What causes knee pain and how do you treat it?
Knee pain is most commonly seen in active individuals and can present due to a number of reasons, such as long distance running, excessive squatting and contact injuries from sport. Pain can be aggravated by movements such as squatting and bending, single leg loading, running, going up and down stairs, and also during prolonged periods of sitting, meaning it can affect many aspects of daily life, not only participation in sport and exercise. In many cases, knee pain is recurrent, with biomechanical issues in the lower limb contributing to ongoing symptoms. Thus, resolving these biomechanical issues plays an important role in rehabilitation from knee pain.
Knee pain may present due to many diagnoses. Some of these include:
- Patellofemoral pain
- Patella tendinopathy (or tendinitis)
- Ligament injuries (e.g. Anterior Cruciate Ligament)
- Meniscus tears / degeneration
Each of these conditions will require different approaches to rehabilitation as they involve different structures. Therefore, receiving a thorough assessment of your knee pain from a Physiotherapist will determine the source of your symptoms, and establish what path of rehabilitation you require.
At Bodysmart, we find the most common diagnosis of knee pain is “patello-femoral” pain. This type of pain is categorized by a diffuse ache in the front of the knee, which in many cases, can be hard to localise to one spot. Most commonly, it commences gradually, and is rarely attributed to a specific event. Once the pain starts, physical activity and movement will aggravate the pain, with squatting and traversing stairs reproducing most of the pain, whereas rest will settle the pain, but not resolve it. In the majority of cases, individuals have had the knee pain for weeks or even months before presenting to physiotherapy.
It is a tracking issue with the patella during bending and squatting movements of the knee. With increased load through the lower limb during a bending movement, the patella will track laterally instead of up and down, resulting in the production of pain. Muscle imbalance around the knee and lower limb are the main contributing factors to this injury. Tightness through the ilio-tibial band (ITB) and tensor fascia lata (TFL), along with weakness through the medial quadriceps (VMO) will contribute to this tracking issue due to their connections around the patella. The gluteal muscles in the hip also play an important role in this pathology. Weak gluteal muscles result in inward rotation of the knee during bending movements, causing tension to develop through the ITB and TFL, along with increasing pressure through the knee joint. Rehabilitation of all the above mentioned muscles plays an important role in the recovery from patellofemoral pain.
How can Physiotherapist help?
Firstly, a Physiotherapist will correctly diagnose patellofemoral pain. From there manual treatment will help to decrease pain and improve movement of the knee joint. This may include massage, dry needling, joint mobilizations, stretching and also taping techniques aimed at giving longer lasting relief from pain. Rehabilitative exercises are started almost immediately, as correcting biomechanical issues through the lower limb plays an important role in the treatment, management and prevention of patellofemoral pain. Exercises will include those aimed at stretching and releasing tight muscles (such as the ITB and TFL), strengthening muscles which have become weak (including the gluteals and VMO), and improving movement co-ordination to decrease excessive pressure on the knee.
Written by Matt Fulco (Physiotherapist). Through the completion of extensive post graduate professional development, Matt demonstrates a very high level of knowledge and skill for his age. He has a very well rounded skill set that enables him to accurately assess and diagnose a vast range of injuries and implement the best evidence based treatments available.
If you have knee pain that is not settling, book an initial physiotherapy consultation with Matt today. You can check Matt’s availability below: