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Knee pain affects millions of people every day and can cause considerable pain and disability. Our expert Physios have years of experience treating knee pain, and can help both in getting to the route cause of your symptoms and in rehabilitating your knee.
The knee is a hinge joint between the femur (thigh bone), the tibia (shin bone) and the patella (knee cap). There are four main ligaments supporting the knee joint; the anterior and posterior cruciate ligaments and the medial and the lateral collateral ligaments.
Unique to the knee joint, are the mensci. These are crescent shaped pieces of cartilage which are attached to the tibia and are present in addition to the articular cartilage on the femur and the tibia. The mensci act as shock absorbers and provide additional stability to the knee joint.
There are multiple muscle groups involved in dynamic control and function at the knee joint. The quadriceps (thigh) muscles play a big role. This muscle group includes the rectus femoris, vastis medialis, vastis lateralis and vastis intermedius; all muscles work together to straighten the knee. The quadriceps originate at the front of the hip and the upper part of the thigh and attach to the tibia via the patella tendon. The hamstrings are the primary muscles that bend the knee. The three hamstring muscles are; the semimembranosus, semitendinosis and biceps femoris. All three muscles originate from the ischial tuberosity (sitting bone) of the pelvis, run down the thigh to attach below the knee to the tibia and the fibula.
Causes of pain vary from simple to complex ligament injuries, cartilage injuries and arthritis.
Osteoarthritis (OA) is common and increases with age. As we get older, the cartilage in our joints becomes dehydrated and can thin and roughen. Other factors including being overweight, a previous knee injury or knee surgery, or work-related repetitive bending at the knee, can also increase the risk of developing OA of the knees.
Symptoms of OA at the knee include knee pain, swelling and stiffness, the knee may also feel unstable at times. The pain is usually activity dependent and can be exacerbated by walking, running, climbing stairs and getting in and out of low chairs. Stiffness often presents in the morning and on moving from prolonged sitting.
A diagnosis is usually made based on the history and clinical tests. In some cases, an x-ray or an MRI scan may be required to assess the joint space or the other knee structures. There is no cure for osteoarthritis at present, however, there are treatments that can help to ease the symptoms and prevent the condition from worsening.
Current best practice guidelines recommend analgesia, education, exercise and weight-management. Physiotherapy plays an important role in this through providing specific exercises to mobilise the knee and strengthen the muscles acting on the knee, the hip and at the foot and ankle. Hands on treatment may also be used to facilitate movement at the knee.
Anterior knee pain is a broad term to describe pain at the front of the knee which can have many underlying causes. It can sometimes be called patellofemoral pain syndrome.
Patients often describe pain around or below the kneecap and this is usually associated with activity. Symptoms can often come on without any injury and it can sometimes be difficult to identify a specific cause. Symptoms include:
There are a variety of causes of patellofemoral pain syndrome and symptoms can often be multifactorial. It can sometimes be attributed to starting a new activity or changes in a training program or intensity. Changes in footwear or wearing inappropriate footwear can sometimes trigger the symptoms. Weakness in some of the muscles in the lower limb and poor exercise technique can also contribute.
Assessment and management through Physiotherapy can help to rule out any other causes of knee pain, establish the underlying cause and help to resolve the problem. It can also sometimes involve podiatry if custom made insoles would be of benefit. It rarely involves surgery. Here are some examples of what physiotherapy may involve:
The menisci are crescent shaped pieces of cartilage that attach to the tibia (shin bone). They are unique to the knee in that they are additional to the articular cartilage on the tibia and the femur. The menisci act as shock absorbers and provide stability to the knee joint.
Injuries to the menisci are common; acute tears can occur as a result of trauma to the knee. As we get older the structure of the meniscus changes, it can become dehydrated, less tough and less flexible; as a result, it is at more risk of degenerative type tears.
If you have injured your meniscus you may experience pain at the inner or outer surface of the knee. You may experience pain at the back of the knee too. This is often exacerbated by twisting or deep bending of the knee ie. squatting or sitting on a low surface. There may be some swelling. In some cases, depending on the location and type of tear, locking or catching of the knee may occur.
Physiotherapy can be helpful to reduce pain, and work on strengthening muscles of the leg to better support the cartilage and structures inside the knee. In some cases, injections can be helpful to settle pain further. If you experience painful and true locking of the knee joint, surgery may be required to clean up the cartilage and improve biomechanics of the knee joint.
There are many ligaments in the knee joint which help provide knee stability, strength and shock absorption throughout all functional and sporting movements. There are four main ligaments of the knee that connect the upper leg bone (Femur) with the lower leg bones (Tibia and Fibula). On the inside and outside surface of the knee joint respectively are the Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL). Located within the knee are the Anterior Cruciate Ligament (ACL), and the Posterior Cruciate Ligament (PCL). Each ligament has its own ‘limit’ and provides a ‘block’ to stop the knee joint moving beyond certain ‘extremes’ of motion. They support the knee through bending, straightening, twisting, pushing off and/or landing.
MCL injuries are the most common ligament injury in the knee, followed by ACL, LCL and then PCL injuries. These injuries often occur during sports activities where the ligament(s) is pulled or twisted beyond that limit. The extent of injury can vary from a slight over stretching of the ligament to partial or complete tear/rupture of the ligament.
Symptoms may therefore vary from a tolerable level of pain with a small amount of local swelling and/or local bruising in lesser injuries, to a knee that feels ‘loose’ or ‘unstable’ with severe initial pain, significant swelling and more bruising in more serious injuries.
Less serious knee ligament injuries can respond well to Physiotherapy with improvements in pain, swelling and daily function. The time to full recovery can vary based on the severity of the injury and the management of that injury. In the presence of more severe symptoms, activities may need limiting initially and referral to a specialist orthopaedic knee consultant may be required. If no serious injury is present, Physiotherapy rehabilitation including hands on treatments and progressive knee specific exercises can help in returning one to full function and higher-level activities/sport.
A thorough examination comprised of specific questions and physical tests can help to diagnose the cause of your knee pain. A treatment plan would then be discussed and implemented, to help you towards being pain free and get you back to performing your desired activities. A fundamental part of the treatment plan is explaining the cause of pain and ways to manage it.
Treatment could include hands-on therapy (joint mobilisation/soft tissue massage), a programme of stretches or strength based exercises, Taping, Acupuncture, Ultrasound or perhaps Shockwave Therapy (if appropriate).
If further investigations such as MRI, Ultrasound scan, blood tests or X-rays are required, our Physiotherapists can point you in the right direction. If the Physiotherapist feels you need to see another health professional (such as an Orthopaedic Consultant or Rheumatologist), they will ensure you see the right person via our vast network and close links with consultants.
So, if you have been struggling recently with knee pain, click here to contact us so we can help you get better!
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