In the last issue, we discussed the difference between Patellar tendinopathy vs Patellarfemoral pain. This issue, we will continue to discuss knee injuries, but will focus on the medial side of the knee.
Let us first look at the anatomy of the medial knee.
If we consider all the anatomical structures on the medial side, or inside, of the knee, there are 9 muscles, 3 ligaments, 3 bones, 2 bursas, 1 mensicus, multiple arteries, veins and nerves and four surfaces lined with cartilage. All of these structures are potential sources of pain and subject to injury.
The following are common causes of medial knee pain:
- Patellofemoral syndrome
- Medial meniscus injury (tear, degeneration or cyst)
- Osteoarthritis of the medial knee
Less common causes of medial knee pain:
- Synovial plica
- Pes anserine (bursitis, tendinopathy)
- Medial collateral ligament (sprain, bursitis, Pellegrini-Stieda lesion)
- Referred pain (lumbar spine, hip, neural entrapment)
Rare causes of knee pain, but not to be missed would include pathology, anatomical deformities and referred pain from other areas of the body like the low back.
As we have discussed previously about patellofemoral syndrome, I will refer to our past article for review. But let us discuss in further detail about the two other common causes of medial knee pain, medial meniscus injuries and osteoarthritis (OA).
The medial meniscus is a disc like cushion between your femur and your tibia on the medial or inside part of your knee.
n young patients, a small tear may cause a synovial reaction and then medial joint line pain. In older patients, a gradual degeneration of the meniscus would result in a a more gradual onset of medial knee pain. Typically, patients will complain of clicking and pain with twisting or pivoting movements, changing direction, rolling over in bed, or getting out of the car. Surgical treatment will be dependent on the age of the patient, chronicity, severity of the tear, functional demands and other ligamentous injury. With degenerative meniscus injuries, conversative treatment is preferred, however, surgical intervention would be warranted if other treatment measures fail.
Conservative treatment would involve:
- assessment of the bilateral lower limbs
- local treatment for pain (ice, heat, laser, acupuncture)
- stretching of tight muscles
- regaining of mobility in ankle, knee, hip and spine
- functional strengthening
Osteoarthitis (OA) of the medial knee joint typically affects the older adult (over 50 years old), but can present in younger patients. In general, OA is the result of increased stress to a bone. Osteoarthritis is considered a bone building disorder. The body reacts to increased tension on the bone by laying down more bone. Often this is done to provide stability. Typically, injuries to the ligaments, meniscus, cartilage and a history of repetitive joint loading can predispose someone to OA of the knee.
Risk factors for OA of the knee:
- Obesity
Sports participation (higher risk in wrestling, boxing, weight lifting, soccer, basketball and football) - Previous knee injury and/or knee surgery
- Genetic history
Treatment:
- Identify and monitor athletes at high risk
- Preventive lower-limb-specific rehab programs have been shown to reduce the risk of lower limb injuries
- Symptomatic relief with ice, laser, acupuncture, medications
- Custom unloading bracing (maintains joint separation), effective in those over 60 years old
- Modification of activity, presciption exercise and weight loss is effective when done early
- Surgical intervention of partial or full knee replacement
As you can see there are multiple causes of medial knee pain. The majority of these conditions or injuries can be addressed in a chiropractic or manual practioner’s office and are treatable (depending on severity of tears). If you are experiencing medial knee pain, please BOOK A REASSESSMENT at our office to have this issue addressed.