Knee – Haw partners 

Howdy folks, Jas and Luke back with everything you kneed to know about your knees. See what we did there? We’ll go over a few more myths like we did a couple of weeks ago when we discussed ankles, but we’ll also highlight some important things to know about your trusty (or not so trusty) knees. We’ll talk about surgery, knee replacements, running causing knee pain,  how the foot and knee work together + some common injuries associated with the knee. 

My x-ray showed bone on bone! 

Ahhhhh, this old chestnut. The old ‘bone on bone’ analogy. Hearing that you’ve got advanced knee osteoarthritis can be extremely distressing. In these circumstances where you’re already feeling down in the dumps, the last thing you want to hear is that your knees are grinding like an L-plater learning manual in dad’s new car. The good news is – they aren’t. 

The kind of language used by medical practitioners when examining x-rays should remain purely pathology based. Analogies such as ‘bone on bone’ are not just false, but also significantly detrimental to the progress of patients with knee osteoarthritis and can lead to over protection. Over protection refers to avoiding activities that someone would perceive as ‘bad’ for the knee, such as running which Luke discusses a bit further down. 

Think about arthritis as the ‘wrinkles on the inside’. The same way we age on the outside, we age on the inside. It is completely normal. I can promise you that if we x-ray you, your sister, your brother, old Jim down the street and Beryl from up the road we will find some degree of arthritis. The way each individual experiences their arthritis is what differs. 

If you are concerned about your x-ray findings and what you can/can’t do with knee osteoarthritis make sure to book an appointment with your physiotherapist or podiatrist who will be able to break down all the nitty gritty details in a clear and concise way. 

Stuff rehab! Just give me a Knee Replacement!

Firstly, slow down tiger! 

As a physiotherapist I hear people say these kinds of sentiments frequently. It’s not as simple as ‘just getting a knee replacement.’ Sure, old Frank from Thursday night tennis got a knee replacement and he’s moving around the court like Federer, but whilst this was his outcome, this isn’t the reality for everyone. In the public health system there’s an extensive wait list for knee replacements (up to 2 years) and not everyone has access to private health. It’s crucial that before choosing to undergo a knee replacement, whilst waiting for a knee replacement, or while considering a knee replacement you are involved in prehabilitation. Yeah, like rehabilitation, but before the fact. 

Studies have shown that participating in a 12 week knee osteoarthritis specific exercise programme can decrease the pain associated with arthritis so significantly that it can continue to push back the necessity for a total knee replacement. Furthermore, patients that underwent a knee replacement following a prehabilitation program had far better postoperative outcomes and long term benefits when compared to patients who did not participate in prehab. 

Long story short – Ask your physio or podiatrist if there are some conservative options for you. 

Okay fine, I won’t commit to a knee replacement… How about a clean out! 

Arthroscopes, or more commonly referred to as ‘clean outs’ are a surgical procedure in which a tiny camera is inserted into the knee joint to identify any degeneration and/or abnormalities which are then ‘repaired’ via keyhole. These ‘abnormalities’ are generally loose cartilage and meniscus tears which might be attributing to pain. Arthroscopes should be considered when the patient is experiencing a ‘true locking’ or a loose body is occluding normal movement. Other lines of treatment should be considered prior to and in conjunction with this option.

Running is bad for your knees in the long-term

The age old saying of running will cause you knee pain later on.  For the average Joe that likes going for a trundle two to three times a week, that’s in fact the opposite. Knee osteoarthritis is commonly found in people living a sedentary lifestyle, or competitive athletes. Even for people living with knee osteoarthritis, running has been shown to cause no further progression of injury or pain. In some cases, there has been a reduction in damage to bony structures around the knee – however run within your limits. If you enjoy running or want to become more active and your knee pain is slowing you down, there are a lot of strategies that your Podiatrist or Physiotherapist can use to keep you moving long-term. 

Orthotics change the alignment of the knee

Have you been on a cruise or seen a particular ad with a famous ex-rugby league player on television saying that ‘arch supports’ change the alignment of the body? 

Genuine woo woo. 

Orthotics (actually known as orthoses) are typically prescribed to reduce load on tissue and evenly distribute the ground reaction force acting on the foot. Orthoses focus on three things when distributing reaction forces at the foot: magnitude (how hard or how much), the location of forces, and finally the timing of that force. There are two types of orthoses that we prescribe – either custom made foot orthoses (made exactly to your foot), or prefabricated foot orthoses, which are generic. Depending on the type of injury either one of those can be indicated to assist with reducing symptoms and returning you to activity earlier. 

How on earth does a foot orthotic reduce my knee pain?

Our legs are like one big chain where muscles link everything together. If we are getting extra or unusual motion at the hip, we will get more motion at the knee and foot. As we discussed earlier, foot orthoses are designed to reduce ground reaction forces, reducing magnitude and altering the timing that structures like muscles, tendons or ligaments are under load.  By altering all of those factors we are able to reduce structural load around the knee joint, primarily by increasing the forces applied to the foot in a way to reduce painful movements at the knee. In saying that, orthoses aren’t a magic fix for knee pain. Sure, they’re a great intervention for the short, medium and long-term, however you’ll need to be diligent with strength and conditioning both around the knee joint, and at the hip joint (we get a lot of extra, uncontrolled motion at the knee if our hips are weak).

Acute knee injuries 

Now I’ve left the juiciest stuff for last. Anyone that loves professional sport would be well acquainted with the plethora of knee injuries that plague the NRL, AFL, EPL and A league (but who watches that lol). You’ve probably heard the terms ACL, PCL, MCL, LCL, LCM (okay maybe not the last one) numerous times, but what are they? How do they get injured? What are the recovery times? How are they fixed? 

Generally speaking the two bigguns are ACL (anterior cruciate ligament) tears, and meniscus tears. Both of these injuries occur via a loading force through the knee often with high speed direction change. In ACL tears, the knee will swell up like a balloon and feel like it is giving way. With meniscus tears, the knee will feel like it locks up and gets stuck in a bent position. 

Think about it like your dance moves at the club – popping and locking. 

Popping = Query ACL injury 

Locking = Query Meniscus injury. 

Keep a keen eye on the Terrace Physio Plus page for a full write up on acute injuries and all the gory details. 

Chronic knee injuries

Chronic knee injuries can be debilitating. We’ve just spoken about acute knee injuries, which are injuries that occur instantly – but let’s look at knee pain that has been brewing for a while. Chronic or overuse knee pain can have multiple causes, but the most common risk factors we see are: poor hip, glute and quadricep strength, poor running form, and excessive pronation (where your feet are flat and roll in). If you’re a runner, you might start to feel some pain after a few kilometres or running downhill around the front of your knee. This is typically a condition called patellofemoral pain (PFP) and is the most common overuse/chronic knee injury. 

Right, so how do you fix it? The most recent research tells us that a multidisciplinary approach is best – particularly physiotherapy and podiatry to sort out everything from foot to hip. The ‘gold standard’ approach focuses on rebuilding strength in weak muscles while reducing excessive loads at the foot, typically with orthoses. So for all of you lockdown warriors continuing to pound the pavement pushing through knee pain – there is plenty we can help you with!

Asleep yet? We hope not! If you’re concerned about anything knee related, contact Hunter Podiatry Services or Terrace Physio Plus for a telehealth or in-clinic appointment today. 

Good knees forever, knee pain never.

Luke Webster, Podiatrist
Jas Whitelaw, Terrace Physio Plus