Knee Pain Treatment
ITB syndrome
What is it?
The iliotibial band (ITB) is a type of connective tissue called fascia that runs from your hip down to the outer surface of your knee. Its functions are to provide support to the lower extremity and act as an attachment site for other tissues. This can become inflamed, often due to overuse and presents as a localised pain on the outside area of the knee.
How does it present?
Usually, pain is felt slightly above the joint line on the outer surface of the knee. It can also elicit pain and become inflamed at its other attachment at the hip but this is less common.
Usually repetitive knee flexion (the leg bending) will cause aggravation and a flare up of symptoms, especially if walking/running up or down hill.
Why has it happened?
This is often caused by overuse, for example training too intensely and too frequently with running or cycling. Certain factors predispose this injury, such as poor shock absorption (old, poorly fitted trainers) weak gluteals (buttock muscles which act to stabilise the pelvis and assists balanced movement) or over pronation (the act of the foot falling inwards on itself when standing and moving.)
How can we help?
Assessment of the foot, knee and hip will provide and insight into any imbalance that could be predisposing to this injury. Certain muscles, such as the vastus lateralis, or tensor fascia latae may have become tight and is predisposing and/or maintaining the injury.
ACL/PCL sprain
What is it?
The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are located within the knee joint. They enable stability, directly preventing the tibia (leg bone below the knee) moving forward or backward too far in relation to the femur (thigh bone)
How does it present?
Often pain over the front of the knee will be described. It might be made worse by attempting to squat or move up and down stairs. If a rupture of the ligaments has occurred, and popping or clicking sensation may be felt at the onset of injury.
Why has it happened?
The ACL is more commonly injured than the PCL. Sudden twisting/pivoting motion or direct trauma are commonly cited causes for this type of injury.
How can we help?
The ligamentous integrity of the ACL and PCL can be tested by a qualified therapist. This can help determine the severity of the tear or if a rupture has occurred. Rehabilitation usually consists of strengthening the muscles that support the knee joint. The hip, foot and ankle should also be assessed to understand the functionality of the lower limb as a whole.
Meniscal Tear
What is it?
The knee joint consists of two menisci, these are cartilaginous platforms that enable connection between the tibia (bone below the knee) and the femur (thigh bone) allowing a congruent surface. The medial menisci located at the inner aspect of the joint primarily provides stability, with the lateral menisci, positioned on the outer portion of the joint, allowing more for mobility. Tears can occur on either meniscus, although the medial is more common.
How does it present?
Popping or clicking sound/sensation might be present on a traumatic onset. Tenderness at the joint line might be felt. With more severe tears, feeling the joint get locked or stuck may occur during movement.
Why has it happened?
Meniscal tears can either be traumatic, such as a tackle in football or degenerative, as the cartilage thins with age predisposing to tears.
How can we help?
Thorough case history and assessment of the knee can help identify problematic or injured structures. Meniscal tears, depending on severity can often be managed well with conservative treatment. Treatment largely focuses on strengthening the muscles around the knee joint and looking at other areas of the body that assist and enable ambulation.
Patellofemoral pain syndrome
What is it?
The cartilage of the under surface of the patella (kneecap) can soften and become inflamed, leading to some deterioration. This is common in young and athletic individuals, but may also arise in older adults coinciding with arthritic change.
How does it present?
This often presents as diffuse anterior (front) pain of the knee. Movements triggering it can be unspecific, but often exercise that increases patellofemoral pressure such as squatting or walking downstairs might trigger symptoms.
Why has it happened?
Overuse is a common cause of this condition. There may be issues with foot/ ankle and or hip joint that could be predisposing this condition. Muscle imbalances and weaknesses can also cause patella maltracking (abnormal movement of the patella during movement) which could be causing unnecessary strain to the patella and associative structures.
How can we help?
Analysing the patients gait and other functional activity can help understand any predisposition to injury or weakness. The quadricep muscles may be too tight and would benefit from release via manual therapy or strengthening other areas to assist patella tracking and decompression.