Osteopathy and the Knee: Between Biomechanics and Myths

Knee pain (gonalgia) affects approximately 25% of adults. Whether dealing with osteoarthritis, patellofemoral syndrome, or IT band syndrome, osteopathy offers an effective conservative alternative. However, to achieve lasting results, one must distinguish validated manual care from obsolete anatomical theories.

Understanding the Knee: A Pivot Under Pressure

The knee is an intermediate joint that endures pressure from what happens above (hip/pelvis) and below (ankle/foot).

• Patellofemoral Syndrome: Often related to the kneecap (patella) tracking incorrectly in its groove.

• Osteoarthritis: Wear of the cartilage where the goal is to maintain mobility to reduce inflammation and stiffness.

• The Kinetic Chain: Ankle stiffness forces the knee to compensate, creating abnormal stress on the menisci and ligaments.

Critical Analysis: The Myths of Osteopathy

Certain traditional explanations lack evidence and may oversimplify complex pathologies.

A. The Myth of "Somato-Emotional" Pain

• The Belief: Knee pain is said to symbolize a difficulty in "bending the knee" (submission) to a situation, or expresses a relational conflict ("I-Us" / "Je-Nous" in French).

• The Critical Reality: While stress and emotions influence pain perception, there is no scientific evidence that specific emotions physically lodge themselves in a joint. Claiming to treat a ligament tear or osteoarthritis solely through "biological decoding" is dangerous. Knee pain is primarily a physical reality related to load and movement.

B. The Myth of the "Displaced Meniscus"

• The Belief: The osteopath claims a meniscus has "popped out" of the joint and that they will "put it back in place" with a quick manipulation.

• The Reality: The menisci are securely anchored to the tibia by powerful ligaments. They cannot "slide out" like a drawer. Manipulation does not "reset the meniscus"; it decompresses the joint and releases protective muscle spasms, which reduces pain.

C. The Visceral Osteopathy Myth

• The Reality: There is no evidence that manipulating the intestines can treat knee pathology. The knee is a weight-bearing joint; its pain is primarily mechanical.

D. The Patellar "Realignment" Myth

• The Reality: The position of the kneecap depends on the muscle balance of the quadriceps. The osteopath does not "reset" the kneecap; they work on the flexibility of the surrounding tissues so it glides more smoothly.

Scientific Reality: What Actually Works

Osteopathy is effective when integrated into an Evidence-Based Practice (EBP) model.

• Joint Mobilizations: Studies (e.g., Degenhardt et al.) show that passive mobilizations improve joint lubrication and reduce pain.

• Releasing Adjacent Joints: Restoring mobility in the ankle or hip is crucial for reducing torsional forces on the knee.
  [Image showing the lower limb kinetic chain: Hip, Knee, and Ankle alignment]

• Neurological Modulation: Manipulations stimulate the joint's mechanoreceptors, which temporarily inhibits pain signals sent to the brain.

An Essential Collaboration

Osteopathy "unlocks" the knee, but it does not replace active rehabilitation.

1. Combined Approach: It works best with strengthening exercises (quadriceps/glutes).

2. Caution: A swollen, hot, or locked knee after an impact requires urgent medical advice and imaging (MRI/X-ray), not immediate manipulation.

3. Balance: Listen to your body, but be wary of purely "emotional" explanations that overshadow a very real mechanical problem.

Alain Guierre