Knee pain is a common complaint for a large percentage of the US population seeking medical care especially the athletic population. There are various names for knee pain depending on symptoms, diagnosis and location. Patellofemoral syndrome and chodromalacia are common terms. Other possible causes of knee pain include arthritis, meniscus/cartilage damage and ligament sprains. This article is going to focus on the role of body alignment and how this relates to knee pain, arthritis, injury and joint replacement.
The picture on the left is a client with an anatomical leg length difference, the right leg is longer. You can see how the belt line tilts up to the right. His original complaint was back pain, I used this picture as an educational tool to show how alignment effects joints throughout the body. If you look carefully you can see the right lower leg angles out more than the left. There is a sharper bend to the right knee as well. With a longer right leg the weight of the body shifts: the pelvis tilts down on the left which “pushes” the weight over through the right knee.
This image from an orthopedic text illustrates the same alignment (Genu Varum/bow legs) as my picture. This alignment can be hereditary if both legs bow out. If one leg bows out more than another there is a good chance this is related to knee ligament/meniscus damage, poor pelvis control or leg length difference. Regardless of cause this alignment scenario places excessive force/weight on the inside of the knee joint while at the same time it creates a gapping on the outer part of the knee – this stretches the lateral knee ligament or LCL. Over time this alignment will result in a loss of cartilage and damage to the meniscus on the inner part of the knee joint. Arthritis will develop over a period of time as joint structures progressively deteriorate. Knee replacement is the end point of this process.
With any injury or pain scenario it can be difficult to determine what caused what. Factors like the natural aging process, poor alignment, genetics, sports injuries, knee surgery etc. all contribute. In my experience I have seen the same poor knee alignment on young(er) athletes and on older clients. Addressing alignment issues at the earliest stage possible is ideal for long term joint health.
Some/many knee replacement procedures could be eliminated if the health care field did a better job screening orthopedic alignment and other “structural” body issues like leg length discrepancy. I understand there is limited research into these issues and evidence based practices may not be there yet. That said there is a shift away from knee surgery for some injuries (meniscus) because of the long term consequences like arthritis that develops as a result of the surgical procedure.