The Origin of Knee Pain – The Medial Compartment

The four compartments of the knee (anterior/front, medial/inside, posterior/back, and lateral/outside) are like dominos. Meaning, when one is injured, the others “start to fall.” This is due to compensatory changes in function—when one compartment is problematic, this places added strain or stress to other compartment(s). Hence, managing knee conditions often requires work on multiple compartments.

The medial/inside compartment of the knee includes muscle, tendon, ligament, and medial meniscus, or “cartilage” attachments. These attachments connect to the top of the tibia/shin bone and/or the end of the femur/thigh bone. The ligaments are strong, non-elastic bands that hold the joint together while the muscles and their attaching tendons move the joint.

Movements of the knee joint include primarily flexion and extension (bending and straightening the leg at the knee). When something “blocks” the knee from fully straightening, an individual may change their gait pattern, possibly walking with a noticeable limp. The meniscus, or fibroelastic cartilage, lies between the ends of the femur and tibia, and when torn or frayed, it can cause the inability to “lock” the joint or to fully extend.

The medial compartment includes the medial collateral ligament, which “checks” the joint from moving excessively inward. Injuries occur when the force is directed to the outside of the knee, such as when a football player is tackled from the side with his foot planted on the ground. Because some of the medial meniscus attaches to the medial collateral ligament, a tear occurring in one often involves a tear of the other.

Moving to the middle of the knee joint, the two ligaments that “check” the joint from front to back are called the cruciate ligaments—specifically, the anterior (front) and posterior (back) cruciates. Injuries to these often occur when excessive force occurs from the front or back of the knee, such as a sudden deceleration when trying to stop when running down a hill.

Due to the intimate relationship between the four compartments, most knee injuries affect multiple structures. For example, the classic tackle from the side can not only tear the medial collateral ligament, but the medial meniscus and anterior cruciate ligament can be injured as well.

Doctors of chiropractic manage many knee conditions using a combination of joint manipulation, mobilization, different modalities, bracing, and exercise training.