Knee pain
Structure and function of the knee joint
The knee joint (articulatio genus) is the largest and strongest joint in the human body. This is essential, as it must bear almost the entire body weight during upright walking and is subjected to high stress, especially during sports activities such as jumping or rapid changes of direction. The knee joint comprises two components: the patellofemoral joint (patellar joint) and the femorotibial joint (knee joint). The latter is a hinge joint, allowing not only flexion and extension of the knee but also slight rotation. It connects the femur and tibia and is surrounded by numerous muscles, tendons, and ligaments that provide the necessary stability.
Muscles, tendons and ligaments
Some of the largest and strongest muscles in the human body cross the knee joint. The quadriceps femoris is a prime example – the large, four-headed muscle on the front of the thigh responsible for extending the knee. On the back of the thigh is the biceps femoris, which consists of two heads and flexes the knee. Also responsible for flexion is the gastrocnemius, the larger of the two calf muscles. It's easy to see that unbalanced and/or severely shortened muscles can exert strong tensile forces on the joint. This is often the origin of knee pain, rather than, as is often claimed, osteoarthritis, i.e., excessive wear and tear of the cartilage. Osteoarthritis is often the result of overstretched muscles and fascia that compress the cartilage in the knee joint.
In addition to the muscles, the knee joint is primarily stabilized by four ligaments. The two collateral ligaments (medial and lateral collateral ligaments) prevent the knee from buckling sideways. The anterior cruciate ligament (ACL) prevents the tibia from sliding forward, while the posterior cruciate ligament (PCL) similarly prevents it from sliding backward. Tendons connect the muscles to the bones, thereby ensuring force transmission. In the knee joint, these are the patellar tendon, the quadriceps tendon, and the biceps tendon.
Bone
The three bony components of the knee joint are the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The patella is particularly noteworthy as it is the largest bone in the human body located between two tendons. Above the patella, this is the quadriceps tendon, and below it, the patellar tendon. The patella increases the distance between the tendons and the joint, thereby also shortening the lever arm of the thigh extensor muscles, which significantly reduces the force required to straighten the knee. Furthermore, the patella prevents the tendons from being damaged by pressure during the knee's reciprocating motion.
The bone-contact surfaces of the femur, tibia, and patella are each covered with 3-4 mm of articular cartilage. This cartilage acts as a kind of shock absorber, preventing the bones from rubbing directly against each other. In the worst-case scenario of osteoarthritis, the cartilage is so severely damaged that this is exactly what happens. We'll explain how you can prevent this later in this article. The menisci (medial and lateral menisci) are also made of fibrocartilage and are responsible for better force distribution in the knee. A firm joint capsule encloses the joint space and produces synovial fluid, which supplies the cartilage with essential nutrients. It also reduces friction and, together with the muscles, tendons, and ligaments, ensures support and stability within the joint.
Types of knee pain – Common diagnoses
Osteoarthritis (Arthrosis)
As previously mentioned, osteoarthritis of the knee (also known as gonarthrosis) involves the wear and tear of the cartilage or even the knee joint itself. There are several different stages of the condition. While minor superficial fraying often goes unnoticed, more severe wear can lead to intense pain. In the worst-case scenario, the cartilage is completely worn away, causing the joint bones to rub directly against each other. This results in joint stiffness, swelling, and inflammation. However, the root cause is usually muscular-fascial tension caused by one-sided or unbalanced strain in everyday life.
Ligament Injuries
Ligament injuries in the knee are among the most common sports injuries. Especially in sports involving quick, abrupt changes of direction—such as football (soccer), skiing, or tennis—the cruciate ligaments (ACL/PCL) as well as the medial and lateral collateral ligaments can suffer partial or complete tears. As a result of a tear, the stability and functionality of the knee joint are severely limited and often accompanied by pain. Severe injuries may lead to swelling and bruising. While medial or lateral collateral ligament tears are usually treated conservatively, surgery is often unavoidable if other structures in the knee or the cruciate ligaments are affected.
Treatment
Osteopathy
In osteopathy, treatment begins with diagnosis and focuses on the affected area. The cause of knee pain is often found in the pelvic region, not directly in the knee joint. Imbalances in the pelvis, which affect the knee joint via muscular and fascial structures, frequently prove to be the cause of knee pain in practice. For example, the adductor muscles can trigger medial knee pain, while shortening of the hip flexor muscles can cause central tenderness below, above, or on the paella (the area above the knee). Prolonged shortening of the hip and knee muscles very often leads to damage in the knee joint, such as osteoarthritis or meniscus tears. Therefore, it is all the more important to align the hip and knee joints in a centered manner to avoid increased pressure or friction on the cartilage and meniscus. Osteopathic techniques make it possible to balance the pelvis by working on the muscles, fascia, and bones, as well as the intestines, bladder, and, if necessary, the uterus. Once the pelvis has been realigned, this condition is sustainably maintained through our physiotherapy and/or training therapy.
Physiotherapy/ Training
In particular, muscles identified as weak points during diagnosis are systematically strengthened through training. Conversely, shortened fasciae are restored to their proper length through appropriate mobilization and stretching exercises. Coordination and balance exercises aim to optimally synchronize the interplay between the core stabilizing muscles and the muscles in the hip and knee area. We will create an individualized training program for you, which you will complete with us as part of your physiotherapy sessions. Afterward, your training plan will be adjusted so that you can also perform the exercises at home.
Learn more about our osteopathic treatment approaches on our osteopathy page or find out about other conditions: back pain , shoulder pain , hip pain Endometriosis
