Knee pain can occur with or without trauma. There are many reasons why someone can develop knee pain. In many cases where there is little or no trauma to the knee, the underlying cause of knee pain is a biomechanical issue creating a maladaptive pattern in loading force through the knee. This may lead to structures of the knee (e.g. fat pad, bursa, cartilage) becoming overloaded, inflamed and painful.
Physiotherapy treatment of these conditions includes taping, soft tissue work, joint mobilisations and exercises to address and correct the underlying biomechanical dysfunction.
Knee Ligament Sprains
There are four ligaments in the knee: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). These ligaments, in conjunction with muscle activation, stabilise the knee and limit excessive ranges of motion.
Ligamentous injuries may occur when high levels of torsional force are exerted through the knee joint which may cause the ligaments to stretch or rupture. Symptoms may include swelling (immediate or delayed), bruising, pain and reduced ability to weight bear.
In some cases, surgery to repair the ligament is indicated which is followed by an extensive rehabilitation programme to assist you in your return to sport. Depending on your age, functional level, goals and severity of injury, most of these injuries can be managed with physiotherapy, including an exercise programme and some manual therapy.
Knee Meniscus Injuries
The knee has two moon shaped cartilaginous structures residing between the shinbone (tibia) and the thighbone (femur). These structures are called the menisci. The menisci help to cushion the knee and reduce the load going through the bones. They are at risk of injury in twisting activities where the foot is fixed to the ground; hence the most likely time to injure these is during sport.
Symptoms of a meniscus injury may include pain, minimal swelling, locking of the knee, difficulty weight bearing and clicking. Most of the time meniscal injuries can be managed with physiotherapy involving soft tissue work, joint techniques and a functional rehab and strengthening programme. In severe cases, further investigation and surgery may be indicated and your sports physiotherapists can guide you.
The Patella is the kneecap. It sits in a bony groove of the thighbone (femur) and within the quadriceps’ tendon. This makes the patella highly mobile within the joint and at risk of dislocation (abnormal separation of the joint) or subluxation (partial dislocation). In most circumstances, dislocation or subluxation injuries require high amounts of force to be exerted through the joint, however in rare cases where a person has significantly lax ligaments, these injuries may happen spontaneously.
Pain, swelling and a feeling of instability in the knee are common symptoms following a subluxation or dislocation of the patella. In the majority of cases, once the joint is relocated exercise and taping or bracing are the best ways to manage these injuries. In more severe cases or recurrent cases, surgery may need to be considered. Your sports physiotherapist is highly qualified to assist you with these injuries and to prevent reoccurrence it is recommended that treatment be sought straight away.
A bursa is a fluid filled sack that lies between two structures to decrease friction between structures and provide force distribution. A bursa is commonly located between the skin and bone, a muscle and joint space, tendon and bone. Bursitis occurs when there are excessive compressive or tensile forces creating friction in the region of the bursa. The bursa can become irritated and inflamed resulting in pain, loss of joint range and significant swelling. In locations where the bursa is superficial a large lump may be visible due to excessive swelling.
Physiotherapy management strategies include swelling management, biomechanical offloading of the affected area (which may include soft tissue work and joint techniques) and activity modification. Your sports physiotherapist will be provide you with a tailored rehabilitation programme to gradually increase your activities and return to full pain free activity.