Whilst not as common as low back pain or neck pain, knee pain is a frequent occurance with around 20% of adults complaining of knee pain at some point. Knee pain is also common in children, often related to sporting activities or following a period of rapid growth.
We see patients of all ages and of all levels of activity with knee pain due to a variety of reasons. So rest assured that if you have knee pain for any reason, the physios at our clinic in Eskbank near Edinburgh will be able to thoroughly assess and treat your problem effectively.
Why do we get knee pain?
The knee is a hinge joint which allows flexion and extension or bending and straightening of the knee; with a small amount of rotation being available. The main components of the knee are bones, the femur, patella and the tibia, menisci often referred to as cartilage, ligaments and surrounding muscles which have a direct effect on the knee such as the quadriceps and the hamstrings.
Additionally structures above and below the knee can have an effect on the knee and any symptoms that are felt in and around the knee. This can be due to referred pain; for example, it is not uncommon for patients with osteoarthritis in their hip to have knee pain which then resolves if they have their hip replaced. It is also common for knee problems such as anterior knee pain to be connected to poor control at the hip and lumbar spine and/or biomechanical issues at the foot and ankle such as over pronation.
Generally the problems affecting the knee can be divided into those affecting the:
Menisci, often referred to as the cartilage.This is can be confusing as in the knee there is articular cartilage which covers the surface of the tibia, femur and the patella. However the menisci are made of fibrocartilage and are a completely different structure. The menisci act as shock absorbers and can be sustain an acute tear when the knee is forcibly twisted. Therefore it is a fairly common injury when playing football and rugby. The menisci can also sustain a degenerate tear. This is more common in a older population and often will occur spontaneously for no apparent reason. Mensical injuries both acute or degenerate are often aggravated by squatting or twisting the knee and locking of the knee can occur.
Ligaments, the main ligaments in the knee are the Medical Collateral Ligament(MCL), the Lateral Collateral Ligament(LCL), the Posterior Cruciate Ligament(PCL) and the Anterior Cruciate Ligament(ACL). The purpose of these ligaments is to stabilise the knee. Therefore if the ligaments have been damaged or torn, the patient’s main complaint will be that their knee gives way for no reason or that they feel unsecure. Patients with ligament injuries will normally be able to relate their problem to a specific incident or injury.
Tendons, the tendons are the soft tissues which connect muscle to bone. They can be acutely torn or ruptured, if this occurs it is normally due to significant trauma and in the case of a complete rupture would require medical intervention. More common are tendinopathies, which often present as a chronic progressively worsening condition. These are often related to overuse in active individuals. Traction apophysitis’s which result in pain at the point where the tendon attaches onto the bone are common in children especially following growth spurts.
The knee joint itself; the knee is in fact made up of two joints, these are the patellofemoral joint and the tibiofemoral joint. As with any joint they can be affected by arthritis such as osteo or rheumatoid arthritis.
Patellofemoral pain syndrome(PPS), sometimes referred to as Anterior Knee Pain(AKP) is a common knee problem in both the active and inactive population. Patients’ often complain of pain at the front of knee, that has had a gradual onset for no apparent reason. Anterior knee pain usually has a multifactorial cause and failure to address each of these factors will result in ineffectual treatment. Treatment will commonly include addressing poor strength, flexibility and control at the knee and often the hip or pelvis. There may also be a foot or ankle biomechanical issue present that may require using orthotics of some sort.
There are a number of other potential reasons for having knee pain, including bursitis, bleeding into the joint and gout. However the above reasons are the more common ones for having knee pain. If you have a problem with your knee that is not listed above please contact us to see if we can help.
So if you have knee pain what should you do ?
If the knee pain has occurred suddenly during sport or some other activity then the advice in this post about acute ankle sprains may be of use. Once you have ruled out serious or bony injury, then it would be sensible to book an appointment so that we can assess your knee and start appropriate treatment and rehabilitation.
If instead your knee pain has had a gradual onset or has been present for some time i.e. it’s a chronic long standing problem. Then it would be advisable to book in so that we can assess your knee and start making a plan to return you to your chosen level of activity or function.
The treatment journey for either an acute or chronic journey starts with a thorough subjective assessment, where the physio will listen to what has happened and ask specific questions about the problem, your general health and your level of activity and expectations. For example are you wanting to return to a high level of sporting function, as this will guide your rehabilitation and how we manage your injury.
The physio will then thoroughly assess the knee objectively, carrying out a series of tests to assess the joint, ligaments and other structures. Once a diagnosis has been made the physio will devise a treatment plan in partnership with yourself to assist you in returning to your chosen level of function. This plan may include manual therapy, soft tissue techniques, electrotherapy, graded rehabilitation and lastly graded return to activity/sport.
If you for any reason are not able to return to sport or your chosen level of activity, we can discuss with you an appropriate way forwards and can liaise with your GP or consultant to expedite your referral onwards.
If you do have a surgical procedure such as ACL reconstruction, menisectomy or total knee replacement. Then rest assured all of the team have had plenty of experience in post op rehabilitation following knee surgery.
Please contact us to make an appointment. We can normally see you in our clinic in Eskbank near Edinburgh within a few days and we have appointments from 8 am to 8 pm, so we can see you at a time that is convenient for you.