Knee Pain in Adults with an Osteopathic Component

The incidence of knee pain is increasing due to the rising prevalence of obesity, sedentary lifestyles, and aging baby boomer population in the United States. Both acute and chronic knee conditions can result in the increased utilization of pain medications and a decreased quality of life. A multimodal approach to knee pain management can thus greatly benefit the patient population and decrease the burden of knee conditions on the healthcare system. This article presents the epidemiology, clinically relevant anatomy, physiology and major risk factors associated with common knee pain conditions. An overview of etiologies is presented in terms of major clinical presentation, diagnostic testing, and treatments. Practical guidelines for an osteopathic approach to the examination and diagnosis of knee pain are then discussed, with a focus on the osteopathic structural exam and the use of special tests to discern and localize soft tissue injury. A novel diagnostic algorithm summarizing a step-by-step approach to a patient with knee pain is also presented. This method integrates the physical exam, special tests, lab work, and imaging to formulate an evidence-based protocol for formulating a knee pain diagnosis. Finally, the article presents management strategies for common causes of knee pain including conservative, pharmacologic, manipulative, and alternative/complementary treatments. Evidence-based recommendations for manipulation efficacy are reviewed from meta-analysis data, randomized controlled trials, and a case report. The article also provides a description of commonly used manipulation techniques and their indications with respect to the anatomic location of knee pain and its underlying etiology.