Topic 06
Joint problems
With pain in limb joints such as the shoulder and knee, it is important to distinguish whether the problem lies in the joint itself, a tendon, a ligament, or the surrounding muscles. Region-specific tests are typically used to narrow down the structure involved. If structural damage is suspected or an accurate assessment is needed, see a qualified healthcare professional.
Do you have these symptoms?
- Shoulder: it hurts in the middle of the range when raising the arm out to the side
- Shoulder: combing hair or reaching into a back pocket is hard, and it hurts at night
- Shoulder: raising the arm overhead feels unstable, as if it might slip out
- Knee: the front of the knee hurts going down stairs, squatting, or after sitting a long time
- Knee: it swells after a twist and catches or locks
- Knee: the tendon below the kneecap hurts after running, jumping, or stairs
- Jaw: the jaw feels uncomfortable and there is facial pain
Causes and understanding
- Shoulder
- A joint with a large range of motion but low stability. The main causes are impingement syndrome, rotator cuff tears, calcific tendinopathy, frozen shoulder, and instability, which are common in weight training, swimming, throwing, and overhead work.
- Frozen shoulder
- More common in people in their 40s to 60s and in women, and associated with diabetes and thyroid conditions.
- Knee
- A joint that relies heavily on ligaments, the joint capsule, and muscles. The main causes are cruciate and collateral ligament injuries, meniscus tears, chondromalacia patellae (softening of kneecap cartilage), patellar tendinitis, and iliotibial band syndrome.
- Knee, foot, and hip
- Feet that collapse inward and weak hip and thigh muscles are also linked to knee pain.
- Jaw joint (TMJ)
- Can occur together with upper crossed syndrome, where the head juts forward.
Assessment from a chiropractic perspective
- Standard sequenceAssessment typically follows this order: observation → palpation → range of motion → orthopedic tests → neurological exam.
- Shoulder testsCommonly used tests: painful arc, Neer and Jobe tests, drop arm test, apprehension test, joint movement palpation
- Knee testsCommonly used tests: anterior and posterior drawer tests, Lachman, varus and valgus stress, Apley, McMurray, patellar apprehension test, squat test
- ImagingIf structural damage is suspected, X-ray or MRI may be needed; imaging is ordered and interpreted by a physician.
How it's managed
Shoulder impingementA commonly described sequence: early pain management and avoiding overhead movements → then joint mobility care, massage, and stretching → long term, strength and flexibility exercises. Manual and adjustment techniques are performed by professionals qualified in the relevant country, and whether they are appropriate is decided after assessment.
Frozen shoulderA common approach is to manage pain first, then use heat followed by stretching and active exercise. Forceful manipulation can actually make it worse.
Shoulder instabilityStabilization exercises focused on the rear and middle deltoids and shoulder blade muscles are commonly used.
Front-of-knee painReducing intense activity and also looking at foot, ankle, and hip function is typical. Avoiding deep squats and stairs, and stretching and strengthening the front thigh muscles, are known approaches.
Patellar tendinitisCommonly used approaches include reducing contributing factors, adjusting activity, and improving flexibility in the front and back of the thigh.
Exercise within a pain-free range, and stop if pain starts.
When to see a doctor first
- The knee swells rapidly within a few hours of an injury → orthopedic specialist
- The knee catches or locks
- A fracture is suspected after a ligament injury
- A severe shoulder tendon injury, or little to no improvement after 2–4 weeks of care
- A joint that is red, swollen, and warm
Related columns
A Shoulder That Hurts Only Partway Up
Frozen shoulder: why it hurts more at night, and care by stage
If the front of your knee hurts going down stairs
If your knee catches or locks, get it checked right awayThis article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.