What To Do About Knee Pain

• Ligament Tears (ACL, PCL, MCL, LCL)
• Meniscus Tears
• Iliotibial Band Syndrome
• Runner's/Jumper's Knee
• Post-Knee Replacement

• ACL/MCL/LCL tears - With these injuries, there are complete tears and partial tears. The only way to know how which occurred is to have an MRI. Partial tears can be rehabilitated without surgery. Complete tears cannot--so the vast majority of cases require surgical correction. Occasionally, people that are unaware that they tore their ACL (it happens) or that are really resistant to surgery will attempt to rehabilitate it without surgery, and sometimes they have success. I've treated plenty of patients who tore a knee ligament a decade or two ago and just learned to live life without it. Just know that this will lead to excessive inappropriate movement in the knee and it will open the door to early arthritis in that joint.

• PCL tears - These are a lot less common than the other types. It happens mainly in automobile accidents and sometimes even in surfing. While surgical correction is an option, many people opt not to have surgery while rehabilitating this injury, as it's viewed as the "least important" knee ligament (which of course is up for debate).

• While there is a huge range of meniscus tears from small to large, the vast majority of these injuries can be rehabilitated without surgery. While knowing the specifics of your meniscus tear is difficult without an MRI, they typically involve a lot of popping, cracking, pinching, and grinding sensations in the knee. You'll know yours is pretty significant if your knee "locks" or "catches" and you find yourself unable to straighten out your knee at times. More often than not, cartilage damage and arthritis go hand-in-hand. Arthritis involves a shrinking of the overall joint space, which leads to stiffness and discomfort within the knee. We'll talk about what to do about it shortly.

• If you find yourself with pain directly above or below the kneecap that is associated with repetitive behavior like running, jumping, basketball, etc you just might have one of these conditions. Typically, these injuries occur because of excessive stiffness in the big toe, ankle, or hip. When you don't have the required amount of flexibility in any of those three areas, your body will shift it's weight forward on the knee. This will overwhelm the quadriceps and patellar tendon in the front of the knee and eventually they will start to break down. On top of the treatment options available below, you'll want to check out my article: The Exercise Fix: Low Back or Knee Pain.

• Meniscus repair surgery, also known as a Knee Arthroscopy, is the most common orthopedic surgery performed. There are certainly times when that procedure is warranted, HOWEVER, I would only recommend such a surgery after a full course of conservative care (meaning chiropractic and/or physical therapy type services) that doesn't resolve the symptoms. Recent research, believe it or not, is showing that there is a lack of correlation between cartilage (meniscus) damage and actual knee pain. Check the references down below for more information on that point. Translation? You're just as likely to have a meniscus tear if you have knee pain or not. So if that's you, don't freak out! Even the New England Journal of Medicine recently published an article stating that "arthroscopic partial meniscectomy was not more effective than physical therapy for a meniscal tear and knee osteoarthritis" (Katz, 2016). So let's take a look at your conservative options.

Conservative Treatment: Manual Therapy and Exercise Therapy

• When we develop painful conditions of the knee, there are typically major imbalances in the muscles and soft issues of the area. The manual therapies that follow will show you how we work to improve the balance in those tissues, which allows the alignment and posture of the knee to improve. Afterwards, we'll need to start some corrective exercise therapy which will train the knee to maintain its newfound proper alignment and help reduce strain on the area.

• My favorite conservative treatment for rehabilitating the knee is Active Release Technique (ART). In this video, I demonstrate a method of evaluating and treating fixations in the meniscus as the knee bends and straightens. This clears up that painful clicking, popping, or locking that so often occurs when the meniscus is damaged.

• Another highly effective manual therapy for rehabilitating knee injuries is called the "Graston Technique." This is a great segment on a new program that describes what the Graston Technique can do. It's very effective at softening up scar tissue and improving the flexibility of soft tissues around the knee that might have gotten shortened or tightened before or after the knee injury.

Popliteus Treatment

• The popliteus muscle sits in the back of the knee. I affectionately refer to it as the "psoas of the knee," as the proper function of the muscle is essential to helping you recover from most knee injuries. I wrote an article specifically on the popliteus that you can check out here called, "The One Muscle That Will Unlock Your Knee for Meniscus Pain."

• The first thing we want to do is improve the range of motion of the knee. In an ideal knee, you can touch your heel all the way to your butt. However, If you can't do that, you need to work on it. Begin your exercise rehab with only 1 set of 4 or 5 repetitions of this exercise. Sometimes adding a rolled up towel helps to reduce discomfort in the knee.

• My favorite exercise to start with in knee rehab isn't really a knee exercise at all. It's a hip exercise! As mentioned earlier, if you don't have proper movement and strength in your hip, your sure not going to have it in your knee. So start here. Since it's a non-weight bearing exercise, there isn't much strain on the knee and most people should be able to perform it. Don't worry about the fact that the title of the video involves back pain, it applies perfectly to knee pain too. Perform 1 set of 10 repetitions on both sides.

Lateral Knee Stability: Side Planks

• The next step we're going to look at is the need for lateral stability and strength in our core and hips to decrease inappropriate, harmful lateral motion in the knee and meniscus. My favorite way addressing this is the Side Plank. Here. I've provided a series of progressions for you to work up to. Eventually, our goal is to be able to perform the advanced side plank, with the top leg elevated for 30 seconds.

• Now, we really take it to the next level. We started with a front-to-back stability and control exercise with Glute Bridges. Then, we progressed to lateral stability with Side Planks. Now, we're going to combine the two into an exercise that combines front-to-back, side-to-side, and rotational balance and control. The exercise is called Chops and Lifts. Hopefully, at this point, your knee is beginning to feel better as this is a partially weight-bearing exercise, so it will require better control and proper movement of the whole body. Just perform 1 set of 10 repetitions on either side.

Noehren, B., Scholz, J., Davis, I. (2011) The effects of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome. Br Journal of Sports Medicine. 45:691-696