Ultimate guide to  your knee pain

Written by Bethany Elliott-Hutton

The knee joint is the biggest joint in the body and is located between the bones of the upper leg (femur) and the lower leg (tibia and fibula). The knee joint supports our bodies in motions of walking, running, jumping, crouching and turning. The knee joint also provides stability to help support the weight of the body.

Knee pain is a common complaint among the general population, and has many different causes ranging from general age related changes from daily activities, to acute injuries or complications of medical conditions.

Knee ligament injuries: There are four main ligaments in the knee that help to stabilise the knee joint. They connect the thigh bone to the lower leg bones. Knee ligament sprains and tears are very common sports injuries and commonly occur to the; medial collateral ligament (MCL), posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) . Any ligament injury can result in severe knee pain in the area of the damaged ligament and depending on the severity could require surgery.

Meniscus tears: A meniscal tear is a common injury and depending on the severity, age and activity level of the individual may require surgery. Unlike a ligament injury that can happen in a variety of different ways a meniscal tear typically occurs from a single twisting movement, where the foot is planted and the knee twists.

Osteoarthritis of the knee: osteoarthritis is a highly prevalent form of arthritis of the knee joint. It is a type of arthritis which is due to the progressive wearing of the cartilage of the knee joint causing pain and inflammation of the knee. It is more common in individuals 50 and over however certain factors other than age can increase the likelihood including weight, genetics, injuries, infections and illnesses such as gout.

Tendonitis: overuse of the tendons can result in pain and inflammation, this is known as tendonitis. The most common tendon to become affected in the knee is the patella tendon. This tendon connects all four quadriceps muscles and attaches them over the knee cap (patella) and inserts onto the front of the shin bone (tibia). Inflammation of the patella tendon is more commonly known as jumper’s knees or patellofemoral tendonitis. It is most often a result of over use of the tendon during sports such as basketball and running. It is a consequence of there being repetitive stress on the knee, creating tiny tears in the tendon.

Bursitis of the knee : bursars are tiny fluid filled sacs that reduce friction and provide cushioning to pressure points between the bones and tendons, muscles and skin. There are more than 10 bursae located in and around the knee joint. Bursitis happens when one of the fluid filled sacs becomes inflamed. This can happen for a number of different reasons, including repetitive pressure on a certain area of the knee, sudden injury or trauma, or can be a secondary result caused by osteoarthritis. Symptoms of bursitis of the knee include swelling, warmth, pain and stiffness in and around the knee joint.

Chondromalacia patella : also known as runners’ knee, chondromalacia patella is a condition in which the cargitalge on the back of the kneecap is softened and weakened resulting in damage to the cartilage. It is more common in females than males and is associated with poor knee alignment or imbalance in the tightness of the muscles around the knee.

Hoffa’s Syndrome: also known as infrapatellar fat pad impingement. Hoffa’s syndrome is a condition in which a fat pad, known as the Hoffa’s fat pad becomes impinged, causing pain at the front of the knee. it is. It is more common in individuals who are hypermobile, this is commonly seen in younger women, dancers and gymnasts.

Osgood Schlatters: is a common cause of knee pain in growing adolescent males. It can cause a painful, bony bump on the shin bone below the knee in an area known as the tibial tuberosity. It is a self limiting disorder which usually resolves as the individual grows older. The condition occurs during growth spurts when the bones, muscles and tendon are growing, resulting in a tug of war type tension pulling on the tibial tuberosity.

ITB syndrome: The IT band is a strong piece of connective tissue that originates from the gluteus maximus muscle and tensor fascia lata and attaches into one of your shin bones known as the fibula. The IT band works with your knee ligaments to stabilize the knee. ITB syndrome is a common overuse injury in runners and sports men and women. When the ITB becomes tight or inflamed it can create pain discomfort around its insertion point on the outside option of the knee.

Rheumatoid Arthritis: this is a long term autoimmune condition which causes pain swelling and stiffness in the joints. It can affect more than one joint in the body and most commonly affects the wrists and hands, however it can be found in the knee joint.

Gout: this is a more complex type of arthritis in which crystals form inside the joint. Gout can cause sudden onsets of severe pain and swelling in the joints. The most common joint to be affected is the big toe, however it can also affect the knee joint.

You don’t always have to see your GP to have knee pain diagnosed. Physical therapists such as osteopaths and physiotherapists are able to diagnose many causes of knee pain. During your consultation a precise case history taking of your symptoms and thorough physical examination will be taken to help diagnose and understand the cause of the knee pain.

Within your physical assessment the practitioner may carry out a series of tests including; an assessment of your posture, orthopedic tests, testing of your reflexes, testing the strength of your muscles and nerve stretch tests.

In some cases further testing may be required, this may include:

X-ray imaging – unnatural alignment and disruption of the bones in the knee can be identified using X-ray imaging. Age related changes can also be see within the bones using this technique. If osteoarthritis of the knee is suspected, this form of imaging may be required.

Magnetic resonance imaging (MRI) – abnormalities within the soft tissues of the body can be highlighted using MRI. These soft tissues include the muscles, ligaments, cartilage, and menisci. If ligamentous damage of the knee is suspected, this type of test may be requested.

Blood tests – despite not being used regularly to diagnose knee pain, blood tests can be utilised to assist in identifying increased inflammation, infection or autoimmune diseases. These diseases include gout and rheumatoid arthritis.

The original cause of the knee pain will dictate the type and duration of treatment required.

Non- surgical options include:

Physical Therapy: receiving a treatment from one of our osteopaths or physiotherapists (physical therapists) can help you relieve your discomfort that has arisen as a result of the knee pain. Physical therapists typically use a range of beneficial hands on techniques. These techniques have been reported to:

• Improve the efficiency of blood flow and circulation to the affected area. This helps improve the body’s natural healing response.
• Release tight muscles to allow for improved functionality and movement ability.
• Stretch tight muscles to allow for improved functionality and movement ability.
• Release endorphins. These are hormones that circulate the body and act as natural pain relief.
• Strengthen the muscles through a comprehensive exercise programme.

Your physical therapist will also advise you about pain management techniques, including the use of hot and cold therapy along with advice about returning to activity.

Exercises for your knee pain may also be prescribed to you by your osteopath or physiotherapist. These will be exercises specific to improving the mobility and strength in the muscles surrounding your knee as well as improving your posture. The exercise programme will be controlled and progressive, tailored specifically to the underlying cause of your knee pain. Adherence to the exercises plays a key part in preventing the return of your knee pain.

Medication for knee pain: if you decide to visit your GP, depending on the severity of your pain they may prescribe you with some oral medications to help you with relieving your symptoms:

• Over the counter painkillers and anti inflammatory medications are prescribed as they can help with the pain and inflammation experienced due to the knee pain.
• Prescription muscle relaxant medication such as diazepam may be prescribed to help with muscle spasms.

Hydrocortisone Steroid Injections: in some cases your GP may recommend a steroid injection to help you with your pain. The hydrocortisone is injected directly into the joint, this is known as an intra-articular injection. The aim of the injection is to give you temporary relief from your knee pain, it does this by reducing the inflammatory response in specific tissues surrounding the knee joint.

If following non invasive forms of treatment, no response occurs, surgery may be considered. Please contact your orthopedic surgeon if you wish to discuss potential invasive treatment options. For some injuries such as meniscal tear or ligament damage surgery is needed before physical therapy can be continued. The type of surgery selected would depend on a few different factors:

• Origin and cause of knee pain
• Patients age
• Patients mental health status
• Capacity to navigate through everyday life

It should be noted that prevention of all knee pain is not possible. However there are a few ways to reduce your risk and protect your knees from any further injury.

Exercise: Having good strength in the muscles surrounding your knees is key in providing stability to your knee joints. Exercises such as Pilates not only helps in improving strength and stability to your knees but it also helps in improving the body’s overall posture and balance. This is important as it helps to equally distribute pressure through the joints, protecting the knees and making sure they don’t sustain too much pressure. Having strong and subtle hip, leg and buttock muscles also help into taking the pressure off your knees. Book in to one of our trial classes to see how Pilates may help you and your knee pain.

Maintain a healthy weight – being overweight increases pressure on all of your joints, especially the joints of your lower extremities including your; knees, hips, ankles and feet. Excess strain or weight put through your joints has been shown to increase your risk of osteoarthritis.

Wear supportive and comfortable shoes – wearing shoes that are a correct fit, comfortable and supportive help take the pressure off your knee joints. Correctly fitted shoes promote proper leg alignment and aid in the equal distribution of weight through the feet.

Wall Squat: Stand up against the wall with your back resting on the wall. Place your feet hip distance apart and feet moved slightly away from the wall. Inhale, on the exhale slide down the wall keeping your upper body in contact with the wall, go down to where your thighs are parallel to the ground. Inhale, on the exhale squeeze your buttock muscles and push back up into the standing starting position. Repeat 10 times.

Shoulder Bridge: lie on your back with your knees bent and feet hip distance apart. Place a small ball or cushion in between your knees. Inhale, on the exhale squeeze your bottom muscles and lift your tailbone up towards the ceiling, continue this movement until you are resting on your shoulder blades. Inhale to hold the position, exhale to lower the shoulder bridge down. Repeat 10 times.

Calf stretch: stand and place one foot against the wall. Place the other leg behind you in a split stance position, keeping the feet parallel and knees straight. Inhale, on the exhale push the hips forwards to feel a gentle stretch down the back of the calf. Hold for 20-25 seconds and repeat 5 times on each leg.

Clam: lie on your side with your knees bent to 90 degrees and hips bent to approximately 45 degrees. Make sure your hips and shoulders are stacked. Inhale, on the exhale keeping your feet together lift the top knee upwards, separating the knees. Inhale to lower the top knee onto the bottom leg. Repeat 10 times on each side.