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Knee Pain

Knee pain is very common and is very successfully treated. It is not unusual for people to say that their knees hurt when squatting, when climbing stairs or if they sit for long periods of time and will classically assign this to age... "I'm getting old". However, much of the pain that one experiences can be handled with physical therapy.

General Anatomy

Bones
Provides structural support for the body and serves as an anchor points for ligaments and tendons.

Ligaments
Ligaments are non-elastic tissues which connect one bone to another bone giving our body structure its stability. When frequently or severely injured, ligaments become "stretched out" causing the joint to become loose or more unstable. Ligaments have a poor blood supply so have a tendency to heal more slowly than other tissues. Injuries to ligaments are called "sprains".

Tendons
Tendons are elastic tissues that connect a muscle to a bone.

Muscles
Muscles are elastic tissues. Muscles and tendons work together to create the body's motion. Injuries to muscles and tendons are called "strains". Cartilage: Cartilage is the spongy material that lines the ends of the bones. It works as the body's "shock absorber", helping to cushion the impact placed upon the bones during activity as well as directly protecting the ends of the bones. This is called articular cartilage.

Bursa Bursa are fluid filled sacs that lie between tissues or tissues and bones preventing friction.

Bones

The knee is made up of 4 bones; the femur, the tibia, the fibula and the patella.

Femur
The longest, strongest bone in the body. This rests on the tibia and forms the knee joint. The patella rests in the center of the femur.

Tibia
Is the largest of the lower leg bones. It meets the femur to form the knee joint. The tibia joins with the ankle.

Fibula
This the smaller of the 2 lower leg bones. It is a "non-weight bearing" bone. It connects to the ankle, but does not bear any weight.

Knee Bones Patella
Commonly known as the "kneecap", the patella sits on the femur and slides up and down the lower part of the femur when the knee is bent and straightened. You are not born with a patella. It forms during our first years of life as we begin to move.

Ligaments

Ligaments of the KneeThe tibia and fibula are connected to the femur, thigh bone, by the knee ligaments.

  1. MCL (Medical Collateral Ligament)
  2. LCL (Lateral Collateral Ligament)
  3. PCL (Posterior Collateral Ligament)
  4. ACL (Anterior Collateral Ligmanet)

Cartilage

Articular cartilage lines the ends of each of our bones. It acts as a shock absorber, helping to distribut stress in addition to protecting our bones ends from breaking down as fast.

Meniscus
The knee also has additional cartilage layers called menisci. These sit on top of the tibia and the femur then rests on them. The purpose of the meniscus is to help deepen the knee joint brining more stability to the knee, in addition it provides an added cushion to the knee for. There are 2 menisci on each knee.

Through activity the meniscus can become sustain different injuries. Common symptoms are joint swelling, pain with weight bearing, locking and/or catching of the joint.

Top View of Right Knee Types of Meniscal tears of the Knee Knee - Articular Cartilage Knee Cartilage Lesions

Muscles

Diagram of the Quadriceps The muscles of the knee play a key role in helping the knee to function properly. The weaker and tighter muscles are the worse the mechanics of the knee become causing more stress to be placed on the tendons and joints. Many people do not know it, but we are not born with a knee cap; it forms as we begin to crawl and walk. The knee cap's alignment is greatly dependent on your body's muscle structure. If the muscles of your thigh are not balanced, then there is a great chance that your knees can begin to hurt.

The muscles of the knee are commonly broke down into 2 groups: the quadriceps (quads) and the hamstrings.

Quadriceps
There are 4 muscles that make up your "quadriceps" muscles; the quadriceps help extend your knee.

Vastus Medialis Oblique (VMO)
This is a major thigh muscle. It is located on the inside of your thigh helping to extend your knee. If you straighten out your leg and squeeze your thigh muscle, this muscle should be firm. It plays a key role in the alignment of your knee cap (patella). The stronger this is the better stability and alignment you will have at your knee. There are many knee conditions (pain) that are associated with weakness in this muscle.

Vastus Lateralis ObliqueU (VLO)
This is located on the outside of your thigh

Vastus Medialis
Located in the center of your thigh

Rectus Femoris
This is a very strong muscle that works both the hip and the knee. It helps to flex/bend the hip as well extend the knee. It is a key muscle in sprinting as well as in sports that involve kicking.

Hamstrings

There are 3 muscles that make up the hamstrings. Together they help to bend the knee, extend and rotate the hip. The hamstrings play a key role keeping the body healthy. They greatly help support and protect both the knee and the back. The tighter and weaker the hamstrings are, the greater amount of strain there is at these joints. The hamstrings are weaker than the quadriceps by about 30%; this is one reason why hamstrings are more frequently strained. Sprinters will work the upper hamstrings (and “glutes”) to help increase their running power (acceleration).

Semimembranosus

Biceps Femoris
This is the largest and strongest of the hamstrings. Tightness in this hamstring can be found to be associated with “sciatica”,

Semitendinosus
The tendon from this muscle is sometimes used in ACL repairs. The tendon is used to replace the torn ACL ligament.

Bursa

Bursa are fluid filled sacs that lie between tissues or tissues and bones preventing friction. They can become injured from being contused (hit, from falling) or from the increased pressure placed upon them by tight muscles.

Knee Bursae