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If I have a knee pain, should I get it manipulated?

 

If I have a knee pain, should I get it manipulated? – Alex, Singapore

Whether a not a knee pain should be manipulated or not, it depends on the cause of pain. However, as a rule of thumb, most manipulative physiotherapists will not manipulate the knee.

Anatomy of the Knee

The knee is a joint whose integrity is generally held by the strength of it’s ligaments, joint capsule and muscles due to the shape of the bones which make up the joint. The knee joint is 2 rounded condyles of the femur sitting on the flat plateau of the tibia (known as knee joint) with a ‘floating’ bone, known as the patella over the femur (known as Patellar-Femoral joint). The knee joint is similar to like putting 2 oranges on a flat plate, make it fairly unstable. Thus the stability of the knee comes from the 2 menisci, which acts to deepen the depth of the tibial plateau (to prevent sideway movements of the femur), the ligaments and joint capsule (to prevent excessive movements) and the muscles (to control the joint movement). There is a good animation of the knee and the ligament in an earlier post (knee-ligament-anatomy-animation)

Causes of Knee Pain

Due to the make-up of the knee, most causes of knee pain would be due to either strains of the ligaments, capsule or muscles or degeneration of the patellar. Manipulation is not warranted as manipulation is generally used for a ‘locked’ joint and not for strains. In most knee pain, mobilization, either accessory or physiological, is sufficient to decrease the pain together with strengthening and flexibility exercises.

However, in meniscus tears, where movement is blocked or limited and mobilization doesn’t work, a distraction manipulation might be done but with sever caution. Manipulation can also be used in a degenerated knee but would need to be done by an orthopedic surgeon – cs

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