Leg and knee pain may be due to herniated discs in the lower back, trigger points which are a hyperirritable spot within a skeletal muscle that can refer pain to a specific region, bursitis of the hip, shin splints and meniscus tears.
Let’s look at these common causes of leg and knee pain:
Bursitis of the Hip (Trochanteric Bursitis)
The greater trochanter is part of the femur on the side of the hip. Tendinitis can lead to bursitis which is inflammation of the bursa. Bursitis is always secondary to tendinitis. A bursa is a fluid filled sac that provides a cushion between bones and muscles/tendons. Its purpose is to reduce friction. The trochanteric bursa is a large bursa. Women are more affected than men due to a naturally wider pelvis which increases the angle that the legs come down from the hips. This is called the Q angle. Symptoms of hip bursitis include severe tenderness upon pressure at the bursa region, pain in the outside of the hip, thigh and buttock, pain when lying on the affected side, pain walking up stairs and pain with certain exercises. Causes of this can be a shoulder strap carrying a bag on one side that repeatedly strikes the hip, trauma as in falling on the hip, hip arthritis, sleeping on one side continually, pelvic misalignment or subluxation that can cause leg length inequalities and exercises like running on an incline. Chiropractic care addresses any pelvic dysfunction, muscle tightness that needs stretching and patient education on exercise revision.
Trigger Points (TP)
Again, these are hyperirritable focal spots within a skeletal muscle that refers pain to a specific region. Several examples are TP’s in the Piriformis muscle (Piriformis Syndrome) which irritates the sciatic nerve as is normally passes between it and the Superior Gemellus muscle. It is a deep buttock muscle. Pain and tingling are usually felt in the affected buttock and posterior thigh. Occasionally, the pain and tingling can travel all the way to the foot. TP’s in the Tensor Fascia Latae (TFL) muscle of the outside of the thigh can refer pain and tingling to the outside of the thigh to the knee, TP’s in the Gluteus Medius and Gluteus Minimus muscles; which are underneath the large Gluteus Maximus muscle; can refer pain and tingling into the buttock, posterior thigh and outside of the calf. Lastly, TP’s in the Psoas muscle can refer pain and tingling into the low back vertically and the front of the groin and thigh. Chiropractic care involves removal of subluxations in the sacroiliac (pelvic) region, TP muscle work and specific stretching to the involved muscles.
Spinal discs lie between two vertebrae with the lowest disc lying between the spine and the sacrum. Anatomically, discs have an outer layer called the annulus fibrosis. It is made up of fibrocatrilage which is the strongest type of cartilage in the body. Its purpose is to withstand compression which it does very well. If a healthy disc is sufficiently compressed between two vertebrae, the vertebrae will fracture before the disc will rupture. The inside of the disc is called the nucleus pulposus which is made of glycosaminoglycans (GAG). It functions to act like a shock absorber/ ball bearing and to absorb water; up to 9 times its own weight. Injuries to the discs of the lumbar spine (low back) are very common. When a disc herniates, it usually goes straight back, to the left or to the right. These herniations can put pressure on the nerves coming out of the spine. Because the nerves in the low back travel down the buttocks and legs all the way to the toes, patients may experience pain, numbness, tingling or weakness down the legs and feet. Many people present for chiropractic as a last resort for relief of disc problems. Many are happy they did.
Meniscus damage is common in sports and may occur with ligament damage such as to the medial collateral ligament (MCL). Soccer has a higher incidence than other sports. We have one meniscus on the inside of the knee and one on the outside. They are made of fibrocatrilage. This is the same type of cartilage in the discs of our spines. Again, fibrocatrilage is very good at handling compression but not very good at handling rotation or twisting. The medial meniscus is 5 times more likely to tear than the lateral meniscus due to the medial being attached to the MCL which gives it less mobility. Injury scenarios are a direct impact to the outside of the knee and rotating the knee when the foot is fixed on the ground. The second scenario is very common. You do not have to be an athlete to tear your meniscus. As degeneration occurs, the meniscus is hardened and more prone to injury. Horizontal tears are more likely in older people while vertical tears are more common in younger individuals. Before the age of 45, 16% of asymptomatic patients have an MRI confirmed tear while after the age of 45, 36% exhibit MRI confirmed tear. Symptoms include pain and swelling, difficulty fully bending or extending the knee, tendency for the knee to “lock” and pain walking down stairs. Conservative management may help in some cases while others may require surgery. Chiropractic management would involve lumbar, pelvic and lower extremity assessment for subluxations, ice, muscle work and stretching.
Shin Splints (Medial Tibial Stress Syndrome)
This is another overuse type injury. Tight calf muscles combined with overuse/tightness of the tibialis muscles contribute to this condition. Flat feet, weak core muscles and poor or worn shoes are also commonly found. The pain is usually felt along the shin bone (tibia). One side is affected, usually the dominant side. There is a dull ache in the affected shin area that worsens with exercise. The continual pulling overload of the muscles of the tibia may lead to a stress fracture. Shin Splints are common in runners, especially those that do not build up mileage gradually or switch to running on hills or uneven surfaces. It also affects tennis players, dancers and military personnel. Chiropractic management would include adjusting any subluxations of the lumbar, pelvic, ankle or foot, stretching, muscle work and casting for orthotics when flat feet (over pronation) are found.
Chiropractors, like other doctors, cannot diagnose or treat patients without examining them in person. The information provided on this site is for general educational purposes only. If you are concerned about actual symptoms or complaints, consult with your own chiropractor.