When someone walks into our office with pain, they usually tell us where it hurts and what may have led to the injury. This is helpful but it does not tells us much regarding what is directly causing the pain. If the pain is due to an acute/traumatic injury, typically the first thing on our list is damage control/pain relief/symptomatic care. There are many that walk in with pain and have no information to give other than where it hurts. That being said, asking the right questions and gathering as much information before starting treatment can help save a lot of time as well as pinpointing what tissue is involved.
Let’s take the knee for example, largest weight bearing joint in the body. It’s main movement is to bend, flex/extend. There are many tissues (muscles/ligaments/tendons/cartilage) that cover and insert around the knee joint. Most commonly we hear of ACL tears in professional and collegiate athletes. There is no hesitation when this injury occurs, it requires surgical intervention. There are other injuries/biomechanical restrictions that can occur up and down the kinetic chain that contribute to knee pain. Not in order of importance, here are 5 of the most common contributing factors we see when someone walks in with knee pain:
1. Lack of stability/weak gluteal musculature
2. Mobility restrictions in the ankle joint, dorsiflexion limited
3. Tissue restrictions in hip capsule (anterior/posterior hip capsule)
4. Lower back tightness, either same side or opposite side of knee pain
5. Increased supination/pronation in arch of foot, increased tension on lateral/medial knee capsule/ligaments
Now that we have an idea of what could be causing the knee to go haywire, the bigger question is, what are we going to do about it?
This is where movement assessment comes in to play. By selecting specific movements to perform in the loaded and unloaded positions, we can determine whether or not the pain is coming from a mobility dysfunction elsewhere or the knee itself or a lack of stability in neighboring areas or the knee itself.
Before treating someone be sure to investigate above and below the painful joint, opposite sides of the joint, for example, anterior knee pain could be due to a soft tissue adhesion in the hamstrings or a joint restriction in the ankle or maybe even a lack of motor control/stability in the glutes/abdominals, or all of the above.
Thanks for stopping by to read!
Brian Gervais, DC