Knee Pain and Knee Injury

Knee pain and/or injury are fairly common. Knee pain or injury can affect nearly anyone whether you are highly active or fairly sedentary. There are many potential causes for non traumatic knee pain, and physical therapy treatment may be the best treatment option for you.

Knee Pain

How Physical Therapy Can Help

  1. Evaluation – a thorough evaluation helps identify your specific issues
  2. Therapy – treatment regimen are suited to your individual needs
  3. Education – you learn new healthy habits to reduce future injuries
  4. Aftercare – the goal is to return you to a normal lifestyle as soon as possible. By practicing new habits with the help of a therapist, you can reduce the need for return visits

Preventing Knee Injuries

Knee Anatomy, Common Knee Problems and Treatments

THE KNEE JOINT

Figure 1: Right Knee

Although the knee joint may look like a simple joint, it is one of the most complex joints. Moreover, the knee is more likely to be injured than is any other joint in the body. We tend to ignore our knees until something happens to them that causes pain. As the saying goes, however, “an ounce of prevention is worth a pound of cure.” If we take good care of our knees now, before there is a problem, we can really help ourselves. In addition, if some problems with the knees develop, an exercise program can be extremely beneficial.

Figure 2: Right Knee

The knee is essentially made up of four bones. The femur, which is the large bone in your thigh, attaches by ligaments and a capsule to your tibia. Just below and next to the tibia is the fibula, which runs parallel to the tibia. The patella, or what we call the knee cap, rides on the knee joint as the knee bends.

When the knee moves, it does not just bend and straighten, or, as it is medically termed, flex and extend. There is also a slight rotational component in this motion. This component was recognized only within the last 50 years, which may be part of the reason people have so many unknown injuries. The knee muscles which go across the knee joint are the quadriceps and the hamstrings. The quadriceps muscles are on the front of the knee, and the hamstrings are on the back of the knee. The ligaments are equally important in the knee joint because they hold the joint together. You may have heard of people who have had ligament tears. Problems with ligaments are common. In review, the bones support the knee and provide the rigid structure of the joint, the muscles move the joint, and the ligaments stabilize the joint.

Figure 3: Cross Sectional View of Right Knee

The knee joint also has a structure made of cartilage, which is called the meniscus or meniscal cartilage. The meniscus is a C-shaped piece of tissue which fits into the joint between the tibia and the femur. It helps to protect the joint and allows the bones to slide freely on each other. There is also a bursa around the knee joint. A bursa is a little fluid sac that helps the muscles and tendons slide freely as the knee moves.

To function well, a person needs to have strong and flexible muscles. In addition, the meniscal cartilage, articular cartilage and ligaments must be smooth and strong. Problems occur when any of these parts of the knee joint are damaged or irritated.

CRUCIATE LIGAMENTS

Figure 4: Right Knee

There are two cruciate ligaments located in the center of the knee joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are the major stabilizing ligaments of the knee. In figure 4, on the lateral view, the posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backwards on the femur). In the medial view, the anterior cruciate ligament prevents the femur from sliding backwards on the tibia (or the tibia sliding forwards on the femur). Most importantly, both of these ligaments stabilize the knee in a rotational fashion. Thus, if one of these ligaments is significantly damaged, the knee will be unstable when planting the foot of the injured extremity and pivoting, causing the knee to buckle and give way. The abnormal motion causes damage to the surface on the underside of the patella. http://www.arthroscopy.com/sp05000.htm

Common Injuries /Situations

Injuries of the Meniscus (or cartilage) may occur if a person moves, falls, or is injured in some way. Severe injuries may require surgical intervention to repair, more minor injuries may respond to rest, ice, compression and elevation (RICE). Once the initial pain and swelling have subsided, our physical therapists can guide you in returning to your normal activities.

Baker’s Cyst is the term given to a fairly common benign cyst that can develop behind the knee in what is know as the popliteal fossa. The cysts may be painful and may be palpable. A consultation with your medical doctor would be warranted, and many treatment options are available including wait and see, surgical removal or physical therapy treatment.

Anterior Cruciate Ligament (ACL) tear is more frequently injured by females (8 times more often). The ACL is a ligament in the knee that attaches the femur to the tibia. An ACL tear is nearly always associated with a traumatic event and can occur in combination with other injuries such as a meniscus tear and/or medial collateral ligament (MCL) tears. Treatment usually requires surgical intervention followed by physical therapy care to insure proper rehabilitation and return to activities.

Patellofemoral pain is a general term used to describe anterior knee pain. It is typically associated with improper tracking of the patella (knee cap) due to muscle weakness or imbalance causing pain and inflammation around the patella. Treatment usually consists of specific strengthening exercises to the lower extremity to promote proper patellar movement and modalities for pain and inflammation. Other treatment options include bracing.

Osteoarthritis of the knee (also known as Degenerative joint disease) is a wearing down of the joint causing arthritis. There are many potential factors that can lead to arthritis in the knee including obesity, trauma, ligamentous instability and malalignment of the lower extremity. It is usually associated with morning stiffness and pain, chronic swelling, crepitus and grating. Severe cases may require surgical intervention (i.e. total joint replacement). However, many times a proper strengthening and exercise program can possibly prevent surgery and can be equally as effective as surgery allowing an individual to lead a normal nearly pain free life as detailed in the following article, http://www.healthyaging.net/articlelive/articles/18/1/Physical-Therapy-Vs-Knee-Surgery/Page1.html

Patellar Dislocation is more common in women than in men, and typically in younger individuals. The causes of patellar dislocation can be varied including trauma or just an awkward movement. Women are more likely to experience this injury because of their knee alignment, ligament laxity and muscle strength imbalances. Typically a consultation with your doctor is warranted to insure no long term damage was done during the injury. Then physical therapy treatment can be beneficial to facilitate return to normal function and for prevention of future reoccurrences.

Knee Injury Treatment Options

Unfortunately, there are no quick cures for knee injuries. You typically have the option of physical therapy or surgery combined with physical therapy, depending on the severity of the injury.

Physical therapy usually consists of two components: 1) ROM and strengthening – exercises specifically designed to help motion and strength of the knee, and 2) return to function and maintenance – exercises specifically designed to help you return to activity and keep your knee healthy.

BRACING

Different types of knee braces are available to help you return to normal activities. If you think you need a knee brace, ask our physical therapist! We can help you with determining if you need a brace and the right kind of brace for your needs.

There are four main kinds of knee braces: (Familydoctor.org)

  1. Prophylactic braces. These are designed to protect knees from injuries during contact sports like football.
  2. Functional braces. These give support to knees that have already been injured.
  3. Rehabilitative braces. These limit harmful knee movement while a knee is healing after an injury or surgery.
  4. Unloader/offloader braces. These are designed to provide relief to people who have arthritis in their knees.

Knee braces need to fit properly to give maximal benefit. They are best used as a tool to help a person’s knee in combination with a specific exercise program.

GLUCOSAMINE

Glucosamine and chondroitin are two dietary supplements that are used alone or in combination that have been often recommended to help with pain from arthritis pain. Some people have received relief from this supplement but research shows no difference between people that took these supplements and those that took a placebo, http://nccam.nih.gov/research/results/gait/qa.htm . There is no ill effect from these supplements (as long as you’re not allergic to shellfish) and some people do receive significant relief. A three month trial of these supplements would be reasonable for a patient to try to determine if these supplements offer any pain relief and are worth purchasing on a more long term basis.
http://arthritis.webmd.com/tc/glucosamine-and-chondroitin-topic-overview

SURGERY

If conservative measures are simply not enough, surgery has become much more effective and much less intrusive with advances in surgical techniques. The most common form of surgery is arthroscopic surgery, which employs small incisions to access the joint. It involves a minimum of discomfort, has an excellent success rate and heals more quickly as the entire joint isn’t opened up.

The following web site shows information of what the knee joint looks like and types of surgery that are done: http://www.arthroscopy.com/sp05000.htm

Total knee replacements have also advanced considerably for patients with severe arthritis of the knee. Incisions lengths have diminished dramatically allowing for quicker rehab following this surgery due to less muscle being cut to perform the surgery and improvement in the materials used for the replacement joint. This is allowing patients to return back to normal activities in as few as 1-2 months.

Contact your physical therapist for recommendations on orthopedic surgeons in your area that can perform these operations. A good relationship between the surgeon and physical therapist can greatly help the recovery process especially if the patient can start the rehab process before surgery. This helps the patient to recover quicker as the patient becomes familiar with the rehab process and is stronger going into surgery.

After Knee Surgery

The following are some ways to incorporate movement after you have had knee surgery. Your therapist may modify some these techniques depending upon your situation (i.e., age, weight, and procedure). Only do the techniques that are recommended by your physician and/or therapist.

Lying Down

To help promote flexibility in your knee while lying down, place a rolled-up bath towel under your ankle. As your knee straightens, you may feel a gentle stretch in your thigh area.

Sitting Up

For the first few times, your therapist may move and hold your leg. Soon you will sit at the edge of the bed with your foot resting on a small stool without assistance. You may be asked to stretch your operated leg and rest it on a chair.

Standing With Support

For a while your therapist may help you stand. A safety belt may be placed around your waist to support you just in case you feel dizzy. A splint may also be placed around your operated leg to keep it from moving and protect your knee as you stand.

Using a Walker

Once you can stand, you will probably use a walker to help you keep your balance. Initially you will be told to place only a small amount of weight on your operated leg as you walk. As your knee becomes stronger, your doctor will tell you when you can increase the amount of weight placed on your operated leg. Step 1 With both hands lift and scoot the walker and place it a few inches in front of you. Be certain all four legs of the walker are down before proceeding. Step 2 Lean on the walker and let it help support your weight. Step forward and through the walker with your operated leg. Be careful not to wrap your leg around the legs of the walker. Step 3 Hold on to the walker firmly with both hands, then step forward placing your non operated leg though the walker.

Walking with Crutches

Once your knee and leg muscles are strong enough, your physician or physical therapist may recommend crutches instead of using a walker. Your therapist will give you guidelines on how far and how long you may walk. Step 1 With the crutches firmly in place, place pressure on your hands, not on your armpits. Step 2 Move the operated leg and both crutches forward at the same time. Step 3 Looking up and straight ahead, first step through the crutches with the operated leg followed by your non operated leg.

Walking Up Stairs with Crutches

With your crutches upright on the floor and firmly planted for support, lift your non operated leg and place it on the step. Leaning forward on the crutches, lift yourself up. Use the crutches and your non operated leg to support your weight. Now lift your operated leg up onto the step. You may want to have someone help you the first few times until you become comfortable with stairs.

Walking Down Stairs with Crutches

Place your crutches and your operated leg on the lower step. Use the crutches for balance and lower yourself carefully down onto the step moving the crutches as you move the operated leg. Again, you may wish to have someone assist you the first few times you try this.

Once You Are at Home

It is very important that you follow your surgeon’s instructions. The following suggestions should be discussed with your surgeon before your hospital discharge:

http://www.zimmer.com/z/ctl/op/global/action/1/id/527/template/PC/navid/125

While knee surgery may be painful the first week or so, with proper therapy, adherence to your home exercises, and following your MD orders, you will be able to return to normal life quickly. What will you do when you “Feel Good Again”?


RehabAuthority offers the physical therapy solutions such as back pain, shoulder pain and knee pain in Boise and throughout Idaho.