Physiotherapy – Knee

Knee pain is the most common musculoskeletal complaint that brings people to their doctor*. With today's increasingly active society, the number of knee problems is increasing. Knee pain has a wide variety of specific causes and treatments.

It is vital to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have knee pain, some common causes include:

• Arthritis
• Ligament damage
• Cartilage damage
• Dislocated kneecap

Signs to indicate you should see a Physiotherapist

• Inability to walk comfortably on the affected side
• Injury that causes the knee to swell or change shape
• Knee pain that occurs at night or while resting
• Knee pain that persists beyond a few days
• Locking (inability to bend or fully straighten) the knee 
• Swelling of the joint or the calf area
• Signs of an infection, including high temperature, redness
• Any other unusual symptoms

Top tips for an injured knee

Follow the principle of RICE for the first few days - Rest the knee, apply Ice for 20 minutes at a time, Compress by wearing a tubigrip or knee support to help limit swelling and Elevate the knee above the level of the heart which will also help prevent excess swelling.

A chartered Physiotherapist can fully examine your knee to establish what damage may have occurred. They will also be able to provide you with specific advice and a course of treatment which is tailored to you and your specific knee problem. Treatment often consists of a specific exercise and stretching programme and soft tissue treatments.

*Source: www.arthritiscare.org.uk

The most common injury to the Anterior Cruciate Ligament (ACL) is a complete rupture of the ligament. This occurs most commonly following a pivoting movement, landing from a jump or during sudden deceleration.

ACL deficient patients tend to fall into one or two categories; those who are able to return to activity and those who have ongoing symptoms and instability.

Those who do manage to return to activity tend to need a course of rehabilitation to strengthen the muscles around the knee to compensate for the deficient ligament. This could take several months.

Those who have ongoing symptoms may require reconstructive surgery. The general time frame for people following ACL reconstruction is 4-6 months to return to running, 6-9 months to return to activities that involve changing direction and 9-12 months to return to competitive sport.

Signs and symptoms

Patients will often describe hearing a pop or crack followed by immediate pain when the ACL ruptures. More often than not the patient will not be able to continue with the activity. The knee will then normally swell very rapidly with the swelling being contained in and around the knee.

Patients will usually present to a minor injury unit or accident and emergency. Often the knee is difficult to assess in this acute stage but an X-ray may be taken and some indications of an ACL rupture may be present. For an accurate diagnosis, the patient will need to be assessed by their GP, a Physiotherapist or an Orthopaedic Consultant and may require an MRI scan.

The ACL deficient patient will often describe a feeling of instability, such as giving way, which usually occurs during changes of direction or pivoting, as well as during sporting activities if they have managed to return to sport following the injury. There is a possibility of other structures being injured alongside the ACL, most commonly the meniscus. This may add symptoms including catching, locking, painful clicking and recurrent swelling.

How physiotherapy can help

In all cases of ACL injury, Physiotherapy is essential. In the non-surgical patients will require guided rehabilitation with a strong focus on strengthening, stability training and sport-specific exercises. For those who undergo ACL reconstruction, they will require on average of 6 - 9 months of regular Physiotherapy to guide them through the stages of rehabilitation and advice on the protection of and maximisation of the rebuilt ligament as well as guidance regarding return to sport.

If you suspect that you have sustained an ACL injury it is very important you follow the RICE principal immediately after the injury. That is you Rest the knee, Ice it, apply gentle Compression and Elevate it. It would also be extremely beneficial to attend our rapid assessment sports injury clinic in the Physiotherapy Department or a minor injuries unit in your local area.

For those not undergoing reconstructive surgery, you will need to spend time focussing on strengthening your quadriceps, hamstrings and core stability muscles as well as improving your balance.

If you have sustained an ACL injury in the past and you continue to have symptoms and have not managed to return to your desired level of activity you should see your GP with the view to being referred to an Orthopaedic Consultant.

The meniscus is a cartilage structure within the knee. Its function is to help to reduce friction, improve shock absorption and improve the fit (congruence) of the bones within the joint. This structure is commonly injured and can result in pain, absence from sport and pain with activities of daily living. The most common way this structure is injured is by twisting the knee with a planted foot. The meniscus can also become frayed and injured through general wear and tear and the degeneration process.

Signs and symptoms

Following a meniscal injury the patient will often report a build-up of swelling and pain over a period of 24 hours. They will often have tenderness along the sides of the knee and can experience a painful clicking with knee movements. Sometimes the knee will also 'lock', that is when the patient is unable to fully straighten or bend the knee. The patient may also complain of a feeling of instability in the knee during daily activities or sport.

How physiotherapy can help

In the acute phase following a meniscal injury, physiotherapy can be helpful in providing and accurate diagnosis and in managing the painful symptoms. Some minor meniscal injuries can be managed conservatively, that is through physiotherapy treatment and prescription of appropriate exercises. Others may need to go on to have surgery. This is often keyhole (arthroscopic)  surgery and has a quick recovery time. Post operatively physiotherapy is very helpful in helping the patient return to full strength, range of movement, activities of daily life and sports. The general recovery time following meniscal surgery is between 2-3 months.

The medial collateral (MCL) is the ligament that runs from the inside of the femur (thigh bone) to the inside of the tibia (shin bone). It is most commonly injured when there is an outwards to inwards stress placed across the knee when it is slightly bent; for example, when someone falls across the knee during a football tackle. There can be several degrees of tears to the MCL from a minor tear often called a grade I, through to grade III which is a complete rupture.

Signs and symptoms

Patients who have injured their MCL will often report a pain on the inside aspect of the knee joint. There may be a localised swelling and bruising. In the case of more severe tears many will describe an unstable or ‘wobbly knee’ when walking. Complete MCL tears are often associated with injuries to the anterior cruciate ligament (ACL).

How physiotherapy can help

Physiotherapy is essential in the early diagnosis and management of MCL injuries. In the case of a high grade tear patients will respond best if braced and supplied with crutches to reduce the amount of weight going through the knee. This devices need to be supplied and fitted by an experienced physiotherapist. The management of a mild MCL injury is primarily through physiotherapy. During session a focus will be placed on improving muscle strength and joint stability whilst helping enhance recovery time and minimising the effects of an acute injury, like scar tissue formation.