Knee Pain: An Applied Functional Science Perspective

As a follow-up to our original discussion regarding the Functional Knee, I thought I’d review how we at Longevity Physical Therapy use our knowledge of Applied Functional Science to evaluate and treat knee pain.

Knee pain is a tremendously common condition that we see at Longevity Physical Therapy.  It can come in a variety of shapes, sizes, and names: Patello-Femoral Joint Pain, Patellar Tendonitis, IT Band Syndrome, Jumper’s Knee, Runner’s Knee, Pes Anserine Bursitis, Chondromalacia, and Osgood-Schlatter are all common diagnoses that we treat.  Even some forms of osteoarthritis and meniscus tears can be considered this type of knee pain for the sake of this discussion.

How do these injuries differ?  In terms of the offending tissue or structure, these injuries can differ greatly.  But in terms of underlying causes, these injuries can be remarkably similar. Their similarity is very often the fact that these are repetitive stress or overuse injuries, and, as such, are biomechanical in nature.  Harkening back to our previous discussion on the Functional Knee (see blog), we know that the foot/ankle complex has a profound effect on the health and function of the knee from the bottom up, while the hip complex has an equally profound effect on the health and function of the knee from the top down.  If either of these “MVPs of the body” is not working as it should, the knee can often take the brunt of the force.  Throw in the function/dysfunction of the trunk or thoracic spine, and you have your primary culprits for non-traumatic knee pain.

At the end of the day, while the knee may be the one screaming in pain, it is frequently the foot/ankle, hip, and thoracic spine complexes that need a majority of our attention.  Our evaluation, then, comes down to not only assessing the knee and its tissues, but also assessing these major structures in the body.  Is the foot/ankle complex too mobile or possibly not mobile enough in all three planes of motion? Is the hip complex mobile enough in all three planes of motion? Strong enough? At the end of the day, those determinations will dictate the treatment to address not only the knee pain, but also the source of the problem.

Therefore, a treatment plan for knee injuries can very often involve a heavy dose of foot/ankle mobilizations, hip mobilizations, thoracic spine mobilizations, core strengthening, and lots of flexibility exercises.

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