Alison Odey

Painful knees?
Many people I see complain of sore knees. Sometimes this is justified as they have had a sporting injury or the cartilage is worn.
But at other times there is no apparent injury and scans shows no cartilage damage, but pain persists.

This is because there are many muscles that influence the function of the knee and all, if in a state of tension can cause pain/inflammation around the knee.
As most of these muscles are innervated from the nerves in the lumbar spine, often this tension can be caused by a problem in the lumbar spine, rather than the knee itself.

There are two major muscle groups that control bending and straightening at the knee.
The first is the Quadriceps group of muscles. They are at the front of the thigh and control straightening of the knee. It is made up of four muscles which attach to the patella tendon. If these are over strained there can be pain above the knee.
The quadriceps femoris occupies the front and sides of the thigh and is the primary extensor of the knee. These muscles are innervated by the femoral nerve which originates from the lower lumbar L2. L3, L4.
The four parts (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius) of these muscles attach to the patellar tendon, which passes over the front of the knee and attaches to the knee cap.

The second is the Hamstring group of muscles. They are at the back of the thigh and control bending. They attach posteriorly on either side of the knee and can cause pain behind the knee.
The hamstring muscles (semitendinosus, semimembranosus, and the biceps femoris) help to flex the knee. These muscles pass along the back of the thigh and connect close to the midline ends of the fibula and tibia. They are innervated from the tibial portion of the sciatic nerve L5 and S1.

There can also be pain medially just below the knee at the pes anserine bursa. This bursa is at attachment of three muscles of the upper leg. Once again if these are over used/strained it can result in pain.
The pes anserinus comprises the tendons of the sartorius, gracilis, and semitendinosus (L5) muscles.

As most of these muscles are innervated from the nerves in the lumbar spine, often knee pain can be relieved by having the lower spine checked.

There are some other muscles attached around the knee that should also be mentioned.
The most important of these is the Gastrocnemius or long calf muscle. This muscle stretches over both the knee joint and the ankle joint. It therefore helps with some flexion (bending).

The Soleus or the short calf muscle does not stretch over the knee joint.
But it is very closely aligned with the gastrocnemius muscle as it lies directly beneath it. These two muscles must always be considered together during rehabilitation. They are vital during walking and running especially when controlling the speed.

Another important muscle at the back of the knee is the popliteus muscle. This is a small muscle, found even deeper than soleus. It lies across the back of the knee joint from the little toe side of the femur above to the big toe side of the tibia below. It helps twist the knee during the first few degrees of bending. This helps “unlock” the joint as it bends.

As a said as most of these muscles are innervated from the nerves in the lumbar spine this may well be the source of the tension, if there is no direct knee injury.
A visit to an Osteopath may be able to resolve this problem and relieve the pain.
Make an appointment.

Up-dated August 2014