Have you ever been told by a doctor that you have “no cartilage” left in your knees?
Do you feel some pain in your knees every time you squat?
Bounding up the stairs two at a time just isn’t your thing anymore, right?
Not necessarily because the good news is that the knee pain can be improved!
At Praxis Rehab Physiotherapy, we see all sorts of knee injuries, both traumatic and non-traumatic. Some of them come to us for post-operative rehabilitation after surgery such as total knee replacement, ACL reconstruction, meniscectomy/meniscus repair to name a few.
What’s commonly seen is most of the serious and some relatively minor knee injuries are ‘non-contact’ injuries. Ligaments and muscles can be sprained and strained without being tackled or coming in contact with a person/object. These injuries occur from excessive forces at the knee due to misalignments such as landing after a jump or running and can have a lot to do with improper habitual movement patterns.
Quick Rundown of the Anatomy of the Knee
- The knee is a hinge joint which allows two main functions – flexion (bending), extension (straightening) and a small degree of rotation only to allow for the proper mechanics of the major motions of flexion and extension.
- The ligaments help to stabilize the knee allowing forward and backward sliding, side to side movements and rotation within the knee joint. Without these ligaments, your knee would be constantly flopping all over the place!
- Another protective structure is the meniscus, a C-shaped cushion between the thigh bone (femur) and the lower leg (tibia) that acts as a shock-absorber. We have two menisci in each knee – medial and lateral.
- The kneecap (patella) forms a joint with the femur called the patellofemoral joint (PFJ). It is the attachment place for the thigh muscles via the quadricep tendon above the joint and the patellar tendon below PFJ. When movement at the patella is not optimal there can be irritations to the underside of the bone and at the patellar tendon. This is the most common source of “crunchy” knees and overuse injury called patellar tendinopathy amongst the runners.
- Lastly, the active component of the entire knee complex is the whole system of muscles – quadriceps, hamstrings, pes anserine, gastrocnemius and soleus (calf muscles). If any of these muscles are weak, tight, or not functioning the way it should, then it can get in the way of how your knee is able to move and can leave you open to injuries.
All the above structures are prone to damage, either from repetitive strain or from trauma. The commoners suffering from knee pain are the elite and recreational athletes, weekend warriors, adolescents, overweight/obese individuals, sporting athletes and ageing population with arthritis.
Common conditions we see include:
- Fractures: conservative and post-surgical management
- Meniscal sprains, strains and tears
- Muscle and tendon tears – quadriceps, hamstrings, calf
- Tendinopathy – patellar tendinopathy
- Fat pad irritation
- Patellofemoral joint pain
- Iliotibial band pain
- Osteoarthritis – conservative management and post-surgical management following total knee replacement (TKR).
Assessment of the Knee
- A proper history-taking of your problem will help us to identify – the barriers limiting your ability to move at home/work/socially, nature and behaviour of pain, coping strategies, your concerns regarding pain, beliefs and attitudes developed over time to manage the pain, and short & long-term goals.
- A detailed assessment will aim to look for any pain, weakness, stiffness, tightness, or instability in general knee movements, functional movements, work-related and sports-specific activities such as stair-climbing, kneeling, squatting, lunges, running, jumping, landing, sudden stop-start and change of directions.
Management of Knee Pain
Research has shown that exercise therapy is most effective as first-line treatment to improve pain, mobility, strength and function. Hands-on/manual therapy such as soft tissue massage, joint mobilization, dry needling and taping may be integrated as additional therapy to help in the initial treatment phase. We want to take you till the end-stage rehab and challenge you with strengthening exercises targeting different muscle groups, plyometrics and agility drills specially if it is a sports-related demand.
At Praxis Rehab Physiotherapy, we aim to derive considerable comfort and results from research that consistently demonstrates improvements in symptoms with a well-structured and graduated exercise program. We will advise you on the type, duration and dosage of exercise, modify activities if painful, calm the load down before reintroducing controlled loading and gradual progression from simple to complex knee movements.
We put great emphasis on education as an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) to enhance outcomes.