The Top 3 Common Diagnosis for Knee Pain

...And why they probably aren’t the cause of yours

I’ve been practicing for 17 years in sports medicine and knee pain is largely being categorized into a few main diagnoses. The most prevalent location is in the font of the knee, and for simplicity purposes, I’ll call the go-to diagnoses the “Big 3”.  Drum roll please:

KNEE PAIN “BIG 3”:

1.       Osteoarthritis, also known as “bad knees”

2.       Patellofemoral syndrome (Friction under the kneecap)

3.       Meniscus tear

It’s easy to slap a quick diagnosis on knee pain in a 10 minute doctor visit or a quick internet search, but what if the real answer is none of the above? Even if you have pursued your knee pain further via xrays or MRIs, confirming one of the above issues, this still might not be (and is probably not) the cause of your pain. How can I be so sure? Consider the following:

·         70-80% of people with MRI confirmed arthritis and partial tears in muscles, tendons, ligaments, or meniscus have absolutely NO PAIN.

·         If your pain is not coming from the lesion/tear, and you have surgery for it, your pain will only become worse.

·         Even if your pain is coming from one of the above problems, you still need to figure out why it broke down to stop the pain. Otherwise, the pain is guaranteed to return.

Imaging of an advanced arthritic knee with NO knee pain

Imaging of an advanced arthritic knee with NO knee pain

It’s imperative that your health care professional correlates the lesion in your knee to your symptoms. For example, if your doctor gives you a default diagnosis of arthritis, you may believe you need to sit around and wait for a total knee replacement in 10 years. We often find a benign rubbing of the kneecap that feels as terrible as arthritis but is 100% treatable with conservative physical therapy. You might have given up running, biking, hiking, etc. (which ultimately affects your quality of life) for nothing.

I’m sure you were looking for a quick and easy answer to your knee pain. But you’re going to have those two legs for the rest of your life and you need to get this right. The knee is simply the middle man between the hip and the foot, and a painful knee is driven from deficits in either or both. Simply put, knee pain with a gradual onset (excluding those from trauma) often results from one, two or three of the reasons below:

#1. You don’t have enough strength to do what you are asking your body to do.

#2. You have enough strength but you don’t have enough control of your leg (for my athletes, consider how you are running, jumping, or cutting).

#3. You are lacking mobility in your hip, knee, or ankle.

Reason number 2 (lack of control) is the BIGGEST problem I have seen in my clients and yet it is the least addressed piece in traditional rehab. For example, if you are only having pain when you run, your body is getting injured because of the way that you run. We help retrain the way our clients move and fix pathomechanics.

Wondering if you have any of the above deficits? Try the following tests to see where your knee might be going wrong:

 

Test #1:  SINGLE LEG SQUAT- A test of strength and control

Key points:    

·         Strength- You should be able to squat to 90 degrees of knee bend and both legs should feel equal

·         Control- Hips/pelvis should be level, knee should stay straight ahead (mid kneecap in line with the second toe), foot should be neutral (maintain arch)

 

Test #2: MOBILITY DEPTH SQUAT- Test for full mobility at midback, hips, knees & ankles

              GOOD FORM                                                  BAD FORM

              GOOD FORM                                                  BAD FORM

Key Points:

·         To pass this test, you must have your heels on the ground in a neutral position (not rotated out), spine straight, and your hamstrings should touch your calves.

·         If your heels pop up, you are limited at your ankle joint or your calves or too tight

·         If you feel strain in your midback, your spine is too tight (typically from posture).

·         You should have NO pain with this test

 

The moral of this story is it is imperative to question your diagnosis, especially if your health care professional gives you no solution or you aren’t getting better. You should expect to see some change in your pain within 2 weeks of the start of any effective intervention. Poor strategies for your knee pain include:

·        

·         Surgery-  90% of cartilage damage, tendon, muscle, or ligament tears can be treated without surgery. Exceptions are complete ACL tears and fractures.

·         Cortisone injections- These mask your pain and are NEVER a real solution, especially in athletes. More to come regarding that beast in another blog. Stay tuned.

·         Pain killers- I tell my clients you NEED to have pain so that you will know if you are putting too much stress on an injured area. Pain killers should be used sparingly and only when you literally can’t tolerate any movement or activity.

·         Surgery-  90% of cartilage damage, tendon, muscle, or ligament tears can be treated without surgery. Exceptions are complete ACL tears and fractures.

·         Cortisone injections- These mask your pain and are NEVER a real solution, especially in athletes. More to come regarding that beast in another blog. Stay tuned.

·         Pain killers- I tell my clients you NEED to have pain so that you will know if you are putting too much stress on an injured area. Pain killers should be used sparingly and only when you literally can’t tolerate any movement or activity.

 

Be safe & keep moving!

Dr. Kerri Kramer Webb

 

Kerri Kramer Webb, MSPT, DPT

Fast Track Sports Medicine & Performance Center, 2751 Prosperity Avenue, Fairfax, VA, 22031

Professional Profile:

Kerri Kramer Webb spent a decade as a young athlete with an undiagnosed spinal fracture. An xray was taken 10 years later and confirmed the diagnosis but no solution was given except to "stop playing sports". She went on to pursue physical therapy at Ithaca College in efforts to find a solution and obtained her Masters of Science degree in 2000. She then went on a mission to provide accurate diagnostics and real solutions for sports injuries. She received her doctorate in Physical Therapy in 2014 through Evidence in Motion.

Kerri created and founded “Fast Track Physical Therapy”, a specialty clinic for athletes with a strong focus in both manual therapy and bio-mechanical analysis. Since its inception in 2009, Fast Track has evolved into an integrated sports medicine and performance center to provide a full spectrum of solutions. This athlete haven currently provides services in a collaborative model through sports doctors, physical therapists, massage therapists, strength & conditioning coaches, and swim experts.

Kerri intends to continue her pursuit to deliver cutting edge sports medicine and performance strategies for athletes from recreational to professional levels. She currently teaches running analysis and rehab strategies on a national level with “Healthy Running”.

Athletic Profile:

Kerri was a multisport athlete in high school playing basketball, softball, and running cross country. She continued on to play collegiate basketball for Ithaca. After graduating, she began running marathons and later transitioned to triathlons. Her athletic achievements include qualification for the Boston Marathon in 2004, completing Ironman twice in 2007 and 2011, and qualifying multiple times for USAT Halfmax National championships. She continues to compete in triathlons and has an affinity to trail running.