Knee Pain

Knee pain is very common in people from all walks of life and activity levels. It can be a frustrating niggle or severely painful and limit physical function or hobbies. The tibiofemoral joint is the main joint between the shin bone (tibia) and the thigh bone (femur). The patellofemoral joint is the joint between the knee cap (patella) and thigh bone (femur).

Common activities which clients complain of are using stairs, kneeling / crouching or even simply walking. Sometimes the joint can swell, feel stiff (or sometimes lock) and have the feeling of giving way. There are many conditions which can give any combination of these symptoms.

• Hamstring strain – The 3 hamstrings run down the back of your thigh from your pelvis to below your knee, 2 attach onto the tibia, 1 onto the fibula. A strain of them is a common sports injury, where pain in the back of the thigh is felt, and an accurate diagnosis of the degree of injury is key to rehab including movement screening.

• Anterior cruciate ligament (ACL) injury. The ACL is a diagonal ligament inside your knee between your femur and tibia. It helps to prevent excess movement between the bones. It can be strained and become lax, or be completely torn (ruptured), mostly during a sporting activity. A complete tear generally needs surgical reconstruction in order to return to jumping or bounding sports, but a lax ligament responds very well to rehabilitation without the need for surgery in less sporty people.

• Medial / lateral ligament problems. The medial (inner) and lateral (outer) ligaments run either side of your knee and help to prevent excess movement between the bones. They are often injured when you have twisted your knee with a foot fixed on the floor, and vary in severity from being minimally sprained (Grade I) up to a rupture (Grade III). Managed correctly both normally respond well to treatment and rehabilitation.

• Meniscal (cartilage) problems. You have a medial (inner) and lateral (outer) meniscus in each knee. They are extra cartilage discs which help with the fit of the joint and reduce friction. Weight bearing and twisting injuries are often causes in younger and sporty people, but innocuous tasks can be a trigger in people over the age of 40 due to degenerative ‘tears’, or wear over time. Rehabilitation and modified duties can resolve mild tears but surgical trimming or repair is the only option in larger tears, followed by rehabilitation.
• Patella tendonitis / tendinosis (jumpers knee). This refers to pain arising from the patella tendon which runs from your knee cap to your shin. Please read our tendinopathy page for more information.

• ITB friction syndrome. This is normally a running or cycling problem. Pain is on the outer part of the leg just above knee level. Current evidence suggests that the pain is from the bursa (a thin fluid filled sac) between the ITB and your femur. This problem normally responds very well to treatment and rehabilitation of the hip muscles. Runners and cyclists can be screened for movement dysfunctions.

• Bursitis – you have a prepatellar bursa on top of the knee cap (housemaid’s knee), infrapatellar (deep and superficial) bursa below the knee cap and suprapatellar bursa between the quadriceps tendon and the femur. Modified activity and rehabilitation along with medication are the most effective ways of improving either.

• Osteoarthritis - Even a painful osteoarthritic knee can be helped. It is one of the main things advocated by The National Institute for Clinical Excellence (NICE). Strengthening the muscles in the thigh and hip often improve symptoms, along with weight loss and activity modification. Steroid or hyaluronic acid injections can often relieve pain temporarily also, but the most severe wear and tear often needs a knee replacement and then lots of rehab!

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