Knee Pain: Caring for Our “Dumb Joint”

Our lead physical therapist here at Step & Spine Physical Therapy, Barrett Ford, holds nothing back when talking about the largest and perhaps most complicated joint in the human body.

“The knee is a dumb joint,” Barrett said, reflecting on words he first heard years ago from a former physical therapy mentor. “The knee doesn’t make many decisions. It’s told what to do by what’s going on above and what’s going on below.”

So when someone walks in our doors of Step & Spine Physical Therapy and says he or she is experiencing knee pain, Barret and our PTs approach the issue globally. Sure, they exam the knee, but they also evaluate the patient’s musculoskeletal system from feet and hips, “otherwise you’re going to miss the real problem,” he said.

“The hips and the feet are like big brothers – they make all the decisions,” said Barrett. “As for the knee, it has no place to go, no place to hide, but it’s the one that’s screaming and gets all the blame.”

Knee Pain and Evaluation

Knee pain can often be attributed to irregular compression either on the inside or the outside of the knee. Such compression can be caused by multiple factors: a person’s gait and stance, the way they step, muscle tightness, and the lack of balance, stability and/or strength in the legs and hips. Oftentimes, it’s a combination of these factors.

According to Barrett, many who experience knee problem can be described as valgus (knock-kneed – knees pointing inward) or varus (bowlegged – knees bent outward). These inward or outward deformities of the knee joint can be caused and/or exacerbated by the conditions above or by activities we enjoy such as hiking, gardening, running or cycling.

Our typical knee evaluation begins here – with the activities you love but which don’t seem to love you back.

“It starts with us watching our clients with knee pain walk and move in function,” Barrett said. “We watch them do the activity that causes the pain, whether than be walking, running, stepping or squatting.”

We then move to an evaluation of balance that includes single-leg stances, balance-and-reach movements and simple steps both with and without footwear. The evaluation ends with a strength and flexibility exam that measures the tractability of the knee, quads, hamstrings, calves and hips.

No two people are the same, so each assessment is specific to the client, the ailment and his or her lifestyle goals. But in general, two findings are common with knee evaluations.

“Typically, people who are more bowlegged are tight-structured and lack good flexibility,” said Barrett. “In contrast, people who are knock-kneed lack structure, are more loosey-goosey and require more strength and balance work.”

Treating Knee Pain

Barrett says that while treatment plans are established to address the specific needs and goals of each client, treatment plans that address basic knee pain typically cover three areas:

Footwear/Orthotics: The tracking of the muscles and joints throughout the leg starts where the rubber hits the road – the feet. Outfitting clients with shoes selected specifically for their foot types can do wonders toward alleviating knee pain. “Correcting footwear or feet can absolutely help what’s going on in the knee,” Barrett said.

Flexibility Program: A flexibility program is appropriate for many who experience knee pain, but it is essential for clients on the more bowlegged side of the spectrum. Such a program should involve foot and calf flexibility and well as address muscles in and around the hip.

Balance & Strength Exercises: Barrett says that bad balance caused by the lack of muscle strength and stability causes joints – especially the knee – the react in a negative way. “With the lack of balance and strength, joints create their own stability, which causes wear and tear,” he said. So our knee pain treatments will typically include a strength, balance and proprioception (the body’s ability to sense movement and joint positioning) regimen.

Prevention – Stretches and Exercises

If you experience knee pain regularly or while you’re doing activities that you most enjoy, it’s always important to get your knee looked at and evaluated either by a physical therapist or your personal physician. Don’t let it continue for long periods of time, forcing you to stop doing the things you love.

While knee pain can be considered a common ailment with both active and aging adults, it doesn’t have to be inevitable. Preventing knee pain before it sets in involves maintaining a good mix of balance and strength in the legs and throughout the body.

With an eye on prevention, Barrett offers these few stretches and exercises that can help you avoid knee pain:

If Inflexible…

• Calf Stretches: Reach your hands out, leaning against a wall, knees bent with one foot ahead of the other, and force your back heel to the floor. Hold for a few seconds, then alternate to the other foot.
• Hamstring Stretches: Lay flat on the floor, hip alongside an open doorframe, and lift your leg so the heel catches on the frame. Hold, then switch to the other side.
• Quad Stretch: Stand on one leg and pull the heel of your other foot to your butt. Hold, then switch.
• Hip Rotation: Lay on your back with one knee up and the heel of the other foot on the knee. Push the other knee down, hold for a few seconds, then switch.

If Lacking Strength and Balance…

• Single-Leg Stance: From a standing position, lift one leg from the floor and hold your balance for several seconds, the switch. For more of a challenge, lift and reach the opposite leg to test your balance.
• Sit-to-Stands: A good exercise for the aging population, simply start in a sitting position and stand without a balancing aid. Perform several reps.
• Leg Lifts/Clam Shells: Simply lay on your side, legs straight, and lift your outer leg toward the ceiling. For clam shells, bend your knees in (also starting from the side-laying position) and open your hips, keeping the heels of your feet together.