Over the years, the medical community has created a need to give everything that can go wrong in your body a name; e.g. lateral epicondylitis (‘tennis elbow’), patellar tendonitis (‘jumpers knee’). A lot of the pain related conditions were defaulted to something ending in ‘itis’ implying an inflammation of a particular tendon or bursa, but these diagnoses only really apply to people in the acute phase of pain or injury. Quite often people continue to experience pain or dysfunction for months in the complete absence of swelling or inflammation. Labeling a five month old elbow or knee problem a tendonitis is just not accurate or helpful to the person in pain. The solution became to call them a tendonosis which acknowledges the tendon is not actively inflamed, but there is ‘disorder in the tendon.’
People tend to seek a diagnosis, but what they are really after is an explanation of why. When it comes to persistent pain, a diagnosis just gives you something to tell your family or employer ‘what you have,’ but typically does very little to help you get rid of it and can even hinder your progress. Most persistent pains in your body develop from a combination of mechanical, cognitive and emotional reasons and where it actually hurts is just the symptom at the end of a chain of events. Unfortunately most doctors’ knowledge level on musculoskeletal pain is limited to the area where it hurts and not the chain of events that made it hurt.
I try my best to not tell you ‘what you have’, but instead explain to you ‘what is going on.’ It is usually way more information than you were anticipating, but makes all the difference when it comes time to convince you that you may have to change some of your habits.
What better time to write about ‘why knees hurt’ than a day and a half after knee surgery as I sit here jealously watching joggers bounce along the sea wall on a gorgeous Vancouver day. I am hiding out from my three little kids today to give my meniscus a chance to calm down. It was a relatively minor surgery, but my knee is very swollen none the less. I can add this one to my list of injuries and operations that help me experience empathy for my clients instead of sympathy. Unfortunately, over the years, I have been way too good at market research for my work as a physiotherapist! This article will hopefully help prevent you from sitting where I am today, or at very least know when to take the plunge and have surgery on that persistent, nagging knee pain.
A little bit of basic anatomy will give you a better context to understand your knees and this article.
Your knees are simply big hinge joints that are built to flex and extend. They are held together by four major ligaments called your MCL, LCL, ACL & PCL. Sandwiched in the middle of the joints are two C-shaped cartilage cups called your medial and lateral meniscus; these act as both shock absorbers and stabilizers. On the front of the joints your knee caps function to protect your knees and act as levers to help strengthen the pull of your thigh muscles.
knee muscular anatomy
When I assess people complaining of knee pain, my first goal is to determine if one of the above mentioned structures is physically damaged or is something simply disturbing the mechanics of the joint, creating friction and causing pain. I would say that 90 percent of the time it is the latter.
I treat a lot of the top Seniors level (35+) tennis players in British Columbia, many of whom compete in the national and world championships every year. These are not professional athletes, but very active adults with full time jobs that work hard and play harder. The combination of work + age + sport inevitably results in aches, pains and unfortunately injuries.
The top five things that tend to bring tennis players into the physio for servicing are:
1. Tennis Elbow
2. Rotator Cuff Impingement
3. Knee Pain
4. Torn Calf/Achilles
5. Low Back Pain
Below I will briefly touch on some of the principles you should follow in dealing with these injuries as they relate to tennis, age and work.
Lateral elbow pain does not necessarily follow the “if it hurts, ice it” rule. Nine times out of ten the root cause of lateral elbow pain stems from your neck and the back of your shoulder. It is usually an irritation of your C6 nerve root in your neck and the radial nerve in your arm…that being said, if your elbow is hot, red and swollen, go ahead and ice it, but don’t expect just ice and rest to fix the problem. Hands down the best way to fix tennis elbow is to go for IMS acupuncture to calm down the nerve irritation. Once the arm feels better have a physio teach you how to move more efficiently so your swing doesn’t create too much strain on your neck and shoulder. You may also need a tennis pro to adjust your technique and/or your racquet.
Suggested articles: Elbow Pain: why it can last so long & how to fix it properly Why Elbows Hurt
Rotator Cuff Impingement
Most shoulder pains are some form of an impingement (which implies a pinching of one or more of the tendons of your rotator cuff).
Chest up, shoulders back and down is the best posture
Most people think of posture as simply the need to keep your chest up and your shoulders back and down. Sounds like a simple feat right?! Then why will most people admit that they think they have bad posture? The answer to that is because good posture is not a simple thing, it is actually a learned, coordinated skill that encompasses the whole body. We are what we repeatedly do and our posture is a reflection of our childhood, our sports, our jobs, our emotions and our attitudes.
There is a continuum of flexibility and mobility among the population. Some people are naturally very loose jointed and hypermobile while others are compressed and stiff as a board. Where you end up on the spectrum seems to be partly genetic and partly personality. The people that fall in the middle or the average/normal people tend to have the least pain and injury problems. The further a person strays in either direction from the average the more and more posture, movement and pain problems they tend to develop. There is not one perfect posture for everybody, but there is a norm that we should all be trying to achieve no matter which side of normal we are on.
“Stiff as a board” “Normal” “Loosey-goosey”
Our bodies are brilliantly built to deal with gravity as a constant downward force, unfortunately most people don’t know how to use their bodies properly or efficiently and end up with muscle imbalances, pain and dysfunction. Posture should be looked at as a life skill not a genetic trait we can blame on our parents. A very basic understanding of anatomy and biomechanics can save people a lot of grief throughout life. Read More
If you experience an acute accident or injury, like spraining your ankle, it is easy to understand why your ankle may hurt. You likely tore some of the ligaments and or muscles around the joint and experienced subsequent swelling, bruising and inflammation. Over a four to six week period your body typically fills in the torn tissue with scar tissue and then slowly remodels it back to its original state. Sometimes though the pain persists beyond six weeks even though all the swelling and bruising have long disappeared. Other times pain appears for no apparent reason in the complete absence of an injury and you can’t understand why or what you did wrong.
Nerves are the electrical wiring of your body. They supply the energy for all your muscles and organs to do their jobs. Your brain and spinal cord are like the electrical fuse box of your body and your spine and skull are their protective coverings. Peripheral nerves extend out from your spine at every level on both the left and right sides. The nerves that extend from your neck are responsible for most of the muscles in your shoulders, arms and hands, while the nerves that come from your low back enervate all of the muscles in your hips, legs and feet. The nerves in the middle are responsible for your trunk and a lot of your organs.
Muscles are comprised of a whole bunch of stringy tissue that can stretch and contract. The muscle should have a certain amount of resting tone in it, i.e. at rest it is slightly contracted, not flaccid or extremely tense; this is dictated by the input of the nerve. Read More