Common knee problems
- Anterior cruciate (ACL)
- Posterior cruciate (PCL)
- Medial collateral
- Lateral collateral
A torn ACL occurs often as a result of a sporting injury. Rotation (twisting) a slightly bent knee, as in a sidestep or evading a player can result in this injury. The knee gives way and becomes unstable.
When ligaments tear, the elastic fibres in them retract, bundling up the fibres and ensuring that the ends of the ligament cannot spontaneously re attach. A partial tear can heal on its own, but without adequate rehabilitation of the surrounding structures, will remain weak and prone to re injury or result in a complete tear.
A complete tear in some instances can be treated without surgery, however, if a return to full sport is required, a surgical reconstruction will be required.
Physiotherapy in the pre operative phase is essential to ensure a speedy recovery after your operation. Regaining strength, range of movement and balance is required before your surgery to make the recovery time shorter. Your physiotherapist will assist you in overcoming the pain and swelling associated with your injury and ensuring that you are ready for the operation.
Post operatively your physiotherapist will address the effects of surgery, pain, swelling, inflammation and weakness. You will need to learn to walk again and regaining your confidence after this operation can be difficult without help from your physio.
PCL tears are less common and debilitating than ACL tears. This injury can occur after a forced hyperextension injury, or a sudden stopping, such as in a front on tackle, or running into something. Surgery is infrequently required, unless there are other injuries at the same time and reconstruction of the PCL is rarely attempted.
MCL tears are the most common knee ligament injury seen and often occur alongside an ACL or cartilage tear. The knee could be hit from the outside, bending the knee sideways.
The time it takes to recover will depend on the type and amount of damage to your knee. However, these tips give you some general ideas on what to do over the next few days, and as your injury gradually heals. If you develop significant, rapid swelling at any stage, it’s important to see a health professional (eg, a GP or physiotherapist) as soon as possible.
What to do over the next 2-3 days This is when you’ll probably experience the most pain and swelling. To deal with this, follow RICE:
- Rest – Reduce the length of time you spend standing and walking.
- Ice – Place ice wrapped in a damp towel on your knee every 2 hours, leaving it there for up to 20 minutes each time.
- Compression - Firm (but not tight) bandaging helps reduce swelling. Remove the bandage at night.
- Elevation – Keep your injured leg raised and straight on a pillow. This will help reduce bleeding and swelling.
Try to avoid the following, which may slow your recovery:
- H – Heat, eg hot showers, hot packs
- A – Alcohol
- R – Running
- M – Massage.
Paracetamol can help with pain, but avoid aspirin, which can increase bleeding. If you’re not sure which painkiller to buy, ask your doctor or pharmacist for advice.
After 3 days
After 3 days, you should try to walk normally, ie, heel to toe. Try not to limp. As well as walking, it’s also a good idea to start other activities that can help get your knee moving again, such as cycling, aqua jogging and swimming (but not breaststroke, which may put too much strain on your knee).
You may still experience pain and swelling for up to 7 days after your injury, but after the first week things should start to settle down.
Cartilage tears (Meniscal Injuries)
The menisci (cartilage) can be injured by the force of rotating the knee while bearing weight. A partial or total tear may occur when a person quickly twists or rotates the upper leg while the foot stays still (for example, when dribbling a basketball around an opponent or turning to hit a tennis ball). If the tear is only small, the meniscus stays connected to the front and back of the knee; if the tear is large, the meniscus may be left hanging by a thread of cartilage. The seriousness of a tear depends on its location and extent.
Generally, when people injure a meniscus, they feel some pain, particularly when the knee is straightened. If the pain is mild, the person may continue moving. Severe pain may occur if a fragment of the meniscus catches between the femur and the tibia. Swelling may occur soon after injury if there is damage to blood vessels. Swelling may also occur several hours later if there is inflammation of the joint lining (synovium). Sometimes, an injury that occurred in the past but was not treated becomes painful months or years later, particularly if the knee is injured a second time. After any injury, the knee may click, lock, feel weak, or give way. Although symptoms of meniscal injury may disappear on their own, they frequently persist or return and require treatment.
Osgood-Schlatter disease is a condition caused by repetitive stress or tension on part of the growth area of the upper tibia (the apophysis). It is characterized by inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia. The condition may also be associated with an injury in which the tendon is stretched so much that it tears away from the tibia and takes a fragment of bone with it (avulsion). The disease most commonly affects active young people, particularly boys between the ages of 10 and 15, who play games or sports that include frequent running and jumping.
People with this disease experience pain just below the knee joint that usually worsens with activity and is relieved by rest. A bony bump that is particularly painful when pressed may appear on the upper edge of the tibia (below the kneecap). Usually, the motion of the knee is not affected. Pain may last a few months and may recur until the child’s growth is completed.
Iliotibial Band (ITB) Syndrome
Iliotibial band syndrome is an inflammatory condition caused when a band of tissue rubs over the outer bone (lateral condyle) of the knee. Although iliotibial band syndrome may be caused by direct injury to the knee, it is most often caused by the stress of long-term overuse, such as sometimes occurs in sports training and, particularly, in running.
A person with this syndrome feels an ache or burning sensation at the side of the knee during activity. Pain may be localized at the side of the knee or radiate up the side of the thigh. A person may also feel a snap or pop when the knee is bent and then straightened. Swelling is often absent, and knee range of motion is normal.
Osteochondritis dissecans results from a loss of the blood supply to an area of bone underneath a joint surface. It usually involves the knee. The affected bone and its covering of cartilage gradually loosen and cause pain. This problem usually arises spontaneously in an active adolescent or young adult. It may be caused by a slight blockage of a small artery or to an unrecognized injury or tiny fracture that damages the overlying cartilage. A person with this condition may eventually develop osteoarthritis. Lack of a blood supply can cause bone to break down (osteonecrosis). The involvement of several joints or the appearance of osteochondritis dissecans in several family members may indicate that the disorder is inherited. If normal healing doesn’t occur, cartilage separates from the diseased bone and a fragment breaks loose into the knee joint, causing weakness, sharp pain, and locking of the joint.
Plica (pronounced PLI-kah) syndrome occurs when plicae (bands of synovial tissue) are irritated by overuse or injury. Synovial plicae are the remains of tissue pouches found in the early stages of fetal development. As the fetus develops, these pouches normally combine to form one large synovial cavity. If this process is incomplete, plicae remain as four folds or bands of synovial tissue within the knee. Injury, chronic overuse, or inflammatory conditions are associated with this syndrome. Symptoms of plica syndrome include pain and swelling, a clicking sensation, and locking and weakness of the knee.
Fat Pad impingement
Infrapatellar fat pad syndrome, also called Hoffa's disease, involves pain below the kneecap (patella) due to the thigh bone (femur) and shinbone (tibia) pinching fatty tissue below the patella. The fat pad is meant to protect the patella from injury. Pain is located below the patella and gets worse with physical activity, including sports or when completely straightening the knee. There is often swelling below the patella, tenderness and swelling on either side of the tendon connecting the kneecap and shinbone (patellar tendon).
Hoffa's disease may be caused by direct injury (acute trauma) or ongoing (chronic) stress on the fat pad below the kneecap. This often occurs during activities that require full extension of the knee. The fat pad is pinched between the thigh bone and shinbone, and becomes inflamed, causing pain. It is often associated with sports that require repeated, forceful straightening or bending of the knee (kicking or jumping), sports in which the knee may receive direct injury (volleyball, soccer, football) or those that require prolonged kneeling (housemaids knee).
Osteoarthritis (OA) is one of the most common natural occurring degenerative conditions of the body’s joints affecting people of all ages however it is more prevalent as we age. It is characterized primarily by a loss of joint (synovial) cartilage and results in pain and swelling as the joint loses its ability to move smoothly.
It can affect any joint in the body however the body’s major weight bearing joints such as the knees, hips, lumbar spine and ankles are mostly affected. Pain and stiffness are the most common symptoms due to the following:
- Joints lose their natural contour and shape developing irregular bone spurs called osteophytes
- A reduction in the stability of the joint occurs including joint space narrowing and erosion, destroying the natural alignment of the joint
- Muscle wasting and weakness affecting the ability to walk long distances and walk up/down stairs or running
- The loss of cartilage reduces shock absorbtion.
Knee osteoarthritis cannot be cured, however, it can be effectively managed to the point where you can still lead a healthy life and do the things you wish to provided you are guided in the right direction.
How can physiotherapy assist in treating knee osteoarthritis?
Physiotherapy can be very useful in the management of mild or aggressive states of osteoarthritis.
- Strength and stability exercise program, knee strengthening exercises for an arthritic knee can reduce the amount of sheering occurring within the joint, provide more stability around the joint, and increase the endurance of the knee.
- Appropriate bracing of the knee: wearing an appropriate brace can provide the knee with more support, reduce the swelling and provide some symptomatic relief.
- Manual therapy and electrotherapy. Physiotherapists can apply their manual therapy skills to reduce the amount of muscle tightness and tension that can surround an arthritic joint. This can also assist in reducing the amount of swelling by flushing it back into the lymphatic system. Electrotherapy such as TENS and ultrasound may also be used in effective pain and swelling management.
In general, physiotherapy is required regardless of the severity of the injury. Your physiotherapist at Prime Physiotherapy is skilled at the diagnosis of these conditions and treatment where indicated. Your physiotherapist will let you know if treatment or further referral to specialist or investigation is needed.