Knee Pain

Knee pain

Knee pain may develop for a number of reasons. In the absence of trauma, knee osteoarthritis has been shown to result in people walking with a sudden outward motion (knee adduction moment) of their knee following heel strike.(1, 2) While abnormal patella tracking resulting in Patello-Femoral Pain Syndrome (PFPS) has been associated with excessive foot pronation, hip abduction and internal rotation. (3, 4)

During a survey conducted by Dr Angus Chard as part of Sydney Universities Talent Identification and Risk Profiling study (2017 – 2019) the most common presentation was knee pain experienced in teenage athletes between the ages of 12 -14. Barton, Munteanu (5) report PFPS being most common among 16-year-old teenagers. Due to its impact on functional performance, it may contribute to knee osteoarthritis in adult years.(6, 7)

A commonly experienced knee pain experienced by teenagers between 11 and 16 years of age is Osgood Shlatters. Osgood Schlatter pains are experienced in the bump under the front of the knee known as the tibial tuberosity where the large quadriceps muscle inserts. In some cases, the loads at this site are excessive either for biomechanical and postural reasons or excessive activity.

Illiotibial band (ITB) friction syndrome occurs at the outside of the knee and is the result of the ITB tendon rubbing over the side of the knee bone ( lateral condyle). This is commonly experienced by those with poor biomechanics and hip and or foot function.

Pes Anserinus bursitis is a noticeable swelling located on the inside of the leg under the knee. It results from the internal leg muscles (sartorius, gracilis and semitendinosus muscles) aggravating the bursa at their insertion. As these muscles protect the knee against internal rotation and excessive knocking, poor foot and or hip function must be considered. Clinically this condition is commonly experienced by middle and mature aged women.  

Regardless of your knee pain, practice practitioners at the Foot and Leg Pain centre fire experienced in assessing and diagnosing your knee symptoms and determining hip and foot functional contributions to your symptoms. In the case of debilitating knee arthritic pain, minor improvements in foot and leg function can make significant improvements in your quality of life and physical freedom.

References

1. Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. Journal of Biomechanics. 1998;31(5):423-30.
2. Schipplein O, Andriacchi T. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. 1991;9(1):113-9.
3. Stefanyshyn DJ, Stergiou P, Lun VMY, Meeuwisse WH, Worobets JT. Knee angular impulse as a predictor of patellofemoral pain in runners. American Journal of Sports Medicine. 2006;34(11):1844-51.
4. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the joint undertaking to monitor and prevent ACL injury (JUMP-ACL) cohort. Am J Sports Med. 2009;37:2108 - 16.
5. Barton CJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome: a systematic review. Sports medicine (Auckland, NZ). 2010;40(5):377-95.
6. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: A theoretical model. J Orthop Sports Phys Ther. 1987;9(4):160-5.

7. Thorstensson CA, Petersson I, Jacobsson L, Boegård T, Roos EM. Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later. Annals of the rheumatic diseases. 2004;63(4):402-7.