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 Introduction:

Knee pain is a very common problem and considerable money and effort is dedicated to treating knee problems.  Typically, the person with knee pain that is not due to a recent traumatic injury is diagnosed with arthritis and few people with knee pain go beyond treatments that merely suppress inflammation and pain, unless they wind up going to the extreme of surgical treatment.  Occasionally, some of the new injectable drugs to promote joint lubrication are used, but rarely are the actual underlying causes of knee pain addressed.  I guess one could argue that because inflammation is a cause of knee pain in the majority of cases, anything that helps inflammation is treating the cause of knee pain; however, I think it bears investigating what is causing the inflammation to occur in the knee joint. 

 Nutrition And Inflammation Control:

There are some individuals who have problems with widespread inflammation and who suffer with pain in most or all of their joints, and who may also suffer other effects of inflammation such as atherosclerosis.  In these cases of an overactive inflammatory response, the underlying cause is often nutritional imbalance.  One of the most common of these imbalances is between omega 6 and omega 3 fats.  Due to changes in how much of our food is produced, there has been a drastic shift in the relatve amounts of omega 6 and omega 3 fats in the diet.  In indigenous cultures that consume primarily vegetables and wild game, and very small amounts of grains, the ratio of omega 6 fats to omega 3 fats in the diet is approximately 1:1 to 3:1.  In the not too distant past, this ratio was relatively common in the United States and other developed countries.  But in the last few decades, the tremendous increase in grain products in the diet, and the consumption of grain-fed meat has radically shifted the ratio of omega 6 to omega 3 to approximately 20:1 or more.  Through various biochemical mechanisms I won’t go into here, this huge shift to omega 6 fats has drastically increased the amount of inflammatory processes in the majority of people. 

So, one of the first goals for anyone suffering from knee pain or any other arthritic conditions is to reduce their ratio of omega 6 fats to omega 3 fats.  There are two relatively simple ways to do this.  First, reduce the intake of grain-based products, such as bread, pasta, cereal, etc..  The second step is to supplement with omega 3 fats, which can be most easily achieved with either fish oil or krill oil supplements.  Various supplements have different levels of the two main types of omega 3, known as EPA and DHA.  I suggest supplementing with an amount of fish or krill oil that provides a dose of approximately 1,000 mg of EPA per day (check with your doctor or pharmacist first if you are taking blood-thinning medication). 

Biomechanical Causes Of Knee Pain:

Foot And Ankle Biomechanics:

The next step in combatting knee pain is to correct any biomechanical misalignments or dysfunctions that are placing any undue mechanical stress on the knee joint, and thereby causing tissue damage and inflammation.  Before working on the knee itself, though, I highly recommend looking to the alignment of the feet.  In many knee pain cases, there is collapse of the main arch in the foot, which results in a change in the alignment of the ankle known as hyper-pronation.  This then causes a compensatory rotation of the knee and exerts abnormal stress on the ligaments, tendons, and other supporting structures.  The following video illustrates how this occurs:

As the video indicates, shoe insoles that support the foot are often beneficial in controlling pronation and consequently taking stress off of the knee and relieving pain.  In my experience, there really is not a clear benefit of one type or brand of insoles for every patient.  Different patients have different needs.  For some people, it may be sufficient to simply wear shoes that have good arch support, while others do well with a very basic arch support such as Dr. Scholl’s, while still others really need a high-quality orthotic that is either custom-made for the patient, or can be easily modified as necessary to get a good result.  My advice is to start with just wearing good shoes and then move up to more substantial arch support solutions if needed. 

If you are unsure as to whether you need arch support, you can do a simple test at home.  You’ll need to have a few sheets of paper (just about any kind will do), and a damp cloth or sponge.  Begin by sitting in a chair where your feet can rest flat on the floor (smooth, uncarpeted floor is best for this).  Place a sheet of paper flat on the floor next to one of your feet.  Bring that foot up and apply moisture with the cloth or sponge to the bottom of the foot and immediately place it on the sheet of paper and press your foot down firmly using only your leg muscles.  Now lift your foot up and notice the moisture pattern on the paper.  Start again with a new sheet of paper, and again bring your foot up, moisten it, and place it on the paper, but this time stand up once your foot is on the paper.   Once again, raise the foot up and notice the moisture pattern on the paper.  If there is a big difference in the moisture pattern between sitting and standing, it usually indicates that you have arch instability and that you’d benefit from at least some amount of extra arch support. Be sure to test both feet in this manner.  In most cases, if there is arch instability, it will be on both sides, but in a few cases, it is much worse on one side (usually the side where the knee pain is).   

Knee Biomechanics:

In some cases, there is a direct mechanical problem in the knee joint.  Usually, this is a subtle rotation misalignment of the joint that may occur from minor trauma that may not even be noticed when it occurs.  Evaluation and treatment by a sports chiropractor or other professional trained in joint manipulation usually solves these types of problems pretty quickly.

 Biomechanical Treatment:

Massage And Stretching:

In many cases of knee pain, muscular restrictions and trigger points can develop around the knee that can interfere with normal joint biomechanics and cause pain either directly or indirectly.  Stretching and massage of the quadriceps, hamstrings, “abductors” (muscles on the outside of the leg that pull the leg sideways out from the body), “adductors” (muscles on the inner side of the thigh, also called the groin muscles, that pull the leg sideways toward the midline of the body), and calf muscles.  If you’re not sure if you are having problems with trigger points, I suggest finding a massage therapist or chiropractor who is experienced with trigger point massage and stretching techniques to be evaluated, and treated if appropriate. 

Stengthening And Endurance:

In addition to tightness, muscles can contribute to knee pain if they become weak and/or imbalanced.  A physical therapist, sports chiropractor, or certified personal  trainer can provide professional guidance in rehabilitative strengthening.  Pilates exercises work quite well in most cases, as they provide both stretching and strengthening.  Most Pilates classes are general-purpose, but some Pilates instructors are willing to give additional instruction for specific areas like the knees.  I have also come across a self-treatment program for knee pain that utilizes Pilates exercises, that I think is a good option for those who are too limited on time and/or money to get professional instruction.

While there are situations in which the damage to the knee joint(s) is too far advanced to get relief from natural treatment approaches, the vast majority of patients I’ve seen do get better through a combination of natural inflammation control and biomechanical correction. 

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Foot problems are a common complaint and are also a common cause of aches and pains in other areas, including the knees, hips, and lower back.  In most cases, foot problems begin as a result of neglect.  There are some simple steps you can take to make your feet happy and solve a host of other muscle and joint pains at the same time.

Step One:  Go barefoot whenever possible.  The feet have many nerve receptors on the bottom of them that analyze pressure on various points on the feet and use that information to help you keep your balance.  In addition, those nerve receptors tell the muscles in the feet when to contract and when to relax, so as to maintain the arches of the feet and aid in mechanical stabilization.  When you wear shoes, the nerve receptors are in constant contact with the shoes, and are much less able to determine differences in pressure on the separate points of the feet.  This leads to poor muscle coordination in the feet and in most cases, eventual loss of the arches, making the feet and the whole body much more susceptible to the effects of mechanical shock.  Unfortunately, going barefoot most of the day is not practical for those of us who work for a living, so the best you can do is take Step Two…

Step Two:  Choose good shoes.  Now, by “good shoes”, I’m not talking about some expensive designer brand and I’m not talking about 3 inch pumps that look really hot.  I’m talking about shoes with good arch support and some shock-absorbing materials to take stress off of your feet.  Are such shoes ugly?  That’s a matter of opinion, but if you have to make a choice between good shoes and good looking shoes, I suggest you go with the good shoes at least most of the time.

 Step Three:  Use arch supports and/or shock dissipation shoe inserts.  Depending on your particular needs, some generic arch supports or gel shoe inserts may work very well for you.  If you already have some significant foot problems, I suggest you look into getting custom-fitted orthotics for your shoes.  There are various types of orthotics.  “Old-school” podiatrists may recommend rigid orthotics which do an excellent job of arch support, but have no shock absorption whatsoever and can be very uncomfortable, particularly for those who spend long hours on their feet, or engage in high-shock activities like running.  I usually recommend “semi-flexible” orthotics that not only support the arches but have built-in shock absorbing materials.  These are much more comfortable for most people and do a good job of not only helping the feet, but also helping with knee, hip, and back pain.

Step Four:  Exercise your feet.  I once saw a video about a woman who was born without arms and she did a lot of the things that you and I do with our hands with her feet.  In my professional training, I learned that the feet are actually anatomically structured to where one can develop fine joint and motor control that is equivalent to the hands, but most people never train the feet for this purpose, except for people like the woman in the video who have a compelling reason to develop foot dexterity.  Now, you don’t need to exercise your feet to the point of being able to sign your name using your foot, but some basic arch conditioning can go a long way toward making your feet feel better.  A very simple foot exercise is to place a towel on the floor and then place your foot on top of it and use your toes to “scrunch” up the towel. 

Step Five:  Massage your feet (or get someone else to).  Because most of us can’t avoid wearing shoes and spending a lot of time on our feet, even just a brief foot massage a few times per week can go a long way toward easing foot pain.  Masage can be done by using the hands to rub and press on tight areas, or you can use a foot roller, a golf ball, or any firm, round object to roll your foot on and rub out the soreness.  The massage effects can be further enhanced by rubbing or rolling the feet while you soak them in warm water. 

So there you have it, the five steps to happy feet.

Stay tuned to my natural remedies blog for more recommendations for healthy feet.

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