the knee. Your knee pain is usually not the knee’s fault!
Quick Easy Stretches to Improve Motion in the Foot/Ankle and the Hip
Calf Muscle Stretch to help the Foot/Ankle
Hip Muscle (Groin) Stretch
Do each of these exercises a couple times a day for a couple weeks and you should start to notice some natural knee pain relief .
If you would like start on the path to natural healing and you’re looking for a natural solution to your knee pain, don’t wait. You don’t have to suffer. Give us a call at Superior Physical Therapy. We have knee pain experts waiting to help you at 231-421-9300.
Stay tuned. Next week we’re going to talk about more common issues people are dealing with that’s preventing them from pain-free living.
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