Physiotherapy for Knee Injuries
Get to know some of the most common causes of knee pain
Get to know some of the most common causes of knee pain
The knee is one of the largest and most complex joints in the human body, it is also one of the most important! Due to its complexities, it can be susceptible to a number of different injuries. Hence, here are 8 common knee injuries, what do they mean and what can we do about them?!
8 common knee injuries, what do they mean and what can we do about them?!
Any of the bones in or around the knee joint can be fractured, however, the most common bone to be fractured in the knee is the patella (aka your knee cap)! Patella fractures typically occur from direct high impact force to the knee cap, such as falling directly on to it or from something like a car accident. Although rest and immobilization of your knee is required at the start of your rehab, when cleared by the doctors it’s super important to come in and see your physio to start gentle range of motion exercises and gentle quad strengthening exercises. A few weeks after that, once you’ve been given the all clear from the doctor, your physio will be able to help you start walking unassisted and get you back to doing what you love! Fracture healing time is 6 weeks in a young, fit and healthy individual and this increases with age, and just because your fracture has healed doesn’t necessarily mean that you’re ready to get back to running marathons, being immobile in a splint for 6 weeks can cause you to lose a large amount of muscle mass around the knee, hence it’s super important to keep up with your rehab!
A meniscus is a piece of cartilage in your knee that works to deepen the articulation of your knee joint to increase the stability of the knee as well as provide force transmission and shock absorption. When people talk about having torn the cartilage in their knee, this is what they are talking about! There are two menisci in your knee, your medial and your lateral meniscus, these can be torn during high impact sudden change of direction maneuvers and sporting activities. They can also tear slowly due to aging, as when we age we lose some of the cartilage in our joints, this is known as a degenerative meniscus tear. There are many variables that affect recovery and rehabilitation from a meniscus tear; these include the grade of tear (how bad it is), its location, your age and current physical capabilities. Some meniscus tears may require surgery, however, most will resolve on their own with rehabilitation. Rehabilitation of a torn meniscus involves strengthening the muscles around the knee joint as well as core and ankle strength and stability. In the initial stages of rehab it may just involve a very gentle range of motion exercises, trying to regain the full range of your knee, however once it is moving well it is super important to start strengthening – clinical pilates and cycling are two excellent ways to rehab a torn meniscus!
Your anterior cruciate ligament (aka ACL) is a ligament that sits deep inside your knee joint to provide stability to your knee, it connects your femur to your tibia (thigh bone to shin bone) and prevents excessive forward movement and rotation of your tibia in relation to your femur. You can tear your ACL during sudden change of direction maneuvers, deceleration maneuvers, landing awkwardly from a jump or trying to pivot when your foot is firmly planted. Athletes such as footy players, soccer players, basketballers and netballers commonly suffer ACL tears, however they’re not limited to just athletes. Like all ligament tears there are grades – a grade 1 being a strain through to a grade 3 which is a full rupture. Some ACL tears may require surgery if it is impacting your way of life or your sporting aspirations, however if not required you can be fully functional with a torn ACL as long as you stay fit and strong. If you do have sporting aspirations, you can be looking at almost a year to get back on the field all going well (9 months after surgery!), which will involve a lot of ‘prehab’ with your physiotherapist, recovery from surgery and then slowly getting back into running and a lot of strengthening. Your physiotherapist will guide you through this whole process and hopefully have you fitter and stronger than you were before injury to prevent further injury!
Your posterior cruciate ligament (PCL) sits deep inside your knee just behind your ACL and works to prevent your tibia (shin bone) from moving backwards in relation to your femur (thigh bone) as well as helps to provide stability and resist rotational forces within the knee. It’s kind of like your ACL’s little brother. A PCL can rupture/be torn in a similar manner to an ACL, however it is more commonly ruptured when an athlete lands on a bent knee, forcing the tibia backwards in relation to the femur, or through any activity that forcefully pushes your tibia backwards such as hyperextension injuries. Surgery for a PCL tear is less common when it is a sole PCL tear, however, these injuries usually appear concurrently with an ACL or meniscus tear which may require surgery if affecting lifestyle and daily activities. People and athletes who have experienced a sole PCL tear can get back to sport and daily living without too many issues with knee stability; however, it is important to work on strengthening the knee and all the other muscles around it to help prevent further injury/reinjury.
Your medial collateral ligament (MCL) and lateral collateral ligament (LCL) are the two ligaments that sit on the sides of your knee joint that connect the femur to the tibia. Again these are most commonly injured in sporting accidents, often in a similar manner to your ACL or PCL, or when there is a direct blow to the inside or outside of your knee. Again, there are grades of injury – grade 1 being a small strain, through to a grade 3 which is a full rupture, and often, especially with a grade 3 tear these injuries can occur concurrently with a meniscal and/or cruciate ligament injury. MCL injuries are more common, due to the biomechanics of the knee joint and the typical forces that are put through our knees on the day-to-day. Most collateral ligament injuries won’t require surgery, although you may be put in a brace to help limit sideways movement of your knee and to help keep you comfortable when moving about. Again when rehabbing a collateral ligament injury, the most important thing is strength, and strengthening all your surrounding muscles from your ankles, through to your core. Clinical pilates, home exercise and cycling are excellent methods of rehabilitation!
Illitobial band syndrome (ITBS) is a common injury that presents as pain and tenderness around the outside of your knee and can be misdiagnosed as a lateral collateral ligament injury! It is considered a non-traumatic overuse injury and is often seen in runners – sometimes called runner’s knee! It is often concurrent with weak hip abductors (glutes) and an increase in strain and tension in your iliotibial band, which is the big band of fascia that runs down the outside of your thigh, attaching from your hip bone down to the outside of your knee. ITBS responds really well to (a bit of rest!) manual therapy, dry needling and strengthening, so pop in to your physiotherapist to get it sorted out early.
A tendinopathy is a failed healing attempt of a tendon, often caused by overuse. Tendinopathy is a rather broad term, and is used as a generic descriptor for pain and overuse injuries in tendons. The most common tendon issue in the knee is what we call ‘Jumper’s knee’ which is also known as patellar (knee cap) tendinopathy. As the name suggests, we often see Jumper’s knee in jumping athletes, such as basketballers, volleyballers and line-out jumpers, however, it is not limited to just athletes and is quite a common issue. This injury often presents itself as pain around the front of the knee, especially when going up or down stairs or when landing from a jump. It is really important to seek out treatment as soon as it starts to be an issue, as continuing to aggravate the tendon can lead to degenerative changes which cannot be reversed. Come and see your physiotherapist and they can help you with a treatment plan that may involve some activity modification and some exercises to get you back pain-free faster!
Bursa are small fluid filled sacs that cushion the joints and allow tendons and ligaments to glide over each other smoothly. There are over 150 bursa in your body! Sometimes, due to direct trauma or overuse, these fluid filled sacs can become inflamed and swell which is then known as bursitis. There are many different bursae in the knee, but the most commonly aggravated is your prepatellar bursa which is the bursa that sits at the front of your knee cap. Prepatellar bursitis is often called house-maid’s or carpenter’s knee as it can become inflamed from long periods of kneeling. Most cases of prepatellar bursitis are not serious and will go away with physio management and a good home management plan.
As you can see knee pain can be caused by a range of different issues and injuries
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