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Knee Pain - Structure or Function?

Knee pain can be classified as either coming from inside the knee or outside the knee.

Knee pain is one of the most common musculoskeletal problems us humans deal with. Millions of people in the US experience knee pain on a daily basis and treatment ranges from conservative to invasive.

Knee pain can be broken into two main categories.

The first type is STRUCTURAL knee pain.

Structural knee pain would include torn tendons or ligaments, meniscus tears, and severe arthritis (aka bone-on-bone).

The second type of knee pain is FUNCTIONAL in nature.

Functional knee pain means that the pain is due to a functional problem. Examples of Functional Knee problems would include muscular imbalances, scar tissue formation, knee cap tracking disorders, etc.

Many times Functional Knee Problems are under diagnosed because traditional testing only focuses on the Structure of the knee.

The mainstays for diagnosing someone with knee pain are X-rays and MRIs. These are great tools for identifying Structural problems such as Arthritis, fractures, tears, etc. But, these imaging techniques fall short when it comes to identifying Functional knee problems.

Functional Knee Problems can only be properly diagnosed via a Functional Exam.

A functional exam would be a hands on approach feeling the motion of the joint and/or watching the person move and bend or squat.

A common example of a functional knee problem is a condition called Patellar Tracking Disorder. This is a common condition where the knee cap basically gets somewhat off track and doesn't glide properly when the leg is bent and straightened. Someone with a Patellar Tracking Disorder will typically have the most pain going up or down stairs or or inclines.

You can take X-rays and MRIs of someone with a Patellar Tracking Disorder and the images can look totally fine. Upon a Functional Exam, this problem is easily identified.

You have to look for it or you won't find it.

The takeaway message here is that when dealing with knee pain, determining wether the pain is coming from a Structural source or a Functional source is paramount to determining the correct treatment.

Dr. Hanson

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