Knee pain and treatment

Did you know this about knee pain and treatment?

The biggest risk factor for knee pain is age.

The knee is the largest; most weight bearing joint of the body.

Kneecaps are distinctive to each person – it can be thought of as a second pair of ‘fingerprints’.

Many injuries, mechanical abnormalities, and diseases affect the knee joint as it is such a loaded part of the body. The knee is loaded during most weightbearing activities such as walking, running, stair climbing and standing up from a chair. In this article we look at the most common causes of knee pain and work through the different types of treatments available for your knee. And we also identify the signs, symptoms, and risk factors for knee pain and treatment.

Signs and symptoms of knee pain:

Symtpoms

Pain (sharp, dull, constant, intermittent)
Swelling
Redness
Area feels hot to touch
Limited/ restricted movement
Instability
Unable to stand on the involved leg
Feeling like the joint is stuck or locking
Clicking or popping sounds during movement

Risk factors for knee pain:

Age
Female gender
Increased weight
Previous injuries
Participation in some sporting activities
Diseases or conditions affecting muscles and joints- osteoporosis, arthritis, lupus, etc

Origins of knee pain:

Knee diseases
Knee movement abnormalities
Knee injuries

More articles to come with regards to each category of knee pain origins.

Exercise therapy:

Hydrotherapy (especially if the pain is too much during land-based exercise therapy)
Weightbearing strengthening exercises (progressive loading according to symptoms)
Mobility and flexibility exercises

Strengthening

1. Knee diseases & treatment

Arthritis is commonly the cause of knee pain, especially within the older population. How we treat and manage arthritis depends on the type. Osteoarthritis (OA) refers to degenerative changes within the knee joint, especially the cartilage. Recent research indicates that chronic inflammation of the lining around the knee joint impacts the development and progression of OA.

Rheumatoid arthritis (RA)

Refers to when the inflammation and degeneration of the joint structures are due to an auto-immune response. In other words, your own body is fighting against itself and degeneration occurs as a result.

OA and RA can be managed with medications that relieve the symptoms like pain, swelling, and stiffness. Exercise therapy is a very effective treatment method for long-term management and functional independance. It can relieve joint pain, improve strength & physical function, as well as improve overall health & quality of life. Exercise therapy is especially effecive when the focus is on strengthening the muscles surrounding the knee joint and lower body. Progressive weight bearing exercises, if tolerated, are the most effective for knee pain and treatment. Especially in the long-term success management for arthritis.

Osteoporosis

Another condition which might cause knee pain. It involves reduced bone density, mineral quality, and bone strength, which is lower than normal. Osteoporosis is normally not reversible, but the condition can be managed with exercise therapy and or medication. A doctor may prescribe calcium & vitamin D supplements to improve bone density.

Exercise therapy improves bone strength, relieves knee pain, and improves physical functioning. Much like with arthritis, load bearing exercises are the most effective training method for strengthening bones. The severity of osteoporosis greatly influences the type and load of training the patient may participate in. A patient with severe osteoporosis is normally more physically limited than a patient with mild osteoporosis. With severe osteoporosis, care is taken to exercise in a way that decreases their fall risk, for example seated strengthening exercises may be used instead.

2. Knee movement abnormalities & treatment

Conditions causing knee pain that develop due to knee movement abnormalities:

A. Bursitis

Bursae are fluid filled sacs within joints that prevent friction build up between muscles, bones, and ligaments. Due to compensatory and abnormal knee movements, more than usuals pressure is placed on the knee bursae and they get irritated and inflamed. This leads to knee pain, swelling, and difficulty with weight-bearing.
The first step in treating bursitis is REST and relieving the knee of the aggravating movements. But it is not the only step. Because compensatory movements may lead to the development of bursitis, it is vital to address those abnormal movement patterns to identify the root cause.
Exercise therapy will be focussed on identifying the patterns that are causing the burisits and rehabilitating it accordingly.

B. Iliotibial band syndrome

Iliotibial band syndrome (ITBS) refers to when you are experiencing knee pain on the outside of your knee due to the tendon being irritated. Treatment for ITBS not only includes rest & initial medication prescription to relieve the pain but must also include exercise therapy once the pain is under control. ITBS develops when the tendon gets irritated due to abnormal repetitive movements, overactive & under active opposing muscle groups, tight muscle groups, or postural abnormalities. Because of these abnormalities, compensation movements, gait changes or altered muscle activation occur. By focussing on correcting these abnormalities with exercises therapy, it decreases the risk of recurring ITBS. With exercise therapy we ensure to treat holistically as possible and rehabilitate the hip and the knee to reduce the risk for recurring ITBS.

C. Patella maltracking

Knee pain can be due to the patella not following the correct movement path when the knee is bending or straightening. Treatment for this condition focuses on improving the movement path of the patella by correcting the muscle imbalances of the surrounding knee muscles. Patella mal-tracking develops due to the following: tight / weak thigh muscles; muscle imbalances, postural deviations, or trauma to the knee structures. Taping methods and corrective footwear, additional to exercise therapy may assist in passive treatment. This provides an external support for pain relief rather than actively improving the involved structure surrounding the knee joint.

Taping

3. Knee injuries

Injuries due to sport participation, activities of daily living or accident-related traumas cause pain in different degrees and locations on the knee. The type of treatment will depend on what structure is injured and how severe the injury is.

Ligament & tendon injuries

The ligaments of the knee connect the bones to each other, provide support, and prevent excessive and harmful movements of the joint. Ligaments are injured when the joint is pressured into an abnormal position. Treatment for ligament & tendon injuries highly depend on the grade of damages. Depending on the direction of, and how much force applied during the mechanism of injury, ligaments can be sprained & tendons can be strained in differend ways.

Grade I sprain/strain: Slight stretched fibres with slight damages; slight loss of function.

Grade II sprain/strain: Partial tear in the fibres; moderate loss of function.

Grade III sprain/strain: Complete tear of the ligament or tendon; severe loss of function.

Grade I ligament sprain/strain treatment primarily includes rest from aggravating movements, cold therapy, decreased weight bearing and compression of the joint. During this healing phase the goal is to decrease the swelling & pain. When we apply cold therapy, it slows down the body’s natural inflammatory response after an injury, preventing excessive swelling and ultimately aiding a quicker recovery. Pain free knee range of motion & low intensity exercises for the surrounding muscles are implemented to assist in the rehabilitation of the injury. Rehabilitation exercises will gradually progress to more weight bearing and more functional exercises. Recovery time: ±10 days.

Grade II ligament sprains/strain have more disabling effects on the joint. Experiencing more pain, swelling, instability, and moderate loss of function. The start of the rehabilitation process remains the same with rest, cold therapy, decreasing the movement, and compression. Due to the severity of the damage, the rehabilitation process, and progressions will be adapted to match the capabilities & healing of the patient. Recovery time: ±3 weeks.

Grade III ligament sprains/strains are completely torn ligaments / tendons with severe loss of function. These injuries are normally treated with surgical repair. After surgery, exercise therapy starts with regaining full and pain free range of motion, followed with gradual muscle strengthening. As with the previous grades, rehabilitation is applied with progression to reach a level where the patient returns to pre-injury activities or sport participation. Recovery time: ±12 weeks.

Crutches

Meniscal injuries

Meniscal tears normally happen when running and suddenly change direction of motion. Depending on the location and severity of the tear, treatment varies from rest, manual therapy to exercise therapy, or surgery. Meniscal injuries present symptoms like knee pain, swelling, limitations with straightening the leg or not being able to bear weight on the injured side. The meniscus is a cartilage cushion in your knee that provides support as well as protection against degeneration between the bones.

Exercise therapy for meniscal injuries focus on the following aspects to fully rehabilitate the injury:

Regaining full flexibility & mobility
Improving the surrounding knee muscular strength
Increasing the joint stability
Training balance and proprioception
Improving functional movements & gait

Exercise therapy is applied with gradual progressions to prevent risk of further injury and to return the patient to pre-injury activities. It should be noted that untreated meniscus injuries increase the risk of developing osteoarthritis. For that reason, care and correct treatment of meniscus tears are vital to long-term success.

Bone injuries

When the knee bones are under excessive stress they may fracture. The first step of treatment is making sure the knee joint is splinted and stable after the injury. Immediate x-rays are required.

The doctor will make use of X-rays to identify the severity of the fracture. According to the diagnosis, the treatment plan can differ between a cast, rest, or surgery if necessary. After the doctor has cleared the patient for exercise therapy, we will assist the patient in regaining the necessary knee mobility, strength, proprioception, and functional abilities that are required by their sport or normal life activities like climbing stairs.

x-ray knee