Conditions · Knee
Knee pain,
and what's above it.
Knees are honest joints. They tend to hurt where the problem is. What they are less honest about is why the problem started, because a knee frequently ends up carrying the consequences of a hip that isn't rotating or a lower back that stopped moving well years ago.
That doesn't mean your knee isn't the problem. It means finding out is worth doing properly before anyone treats it.
01 · The differential
What's actually going on.
Knee pain in clinic tends to sort into a few groups, and the first appointment is largely about establishing which one you are in.
The joint itself
Pain with weight-bearing, stairs or kneeling, often with stiffness after sitting. Knee osteoarthritis sits here. It's the commonest site of OA, and I work alongside the core treatments and exercise for it rather than in place of them.
How the knee is being loaded
Pain around or beneath the kneecap, often worse on stairs, hills or after a change in activity. Frequently a timing and control problem rather than a structural one — which is why what happens at the hip matters so much here.
Handed down from the hip or lower back
A knee that examines relatively cleanly, with restricted hip rotation or a stiff lower back on the same side. Treating the knee alone in this pattern tends to produce short-lived improvement that keeps returning.
Load that has outgrown capacity
New running distance, a return to sport after time off, a change of surface or footwear. Common, and usually more about how quickly the load changed than about the knee itself.
02 · The chain
Why I'll look at your hip.
The hip and knee are directly linked. The same large muscles cross both, and the knee has very little ability to compensate for a hip that isn't doing its share. When hip rotation is restricted, the knee absorbs movement it was not designed to absorb, and the muscles controlling it start working out of sequence.
So a knee examination here includes the hip and the lower back on the same side as a matter of course. If the knee genuinely is the whole story, that takes a few extra minutes to establish. If it isn't, it is the difference between treating the problem and treating the place it hurts.
03 · The appointment
What the examination covers.
A first appointment is 45 minutes. The history comes first: where it hurts, what brings it on, what changed before it started, whether it swells, whether it gives way or locks. The examination then covers knee range and stability, testing around the kneecap and the surrounding soft tissue, how you load the leg when you move, and the hip and lower back on that side.
Then a straight account of what I have found, including whether this is one for me at all.
04 · The limits
Knees that belong elsewhere.
Knees produce a clear set of presentations that belong elsewhere, and I screen for them at the first visit.
Go to A&E
A knee that has dislocated, an obvious deformity after an injury, an inability to bear weight following trauma, or a hot, swollen knee with fever. These need urgent assessment, not an appointment.
Needs an orthopaedic opinion
A knee that locks, catches or gives way repeatedly, significant swelling that came on within hours of an injury, or symptoms following a twisting injury. These point at structures I would want imaged and assessed by a surgeon. I refer rather than work around them.
Patients who came in with this
Richard was recommended to me by a friend when I had ongoing hip and knee pain that was not resolving. Within the first session Richard identified the problem and has been working on this since with great results. Richard is highly professional and knowledgeable and an expert in his field. I highly recommend him
I’ve been seeing Rich for a couple of years now with various back, neck and knee issues. Rich manages to translate my description of the issues into appropriate treatment, which usually does the trick in one or two sessions. Totally recommend Rich, he’s a great guy.
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.