Our legs are at the mercy of the forces placed upon them by other areas such as your hips and ankles. The health of all of these needs to be considered together.
The knee joint itself is very rarely a problem on its own. It is a very simple hinge joint which has a small amount of twist available to it, but it's not built to continually be able to tolerate it. Usually either an ankle or a hip and pelvis problem tends to create a degree of twist through the knee which then leads to gradual deterioration over time, or a predisposition to sudden injury because other areas are not doing their job.
The knee has meniscii made out of cartilage. The thigh bone and shin bone have a layer of cartilage on them, the meniscus is additional to that. It helps the stability of the knee. As a result when excessive or inappropriate force is put through the knee, the meniscus absorbs it first and gets damaged. The muscle balance around the knee is very important and so long as you get your knee pain addressed early enough it can prevent any damage being done to the meniscus or the ligaments. When the muscles are left unaddressed, it can lead to a small tear or damage to the meniscus, it is important to get this fixed. This usually involves minor surgery to clean it up arthroscopically in order to maintain the stability of the joint and prevent further damage. Once this is cleaned up we can address the muscle balance properly. In general when there is a degree of meniscal damage you will have trouble either fully bending or fully straightening your leg.
The capsule of the knee can also be a problem if there is too much pressure on the joint. In these cases there is usually a palpable lump at the back of the knee. This can be fully diagnosed on ultrasound. Also the knee pain coming from this source tends to be worse when you spend more time on your feet and it causes pain at the back of your knee.
Kneecaps can also be a big problem, despite the actual knee joint being healthy. The kneecap (patella) has a layer of cartilage at the back of it and it can also become arthritic. This generally happens in patients who have very tight quadriceps muscles or spend a great degree of time sitting and not doing much in the way of exercise. Patellar / kneecap dysfunction can be addressed through osteopathy, but usually it takes some participation from you as well in the form of stretches, exercises or activity alteration.
The ligaments around the knee are very strong, but can also be injured and become lax and weak. The cruciate and collateral ligaments are most often affected. This sort of problem needs to be addressed through a good balance of stretching and strengthening of surrounding muscles depending on which ligaments have been affected. In severe cases surgery may be necessary before we can retrain muscle strength and flexibility.
The tendons around the knee are prone to overuse injuries. Some of the common issues are developmental problems with growing children such as Osgood Schlatter's disease. This happens when a child grows too quickly and the bones grow faster than the muscles. The pain is located at the front of the knee just below the kneecap and is made worse with jumping, running or direct pressure over this area. In general such problems can be alleviated through appropriate treatment and exercise regimes. Other common tendon issues in the area of the knee are hamstring tendinosis, iliotibial friction syndrome and pes anserinus inflammation on the inner side of the knee just below the joint. Repetitive activity tends to bring these about and with treatment and exercise modification these can be easily addressed.
Shin splints are a very commonly misdiagnosed condition. Any pain in the area of the shin tends to be called a shin splint. The actual condition is when the muscles which pass in front of the shins become too large for the sheaths in which they sit. Then when they are used they run out of blood supply quite quickly because of the excessive pressure which the sheates create on them. This condition usually affects those who are involved with running sports. Generally either stopping the sport which is aggravating it or a minor surgery to release the sheath in which the muscles sit can alleviate the problem. Just pain in front of the shins is most often a tight muscle or two due to general ankle and leg dysfunction rather than a shin splint.
For example if your ankle doesn't lift up well - the muscles in front of your shins will need to try to contract much harder in order to move your foot which causes undue loading. In such cases, through treatment, we address all of the various mechanical dysfunctions in order to relieve the shin pain. If there is any doubt that you have full blown shin splits, we would order further investigations to confirm such a diagnosis. In most cases a complete return to your desired activity is possible.
Systemic conditions can also have an impact on this area. Diabetes can diminish blood supply to the peripheries and this will create the impression of shin splints when you increase load on the muscles. We would advise you on any such interactions which may be taking place and help you find an appropriate solution.
Our legs have a great many muscles in them and they are all considerably strong. Hence if they are either weak or tight they have a major negative impact on the joints, tendons and ligaments in our legs. The most common problems are tight quadriceps, hamstrings and calf muscles. All of these are easily addressed through osteopathic treatment, but we need to aim to keep them balanced. We usually need to involve you with doing stretches or exercises regularly. These are most often simple home or workplace based exercises.
For example, we get many patients who work in an office all day sitting. This leads to tightening of both hamstrings and quadriceps. Then in the evening they go for a run which loads the legs with a repetitive impact, but because the muscles are tight, all that impact goes to the wrong place. Ankles, knees, hips or the lower back will suffer as a result. Another example would be concrete contractor who spent the whole day bending forward. He then decides to unwind by going for a leisurely run, but his lower back, hip and knees muscles and ligaments were overstretched and the running leads to impact into slightly weakened structures. The resultant pain may be exactly the same, but the approach to correct the imbalances affecting the legs would need to be completely different.
The hip joint and surrounding muscles can refer pain down to the knee and leg and in such cases most of the treatment would need to focus there. The lumbar spine and its surrounding muscles can also refer pain down to the knee and leg. The ankle can send pain up the lower leg and to the knee. It becomes clear rather quickly that many various sources of dysfunction can send pain into various aspects of the leg. While it may seem like treatment is not addressing the direct site of pain, rest assured that we are addressing the cause of the pain. All of this would be clearly explained to you as diagnosis and treatment progresses.
The main problem in the legs, when it comes to referred pain, is to distinguish between simple joint and muscle problems sending pain, pins and needles or numbness into the leg - and more serious concerns such as compressed nerves in the lower back. The former we can easily address through osteopathic treatment. The latter may need some additional diagnostics and attention from specialists.
Other systemic conditions can also affect the legs. Diabetes for example can cause numbness in the lower legs and feet. Clogging of the arteries can lead to pain all over the legs when you use your muscles and usually the pain sets in after a few minutes of activity and begins to ease within several seconds of rest. Gout can create pain in a variety of joints in the legs and feet. If we suspect that some of these conditions are involved - we would advise you appropriately.
The Achilles tendon, when it's healthy, is stronger than steel. It is able to withstand a force of about 100 times your body weight. Over time it can of course weaken and this leads to micro-tearing or ruptures developing. Tightness in your calf muscles can lead to a predisposition to tearing because it pre-tensions the tendon and then running, jumping or even just walking leads to an overload. Also ankle positions are quite important. A flat or a high arch can lead to a bowing of the tendon which further predisposes it to weakness.
In order to treat an Achilles injury we need to address all areas which are putting undue pressure onto the Achilles. We generally do a scan of the entire leg and lower back area in order to find all potential problems and address them in order of severity. If the Achilles pain you are suffering from doesn't improve with osteopathic treatment, it may be a good idea to get an ultrasound done and confirm the degree of damage.
In cases where a patient is trying to recover from a complete rupture or from Achilles surgery, we will treat all predisposing factors but then we will also discuss activities which are recommended in order to give the body the message needed to heal your Achilles into a new, strong tendon rather than a weak one which will rupture again as soon as any form of mechanical stress is put through it. This is quite important to prevent because your overall fitness and exercise potential may be at stake.