Despite knee pain being a common problem among clients, it somehow rarely managed attention in any of my writing.
Knee pain that clients arrive with has been highly varied. For some it’s sharp knee pain, others dull aches. For some it’s felt on stairs, while others it’s when walking on flat. Sometimes it hurts more when the knee is bent, sometimes more when straight The location of knee pain is also variable – outside, inner knee, above, below, behind…
With so many different presentations of knee pain, there’s no one solution. But there is a very common outcome – most clients feel reduced knee pain using Bowen Therapy.
In this blog, I’m going to give an overview of 6 of the more common knee pain problems I encounter.
first, some basic knee anatomy
For a joint that basically works like a hinge, there’s a fair bit of complexity in the knee.
The knee joins the femur (the thigh bone) to the tibia (the big shin bone). The fibula (the smaller shin bone) and the patella (the knee cap) also make up the knee joints.
The main knee joint is the tibiofemoral joint, between the tibia and the femur. There is also the patellofemoral joint between the femur and the patella.
Ligaments join the bones at the knee and provide joint stability. The collateral ligaments are on the inside and outside of the knee, and prevent the femur sliding sideways. There are also two cruciate (cross) ligaments on the anterior (front) and posterior (back) of the joint. These cruciate ligaments prevents the femur from sliding forward or backward on the tibia. You’ve probably mostly heard about the anterior cruciate ligament by it’s initials – the ACL.
There is also cartilage that acts like a shock absorber between the femur and tibia, the medial and lateral menisci.
A few key sets of muscles in the leg move the knee joint.
The hamstring group (biceps femoris, semitendinosus and semimembranosus) connects the sit-bone on the back to the pelvis to the tibia and fibula. The pair of gastrocnemius muscles join the femur to the heel (via the achilles tendon). Tucked away in the bend of the knee is the small popliteus, joining the top of the tibia to the bottom of the femur. These hamstrings, gastrocnemius and popliteus muscles are the key muscles that flex, or bend, the knee.
The quadricep group (rectus femoris, vastus lateralis, vastus intermedius and vastus medialis) are key muscles that extend, or straighten the knee. The rectus femoris originates on the pelvis, while the vastus lateralis and medialis originate on the femur. All these muscles join into a single tendon above the knee. This tendon then connects to the top and sides of the patella before attaching to the top of the tibia.
knee pain – different location, different cause
The cause of knee pain is dependent on the location that the pain is felt.
Dull ache at various points around the knee joint is often felt by those with arthritis (and you’ll need a doctor to diagnose this for you).
Sharp pains at the outside of the knee is often cause by problems with the iliotibial band, while pain on the inside of the knee may be related to meniscus or ligament injuries.
Pain above the knee cap may be related to irritation of quadricep muscles.
Below the knee cap may be jumper’s knee caused by impact or Osgood-Schlatter disease in younger people.
Pain at the knee cap, often worse when walking down stairs, may be runners knee, impacted by tracking of the patella.
Pain in the back of the knee may be caused by a Baker’s Cyst or could be related to muscle firing patterns on knee flexion.
knee pain almost anywhere on the knee
Knees are one joint commonly affected by arthritis.
Osteoarthritis may give pain and stiffness in the knee. It may be particularly worse after periods of non-movement – getting out of bed in the morning or sitting for a long period. The knee may also be stiff or sore when climbing stairs, walking or kneeling, and sometimes feels like it might give way. Osteoarthritis pain can sometimes get worse throughout the course of the day.
Rheumatoid arthritis is an inflammatory condition. Pain may be strongest in the morning, and feel better through the day as movement increases.
Exercise, weight loss, pain medication, ice packs, and mobility aids are the usual self-care for osteoarthritis.
Bowen Therapy can’t help rid you of arthritis, but is great for improving mobility and thus reduced pain. Bowen moves around the knees have reduced the pain for many, and regular maintenance treatments help people continue an active life. With knee pain and restricted movement often comes compensatory patterns – regular Bowen treatments can also help prevent other problems that arise from compensations.
knee pain above the knee cap
Pain in the lower thigh, just above the knee cap, is often the result of quadriceps tendonitis.
This is often a problem of overuse, with contributing factors of alignment. Repetitive stresses on the knee structure can lead to injury, strain or irritation of the quadriceps muscles and tendons. Those doing activities such as running, jumping, or sports with quick starts and stops tend to experience this problem more frequently. However, even those who don’t play sports can experience this problem.
The area is often warm and very tender to touch, with pain more noticeable when the knee is moving. Many find that their knee is stiff when getting up in the morning or after a period of inactivity, as well as during and after exercise. The pain may be mild, or strong enough to prevent athletes from playing their sport.
My experience with this was thankfully a short-lived injury years ago. I’d only recently started to hike – how hard could walking be ? one foot after the other ! But, at the end of a long downhill, my lower thighs were burning. The next morning, the pain was worse, and walking down stairs was difficult. No Bowen for me back then, but lots of rest and words of advice from seasoned hikers: “you were using your knees going downhill,” I was told “but you need to use your quads.”
Bowen would have gotten me back to action faster, helping muscles recover and bringing a level of balance back to legs and body. Key is also strength exercises, ensuring that the quadriceps are strong enough and are firing – especially for those downhills and quick stops.
knee pain below the knee cap
Pain felt below the kneecap may be a sign of patellar tendonitis. This is inflammation in the patella tendon, that connects the kneecap to the shinbone.
Micro-tears from repetitive stress during jumping may result in inflammation of the patella tendon. Thus, the condition is often referred to as jumper’s knee. It is an injury that’s often specific to athletes who play jumping sports such as basketball, volleyball, or long jump. Overtraining or playing sport on hard surfaces are also risk factors.
Rest is commonly recommended to give the tendon time to repair, together with ice and anti-inflammatories. Knee braces are also useful for many.
The underlying cause is often linked to poor quadricep flexibility, preventing the knee from bending as well as it should. Bringing balance to the body through Bowen Therapy, with focus on leg musculature, will help with recovery.
knee pain on the knee cap
Pain on or around the kneecap is likely to be caused by patellofemoral pain syndrome.
This is usually a pain that comes on gradually, and is most noticeable when going up or down stairs, kneeling or running. It often develops as an overuse injury, seen commonly in runners – thus, often known as “runner’s knee”.
With this problem, the pain is often caused by the kneecap not tracking smoothly in the groove in the femur when the knee is bending or straightening.
There are a number of possible underlying causes, many of which are related. Altered firing patterns in the quadricep muscles, over-pronation of the foot, and imbalances in thigh muscles can contribute to the patella being pulled from the best position.
Bowen therapy can help bring balance to the pelvis and muscles of the thigh. Strengthening exercises will probably also be needed to maintain that balance and keep the patella tracking correctly.
knee pain on the outside of the knee
Pain on the outside of the knee could be from widely varied causes. It may be a sign of a torn collateral ligament or meniscus – these need to be properly checked by a doctor if this is suspected.
Sharp pain on the outside of the knee or the hip is commonly caused by iliotibial band tightness.
The iliotibial band is part of the tensor fascia latae muscle, running from the pelvis/gluteal muscles in the buttocks, down the side of the thigh to the side of the shinbone.
If something causes the iliotibial band to be under increased tension, it may rub against the side of the knee when bending, resulting in pain.
Reducing the tightness and friction on the iliotibial band is the goal. This can only be achieved through work further up the body, working with muscles that influence pelvic stability
The last person I treated for this was back to hiking within a few months with focussed Bowen, easy walks rather than hard hikes, and some exercises – a far better result than the year I spent recovering.
knee pain behind the knee
Pain behind the knee is one of the more common problems I see. Many people come for general knee pain, then advise that they have a Baker’s Cyst.
A Baker’s Cyst is swelling or a fluid filled lump behind the knee. It is often the result of some other knee joint problem such as injury, arthritis or gout.
When it’s small, it usually causes no problems. However, if it grows larger, it may cause pain. It may cause stiffness or tightness behind the knee, and prevent the knee from straightening.
Bowen Therapy doesn’t specifically treat a Baker’s Cyst, but treats the body and legs to help them function well. Focus generally needs to be on the back line of the leg – the hamstrings and gastrocnemius will likely receive some extra attention.
Clients who visit for other reasons such as general lower back, hip or knee problems often comment that their Baker’s Cyst has reduced in size or disappeared.
Bowen Therapy for knee pain
Bowen Therapy is a gentle and non-invasive treatment option for knee pain.
Assessment of posture, leg length and muscle tension helps determine treatment to bring balance to the body as a whole. Specific moves help target muscles that directly impact the knee.
For some with a recent injury, recovery may be fast, within a few treatments.
Long-term knee problems may require more time to resolve, as the body will have taken on compensatory patterns. These compensatory patterns need to also be addressed, or the problem (and knee pain) will return.
For chronic knee problems, regular maintenance is what’s really needed. This is especially the case for managing arthritic pain, or for Baker’s Cysts that tend to flare up and give frequent problems. Work with your Bowen Therapist to determine the best frequency for you.
Centers for Disease Control and Prevention (NIH) (Centers for Disease Control and Prevention (NIH)) [Public domain], via Wikimedia Commons
Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons