So you have tried everything from stretching and foam rollers to deep tissues massages and massage guns and everything helps for a short while but then the problem is straight back! Sound familiar?
We hear this often, and althought all those things help, sometimes it's not solving the underlying problem. Often the problem is not directly around the knee but further up in the pelvis and even occationaly further down towards to the foot and ankle.
The position of your pelvis can play a huge role in lower limb issues, including the knees.
Simply put, a lot of muscles that surround the knee will also connect higher up into and around the pelvis, so having a slight twist or tilt may change some of your patterns of knee movement, thus causing some pain and discomfort! This is something you may be able to feel yourself, as if one hip is higher than the other or maybe your trousers don't sit right on your hips when you look in the mirror.
Running is an amazingly accessible form of exercise, but the downside of this is that there are many things that can go wrong when performing this highly repetitive and impact-filled exercise due to a lot of people never having any real training or education surrounding the many important components of running itself such as running technique, muscle imbalances,, the type of shoes you run with and of course getting their pelvis and posture alignment checked.
Knee pain is the most common chronic issue that runners experience and can have many different components and mechanisms at play, making a diagnosis and rehabilitation plan for this sometimes quite complex. There are many structures in the knee that can become injured, such as:
● The three bones that make up the knee joint itself, femur (thigh bone), tibia (shin bone), patella (kneecap) could sustain a fracture or dislocation
● The ligaments and meniscus of the knee can become sprained or torn (mostly commonly ACL or medial meniscus)
● The muscles and tendons surrounding the knee can become strained or torn (most commonly patella tendon or hamstring)
Common diagnoses
All the following common diagnosis can have an underlying issue with the pelvis leading to that issue!!
Runners knee
The most commonly diagnosed condition for pains in and around the knee and is found very frequently in runners, also known as patellofemoral pain syndrome (PFPS). It is typically caused by an muscular imbalance of the muscles that surround and support the knee and attach into the pelvis
and will generally encompass some sort of knee tracking issue too, for these reasons this sort of injury does usually occur slowly and over time. Common symptoms for PFPS include pain during the act of running, these pains can range from feeling annoying to severe sharp discomfort and usually will worsen in accordance to the intensity of the exercise performed.
Chondromalacia Patellae
This is a chronic condition that involves continuous damage to your articular cartilage of the knee, this causes a softening and breaking down of the shock absorbing areas of the joint. Causes of this are usually due to repetitive overuse of the knee joint, usually through impact exercise but can be worsened by aging, previous injuries or alignment/tracking issues. Key symptoms for chondromalacia patellae include pain upon sitting for long periods with bent knees, or walking on some sort of gradient (uphill or downhill) and going up and down stairs.
Jumper's Knee
This is a chronic overuse condition that affects the knee, most commonly found in individuals who participate in jumping sports. It is also known as patellar tendonitis/tendinopathy and will usually involve pain below the knee cap, stiffness and loss of strength.
Iliotibial band (ITB) syndrome
The iliotibial band is a thick band of fascia that runs on the outside of your upper leg and connects your knee to your hip. The ITB assists in making sure your leg is in proper alignment and has a major job in stabilisation, as a result the most common injuries to this area are situations where the structure becomes overused and strained. This overuse injury increases tightness in the area causing stiffness and a feeling of irritation or inflammation. Common presentation for this issue is pain on the outside of the knee that may potentially travel up the outside of the upper leg up to the hip.
Ligament injuries
Most common injuries to the ligaments of the knee are the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and will usually be some sort of traumatic overstretching of the structure. With exercise, this may occur when the individual stops running suddenly, lands improperly, changes direction too quickly or through a direct impact trauma. Some swelling may be present with this type of injury, as well as some instability and of course pain.
Bursitis
This is an inflammation of the capsule within the joint that acts to lubricate and cushion the area, thus reducing friction. Causes of this condition will involve repetitive overpressure or friction placed on the knee itself, this can be from overly tight muscles or through direct trauma. Upon irritation of the bursa, the knee may become swollen, inflamed and the individual may experience an increase in pressure in the area.
Kneecap subluxation/dislocation
Typically through a direct trauma but also through sudden movements that involve changes in direction, the kneecap can either partially or fully dislocate from the groove that it will normally glide over the knee and a popping sensation may be heard. When this happens, other supporting structures can sustain moderate to severe damage as they are overstretched. Common presentations from a partial or full dislocation will be the kneecap looking abnormal and out of place, there may also be swelling in the area.
Meniscus Tear
The meniscus are thick cartilaginous structures within the knee that help shock absorb and stabilise the joint. Similar to ligament injuries, there will be a strain or tear to the structure due to overstretching from sudden movement changes, most commonly that of twisting the knee side to side. Meniscus tears can cause pain typically over itself, so this can be felt on the inside or outside of the knee.
Knee Stress Fracture
Stress fractures can typically occur when there is a big change with the frequency or intensity of the exercise or activity. With running, people may be just beginning to get involved in the sport or just out of practice and they will run a little bit too far, or too often, or both. Certain running shoes which are less flexible and running on unfamiliar surfaces (sand instead of concrete) can also lead to increased chance of stress fractures.