Most knee injuries can be categorised into acute or overuse injuries. Acute injuries result from a sudden trauma such as an awkward fall, collision or twist of the knee joint. Overuse injuries result from continuous activity or sudden overload such as running, cycling, weight training or bushwalking- these injuries start to progressively worsen. Whether your knee pain is acute, or is an overuse injury, it is typically a result of:
Musculoskeletal (muscle, joint) imbalances: this may be a weakness, range of motion issues or under/over active muscles.
Degenerative changes: in the knee joint itself, such as arthritis.
Structures issues: such as flat feet which can place additional pressure on the knee, or weak hip muscles which may put too much strain on the knee due to a lack of mechanical support.
ANATOMY OF THE KNEE BY YOUR SYDNEY PHYSIOS
The knee can be considered as two joints combined in one. Making up the knee, the tibia (shin bone) meets the femur (thigh bone) to make the tibio-femoral joint and the kneecap joint which makes the patello-femoral joint. These joints rely on the surrounding musculature, ligaments and tendons to keep optimal alignment and joint stability to keep the knee healthy and pain free.
Muscles which act on the knee include the: quadriceps, hamstrings, soleus & gastrocnemius (calf), hip flexors & the glutes.
Ligaments which support the knee include the ACL, PCL, MCL & LCL. The two main tendons in the knee include the patella tendon (below the kneecap) and the quadricep tendon (above the kneecap). Inside of the knee joint, there is also a rubbery cartilage called the meniscus.
The mechanical efficiency of the hip & ankle joint is also important as the knee sits between these two ends. If the ankle or hip is compromised, this commonly also affects the knee as a consequence.
In order to determine the true cause of your knee pain, pay a visit to one of our sydney physiotherapy clinics and connect with one of our expert practitioners. Alternatively, sign up for one of our online services if you prefer a remote treatment.
COMMON CAUSES OF KNEE PAIN
The meniscus is a C shaped piece of rubbery cartilage, which acts to provide shock absorption within the knee. Meniscus injuries are usually caused from a sudden twisting or rotation motion on the knee whilst weight bearing as well as long term overuse. It is one of the most common knee injuries, as it can happen as easily as stepping out of a car awkwardly. Common symptoms include: pain (especially when twisting or rotating on the knee), swelling, joint stiffness and difficulties extending the knee.
The anterior cruciate ligament is a primary structure which stabilises the knee joint, and connects the thigh (femur) to the shin (tibia). Within the sporting world, it is one of the most prevalent knee injuries to sustain. Typically, this injury is induced by: 1) changing direction rapidly, 2) stopping suddenly, 3) slowing down while running, 4) landing from a jump incorrectly, 5) direct contact or collision, such as a football tackle.
Symptoms usually include: a loud audible pop or popping sensation at the time of injury, pain with swelling (especially the first 24 hours), loss of full range of motion, tenderness along the joint line, pain and instability (or ‘giving way’) while walking or climbing stairs. There are different degrees of ACL tears, ranging from Grade 1 (ACL strained and overstretched, but not fully torn), Grade 2 (the ligament is stretched to the point where it does not recoil and is loose, therefore makes the knee unstable), Grade 3 (full rupture/tear of the ligament).
What is the treatment?
Surgical: involves ACL reconstruction using a graft (tissue typically from the hamstring tendon or patellar tendon). Post surgery, 9-12months is the typical time frame prior to the return to sport for the athlete.
Non-Surgical: whilst ACL injuries CAN be managed without surgery, the ligament will not repair. Utilising strength rehab to improve the overall strength of the knee can allow people to still live their daily lives, but since the ACL will not repair on it’s own, this will impact the ability to participate in any jumping/running sports as the knee itself will still remain structurally deficient.
This tendon sits just above the kneecap, which acts to help straighten the knee, helping you to walk, jump and climb up and down stairs. Any pain in this tendon can result due to repetitive movements like jumping or kneeling. This overuse leads to tiny tears, which cause pain and swelling. Its underlying cause may be due to weakness in surrounding muscles which help move the knee, poor recovery in between sports (overuse) or a flexibility/mobility issue with the knee itself. Symptoms may include: sharp pain, swelling, stiffness, tenderness to the touch or aching post high impact movement (jumping, running or walking for prolonged periods).
The iliotibial band is a long piece of connective tissue extending from the side of your hip, down to your shin, where it crosses both the hip & knee joint. This structure acts to stabilize the outside part of the knee & assist with movement, as well as giving support to the lateral (outside) aspect of the hip. ITB syndrome is the condition that arises when the area is overused, resulting in progressive tightening of the ITB to the point that it begins to rub against the thigh bone, causing inflammation and pain. Long distance runners, sprinters, bike riders or those who engage in running sports are usually the ones more likely of developing this condition.
Symptoms include: pain when running or movements involving the knee/hip, a clicking sensation where the ITB rubs on the knee, a burning type pain after exercise, tenderness to the touch, redness and warmth around the knee.
The medial collateral ligament (MCL) is situated on the inside of the knee. It connects the thigh to the tibia, giving the inside of the knee stability. Similarly to ACL injuries, MCL strains are classed into 3 categories: Grade 1 (MCL strained and overstretched, but not fully torn), Grade 2 (the ligament is stretched to the point where it does not recoil and is loose, therefore makes the knee unstable), Grade 3 (full rupture/tear of the ligament). Typically, this injury is sustained during running/sporting activities such as: a collision with another player (blow to outside of knee) or a quick change of direction which causes the knee to collapse inwards (this is knee valgus).
Symptoms include: a popping sound at the time of the injury (this is the sound of the MCL tearing), pain & swelling primarily around the inside and front of the knee, sensation of knee stiffness, difficulties straightening & bending the knee.
Patella Tendinopathy/Tendonitis (Jumper’s knee)
The patella tendon attaches at the bottom of the kneecap onto the tibia. This tendon is important with keeping ideal alignment & position of the knee cap, and also assists in bending the leg at the knee joint. A patella tendinopathy (or jumper’s knee) is an overuse injury, where either the surrounding musculature is too weak and therefore more force is placed onto the tendon, or the knee is being overused (too much sport with potentially poor rest times can result in the tendon’s irritation).
Symptoms usually include: pain during or after exercise, tenderness/soreness when pressing around the tendon, sharp pain when walking up stairs or squatting and burning sensations around the tendon region. Ideally, the first step is to reduce the amount of exercise you are doing which is irritating the tendon. Once inflammation and irritation has reduced, working on the strength of the surrounding knee musculature & improving the resilience of the tendon to force is paramount for returning to a sport/activity pain free.
This is a condition where the knee joint produces too much synovial joint fluid. This is usually caused from: torn cartilage, injury/trauma to the knee causing the inflammation, arthritis & infections. As the excess fluid builds, it causes the bursa behind the back of the knee to expand which can result in posterior (rear) knee pain. It is also known as a popliteal cyst.
Symptoms include: a visible & palpable lump on the back of the knee, pain when touching the rear knee, stiffness/tightness along the rear compartment of the knee and surrounding areas (calves/hamstrings). Excessive use, or engaging in movements/activities which make the pain worse will likely increase the amount of fluid in the baker’s cyst. So, a combination of rest & specific knee rehab exercise is recommended to return to daily life & activity pain free.
Patellofemoral Pain Syndrome (PFPS)
This is an umbrella term given to pain coming from the patellofemoral knee joint (knee cap). It is typically characterised by pain surrounding or on the knee cap itself. Pain can be worsened by sitting for too long, or by bending the knee such as walking up/down stairs. This syndrome can happen in any age demographic, but is typically experienced by those who play sport which involves much running, jumping or squatting. Typical causes of patellofemoral pain syndrome include: overuse of the knee joint, kneecap misalignment, poor surrounding muscular stability and support for the knee joint, poor technique with running/jumping or squatting and recent changes in footwear.
Symptoms can include: pain during movement (running/sport/bending the knee/climbing stairs), pain after sitting for long periods of time and crunching or popping sounds in the knee when bending/walking.
You must have now guessed that the ‘patella’ structure that we referred to is your kneecap. When a knee experiences a patella maltracking issue, this is where the kneecap is not moving in its normal position and therefore tracks sideways. Commonly, the kneecap will maltrack laterally (outwards), but can also be seen tracking medially (inwards). This type of knee condition is usually sustained from high stresses which travel through the knee, especially rotational/twisting stresses on the knee which can be experienced in running sports. A maltracking knee cap can be caused by: weak quad muscles (which help support the kneecap), an imbalance between the anterior (front) and posterior (rear) leg muscles, muscular/tendon tightness around the knee and structural issues (such as valgus knee collapse or internally rotated hips). Typically, the fix is strengthening the muscles around the knee which act on the kneecap’s position, the main muscle being the vastus medialis oblique (VMO).
This condition is seen in children to young adolescents, which causes inflammation just below the kneecap on a structure called the tibial tuberosity. The onset of the condition commonly coincides with a growth spurt, where the bones grow faster than the muscles/tendons surrounding the knee. This causes the muscles and tendons which attach onto the tibial tuberosity pull upwards, which results in pain & inflammation. The pain is usually worsened with repetitive knee extension (straightening), so it’s advised that running & jumping sport should be limited to allow healing to take place.
Symptoms include: pain with palpation/touching over the lower aspect of the knee (below the kneecap), pain with squatting/stairs/jumping, inflammation and in some cases a bony protuberance. Physio treatment with this kind of condition would include modifying sport/activity, stretching the area, manual therapy to reduce pain & inflammation, and strength exercise to improve the overall strength & integrity of the area.
This condition is where the cartilage on the inside of the kneecap softens and begins to deteriorate. This condition predominantly affects young athletes, but may also occur in those with arthritic knee changes (more likely elderly).
Symptoms include: pain at the anterior (front) aspect of the knee, grinding & cracking when bending the knee, sitting or standing for long periods or pain increasing with exercise (including squatting, running or jumping sports).
The condition is categorised into:
Stage 1: softening and swelling of the knee cartilage.
Stage 2: continuation of the softening of cartilage, which is usually the beginning of tissue erosion.
Stage 3: thinning of the cartilage.
Stage 4: significant deterioration of the knee cartilage, essentially resulting in bone on bone rubbing.
KNEE PAIN PREVENTION TIPS BY EXPERT SYDNEY PHYSIOTHERAPISTS
Exercising & stretching regularly – a good target would be 30 minutes daily of aerobic activity such as brisk walking or cycling will keep your lower body strong and ready for day to day activities. Focusing on also a stretching routine to keep your body mobile and flexible will decrease the chance of tightness and stiffness accumulating.
Strengthen your hips, knees and ankles by squatting & lunging! Strengthening and learning how to use your legs correctly can give your lower body, specifically your knees, a better chance of staying injury and strain free.
Managing your weight – this will limit the amount of force being placed through your knees & body when walking around, running etc.
KNEE PAIN PHYSIOTHERAPY TREATMENT
Try the above preventative strategies, otherwise if symptoms and pain persists, a trip to your friendly Sydney physio could help fix the problem. The key is for an accurate assessment and early treatment by a trained practitioner who will advise you on how to avoid worsening the problem and how to maximise healing potential.
Here at Infinite Health, our highly trained Sydney physiotherapists will assist you through the healing process, on to resuming pain-free activities, return to day to day normal activities and most of all reduce the risk of recurrence in the future.
Physios are highly skilled with diagnosing and providing knee pain treatment. Initially taking a thorough subjective examination (understanding the history and behaviour of your knee pain) combined with what is found in the physical examination will allow the clinician to establish an accurate diagnosis.
In the second part of the assessment, a Physiotherapist will physically assess how your body moves, via assessing the movement & function of joints, muscles, ligaments and overall movement patterns/restrictions to understand how your body is functioning.
Determining the CAUSE of your knee pain, and then working to effectively treat this and prevent reoccurrence is the MOST important factor to understand. It is important to continue to keep active and engage in your normal activities as best you can whilst avoiding any aggravating factors whilst this occurs. Though if your pain has not eased in a few days, or in more chronic conditions which are long standing, it is greatly advised to seek the intervention of a physiotherapist.
Every knee treatment plan is different and specific to each individual but should have the following aims and checkpoints. This is what we will help you with at our Sydney physiotherapy clinic.
Pain relief is what your Physiotherapist can help you with. This is achieved through soft tissue therapy, joint mobilisation, knee taping/bracing (if required) which will help to alleviate muscular tension, joint stiffness, spasm & pain. You will also be prescribed with gentle stretches initially to unload the tight or stiff structures in your knee (or ankle/hip if these areas are also contributing to your knee pain).
To prevent reoccurrence, the prescription of strength & stability based exercises will be developed in a tailored program to ensure your body is resilient and not at risk of the same issue! Your friendly and professional Sydney physiotherapists will also provide you with education and understanding of your knee so the individual is able to self manage their knee issues, ultimately providing YOU with the understanding of how to keep your knee & lower limbs healthy and prevent reoccurrence.
For expert help and treatment visit one of our Sydney physiotherapy clinics or sign up for one of our online services if you're not based locally. We'd love to help.