We often hear about knee injuries, either from contact sports like football and basketball with torn ACL and torn meniscus injuries, or from running with IT Band syndrome or “runner’s knee”.  There is also degenerative arthritis with older knees and we hear about knee replacements.  

When running, hiking, or getting down and playing with your grandkids, your life and your knee pain all of a sudden stops you from doing that, you then realize how crucial your knees are to your life. When your knee pain stops you from running, hiking, or getting down to play with your grandkids, you realize how crucial your knees are to your life.

Tim is retired, and with all the extra time with his retirement, he is traveling to go hiking around the world. He has hiked Machu Picchu, Kings Peak several times and other high adventure hiking.  Some time in his adventures his knees started to bother him. He wants to avoid knee replacement because that will take more time to recover… which means less hiking for a period of time.  

Here are several common knee conditions that we see when someone comes in with knee pain.

Structural ligament sprain or torn. (ACL, MCL and more)  

These are large ligaments that pretty much hold your knee together.  Your knee is built to be a very stable joint. It primarily only moves in one plane (forwards and backwards).  Large muscles make this movement, your quads and hamstrings.  These ligaments get injured when your knees move beyond their primary movement. Examples include to much extension (hyperextension) and when your knee bends sideways (lateral blow in football).  Also the dreaded, non-contact injury, to the knee when there is a sudden change in direction. This is a big leading indicator of ligament injuries, like a torn ACL.  

So what can you do about it? For fully torn ligaments, it is recommended to have those surgically repaired, especially if you are wanting to maintain your activity levels.  After surgery, physical therapy is needed to regain the range of motion and muscle strength in order to return to activities and prevent reinjury.  

Partially torn ligaments can either be repaired through surgery (depending on the severity) or rehabbed through physical therapy.  But physical therapy is a must.  You must strengthen the large muscles of the lower leg, thigh and your HIP to recover.  

What does physical therapy look like?  Research shows physical therapy for the knee should really look like active care.  That is some stretching of those tight muscle groups and then strengthening other large muscle groups.  The muscle groups that tend to be forgotten about are those of the hip.  The hip muscle plays a primary component to the knee in function and performance.  More often than not, injury to the knee happens because the muscles of the hip aren’t doing their jobs.  So you must strengthen the hip muscles.  

Meniscus tears

The meniscus has an additional stabilizing structure to the knee.  This makes part of the knee joint act like a dish to keep the knee in place.  These menisci can tear similar to the ligaments above.  Then they cause pain while bending the knee or with twisting.  

So what can you do about it?  This is going to be very similar to the ligament injuries.  With a large tear and your high activity levels, surgical repair may be required. Then physical therapy.  With physical therapy, we need to work on strengthening the large muscle groups around the knee AND the HIP. We can not forget about the HIP.  

Hyperextension

This is when your knee straightens so much that it bends backwards. This usually happens with a fall and you try to catch yourself with your leg and your knee buckles.  This can lead to some ligament sprains.  Strengthening the quad is going to be the primary muscle to work on for this.  The hamstring muscle group is the large muscle on the back of your thigh. 

Jumper’s/Runner’s knee

This is the common name for Infrapatellar tendonopathy.  This is when you feel pain in the front of your knee and under your “knee cap”.  You can feel this tendon just on the bottom part of your knee.  This will come up with those who jump and/or run often. Maybe you’re trying to increase your mileage or your vertical jump. This increased quadriceps muscle activity with jumping and running will increase the load put on that tendon and can increase inflammation which will cause pain.

What can you do about this?  Surgery is not needed for this, but proper stretching and strengthening rehab will be the best thing.  

What rehab will be the best? Stretching the quads out is important, even using the foam roller for the quads will be helpful. With strength we really need to work on the function of the hips.  If the hips are tight then that leads to a tracking issue with the patella and that can lead to this injury as well. 

IT band syndrome

Pain down the outside part of your hip, thigh and/or knee.  Very common with runners and those who are increasing their mileage.  There is pain along the outside thigh because that is where the IT Band is located. The IT band is a thick ligament/tendon structure that is meant to help you stand up right when you are standing on one leg. Something you do all day while walking and running.  

What can you do about this?  You probably guessed it, but rehab to the hip muscles is going to be key for this one. There are two muscles that are attached to the IT band at the hip and they directly affect the IT Band. Often you’ll see treatment with scraping or foam rolling the IT Band which hurts so much.  The truth is, that is not where you should be focussing your attention. 

You should be focusing your attention on the small Tensor Fascia Lata (TFL) muscle in front of the hip and the Glute Medius near the back. Those two muscles affect the IT Band.  The TFL muscle is usually the tight muscle pulling the IT Band more and the Glute Medius muscle is the inactive muscle which is failing to pull the IT Band back to center.  So the goal for rehab should be to stretch the TFL and strengthen the Gluteus Medius muscle. 

Dislocated patella

This is a traumatic injury that occurs when your knee gets hit at an angle and the kneecap moves out of place. You may see the kneecap move all the way toward the outside part of your knee. 

Knee Arthritis

This is more of a long term condition that takes years and years to develop. Previous injuries can lead to this developing faster than normal.  But something that gets forgotten about is just nutritional health.  The standard American diet is not favorable to any of our joints.  High sugar, unhealthy fats and low healthy fats and protein.  

Poor nutrition along with a sedentary lifestyle accelerates the arthritic process.  So some of the best advice I can give for this is, eat a healthy diet and move more frequently.  

What can you do about it?  With severe arthritis, knee replacement surgery is an option. But use that as your last option, because you can never go back from that.  Some joint supplements help slow the arthritic process down a bit as well. These supplements would have glucosamine sulfate and chondroitin sulfate.  Sulfate is going to be the key to this.  You’ll see a lot of glucosamine chloride and chondroitin chloride, but those are not as effective as sulfate is.  The ones with chloride will cost less but I would recommend just getting the sulfate because of how effective it is.  

As you have seen, the hip plays a major role in the health of your knees.  Maintaining proper hip mobility and strength along the gluteus muscles is a key part of this.  This will not only help with your knees but it will also help with your lower back.  

Now that we know that the hips are important for your knees, let’s talk about the common conditions that we see with hips.  

Hip impingement

This presents itself as pain along the front part of your hips, especially when you flex your hip (bring your knee to your chest). There are a few things that can cause this. There can be some additional calcification on either the knee of the femur (thigh bone) or the rim of the acetabulum (pelvis).  This needs to be diagnosed with x-rays and if so, they can go in surgically and file them down.  

Hip impingement is when your femur bone is just running out of room when you bring your thigh up. If it’s not from the calcification mentioned above.  This can also be caused by some muscle imbalances. 

Lower cross syndrome is what we see most of the time that leads to this.  This is a muscle imbalance that is typically, tight hip flexors, tight lower back muscles, and “weak” or “inactive” gluteus muscle and core muscle groups. Stretching those tight muscles, and strengthening the weak ones is a part of rehab.  Chiropractic adjustments are also very helping and important in this situation.  Maintaining proper joint mobility and spacing in the hip and the pelvis is crucial.

Muscle Strain

Common muscle strains that we see are Hip Flexor and Adductor (groin) strains.  These are soft tissue injuries that are best treated conservatively with massage and physical therapy.  Chiropractic adjustment to the lower back and ankle is important because as you are walking around with strained muscles, your body will tend to compensate.

Labral tear

A labrum to the hip is like what the meniscus is to the knee. It is a structure that helps give stronger stability to the hip joint.  These can tear as well with trauma or overuse, the later is more common.  Like meniscus, this can be treated conservatively to prolong surgery as long as you would like, but surgical repair may be the best recommendation based on the severity and your daily activity levels that you want to maintain. After which, physical therapy is key to return to full function.  

As you can see there are few common themes here.  The hip plays a big part in knee health.  Muscle imbalances like the lower cross syndrome can be a leading cause for overuse injuries.  Chiropractic adjustments and Physical Therapy, such as proper stretching and strengthening is very important for rehab to these conditions.  

If you have been dealing with hip or knee pain and are still looking for answers, we would be happy to help you out.  Let us help you get back to those activities that you love so dearly.