Knee osteoarthritis (KOA) is a very common condition that is a significant cause of disability in older adults, often resulting in knee replacement surgery. There are several contributing factors to KOA, and perhaps one of the most important issues is excessive force exerted on the knee joint by improper biomechanics of the foot and ankle.
In the normal gait or walking cycle, there are two primary phases called the stance phase and the swing phase. As the names imply, the stance phase refers to the entire time the foot is in contact with the ground and the swing phase occurs when the foot is off the ground.
A 2019 systematic review and meta-analysis reported that the forces across the knee are not transmitted equally during walking, with the inside of the knee joint bearing greater loads than the outer knee joint in most individuals. This leads to breakdown of the cartilage faster on the medial side of the joint, which leads to KOA. One identified cause of this is called ankle pronation, which is an excessive rolling-inward of the ankle that occurs during the stance phase. This results in the knee knocking inward, which is technically called external knee adduction moment, or EKAM.
Fortunately, this can be addressed with the use of lateral wedge insoles or shoe inserts that try to minimize or eliminate the ankle pronation aspect that reduces the EKAM and associated excess loading of the medial knee joint.
When assessing a patient, doctors of chiropractic will expand their examination to regions of the body outside of the area of chief complaint as it’s common for dysfunction in one body part to affect another. In this case, we can see that abnormal motion of the ankle can place added stress on the knee, potentially leading to knee replacement. For the patient to achieve an optimal outcome, such issues need to be addressed.
Chiropractic treatment for the KOA patient can include manual therapies to restore proper motion to the affected joints, specific exercises to strengthen weakened muscles, and nutritional recommendations to reduce inflammation. If ankle pronation is suspected to contribute to the patient’s knee condition, then an orthotic insert may also be necessary. As with many musculoskeletal conditions, it’s better to seek care sooner rather than later. The earlier treatment can be provided, the faster and more likely there will be a satisfactory outcome.
You may wonder, what is wrong with my knee?
Pain in the knee or pain on the knee is a problem that needs attention. Kneecap pain can be particularly annoying.
Do I have a muscle strain in the knee or neuropathic pain?
You may be worried about a torn meniscus or a Baker’s cyst or kneecap pain.
Pain in the knee or pain on the knee is concerning for sure. Some who may be concerned about neuropathy may be concerned if this is neuropathic pain. Many who have been diagnosed with neuropathy have been on high-dosage chemicals and wonder why their knee pain remains persistent. Pickleball, golf, and tennis are common sports to cause knee pain. Some try strong chemicals to no avail. Some have tried applying chemical gel to the affected area with temporary relief at best.
As a last resort, some type in pain management to find relief. Hopefully, you won’t have a torn meniscus but if you do it doesn’t mean surgery is your only option. Obviously, most want to avoid a knee replacement. Sometimes it can be a patellar tendon irritation easily resolved with conservative non-surgical treatment. Persistent or worsening pain intensity and/or frequency necessitate a visit to see a professional before it becomes a surgical case.
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