Treating Knee Joint Pain with Physiotherapy

Knee Joint PainThe knee joint is particularly vulnerable to damage and pain because it takes the full weight of your body and any extra force when you run or jump.  You’re more likely to experience knee pain as you get older, and people who are overweight or do lots of sports have a higher risk of damaging their knees.

Simple sprain or strain

If you think your pain is the result of having done more activity than you’re used to, you’ve probably just sprained or strained your knee. This means that the knee tissues have stretched, but aren’t permanently damaged.

Most sprains and strains can be managed yourself using PRICE therapy (protection, rest, ice, compression and elevation) and painkillers.

Anterior Knee Pain (Patellofemoral Joint Pain)

Anterior knee pain is an umbrella term which includes a range of related conditions resulting in pain around or behind the patella.

It is caused by compressive forces in the patellofemoral joint.  Symptoms are usually provoked by climbing or descending stairs, squatting and sitting with flexed knees for long periods of time.  It seems to be multifactorial, the patella may not be tracking correctly caused by a muscle imbalance around the pelvis and the quadriceps muscle, which causes the patella to drift off path during movement of the leg. Alternatively, it may be due to a ‘design-fault’ of the patellofemoral joint.

Its a common cause of knee pain in adolescents and young adults, especially among those who are physically active and regularly participate in sports.

Management normally involves stabilising the patella with specific, progressive rehabilitation exercises.  Various core stability exercises are also recommended to support  the hip, pelvis and lower limb complex.   If there is a biomechanical problem with the feet a podiatrist will need to be involved.

Meniscal Injuries

Sitting between the upper and lower leg bones at the knee joint are rubbery pads of tissue called menisci. These cushion the bones, acting as shock absorbers.  A meniscus can be torn after suddenly twisting the knee joint, resulting in pain, swelling, locking of the knee or give way. Rarely, the torn meniscus can flip into the joint and prevent you from straightening it.

Unfortunately, some cartilage injuries do not settle, despite rest and appropriate conservative management (rest, range of movement and strengthening exercises).  Therefore an arthroscopy is needed to flush out debris or repair the damaged part of the cartilage.

Following surgery Physioleeds can help rehabilitate the knee safely.

Osteoarthritis

In older people, recurrent pain and stiffness in both knees is likely to be caused by osteoarthritis, the most common type of arthritis in the UK. Osteoarthritis causes damage to the articular cartilage (protective surface of the knee bone) and mild swelling of the tissues in and around the joints.

The pain in your joints may be worse after putting weight on your knees and your knees may become stiff if you don’t move them for a while. They may also occasionally become locked or feel as though they’re going to give way.

In some cases, osteoarthritis can also cause a painful fluid-filled swelling to develop at the back of the knee – this is known as a Baker’s cyst, or popliteal cyst.

Less commonly, osteoarthritis can affect younger people, especially those who are overweight or have had serious injuries to the knee in the past.

It is advisable to see a physiotherapist at Physioleeds if you think your knee pain may be caused by osteoarthritis. Depending on their assessment they may recommend range of movement  and strengthening exercises, wearing suitable footwear to reduce the strain on your joints, using assistive devices such as a walking stick and/or losing weight.  Pain management can also be provided.

Patella Tendonitis

Patella tendonitis is caused by the  repetition of certain movements which causes minor stresses to the patella tendon without allowing for sufficient rest or adequate control of the movement. Symptoms may feel easier during activity  but feel worse afterwards often resulting in mis-management of the condition by the individual who continues to play their sport, later developing a tendinopathy.

Although the area of pain is very specific to the patella tendon the cause maybe due to a complex biomechanical problem occurring during activity. Therefore, a full in-depth assessment and management program should be carried out by a physiotherapist at Physioleeds.

Osgood-Schlatter’s Disease

In teenagers and young adults, pain, swelling and tenderness in the bony lump just below the kneecap could be a sign of Osgood-Schlatter’s disease.

This is a where the bone at the top of the lower leg becomes damaged during a growth spurt. It’s relatively common in active children who participate in sports that involve running, jumping and repetitive bending on the knees.

Immediate first aid and the best way of relieving symptoms is applying the PRICE principles of protection, rest, ice, compression and elevation.

Muscles, specifically the quadriceps muscles need to be strong enough to cope with the demands being placed on them. If this injury has been a problem for some time then wasting away of the thigh muscles, particularly the vastus medialis on the inside of the knee. If this muscle is weak then other problems such as Patellafemoral pain may also develop.

Stretching exercises – Gently stretch the quadriceps muscles if comfortable to do so. Osgood Schlatters coincides with a growth spurt so if the bone has grown too quickly leaving the muscle tendon unit tight then stretching will help. Keep the knees together and gently pull up on the foot. Push the hips forwards to Sports massage techniques for the quadriceps muscles and myofascial release techniques to help stretch the muscles can help ensure they are strong enough to cope with the loads placed on them as well as not being too tight. Massage should not be applied directly to the tibial tuberosity where the patella tendon inserts as this is likely to make symptoms worse.

Hold the stretch for 10 to 15 seconds and relax. Repeat 3 to 5 times.

It is important to manage the young athletes training program so they only do what pain will allow. If this means training just once or twice a week then so be it. They will make more progress with one or two quality sessions as opposed to daily training where lack of progress and frustration is the outcome.

What often happens is the pain will settle down, then the athlete goes back to the usual levels of training. Then it will get to a stage again where it is inflamed and you will need to rest and calm it down again.

That will be the pattern that quite a few children will do for years and years. They can still get enough training done so they can improve technically so they still have a chance of making it as a professional sports person. But if you keep pushing and pushing and ignore it then you might end up with a situation where it is so painful that you could miss 12 months or more of training and that then could end the chances of that child achieving a career in professional sport.

Reducing activity levels, taking painkillers and using ice packs can help relieve the pain in most children. The problem will normally resolve completely once your child stops having growth spurts, although occasionally it can persist into adulthood.

Physioleeds can advise on treating knee pain and knee injuries.

Book Physiotherapy for Knee Pain

PhysioLeeds Fit4Work, Bankside, 71 Breary Lane East, Bramhope, Leeds, LS16 9EU

PhysioLeeds Fit4Work, Trinity Fitness, Brownberrie Lane, Horsforth, Leeds, LS18 5HD