Knee pain can be caused by a number of different structuresand the treatment of your knee pain depends on what structure is the cause. Your Physiotherapist is highly skilled in both the assessment and treatment of your knee.

Some Common Causes of Knee Pain

Patellofemoral Syndrome

Patellofemoral pain syndrome is the term given to pain originating from the patellofemoral joint – the joint between the knee cap (patella) and thigh bone (femur). Patellofemoral pain syndrome is usually associated with inflammation or damage to the cartilage of the patellofemoral joint.

What Causes it?

Normally, the patella is aligned in the middle of the patellofemoral joint so that forces applied to the knee cap during activity are evenly distributed. In patients with patellofemoral pain syndrome the patella is usually misaligned relative to the femur, which therefore places more stress through the patellofemoral joint during activity. As a result this may cause pain and inflammation to the patellofemoral joint. The misalignment of the patella may occur for various reasons. One of the main causes is an imbalance in strength between two parts of the quadriceps muscle. Other causes can be tightness of the outer structures of the knee, hip and pelvis position and control, and foot position and control.

What can Physiotherapy do?

Your Physiotherapist will complete a thorough biomechanical assessment and direct your treatment accordingly, dependant on the nature and source of your symptoms

Meniscal Injury

The meniscus is a small crescent shaped piece of cartilage that acts as a cushion in the knee joint. They sit between the thigh bone (femur) and the tibia (shin bone), one on the outside (lateral meniscus) and one on the inside of the knee (medial meniscus). The menisci absorb weight within the knee during impact as well as providing stability during movement.

What Causes it?

The most common mechanism of injury to the meniscus is a twisting injury with the foot anchored on the ground. The degree of pain with such injuries varies considerably. A small meniscal tear may take 24 hours to develop swelling. Meniscal tears may only require very minimal trauma in the older person due to degenerative change of the meniscus. In the case of more severe meniscal injuries pain and restriction of movement occurs. Intermittent locking of the knee may occur due to the torn flap of the meniscus.

What can Physiotherapy do?

Treatment will vary dependant on the severity of the condition. You Physiotherapist will set your treatment protocol dependant on assessment findings, and in certain cases may recommend you be reviewed by an Orthopaedic Surgeon. The focus of Physiotherapy treatment will be to reduce swelling and improve range of motion through, with progression back to your functional activities and day to day tasks.

Patella Tendinopathy

The Patella Tendon runs from the knee cap to the tibia (shin bone). It works with the quadriceps muscle to straighten the knee. Patella tendinopathy is most frequently seen following overuse. The most common site of tendinopathy is the attachment of the tendon into the patella. Pain is frequently non specific or quite vague. Knee movement is not generally affected, nor is swelling commonly present.

What can Physiotherapy do?

One of the first tasks of your Physiotherapist, following assessment is to modify your activities to address any possible factors of overuse. There will generally be a gradual reintroduction of activity, and addressing of the cause of symptoms.

ITB Friction Syndrome

The Iliotibial Band (ITB) is a superficial thickening of tissue on the outside of the thigh. It runs from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The ITB is important to stabilising the knee during running, moving from behind the femur to the front as the knee bends and straightens with walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

What Causes it?

Pain is felt on the outside of the knee at the ITB attachment site and directly above on the outside of the thigh. This is often described as an ache or burning which worsens during continued activity. Tightness along the ITB may also be felt.

What can Physiotherapy do?

Treatment is initially focused on reducing inflammation at the ITB insertion and bursa. This will often include a period of rest. Stretching of the ITB and strengthening of the hip is also generally indicated. Issues related to biomechanics and training load may need to be addressed.

ACL Rupture

The Anterior Cruciate Ligament (ACL) is one of the four main stabilising ligaments of the knee. In cases of partial or complete rupture of the ACL, a person will often report instability or locking of the knee.

What Causes it?

The majority of ACL tears occur in a non-contact sporting situation where the individual is landing from a jump, pivoting or decelerating. Such an injury often causes an audible ‘pop or ‘crack or a sensation of ‘something going out and coming back’. Commonly there is a large amount of swelling that occurs following an ACL tear and an ongoing sense of instability or lack of confidence of the knee.

What can Physiotherapy do?

Such an injury requires review by a Sports Medicine Practitioner or Orthopaedic Surgeon. Surgical intervention may be chosen as the most appropriate method of management, or in some instances conservative management will be preferred. In the acute phase following injury it is important to reduce swelling and restore movement.

The rehabilitation process will be guided by your Physiotherapist and will depend very much on the chosen method of intervention for managing the ACL rupture. A long period of rehabilitation is required to recover from an ACL injury and will focus on good range of motion at the knee, improving strength of the muscles at the knee and improving balance and muscle coordination.

Patella Dislocation

The knee cap (patella) forms a joint with the thigh bone (femur) called the patellofemoral joint. The patella has a slightly convex surface that sits on the slightly concave surface of the femur. The patella is held in place by several ligaments.

What Causes it?

Patella dislocation commonly follows a traumatic event, such as excessive twisting or jumping forces or a direct blow. Occasionally however, it may occur in the absence of trauma, particularly in young girls who are hyper-flexible.

Patella dislocation usually occurs towards the outside of the knee. Tearing of the soft tissues around the knee often occurs during the injury. There may also be some damage to the joint surface as a result of the dislocation. Often the patella will spontaneously return to its normal position as the knee is straightened. Following dislocation mild to moderate swelling commonly becomes present around the patella. Pain will tend to occur with bending and straightening of the knee, and weight bearing activities.

What can Physiotherapy do?

Early assessment and Physiotherapy intervention is advised to settle down the acute inflammation and develop a plan for recovery (includinga tailored exercise programme to expediate your rehabilitation). If deemed appropriate, your Physiotherapist may also refer you to a Sports Medicine Practitioner or Orthopaedic Surgeon.

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