Knee pain is one of the most common complaints in people who participate in physical activities or sports "“ from weekend warriors to dancers to professional athletes. In many cases, the injuries are self-limiting, such as a ligament sprain or even muscular strain. In other cases, a full evaluation is required.
A good physical examination should be able to provide the doctor, in many cases, with an idea of severity, location, and type of injury. If pressing down on the kneecap causes pain, for instance, the patient may have something called chondromalacia "“ a softening of and damage to the protective cartilage under the kneecap. Tenderness along the joint line, or a clicking deep within the knee during a specific maneuver might indicate damage to one or both menisci of the knee. There are several other specific tests, as well. An X-ray is sometimes helpful, but a skilled physical examination may obviate the need for radiological testing.
History is also very important and can provide clues to the origin and type of injury. For instance, I recently had a patient present with knee pain after dancing. She had been twisting and hopping about and felt no pain. The next day, however, her knee hurt. Physical examination did not demonstrate any significant swelling, nor damage to the external or internal ligaments, nor menisci. She could not, however, flex her knee, and attempting to do so elicited pain.
I immediately recognized this syndrome. It is, in fact, very common in athletes, especially football players who plant their foot and quickly stop or turn or soccer players who attempt to kick the ball and end up hitting the ground, instead, while their body keeps moving forward. This led me to examine the motion of the patient's tibia (the main bone of the lower leg) under the femur (the main bone of the upper leg). The examination confirmed my suspicion: the tibia had been driven slightly backward under the femur, slightly out of position, by just a few millimeters. This was enough, however, to block flexion of the knee.
Using an osteopathic maneuver, I was able to quickly reposition the tibia. The patient instantly regained full motion of the knee and marked reduction in pain. Within two days, the patient felt completely normal, though full healing of any stretched ligaments and regaining full stability of the knee would likely take 6 to 12 weeks.
Though knee injury is common, there are a great many possible causes for the associated pain "“ from the very minor (as above) to major ACL or meniscal tears or other damage requiring more extensive treatment and/or rehabilitation. In many cases, however, a good osteopathic examination and manipulative treatment may help avoid extensive and expensive examinations and even surgery.
Dr. Cohn is employed at the Born Preventive Health Clinic in Grand Rapids, Michigan, where he is focused on treating acute/chronic pain and injury via osteopathic manipulation and prolotherapy. Dr. Cohn regularly blogs on medical issues and other issues of global and personal interest.