Knee Pain

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The knee joint is complex and consists of many different structures including muscles, tendons, ligaments, nerves, blood vessels and bursae. As a result, for us to provide a diagnosis for pain around your knee may be challenging. However, based on the anatomical location of your pain, we can determine the most likely cause of your pain, and thus treat you effectively. The most common causes for knee pain are discussed below.

Pain at the front of your knee

Patella-Femoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a broad term used for pain in and around the front of the knee. PFPS is also sometimes called “Runner’s/Jumper’s knee” since it is common among people who exercise or participate in sport. However, PFPS can be experienced by anyone.

Many potential factors may contribute to the development of PFPS. It can be triggered by a fall onto your knee, overloading knee joint, muscle weakness or tightness, or irregularities in your body structure. One common finding leading to PFPS is an abnormal positioning of the patella (kneecap).

Knee Pain

With repeated knee movements, this malalignment causes stress and strain to the surrounding knee structures, which can cause pain and discomfort. Vigorous activities (often when combined with patellar mal-positioning) that include running, jumping, stair-climbing or squatting are usually what lead to the development of PFPS.

Pain from PFPS comes on with activity, especially activities where you have to bend your knee repeatedly. It typically causes a dull ache at the front of the knee. Changing the level or intensity of your exercise, the surface on which you exercise/train/play, or your equipment, including training shoes, can predispose the development of PFPS.

The first and the best thing you can do if you suffer from PFPS is to stop or reduce the activities that cause pain. Rest until your pain has been resolved, or stay active with alternative activities such as lower-impact swimming or stationary cycling. If you have severe pain or pain with swelling, try applying ice for 20min at a time while elevating your knee.

Physiotherapy can help resolve your knee pain. Firstly, we help to identify and then address the cause of your problem, whether it is your patella that is not ideally aligned, your foot posture, hip muscle weakness or thigh muscle tightness pulling on the patella. Based on our assessment, we will help you manage your pain, reduce muscle tightness, and provide you with strategies to address any predisposing factors to avoid recurring pain in the future. We have various treatment techniques we can use including ultrasound, dry needling, electrotherapy, massage, joint mobilisations, and taping. Our choice of technique will depend on your unique situation. We will also develop a stretching and strengthening program for you to address muscle weakness or tightness.

Knee Osteoarthritis

Osteoarthritis is a chronic disease of the joints, where wear and tear result in gradual loss of cartilage and inflammation within the joint. It is more common in older people, and women tend to be more prone to osteoarthritis (OA) than men. The degenerative process can occur for no known reason, or it can develop as a result of previous injury, joint hypermobility, joint immobilisation, birth defects, metabolic diseases or obesity. Although knees are the most commonly affected joints, OA can target any joints in your body.

Symptoms of pain, reduced mobility of your joints, and stiffness develop gradually over time. You may experience a dull, aching pain in and around your knee that is worse with activity. Pain is typically also worse when you sit or rest for too long. Your knee might feel stiff, especially when you wake up in the morning since the joint has not been moving throughout the night.

Knee Pain

If there is inflammation in the joint, you may have pain or discomfort at night, and your knee may be swollen.

Since OA is a progressive disease, the pain, swelling and stiffness will worsen with time if you do not address it. Treatment for knee OA must always start with non-surgical methods aiming to reduce your pain and swelling and to optimise the function of your leg as much as possible. Physiotherapy has been proven to significantly reduce symptoms associated with knee OA as well as improve joint function and quality of life. Exercise therapy is the preferred, and most effective, treatment for knee OA. Movement or exercise truly is the best medicine! Joints are made to move and keep themselves healthy through movement.

At Just Physio we will help to manage your symptoms, and then help you regain the mobility and use of your knee. Initial treatment to address pain and swelling may include ultrasound, electrotherapy, massage, joint mobilisations, dry needling, and taping. Once your symptoms are manageable, we will start working on specific exercises to maintain your joint integrity and function.

Effective therapy will include exercises for your hip, knee, ankle and core. We will work on strengthening your muscles, as well as improving your joint movement and balance. Walking, Yoga, water-based exercises and stationary cycling are very good, safe options for staying healthy and active.

Along with symptom management and exercise therapy, we can explain the long-term disease process and teach you ways to self-manage your OA. We will also provide you with valuable information regarding the role of maintaining a healthy lifestyle, activity modification, nutrition, and weight loss.

Even if you need joint replacement surgery later on, we can help to extend the time to surgery. By improving your overall conditioning prior to surgery, you will also most likely have an easier and more successful recovery. We can help you master the exercise program prior to your surgery to make the process much less stressful after surgery.

It is important to note that symptoms vary from person to person, and that x-rays do not necessarily correspond to the severity of the disease or the symptoms. Many people who have radiological evidence of OA will not have any symptoms. Joint degeneration, or wear and tear, is a natural process as we age. However, if the symptoms start impacting on your daily functioning and quality of life, then please contact us to help you!

Pain at the back of your knee

Hamstring tendinopathy/tendinitis

When pain comes on gradually over time, the most likely diagnosis is tendinopathy of the hamstring. Tendinopathies are overuse injuries, and usually associated with repetitive loads or stresses to the muscle or its tendon. This repeated minor trauma leads to damage to the muscle tissue over time, causing degenerative changes to the tissue. The hamstring muscle or tendon then becomes weak and may tear. Generally with tendinopathy you will have aching pain when you are resting. The pain may lessen or go away with activity, but will return once you stop the activity again. You will most probably feel stiffness at the back of your knee and in your hamstring muscle, especially in the morning, or after sitting for a long time.

Tendinopathy is common amongst runners and sprinters. Changes in training, such as when you increase your running distance too much too soon or do more intense sprinting can predispose to tendinopathy. Other risks include incorrect or worn-out footwear, or altered running mechanics. At Just Physio, we will help you in identifying and addressing these factors.

Some people with tendinopathy delay seeking professional help since they think the “niggle” might go away with time. However, the longer you wait to treat your tendinopathy, the more potential damage is caused to your hamstring and surrounding structures. A proper assessment is vital for us to see whether there are any factors potentially causing or contributing to the onset of your injury. Initial treatment will be aimed at reducing pain and discomfort. Thereafter we will address any of these contributing factors, be it limited flexibility, muscle weakness, poor balance, improper training techniques or movement patterns etc. We will develop a specific rehabilitation program for you to enable you to recover to your full potential and return to your activities as soon as possible, as well as to prevent recurring injuries.

Occasionally, if there is friction or irritation to the tendon, it becomes inflamed. This injury is referred to as tendinitis. Tendinitis will be treated in a similar way to tendinopathy, but we will also have to address the inflammation. Modalities such as ultrasound, ice, laser, and taping will assist us in reducing the inflammation.

Hamstring sprain

If the pain at the back of your knee comes on suddenly, especially during running, sprinting or jumping activities, you most likely tore the lower part of your hamstring. You will feel a sudden, sharp pain at the back of your knee, which may be associated with a snapping or tearing sensation. Usually, you will struggle to continue with the activity and have difficulty walking immediately after injuring yourself. The first few hours after the injury are vital, and you must follow the PRICE principles of Protection, Rest, Ice, Elevation and Compression. Contact your physiotherapist to guide you during this phase and to make an appointment within the next 48 hours. It is important to treat a torn muscle or tendon effectively, and doing so earlier will ensure a more desirable recovery.

If you have bruising and swelling, and subsequently pain, after your hamstring tear, we can treat this with ultrasound, laser, gentle lymph drainage techniques, and taping. We will also guide you as to which activities it will be best to avoid and provide you with gentle exercises to keep your knee joint and surrounding tissues mobile. Early and gentle movement will encourage the absorption of fluid or blood that builds up at the site of injury and will help reduce the swelling. We can also teach you how to walk using crutches if necessary.

Following the initial phase of treatment, you need to follow an 8 – 12 week rehabilitation program. This is vital. During this time, you will go through progressive stretching and strengthening exercises to allow you to recover fully.

Calf muscle sprain

Your calf muscle, the gastrocnemius muscle, has two upper parts. These two parts attach to the lower end of your thigh bone or femur. This means that the gastrocnemius muscle crosses over your knee to attach just above it. Either of the two parts, the inner or outer part, may be torn or injured, resulting in pain at the back of your knee. Tendinopathy of the upper part of the gastrocs muscle is uncommon, but tears happen frequently. Activities involving jumping or “pushing-off” of your foot can cause a tear in this muscle. Pain will come on suddenly, and may be associated with a sensation of tearing or pulling. Generally, you won’t be able to commence activity and have difficulty walking. Your upper calf and knee may start to swell soon after the injury, and sometimes bruising will occur.

Within the first 24 hours of a muscle tear, it is important to follow the PRICE regime of protection, Rest, Ice, Compression and Elevation. Call us to guide you through this phase, and to make an appointment as soon as possible. Managing the pain and swelling early-on is important.We do so using ultrasound, gentle lymph drainage massage, electrotherapy and taping.

We will also show you how to avoid aggravating activities and teach you to walk with crutches if necessary.

After the initial healing phase, we will start a rehabilitation program specifically tailored to your needs. This program will focus on regaining as much movement, strength, flexibility and function in your leg.

Popliteal muscle injury

The popliteus muscle is a tiny muscle deeply located at the back of your knee. It stretches from the outer lower end of your thigh bone (femur), goes over the back of your knee joint to insert again on the inner upper part of your shin bone (tibia). The location of the popliteal muscle enables it to control rotation forces within your knee joint. It also acts to “unlock” the knee joint when you start to bend your knee from a fully straightened position.

Knee injuries, especially those that force the knee out or backward, may injure this muscle. Usually, other structures such as your cruciate ligament and muscles are also injured with such trauma. However, the popliteus muscle can often be overlooked as a cause for pain at the back of the knee, especially when pain recurs or persists. Pain as a result of popliteus muscle injury can typically be brought on by standing on your leg with your knee slightly bent. It can be worse when you stand in this way and then try to turn your body side to side. Your knee will most probably feel unstable too.

Treatment for popliteus muscle injury will include resting from activities that cause more pain, cold therapy, knee support via a brace or taping, massage, ultrasound and therapeutic exercises.

Baker’s Cyst

A Baker’s cyst is when fluid builds up at the back of your knee joint. It feels, and looks like, you have a golf ball behind your knee. The fluid may build up as a result of injury within your knee joint, and gradually increase in size. This fluid takes up space behind your knee, making your knee feel stiff, and reducing your ability to bend your knee. Although the cyst is fairly harmless, we need to identify why it developed in the first place. We also need to help you maintain the amount of knee movement so that you do not sit with a stiff joint later on.

Typically, treating an uncomplicated Baker’s cyst is easy, and may only require ice, compression, and exercises to improve your mobility. For unresolving cysts, you may need to go for drainage or aspiration of the fluid. Thereafter, we still need to encourage full knee movement and strength. Baker’s cysts commonly come back, and therefore we need to try to identify the reason they developed in the first place. This is where our thorough assessment will guide us to determine potential joint or soft tissue abnormalities that we can also help you with.

Pain on the inside of your knee

Medial Meniscus Injuries

The knee contains two menisci, which are cartilage discs covering the top surface of the tibia (shin bone). These discs are made to withstand stress and strain forces, acting as shock absorbers and therefore protecting your knee joint. However, if there is excessive force to your knee joint, especially when you are standing (weight-bearing) and twisting on your leg, the menisci can get damaged. Typically, an acute meniscus injury will cause immediate pain and you may hear a popping, clicking or snapping sound. Your knee may start to swell and you will have difficulty bending or straightening your knee.

It is important to seek help as soon as possible after an acute meniscus injury. If the injury is severe and you are unable to walk or move your leg, surgery is recommended. Your physiotherapy program should ideally start prior to surgery, and continue for a few weeks after surgery to enable your full recovery. Minor meniscus injuries can heal effectively without surgery but with a graded physiotherapy rehabilitation program. Initial rehabilitation will focus on resting or protecting your knee, managing pain and swelling, and regaining knee movement. Over the course of a few weeks, you will be doing graded exercises to regain and improve the strength and function of your leg.

Sometimes, menisci get damaged over time with repetitive activities and overuse, which can cause gradually worsening pain in your knee. Your knee may feel like it catches as you move it, or it may give in at times and feel unstable.

More chronic meniscus injuries such as these can also be treated quite successfully with physiotherapy. The treatment of such injuries will be aimed at restoring joint health, maintaining your mobility and function, while also treating other symptoms such as pain and swelling if necessary. A thorough assessment is vital when anyone presents to us with a chronic injury, since there may be other contributing factors that need to be addressed. Based on our findings, we can assist you in this regard. For these types of injuries, we will develop a specifically tailored rehabilitation program for you, which is the most important aspect of your treatment. Complementary treatments such as ultrasound, electrotherapy, joint mobilisations, massage, myofascial release, and dry needling may be used, where indicated, if we see they may aid in your recovery.

Ligament injuries

Injury to the inner ligament of the knee usually happens when your knee is forcefully moved to the inside. Most of these injuries are mild and rarely result in a complete ligament tear.

Treatment of acute ligament sprains will depend on the severity of the injury, as well as your symptoms. If you have localised swelling and pain, we can manage it with ice, ultrasound, taping techniques, gentle massage, and joint mobilisations. We will also advise you on the use of a knee brace and crutches if needed, as well as the type of activities to avoid while you recover. Early movement of your knee joint will be important, and we will guide you through a progressive rehabilitation program for 6-12 weeks.

Pes Anserinus Syndrome

Pes Anserinus (PA) syndrome is the inflammation of a bursa just below the inner part of the knee joint. PA is thus a type of bursitis. The bursa is a fluid-filled sac that reduces friction between different tissues and thus allows for smooth movement. The tendons of three different muscles join to insert at the same place on the inner aspect of your knee. This insertion is the pes anserine. PA is also called “Goose Foot” since the insertion of these 3 tendons looks like the webbed foot of a goose.

Pes Anserinus bursitis, although uncommon, may develop as a consequence of repeated or vigorous activities that involve bending or rotating your knee. Long-distance runners or golfers who repeatedly drop their knee inward may be at risk for developing PA bursitis. The repetitive movement causes friction and pressure on the bursa, irritating it. Direct trauma to the bursa, such as being hit on the inner part of your knee, can also lead to the development of bursitis.

Symptoms of Pes Anserinus bursitis are pain, swelling and tenderness along the inside of the knee. Pain will be worse during activity, especially activities such as running, going up or down stairs, squatting, walking on steep slopes or sitting and rising from a chair. The inner part of your knee may be swollen and tender. Pain will usually decrease when resting or walking on level surfaces. As the condition progresses, you may experience pain at rest or at night. This indicates inflammation of the bursa and/or surrounding structures.

Treatment of PA should initially focus on relative rest. You may need to take anti-inflammatory medication to ease symptoms. However, physiotherapy is the mainstay treatment for this syndrome. We will teach you how to rest and avoid aggravating activities to allow for healing to occur. Then, during the inflammatory phase, we can assist with reducing the pain and inflammation by applying ice, ultrasound, electrotherapy, and taping. Ice application is something you can do at home as well. Once the acute symptoms have resolved, we will guide you through a stretching and conditioning program to allow for optimal recovery and return to your normal activities. This will also help to prevent bursitis from coming back again. If we note any postural abnormalities, we may advise you on the use of orthotics such as shoe inserts.

Pain on the outside of your knee

Lateral Meniscus Injuries

The knee contains two menisci, which are cartilage discs covering the top surface of the tibia (shin bone). These discs are made to withstand stress and strain forces, acting as shock absorbers and therefore protecting your knee joint. However, if there is an excessive force to your knee joint, especially when you are standing (weight-bearing) and twisting on your leg, the menisci can get damaged. Typically, an acute meniscus injury will cause immediate pain and you may hear popping, clicking, or snapping sounds. Your knee may start to swell and you will have difficulty bending or straightening your knee.

It is important to seek help as soon as possible after an acute meniscus injury. If the injury is severe and you are unable to walk or move your leg, surgery is recommended. Your physiotherapy program should ideally start prior to surgery, and continue for a few weeks after surgery to enable your recovery. Minor meniscus injuries can heal effectively without surgery but with a graded physiotherapy rehabilitation program. Initial rehabilitation will focus on resting or protecting your knee, managing pain and swelling, and regaining knee movement. Over the course of a few weeks, you be doing graded exercises to regain and improve the strength and function of your leg.

Sometimes, menisci get damaged over time with repetitive activities and overuse, which can cause gradually worsening pain in your knee. Your knee may feel like it catches as you move it, or it may give in at times and feel unstable.

More chronic meniscus injuries such as these can also be treated quite successfully with physiotherapy. The treatment of such injuries will be aimed at restoring joint health, maintaining your mobility and function, while also treating other symptoms such as pain and swelling if necessary. A thorough assessment is vital when anyone presents to us with a chronic injury, since there may be other contributing factors that need to be addressed. Based on our findings, we can assist you in this regard. For these types of injures, we will develop a specifically tailored rehabilitation program for you, which is the most important aspect of your treatment. Complementary treatments such as ultrasound, electrotherapy, joint mobilisations, massage, myofascial release and dry needling may be used, where indicated, if we see they may aid in your recovery.

Ilio-Tibial-Band Syndrome

Ilio-tibial band (ITB) syndrome is a very common knee injury, especially in runners. The ITB is a thick band of connective tissue that runs from your outer hip, along the outside of your thigh to the outer part of your knee. The ITB does not attach to bone to allow it to move when you bend and straighten your knee. A small fluid-filled sac, called a bursa, lies just underneath the ITB to reduce the amount of friction that takes place as the ITB glides forward and back with the movement of the knee. If there is too much compression on this bursa, it can become irritated and inflamed.

ITB syndrome typically starts as a niggling pain on the outer part of your knee. Initially, this pain will subside as you warm up. Over time, you may notice that your pain becomes worse as you exercise. Activities that make you bend and straighten your knee repeatedly will most often cause pain. You may start having pain during your daily living e.g. going up or downstairs or when sitting for long periods of times. Other important considerations that may worsen your pain include improper warm-up, sudden increases in your exercise intensity or duration, running or training on uneven or very hard surfaces, improper footwear, and not taking enough time to rest and recover between sessions. Other things that we will assess that may contribute to the development of ITB syndrome are core or hip muscle weakness, leg length differences and foot posture. If we identify any of these factors, we will develop a specific rehabilitation program for you to address these.

Our initial treatment of ITB syndrome will focus on symptom management. Pain and swelling can be treated using ice, ultrasound, electrotherapeutic modalities, gentle massage, stretching, taping and dry needling. We will encourage you to take some time for active rest i.e. avoiding any activities that aggravate your pain and opt for alternative ways to stay fit such as swimming. Thereafter we will start a personalised exercise program with you to address any muscle weakness or tightness. Some people may need a cortisone injection in cases where the pain is persistent, and we can refer you to a medical professional if needed.

Prevention is always better than cure and we can provide you with information on proper warm-ups, running techniques, type of training shoes or shoe inserts, and other self-management strategies.

Knee Osteoarthritis

Osteoarthritis is a chronic disease of the joints, where wear and tear result in gradual loss of cartilage and inflammation within the joint. It is more common in older people, and women tend to be more prone to osteoarthritis (OA) than men. The degenerative process can occur for no known reason, or it can develop as a result of previous injury, joint hypermobility, joint immobilisation, birth defects, metabolic diseases, or obesity. Although knees are the most commonly affected joints, OA can target any joints in your body.

Symptoms of pain, reduced mobility of your joints, and stiffness develop gradually over time. You may experience a dull, aching pain in and around your knee that is worse with activity. Pain is typically also worse when you sit or rest for too long. Your knee might feel stiff, especially when you wake up in the morning since the joint has not been moving throughout the night. If there is inflammation in the joint, you may have pain or discomfort at night, and your knee may be swollen.

Since OA is a progressive disease, the pain, swelling, and stiffness will worsen with time if you do not address it. Treatment for knee OA must always start with non-surgical methods aiming to reduce your pain and swelling and optimise the function of your leg as much as possible. Physiotherapy has been proven to significantly reduce symptoms associated with knee OA as well as improve joint function and quality of life. Exercise therapy is the preferred, and most effective, treatment for knee OA. Movement or exercise truly is the best medicine! Joints are made to move and keep themselves healthy through movement.

At Just Physio, we will help to manage your symptoms, and then help you regain the mobility and use of your knee. Initial treatment to address pain and swelling may include ultrasound, electrotherapy, massage, joint mobilisations, dry needling, and taping. Once your symptoms are manageable, we will start working on specific exercises to maintain your joint integrity and function.

Effective therapy will include exercises for your hip, knee, ankle, and core. We will work on strengthening your muscles, as well as improving your joint movement and balance. Walking, Yoga, water-based exercises, and stationary cycling are very good, safe options for staying healthy and active.

Along with symptom management and exercise therapy, we can explain the long-term disease process and teach you ways to self-manage your OA. We will also provide you with valuable information regarding the role of maintaining a healthy lifestyle, activity modification, nutrition, and weight loss.
Even if you need joint replacement surgery, later on, we can help to extend the time to surgery. By improving your overall conditioning prior to surgery, you will also most likely have an easier and more successful recovery. We can help you master the exercise program prior to your surgery to make the process much less stressful after surgery.

It is important to note that symptoms vary from person to person and that x-rays do not necessarily correspond to the severity of the disease or the symptoms. Many people who have radiological evidence of OA will not have any symptoms. Joint degeneration, or wear and tear, is a natural process as we age. However, if the symptoms start impacting on your daily functioning and quality of life, then please contact us to help you!

Osgood-Schlatter Syndrome

Osgood-Schlatter syndrome is an inflammatory condition that happens to children or adolescents going through a growth spurt. During a growth spurt, a child/adolescent’s bones, muscles and tendons change and grow at different rates. The tendon that attached the patella (kneecap) to the shinbone can pull on the area where it attaches, causing inflammation. This area where the tendon attaches is where the shinbone’s growth plate is. The growth plate is a layer of soft bone where bone growth happens. The plate is thus weaker and more prone to injury.

When strong muscles and tendons start pulling on the area near the growth plate, it causes inflammation and pain. In other words, children or adolescents who are very active and have constant muscle pull on the area can develop Osgood-Schlatter syndrome. However, it can also occur in those who are not very active but are going through rapid growth. Osgood-Schlatter can occur in one or both knees.

Pain is usually worse when running, jumping, climbing stairs, or playing sports. There may be tenderness and swelling over the small bony bump at the top of the child/adolescent’s shinbone.

Symptoms typically go away once the child/adolescent reaches the end of their growth spurt. In most cases, it does not cause any long-term problems. Osgood-Schlatter syndrome is usually treated very easily with rest and symptoms management. Your physiotherapist will focus on reducing pain and swelling and provide advice on how to manage daily activities to prevent aggravating the symptoms. Applying ice will help relieve pain and reduce swelling. We can also help to release tight muscles by doing massage and showing you stretching exercises specifically targeting those tight muscles.

Post-operative Rehabilitation

⦁ Lower leg & Calf pain

⦁ Calf muscle tears/strains
⦁ Achilles injuries (rupture, tendinopathy
⦁ Posterior impingement syndrome
⦁ Fractures (conservative management or post-operative rehabilitation)
⦁ Tibial stress fracture
⦁ Compartment syndrome
⦁ Referred pain
⦁ Nerve entrapment
⦁ Bone contusion

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