Knee Pain

KNEE PAIN

COMMON CONDITIONS AND HOW A PHYSIOTHERAPIST CAN HELP

PATELLO-FEMORAL PAIN SYNDROME (PFPS)

Signs and Symptoms  

• Pain typically in the front of the knee (though sometimes sides and posteriorly)
• Swelling/puffiness around the kneecap
• Aggravated by going up/down stairs, sitting with knees bent, kneeling and squatting
• Clicking/grinding noises

What is happening with the body? 

• The name Patello-Femoral Pain Syndrome (PFPS) is actually an umbrella term for pain that is felt in the patello-femoral (knee cap) joint or the surrounding soft tissues which is not to be confused with chondromalacia patellae and patellar tendinopathy.
• It is sometimes the result of direct trauma, but in most circumstances the result of a number of factors including patellar orientation, imbalance of the surrounding muscles, rapid change in load of the joint and the individuals biomechanics (e.g. pes planus causing compensatory internal rotation of the tibia/femur).

What can you try at home to help? 

• Using ice, elevation, compression and relative rest from aggravating loads is a good initial step to helping manage the acute symptoms in a flare.
• Stretching the calves, hamstrings, TFL and gluteals can also be quite helpful in alleviating tension and stress from the lateral aspect of the knee.
• Consulting with a doctor and pharmacist can also be helpful to understand which medications will help alleviate swelling and/or pain.

How can physiotherapy help? 

• Accurate diagnosis; it is important to differentiate the diagnosis from chondromalacia patellae and patellar tendinopathy as the treatment and prognosis is very different.
• Activity modification; your physio is an expert at helping you still stay engaged in the activities that are most important to you while not aggravating your symptoms, as usually you will not have to stop activity all together with PFPS.
• Pain relief; there is an arsenal of treatments that a physiotherapist can provide, which includes manual therapy (massage/joint mobilisations), bracing, taping, stretching, dry needling.
• Exercises; depending on the cause of the symptoms, your physiotherapist will use their expertise to analyse your biomechanics to identify what is driving the symptoms, and provide a structured, tailored exercise plan to rebuild your strength to be able to tolerate all your previous activities once more.

KNEE OSTEOARTHRITIS (OA)

Signs and Symptoms  

• Feeling of change in stability (stiffness or giving way)
• Reduced range of motion (unable to bend or straighten knee fully)
• Pain on weight bearing
• Red, hot or swollen looking knee
• Worse with rest or walking first thing in morning

What is happening with the body? 

• Osteoarthritis of the knee is a condition where the articular cartilage (lining of the bone joint surface) of the knee begins to diminish in size and changes to the surface of the joint occurs (e.g. osteophytes, irregular surfaces of joints).
• This process can cause an inflammatory reaction, leading to swelling, pain and reduced strength of the surrounding muscles (e.g. quadriceps, hamstrings and calves).

What can you try at home to help? 

• Evidence largely supports weight loss and exercise as the most effective long term treatment for pain relief and control of knee osteoarthritis.
• Using heat or ice for pain relief, topical creams/ointments, gentle range of motion exercises throughout the day, pacing your activities and using pain medication/non steroidal anti inflammatories as prescribed by your doctor or pharmacist are some other options to consider.

How can physiotherapy help? 

• Accurate diagnosis; knowing what compartment of the knee has OA is an important part of management as it will allow any treatment to be specific to where the issue is.
• Activity modification; your physio is an expert at helping you still stay engaged in the activities that are most important to you while not aggravating your symptoms.
• Pain relief; there is an arsenal of treatments that a physiotherapist can provide, which includes manual therapy (massage/joint mobilisations), bracing, taping, stretching, dry needling.
• Exercises; current research shows that specific, guided exercise programs targeted at building muscle strength and joint stability is the main stay treatment for knee OA, one such program is the GLAD program which is run here in the clinic. Your physio will guide you safely through the progressions towards your functional goals, whatever they may be.