At Global Health Physiotherapy Clinic we have successfully treated hundreds of patients presenting with knee pain. The knee is composed of 4 articulating bones (Femur, Tibia and Fibula and Patella), ligaments, tendons, bursa (sacs of fluid), and meniscus (cartilage). When something goes wrong with the function of any components in your knee joint, the result can be quite painful. Physical therapy treatment is highly effective in reversing pain, inflammation and speeding the recovery of your knee from a number of potential ailments.
Potential causes of knee pain
At some point or another, the majority of people will experience knee pain. Pain can occur at any age and may be the result of an overuse injury or simply the result of a traumatic event such as a fall or a car accident.
In some cases, there may be a genetic predisposition to having pain that may present as reduced integrity of the joint components.
At our physiotherapy clinic in Midtown Toronto, our physiotherapists will perform a detailed orthopedic assessment, to gather and analyze data to create an individualized evidence-based approach for the treatment of knee patients’ knee pain.
When to see a physiotherapist for treatment
If knee pain is left untreated, in the majority of cases, knee pain responds well to a passive approach, such as resting and applying a cold or warm compress. However, in some cases, the pain is too severe or reoccurring, and patients often feel that the knee pain is interfering with activities of daily living.
At Global Health Physiotherapy Clinic, our physiotherapist can provide exceptional relief of pain through the use of a structured exercise program, the use of modalities, such as ultrasound, shockwave therapy and in some instances a physiotherapist may recommend a knee brace to control or stabilize the knee joint until the condition is treated thoroughly.
Unfortunately, in rare circumstances, a patient may simply have any injury that is beyond the physiotherapy scope of practice and may require surgical intervention. Physiotherapy can still play a vital role in pre-surgical physiotherapy and post-surgical physiotherapy care.
How to identify the root source of the problem
Patients will often be able to point to the exact location of the knee pain and be able to describe how the injury occurred. A physiotherapist will ask the patient to rate the pain on a Visual Analog Scale (VAS) in order to better understand the severity.
This subjective scale is utilized to decipher the effects of physiotherapy care during follow-up appointments.
Common symptoms
Patients will often describe knee pain as warm to the touch and experience a feeling of tightness from the swelling.
Sometimes a patient may feel that the knee is weak and patients feel uncertain whether the knee has sufficient strength and stability to bear weight while walking and ascending or descending a flight of stairs.
In the event that the knee pain onset was sudden from an injury, a patient may for example state that they felt a “popping noise” which could be related to knee cap dislocating.
The majority of meniscus injuries are the immediate onset of pain and difficulty with weight-bearing.
In the event that the knee pain was a gradual onset, the patient may state that the knee pain became worse over time as may be described as a “gridding” sensation, such as is in the case with a mal-tracking knee cap and early onset of osteoarthritis.
A RED FLAG that physiotherapists often look for is the presence of a fever and patient having no recollection of an event that may have caused the knee pain, which may require additional screening such as blood work to rule any other underlying medical condition, such as septic arthritis.
Common injuries associated with knee pain
The following are some of the most common knee injuries that we have treated at Global Health Physiotherapy Clinic.
Ligament Injury
The knee is composed of 4 ligaments (ACL-Anterior Cruciate Ligament, PCL-Posterior Cruciate Ligament, MCL-Medial Collateral Ligament and LCL-Lateral Collateral Ligament). These types of injuries are typically seen in patients playing sports that require quick multi-directional movements such as when playing soccer, football or basketball. A knee brace is typically recommended in the majority of cases to maintain the integrity of the joint while physiotherapy addresses the stability to the joint through a structured exercise program.
Fracture
In some cases, a fracture may occur most commonly in the knee cap (Patella) brought about from a direct impact of the patella on a hard surface. Nonetheless, an x-ray is required to confirm the findings and monitor the progress of healing. Oftentimes, an underlying medical condition such as osteopenia or osteoporosis (fragile bones) may have increased the risk for the fracture.
Damaged Meniscus
The Meniscus is found between the femur and the tibia bone. The meniscus acts as a shock absorber of the heavy forces of the femur on the tibia. A very common injury while playing sports may involve tearing the meniscus from twisting maneuvers. Meniscal tears can present themselves in a variety of forms, oftentimes a loose piece of cartilage may float within the joint, causing tremendous discomfort with standing or walking. In rare circumstances, the medial meniscus may be accompanied by an MCL injury and in even more rare cases, with an ACL injury (coined “Unhappy Triad”).
Knee Bursitis
A Bursa is a fluid-filled sac found throughout the body. The knee is surrounded by 8 bursae, which act to reduce the friction of the tendons and ligaments against the bone. Oftentimes, these sacs will swell up after an injury, which is a protective mechanism for the joint to remain relatively immobile and prevent further damage, until healing is complete.
Infrapatellar Tendonitis
The tendon connects the kneecap to the tibia. Infrapatellar Tendonitis is commonly seen in young children where there is a lot of jumping and running. Repeated high and quick forces on the tendon, will generally cause knee discomfort that gradually worsens with time.
Iliotibial Band Syndrome (ITB)
This is the longest ligament or tendon in the body extending from the joining of the Tensor Fascia Lata (TFL) and Gluteus Maximus muscle, attaching distally to the side of the fibula. A patient may describe feeling a “clicking” sensation along the outside of the knee at approximately 20 degrees of knee flexion. This condition is primarily seen in long-distance runners and long-distance cyclists
Dislocated knee cap ( Patella )
Typically occurs when the knee accidentally hyper-extends causing the patella to briefly “float out” of the saddle joint and in most cases dislocate towards the outside of the knee. In most instances, the patella will relocate immediately on its own, otherwise, a quick thrust of the patella is needed to place the patella back into its original position. These patients often will present with severe swelling (described as a water-filled balloon) on the lateral aspect of the distal quadriceps muscles. Change in the way a patient is walking, such as when having injured another joint such as the hip or ankle joint, may cause the patient to compensate and walk in a manner that places additional forces on the knee joint
Arthritis or Osteoarthritis
Earlier than typical normal onset occurs when the surrounding muscles do not provide sufficient stabilization to the knee causing shearing forces along the superficial surface of the meniscus. Rheumatoid arthritis is another form of arthritis that is an autoimmune condition that can affect the knees as well. Additional diagnostic procedures are required to confirm the presence of rheumatic disease. Other forms of arthritis include pseudogout, which is the presence of calcium crystals that form within the joint fluid.
Patellofemoral pain syndrome ( PFPS)
Is the most common form of knee pain experienced by most patients. The patella (knee cap) typically glides centrally in the femoral groove while the knee is bending, however, in the majority of instances, the patella begins to glide against the outside or lateral aspect of the articulating femur. This mal-alignment causes crepitus (“gridding”). The majority of factors that contribute to PFPS may include muscle imbalance between the various components of the quadriceps muscles, reduced foot arches or recently increased weight gain.
Potential Risk Factors that May Lead to Knee Pain
The majority of patients that will experience knee pain at one point or another will most likely be due to the reduced muscle strength and stability of the knee joints.
For example, patients that are having a scheduled total knee replacement, typically attend pre-op physiotherapy to increase the strength and stability of the knee joint to promote quicker recovery after surgery.
Interestingly enough, the majority of patients reported feeling a significant reduction in knee pain only after two weeks of pre-op physiotherapy, which clearly demonstrates the importance of maintaining good joint integrity.
Playing sports is a great way to keep in shape, however, there is an increased risk for early degeneration of the knee joints, as repeated high impact pressures such as running will cause premature erosion of the meniscus.
Complications
At Global Health Physiotherapy Clinic we understand that knee joint pain is bound to occur at one point or another in a person’s lifetime. We recommend a balanced and moderate approach when using our knee joints to enjoy sporting activities such as running, to live a healthy and pain-free lifestyle.
Balance your sporting activities with preventative exercises
We recommend that patients speak with a physiotherapist, in order to better understand the biomechanics and impact on knee joints with various activities. For example, if a patient is an avid long-distance cyclist, it’s important to balance the patellar tracking with certain strengthening and stretching exercises to significantly reduce the risk for future knee injuries.
We also recommend for patients to be involved with a variety of activities ranging from high impact to low impact activities to allow muscles surrounding the knee joint to be well balanced. The amount of time that is spent on the actual activity must be matched by the time it takes to adequately prepare the knee and surrounding components.
Protect your knee (and joints) by building protective muscles
The bottom line is that the physical integrity of the joint is directly related to the strength and stability of the surrounding muscles. It is very important to invest the time and effort to strengthen the quadriceps and hamstrings muscles. Additional recommendations that yield optimal results is to incorporate a dynamic balance routine.