Knee pain

Posted by Dr. Lev Kalika on Wednesday, April 4, 2012 · Leave a Comment

Various factors predispose people to developing knee pain, a frequent and severe musculoskeletal concern that affects all age groups. Most commonly the knee joint pain results from structural misalignments and muscle misbalance that occurs in the knee joint area or in the entire lower extremity.

Knee joint

Runner’s Knee

is one of the more complex joints in the human body. Injuries to the knee joint are amongst the most common and understanding the anatomy of the joint is fundamental in understanding any subsequent pathology.

The knee is made up of four bones – the femur (thigh bone), the tibia (shin bone), fibula (outer shin bone) and patella (kneecap). The main movements of the knee joint occur between the femur, patella and tibia. The joint-forming end of each bone is lined with the articular cartilage, which is designed to decrease the frictional forces between the bones.

The joint capsule wraps tightly around the entire knee and provides support and nourishment to the knee joints structural components. Intra-capsular structures include the infrapatellar fat pad and bursa, both functioning as cushions against the exterior forces on the knee.

Strong surrounding ligaments further ensure the stability of the knee. Each ligament has a particular function in helping to maintain optimal knee stability in various positions:

Medial Collateral Ligament (MCL) runs between the inner surfaces of the femur and the tibia. It resists forces acting from the outer surface of the knee.

Lateral Collateral Ligament (LCL) travels from the outer surface of the femur to the head of the fibula. It resists impacts from the inner surface of the knee.

The Cruciate ligaments (anterior and posterior) form a cross in the middle of the knee restricting movement of the structural elements of the joint.

Two crescent-shaped menisci line the inner and outer edges of the tibia bone. They act as shock absorbers for the knee as well as allow for correct weight distribution between the tibia and the femur.

The two main muscle groups of the knee joint are the quadriceps and the hamstrings. Both play a vital role in moving and stabilizing the knee joint.

The structural misalignments of any of these elements lead to abnormal biomechanics of the knee, altered motor control and muscle misbalance around the joint. These factors ultimately lead to the disturbed tissue homeostasis, which eventually causes pain through wear and tear of the cartilage, tendons and other soft tissue structures.

In another scenario, altered tissue homeostasis leads to the knee hyper mobility or structural instability that eventually causes either repetitive trauma or a spontaneous traumatic event in which tearing of the ligaments, bone dislocations and even fractures can occur.

Compression is yet another common cause of the knee joint pain. In this type of dysfunction the tightening of the soft tissues around the knee joint due to muscle misbalance lead to the soft tissue contractures and fasciae adhesions that create abnormal pressure inside the knee joint.

Whatever the cause, the result is the ultimate outcome of any type of knee pathology osteoarthritis progressive degenerative condition in which the joint cartilage gradually wears away, exposing the bone underneath. Deprived of the protective cushioning, the bones surfaces grind against each other with every move, causing excruciating debilitating pain.

OUR APPROACH TO TREATMENT OF KNEE PAIN

Our treatment of knee joint pain begins with complete ultrasonographic and dynamic evaluation of the kinetic chain of the lower extremity by technological Gait analysis which includes the hip and the foot. The hip and foot misbalance directly affects the knee since foot placement and hip alignment determines movement at the knee. In such cases, repairing movement dysfunctions of hip and foot will reduce stress overload to the knee and encourage its tissue healing. This strategy is combined with direct treatment of the injured knee tendons and other affected tissues. Avoidance strategies in the daily activities are introduced at that time to minimize habitual harmful movement in the affected limb. Patient-specific home exercise programs are designed and trained to secure conditions for optimum healing.

At Dynamic Neuromuscular Rehabilitation we use variety of diagnostic and treatment methods to deal with all types of knee pain. We treat multitudes of knee disorders ranging from various overuses in the sports activities, post surgical ACL rehab, to treatment of arthritic knees. We are proudly the first outpatient Gait analysis lab in New York City.

The key to our successful treatment of knee pain lies in our expertise in conservative orthopedics, use of diagnostic modalities such as real time ultrasound, Gait analysis, surface EMG and, most importantly, using functional movement diagnosis.

We use variety of treatment methods including above mentioned approaches and techniques, surface EMG biofeedback training, force plate video feedback training, ESWT (Extracorporeal Shockwave Therapy) for degenerating tendons, and Myofascial release techniques to eliminate myofacial trigger points.

We also use vibration therapy and a revolutionary knee rehabilitation technology AlterG, the gravity reduced treadmill.

We offer the most advanced and comprehensive treatment for variety of running knee injuries, patella-femoral pain syndrome and ACL post surgical rehabilitation.

KNEE CONDITIONS WE TREAT