The knee joint is a complex structure of bones, ligaments, muscles, cartilage and the joint capsule. This anatomy lends itself to a multiple of injuries ranging from ACL tears to other ligament sprains and tendon strains. Direct trauma, as well as wear and tear, also contributes to some knee injuries. Most knee injuries will usually require physiotherapy. Some of the more common knee injuries are discussed here.
Anterior cruciate ligament (ACL) injuries
The anterior cruciate ligament (ACL) is one of the four main ligaments in the knee. It binds the back of the thigh bone (femur) to the front of the shin bone (tibia). If the ACL is damaged the knee becomes unstable and may feel like it is “giving way”. ACL injuries are very common and mostly occurs in sports that involve a pivoting (twisting) action of the knee such as skiing, football, netball, soccer, basketball and gymnastics. Women are significantly more vulnerable to ACL injuries because of the difference in the anatomy of the knee, which results in a weaker ACL.
The injury usually occurs without contact from another player and may result from an awkward land from a jump, pivoting at the knee or running and stopping suddenly. In all these cases excessive force may be placed on the ACL and it snaps.
The symptoms of an ACL injury are:
- A feeling of initial instability, the athlete will describe something “going out”
- Extensive swelling
- Intense pain immediately after sustaining the injury
- There is usually an audible pop or crack at the time of injury
- Inability to fully straighten the leg or continue with the sport
- Possible widespread mild tenderness
Treatment for an ACL injury may necessitate surgical reconstruction, or it may be non-surgical. There are many factors to consider when deciding on surgical intervention including whether the patient wants to return to pivot related sport and if they are prepared to have the time off work to recover from surgery among other issues.
Non-surgical intervention includes the wearing of a knee brace to provide stability and physiotherapy which may involve ice, heat, ultrasound, passive mobilisation of the knee joint, specific taping techniques and strengthening exercises of the surrounding muscles to stabilise the knee and prevent re-injury as well as mobility and functional/sport-related exercise until full recovery has occurred.
If surgery is indicated, a pre-surgery physiotherapy programme will be implemented to help strengthen the joint and reduce swelling, thereby ensuring a successful surgery.
Following surgery, the joint loses flexibility and the muscles around the knee tend to atrophy (or get smaller). This requires physiotherapy to strengthen the muscles and increase range of motion. The programme begins with ice, heat or ultrasound to manage pain and swelling. This is followed by range-of-motion exercises and then by exercises to strengthen the joint and the surrounding muscles. Walking, swimming or cycling is helpful at this point to maintain fitness. The physiotherapy programme following ACL repair is intense and structured so that there is a gradual return to full functional activities and sport. As rehabilitation progresses, the exercises become more advanced and specifically related to the athlete’s sport, ACL rehabilitation may take a few months, but in the end, you will be able to return to the playing field.
Patellar tendinopathy (Jumper’s knee)
Patellar tendinopathy is often referred to as Jumper’s knee because of its high rate of incidence in athletes who performing jumping activities such as volleyball players, high jumpers, basketball players and netball players. It is a chronic condition that affects the patellar tendon, which is the tendon of the quadriceps muscle as it inserts into the tibia (shin bone).
Signs and symptoms of patellar tendinopathy include pain at the front of the knee which is aggravated by jumping or squatting, pain when straightening the knee and tenderness over the patellar tendon.
Patellar tendinopathy rehabilitation is intense and the condition is difficult to overcome. Those who suffer from it may expect a rehabilitation programme to take anywhere between 3-12 months. Avoiding jumping is crucial to recovery in the beginning. Physiotherapy treatment involves pain-relieving modalities such as ice and ultrasound, soft tissue massage and trigger point therapy, correcting biomechanics so there is less strain on the knee by correcting foot posture with orthotics, strengthening the quadriceps muscle with a specific strengthening exercise programme which is graduated for a full return to sport.
Patella dislocation
The patella or kneecap is a protective bone at the front of the knee that assists the quadriceps in straightening the knee. It can become dislocated when it moves out of the groove in which it rests at the front of the thigh bone. This type of knee injury can occur through a sudden twisting movement or as a result of a blow to the knee.
With a patella dislocation, the patella moves out laterally (towards the outside edge of the knee). There may be an audible crack or pop and a feeling of the knee giving away. Pain, swelling and difficulty with mobility as well as obvious displacement of the kneecap are other symptoms. An x-ray should always be performed after a patella dislocation to rule out any associated fracture.
Quite often when the knee is extended (straightened), the dislocation will spontaneously resolve, meaning that the patella goes back into its correct place. Sometimes though, it requires manual assistance to relocate it. After the doctor has repositioned the patella, he will prescribe pain medications and then physiotherapy rehabilitation begins which may involve pain relieving techniques such as ice, compression, taping and ultrasound.
The most important part of physiotherapy treatment for patella dislocation is to prevent a recurrence of the injury, which is quite common. Therefore we will focus on exercises to strengthen not only the muscles surrounding the knee but also the core stabilising muscles to control the pelvis and give the leg greater stability. We will give you a graduated and specific strengthening exercise programme to help you to return to your normal sporting activities.
For these and any kind of knee injuries, please come in or call us now to make an appointment
Patellofemoral (knee cap pain or PFJ syndrome)
The patellofemoral (knee) joint is the largest joint in the body and the most easily injured. The patella (knee cap) fits in a groove between where the femur (thighbone) meets the tibia (shinbone). The knee is also made up of ligaments, which connect bones and help control motion. Patellofemoral pain or patellofemoral joint (PFJ) syndrome refers to pain in and around the patella.
There are many contributing factors to patellofemoral pain which include injury to the fat pad of the knee joint, poor biomechanics and foot posture such as overpronating (flat) feet, tight or weak quadriceps, gastrocnemius or hamstring muscles and tight iliotibial band, weak core stabilising muscles, poor technique with sport or overtraining.
Symptoms of PFJ syndrome are:
- Non-specific, vague pain around the patella
- Mild swelling
- Tender to touch along the borders of the patella
- Pain worsens when descending stairs or running downhill
- There may be a feeling of the knee giving way
- A cracking sound may be heard when the knee is bent
- Temporary loss of function
If you suffer this kind of injury you should use the RICE protocol in the acute phase.
- Rest the knee by staying off it or use crutches.
- Ice the knee to reduce pain and swelling.
- Compression with an elastic bandage helps to reduce swelling and pain.
- Elevate the knee to reduce inflammation.
Your doctor may prescribe anti-inflammatory medications. If you have overpronated (flat) feet, you may need to see a podiatrist for orthotic foot supports.
Physiotherapy may involve the use of ultrasound, ice, heat or electrical stimulation to relieve pain. A big emphasis is placed on taping techniques to stabilise the knee and on specific strengthening exercises. It is very important to strengthen the core stabilising muscles of the pelvis and leg. Manual therapy such as mobilisation of the patella, soft tissue massage and trigger point therapy of tight muscles and structures around the knee also help with recovery and prevent a recurrence.