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 The knee is the joint between the thigh bone and shin bone. At the front of the knee is also the joint between the knee cap and the thigh. The knee moves like a hinge back and for, with a slight twist on full straightening to lock it. As the knee bends, the knee cap rides up the thigh bone. Inside the knee are two meniscii made of cartilage and two cruxiate ligaments that hold the knee together. On the outside are the inner and outer collateral ligaments, that brace against sideways shears. Another joint close to the knee is the small superior tibia-fibular joint that that attaches the thin bone on the outside of the shin, the fibula, to the larger tibia. This joint is often overlooked.
Strong muscles act on the knee – the quadriceps at the front of the thigh, the hamstrings behind, and the gastrocnemius muscle in the calf. The knee ligaments can be strained, the meniscii torn, the muscles can strain , and the knee joint and patello-femoral joint are prone to osteoarthritis.
The osteopath will ask about swelling, locking and collapsing of the knee. Locking and collapsing can indicate meniscal or cruxiate ligament damage or loose bodys floating in the knee.
Long term swelling may be due to osteoarthritis or gout. Swelling at the back of the knee is common in osteoarthritis ("Bakers cyst"), but if pulsating is likely to be an anurysm (defect in the wall) of the popliteal artery,
Sudden swelling often follows a trauma, Swelling that develops within 20 minutes of a strain is likely to indicate a cruciate ligament injury. Other localised swelling around the knee occur with busitis (Eg "Housemaids" knee). Swelling that arrises for no apparent reason in someone on bloodthinners could indicate bleeding into the knee.
Early arthritis of the knee can be helped by osteopathy; if advanced a knee replacement may be needed. If in just one side of the knee, an off-loader knee brace can help. Weight loss in the overweight can give a marked improvement. Ligament tears can respond to osteopathic treatment, although the cruxiate ligaments are more difficult and severe tears may need surgery, especially if it causes recuurent locking or collapsing and effects elite sport people. Reccurent meniscal tears may also need surgery, and loose bodies may need a “wash out”. The tendons of the muscles around the knee can also give pain and respond to osteopathy. Osteopaths also see patients with Osgood Sclatters disease, which affects boys in the early teens, especially footballers. In this, the tibial tuberosity just below the knee cap gets inflamed due to the tightness of the quadriceps muscles. Advice and a temporary tendon support band usually works |
