This month we’ll be exploring the knee and those structures within that cause my patients and you so much discomfort! So how does a knee work?


The knee joints are essentially four bones held together by ligaments. The thighbone (femur) makes up the top part of the joint, and two lower leg bones, the tibia and the fibula, comprise the lower part. The fourth bone, the patella (or kneecap), slides in a groove on the end of the femur. Each surface that comes into contact with another is covered in cartilage to allow the joint to glide more smoothly. This is all contained within a fluid filled bag to aid lubrication.


Ligaments are large bands of tissue that connect bones to one another. In the knee joint, four main ligaments link the femur to the tibia and help stabilize your knee as it moves through its arc of motion. These include the collateral ligaments along the inner and outer sides of your knee, and the cruciate ligaments, which cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone. Damage to these structures is most commonly after strong trauma, and most often related to sports. It can leave the knee swollen, painful, and very unstable. Bursae. A number of these fluid-filled sacs surround your knee. They help cushion your knee joint so that ligaments and tendons slide across it smoothly. Bursitis, sometimes called housemaid’s knee or carpet layer’s knee, is an inflammation of these sacs. Prepatellar bursitis often occurs after an activity that requires you to kneel for long periods — scrubbing floors, gardening, or installing tile or carpet, for example. It can also result from an infection or as one of the signs of arthritis or gout.


Iliotibial band syndrome (ITB). This is a common cause of outer knee pain in runners. The ITB is a strong structure running up your outer thigh from the knee to the hip. Competitive runners are especially susceptible, but amateurs aren’t exempt. You’re more likely to develop iliotibial band syndrome if you have problems such as unequal leg length or weak hip muscles. Exercising on concrete surfaces or uneven ground, increasing the intensity or duration of your exercise too quickly, wearing worn or ill-fitting shoes, and excessive uphill or downhill running also can contribute to iliotibial band syndrome.


Tendon injuries. Inflammation of the quadriceps tendon (tendonitis) can occur in people who run, bicycle or ski. It can also result from inflammatory diseases that occur throughout your body, most notably rheumatoid arthritis. Middle-age weekend warriors are more likely to rupture their quadriceps tendon than seasoned athletesare. Patellar tendon ruptures frequently occur in active younger people who have a history of tendonitis or who have had steroid injections in their knees.


The majority of patients I see in clinic have had no specific cause for there knee pain, which is often more frustrating than a sports related injury. These often occur due to a gradual weakening of some muscles, an over-use of others and inflexibility in the surrounding joints. The most important thing with knee pain is the correct diagnosis, to allow prescription of the right course of treatment, and the correct exercises that will strengthen and stretch the problem structures, otherwise the problem will get worse.


For more information on osteopathy or treatment at Bingham Osteopathic Clinic please call 01949 839 238, visit or e-mail



Tristan Hill B.Ost