I was proud of being promoted from the ski beginners to the not quite beginners ski group. However as I ploughed into another heavy turn on my first skiing trip off piste my ski tip caught in a patch or deep snow; my right leg twisted suddenly behind me causing a searing pain inside my knee as the rest of me tumbled ungraciously head over heels into a static heap. My French ski teacher and the rest of the class meanwhile disappeared into the distance none the wiser. Sadly that was the end of that ski trip, also the beginning of wearing a knee support for 12 months, and the beginning , for me of taking a big interest in knees. X-rays revealed no damage but I had torn the soft tissue ligaments which take a long time to mend thoroughly.
Anatomy of a knee
The knee is the largest joint in the body. There are really three knee joints, one beneath the knee cap and the main joint which is divided into two, the medial and lateral joints between the long bone of the thigh, the femur, and the menisci, or cartilages, which are attached to the lower leg bone, the tibia. The menisci deepen the joint adding stability preventing side to side rocking within the joint. They are attached to the tibia around their outer edges, and frequently tear. The knee joint is primarily a hinge, flexing and extending, but a small amount of rotation is also possible. Side to side movements are normally prevented by strong ligaments inside and outside the joint (the medial and lateral collateral ligaments) supported by muscles.
A quarter of all women experience knee pain daily and women are about eight times more likely to suffer from a knee injury than men. The knees are susceptible to sports type injuries due to the relative instability of the joint which relies on the surrounding musculature for stability rather than its shape. The knee can absorb seven times the body weight when applied vertically- from the top down; but it is vulnerable to horizontal strains such as those which occur in tackles playing football. Actual lateral blows to the knee tend to tear the side ligaments particularly if the knee is straight/ extended at the time of impact. Some 50% of professional footballers have knee injuries during their career. The anterior cruciate ligament is more likely to be damaged by rapid directional changes while running.
Muscles used to be thought of as just the motors that moved the joint, but actually they provide much of the stability to the knee joint. Many knee problems stem from weakness in one or more of the knee muscles. For example when a muscle on the inside of the knee becomes weak the knee joint can bend abnormally inwards possibly leading to injury; it may cause the cartilage to catch or tear. In assessing the knees the surrounding muscles should be tested for strength and if weak treated appropriately to restore strength, this will often sort out a sore knee. Gym work can strengthen weak muscles around the knees and this helps some people get out of pain.
Treating the whole body
Knee pain is often a secondary problem with the true cause found elsewhere in the body. We know the body works as a closed kinematic chain- this means like a wind up watch; you cannot move one piece of the watch without affecting everything else.
One of the most important factors is a balanced pelvis with properly functioning sacro-iliac joints and hips. These are routinely checked by chiropractors.
Feet and ankles
You can demonstrate the effect of the foot and ankle to yourself as follows. While standing roll in on your arches flattening your feet, and then roll out again; see the effect on your knees. As you roll in the knees come together putting pressure on the inside of the knees. If your feet are normally flat/pronated then shock will be transmitted from the floor through the feet to the knees with every step taken; orthotics may then be of benefit.
As one muscle contracts another must relax. When you bend your knee the hamstrings at the back of the knee contract while the quadriceps at the front relax/ pay out slack. In injuries this co-ordination may be lost. In my experience co-ordination problems are also commonly found post operatively.
If you are fit, running can provide a useful exercise but it puts 3-7 times your body weight through each leg with each step, while walking its just I times. Why? Because you are moving faster. To avoid injuries to the knees it is better to avoid hard surfaces and instead choose surfaces that have shock absorbing qualities for the majority of your runs and be consistent with your route as changing surfaces can also lead to injuries. A web survey from fitsugar.com graded running surfaces from good to bad as follows: Grass 9.5, Wood chips 9, Dirt 8, Cinder track 7.5 ,Track 7, Treadmill 6.5, Asphalt 6, Sand 4, Snow 2.5, Concrete 1. So maybe the local football field at least to start with whether you are walking or especially when running. Of course resilience should improve with training but don’t rush. I recommend my older ‘athletes’ for whom grass would be too uneven, get a trolley and walk around Sainsburys for a half hour daily! Nice smooth floors and something to hold on to is excellent for elderly people who like to exercise to stay fit. Don’t forget your nectar card!
Non-Surgical Knee Surgery Alternatives
- Re-aligning the knee joint
- Balancing and strengthening the muscles
- Checking the feet for pronation/ flat feet and providing recommendations for their correction by manipulation or orthotics;
- Checking the spine and pelvis for nerve supply to the leg muscles
- Good diet and advice on proper posture
all can go a long way to correcting troublesome knee complaints. If you are being offered surgery here are some further options you might like to try in addition to your chiropractic treatment.
Most knee problems are made worse by being overweight. The best way to normalize weight is through having a permanently healthy diet coupled with exercise rather than a series of fad diets. Avoid activities such as running and twisting which can aggravate the knee injury. Instead take up low impact exercise such as swimming the crawl or back stroke or Tai Chi. Specific exercises and physical therapy may help to improve strength and flexibility. Exercises may include strengthening exercises such as riding a stationary bike and weights particularly for the thigh muscle the quadriceps
Your GP can prescribe various drugs to reduce inflammation. Natural anti-inflamatories include omega 3 oils from fish, flax seed oil and Boswellia, a herb.
There is a wealth of research into chondroitin and glucosamine over the last 20 years. Definitely worth taking for 3 months to see if it helps you. It can thicken joint fluid and help repair cartilage. Dosage typically 1.5 to 2.5 grams depending on your body weight. Best taken near bedtime as joints repair when you are not using them. Glucosamine, chondroitin, MSM and collagen are very similar and all help; in my opinion they are better taken sequentially rather than together. So try one of the above for three months and then the next and so on.
Injection of joint fluid
There is an injectable substance called synvisc or supartz which is a nature identical liquid. When injected it acts as a joint lubricant and can delay the need for joint replacement for months or years. Several of my patients have reported benefits although this is a last resort before replacement of a worn osteoarthritic knee. Several injections are usually needed from a consultant orthopaedic surgeon.
Chiropractic treatment in combination with Applied Kinesiology and extremity work often alleviates knee pain by balancing muscle function and improving joint function. Exercise and nutrition can also play a big part. If you are being offered surgery my advice is to have chiropractic treatment before and soon afterwards to maintain muscle tone and make sure you return to normal mobility as soon as possible.