Understanding knee pain

The knee is the largest joint in the body and is a hinge joint made up of the shinbone (tibia) and thighbone (femur) with the kneecap (patella) located at the front. The knee is supported by four strong ligaments, a group of muscles and two meniscus — cushions within the knee to help with pivot movements and shock absorption.

 

So, what causes knee pain?

 

A specific event

  • An injury caused by a certain activity or movement — it is easily the one you remember most!
  • Trauma injuries to the knee are common, largely due to the nature of the joint and its function of propelling the lower limb during weight bearing. Common trauma-related injuries include:
    • Ligament damage: The knee is supported by four strong ligaments: medial collateral (MCL), lateral collateral (LCL), posterior cruciate (PCL) and anterior cruciate (ACL). Common mechanisms of trauma of these ligaments are sports related and are often seen in AFL and soccer players. Injuries can occur to any one of the four ligaments and it is important to get an early assessment to help determine the best management plan. A growing body of evidence recommends a trial of exercise physiotherapy rehabilitation for ligament injuries, including the ACL. It is important to have this discussion with your physiotherapist, local GP and specialist.
    • Meniscus tears: There are two menisci in each knee — tough C shaped fibrocartilage with the function of shock absorption and helping with pivoting and stability. Acute injuries can occur with sudden rotational movements while the foot is on the planted on the ground. This mechanism can result in a tearing injury to the meniscal but can also happen in conjunction with other ligament injuries. Initial management is to help settle symptoms and perform pain-free exercises to minimise weakness. Once settled, a guided rehabilitation program of exercises and increased mobility will be required to enable return to all activities.

 

Gradual onset and overuse

  • Gradual onset and overuse injuries are usually linked to those tasks we do at home, sport or at work that require repetitive movements or positions.
  • Patellofemoral pain (PFJ) refers to pain felt at the front of the knee and occurs usually gradually or post a sudden change in knee requirements, such as a sudden increase in running. Current best evidence indicates the most common causes are due to weakness in the muscles that support the knee (quadriceps) and hip (gluteals) as well as the calf (gastrocnemius and soleus). Physiotherapy management can help by working to identify the deficits, settle symptoms, strengthening deficits and development management strategies such as taping, running technique modification and a return to exercise/running plan are employed.
  • Iliotibial band (ITB) syndrome or iliotibial band friction syndrome
    The ITB is a thick band of connective tissue that runs from the outside of your hip to the outside of your knee and acts to help stabilise and move the knee. The band can become tight and inflamed for a variety reasons such as overuse, weakness at the knee or hip, causing increased loading to the ITB. When this occurs, movement of the knee and activities such as running become painful. Management focuses to not only help settle initial painful symptoms, but to identify the cause to prevent future re-injury.
  • Knee bursitis
    Like many other joints, within the knee there is a bursa: a fluid-filled sac that reduces friction between the tissues of the body. Knee bursitis — inflammation of the bursa — can occur when the joint has been overloaded due to poor technique, a sudden change in use or if there is insufficient strength and muscle control. Treatment aims to first settle symptoms by avoiding aggravating activities and then focuses on addressing the deficits, as the inflamed bursa is usually just a symptom, not a cause of the problem.
  • Fat pad impingement
    The fat pad is a layer of fatty soft tissue located at the front of your knee under the patella (Hoffa’s fat pad). The function of the fat pad is to act as a cushion for the patella from the femur and tibia. Impingement can occur when the pad is compressed between the kneecap, femur or tibia, resulting in pain. Management focuses on settling symptoms, then moves towards addressing the deficits and cause that resulted in this tissue in being overloaded in the first instance.
  • Degenerative injuries
    As we age, cartilage within the knee, including the meniscus, reduces in strength and starts to thin. Tears to the meniscus and cartilage are fairly common and often do NOT cause any pain.

Postoperative recovery for knee pain

Post knee replacement

A knee replacement is performed when there is significant damage due to arthritis over a period of time. Post-knee replacement rehabilitation focuses on graded movement (such as a walking program) and exercise is also used as it helps initiate and promote healing. It is a common misconception that rest is what is needed to heal and that surgery has fixed the problem, when surgery is actually just the first step. Working with your physiotherapist, surgeon and GP, a comprehensive treatment plan will be made to help you recover fully.

ACL reconstruction

ACL reconstruction surgery is performed when the ACL is ruptured and there is clinical and functional instability of the joint. The surgery replaces the ligament with a hamstring tendon graft to help restore the stability and function of the knee. Post-surgery rehabilitation begins immediately and you will need to be guided by your physiotherapist to help restore knee mobility and strength.

Overcoming the rehabilitation process is extensive and, if all goes to plan, a full return to sport will occur around 12 months post surgery.

 

Knee pain treatment with Life Ready Physio

With expert treatment such as joint mobilisation, massage and therapeutic exercises for improved functionality, Life Ready Physio will not only alleviate knee pain, we’ll provide you with the tools to prevent future injuries too.

For an in-depth assessment by one of our skilled physiotherapists, book a consultation here. We look forward to joining you on this journey to pain free living.

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