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Knee Pain

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Knee Pain

Overview

The knee is one of the largest and most complicated joints of the body. Although it seems like a relatively simple hinge joint which just bends and straightens, there is in fact a lot of complex biomechanics that takes place at this joint. The knee is used for everything from standing up, sitting, walking, running, landing etc. It’s a weight-bearing joint that straightens, bends, twists and rotates. All this motion can make the knee susceptible to acute or overuse injury. 

Knee injuries can broadly be placed in three categories:  

  • Acute knee injuries (including torn ligaments and cartilage) are often caused by twisting the knee or falling. Sports that involve running and jumping and sudden stopping and turning increase the risk of an acute knee injury. 
  • Overuse knee injuries (including muscle strain, tendinopathies and bursitis) may develop gradually over days or weeks. Pain is often mild and intermittent in the beginning and worsens over time. When muscles and tendons are stressed even slightly beyond their capabilities, microscopic tears occur. Overuse injuries are best treated early to prevent chronic problems. 
  • Knee osteoarthritis is one of the most common causes of knee pain. The risk increases with age. Osteoarthritis is a form of wear and tear involving age-related changes of the articular cartilage. Appropriate exercise is vital to maintain strength and flexibility of muscles supporting the knee, which reduces the stress on the joint and may help minimise the rate of wear and tear.  

Owing to the high complexity and numerous structures situated in and around the knee, there can be numerous factors which may contribute to pain and/or discomfort. Knee issues are commonly broken down further based on where the pain is in relation to the local anatomy.  

Anterior Knee Pain

Anterior knee pain refers to symptom development in the front and central regions of the knee and can be attributed to numerous conditions including patellofemoral joint pain, Osgood-Schlatter’s, Infrapatellar fat pad impingement, pre-patellar bursitis and quadriceps/patellar tendinopathy to name a few that are commonly seen across out clinics at Pure Physiotherapy.

Most anterior knee pain symptoms tend to arise from overuse/overload injuries from a sudden increase in activity or from muscle weakness/imbalance. As previously outlined, the knee is a complex joint and there are a multitude of symptoms which can develop which makes it difficult to ascertain all the factors contributing to the onset of symptoms.  

a physiotherapist giving a patient with ACL injuries treatment

At Pure Physiotherapy, our skilled clinicians will carry out a thorough examination to identify structures and factors leading to the symptoms you experience. Your Physiotherapist will ask about the location, duration, character and aggravating factors such as stairs, squatting, sitting with the knees bent. This information will give your Physiotherapist a greater understanding of your symptoms and can assist in your diagnosis so that optimal treatment and management can be implemented.  

Although symptoms and severity can vary significantly, most anterior knee pain conditions can be managed conservatively with a combination of hands on treatment, self-management advice and exercise rehabilitation. All our Physiotherapists at Pure are highly skilled in providing complimentary hands on treatment and will work with you to develop a personalised treatment plan to help you recover and return to the activities which are important to you. In more acute conditions where symptoms are irritable, your Physiotherapist may recommend some activity modification strategies to reduce symptom severity 

Medial Knee Pain

Pain on the inside of the knee is another common area in which patients visit our clinic seeking advise for at Pure Physiotherapy. Again, this can be from an acute injury such as a twist, fall of sporting incident or something that has developed over time. Your Physiotherapist at Pure may ask specific questions such as if the knee has physically locked in place, swelled or given way on you as this may assist in diagnosis and the plan for management of your injury.  

Medial knee pain is most associated with the medial meniscus which is a cartilage structure situated between the two large bones which make up the knee (femur and tibia), providing stability & shock absorption. (See below – the two C-shaped structures are the meniscii)

Injury to this structure typically occurs with a twisting movement whilst the foot is planted which is a combination of compression and torsion which can cause tears of various severity. The common symptoms associated with damage to the medial meniscus include tenderness along the joint line, weak quadriceps muscles and pain at end ranges or during a specific position through range.

Many patients feel that having an X-ray or MRI will help with the recovery however in most cases this is unnecessary and will not change the rehabilitation plan however they may be useful in severe presentations where a physical locking of the joint and frequent giving way occurs.

Most commonly meniscal injuries can be managed conservatively with a well-designed exercise rehabilitation plan and self-management strategy, all of which our skilled clinicians at Pure Physiotherapy can assist with. Knees tend to respond well be being loaded, provided that is it optimal to support healing and strengthening of the damaged structures. Your Physiotherapist at Pure will work in collaboration with you to establish the activities which are important to you so that a clear plan can be implemented to help you return to these.  

Another structure associated with medial knee pain is the medial collateral ligament (MCL) which is a flat band of connective tissue situated on the inside aspect of the knee and is fused to the medial meniscus. The MCL is one of 4 ligaments which supports the knee and works to prevent the knee from caving inwards. MCL damage is common in sport such as tackles in contact sports, awkward falls/landings and in skiing. As a key stabiliser for the knee, damage to the MCL can make the knee weaker and subsequently it is vital to strength the articulating muscles to provide greater robustness in the area.  

Below are some exercises which Pure Physiotherapy recommend:

Posterior Knee Pain

The posterior knee is another area that can be injured or overloaded and is a region our Physios at Pure can provide information and treatment for. The most common issues seen in the posterior aspect of the knee relate to bones, muscles, tendons and ligaments. Many issues in the back of the knee tend to present with palpation tenderness coupled with pain and swelling. There are numerous structures located in this region which means an in-depth knowledge of the anatomy and a thorough physical assessment is crucial in providing an accurate diagnosis. At Pure Physiotherapy, our experienced Physiotherapists will take a detailed history of your condition and perform a comprehensive physical examination so we can provide a definitive diagnosis and guide you through your recovery and rehabilitation.  

The hamstrings and calf muscles cross over the posterior aspect of the knee and attach inferior and superior, respectively.

These are common structures which could contribute to symptoms in the back of the knee, alongside the area in between known as the popliteal space in which swelling is common.

Lateral Knee Pain

Finally, the lateral region of the knee can present with pain and discomfort which is typically attributed to several structures. As seen in medial knee pain, we have a lateral collateral ligament (LCL) which performs the opposite role to the MCL and provides lateral stability, preventing the knee buckling outwards, again a common injury in contact sports. The lateral meniscus is another structure which can be injured and is managed as aforementioned for medial meniscal damage. Going further, the iliotibial band (ITB) which is a tendinous structure and is an extension of the lateral gluteal tendons, travels along the outside region of the thigh. Tension can increase due to weakness and overactivity of the lateral hip and quadriceps muscles which can lead to friction and inflammation around the lower region of the thigh bone. This is diagnosed as iliotibial friction. This condition is commonly managed by increasing the mobility in the lateral hip and thigh musculature coupled with activity modification and focused strengthening.  

Through detailed physical examination coupled with a history of the presenting problem, our skilled & experienced team at Pure Physiotherapy can identify which structures are injured, weak or dysfunctional and work with you to formulate a personalised exercise and self-management protocol coupled with hands on treatment to assist with recovery.  

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