Common injuries we can treat at the knee
Ligament sprains, such as cruciate ligament and collateral ligament tears
The knee has four ligaments holding it in place and giving the knee stability needed when changing
directions, accelerating and decelerating. There is one at each side of the knee to stop movement
sideways (collateral ligaments) and two in the middle of the knee joint to prevent the bones sliding
forward and backwards (cruciate ligaments). These cruciates also have an important role in giving
sensory information to your brain about the knee’s positions.
Ligaments can be injured by twisting the knee, usually while weight bearing. Commonly a quick
change of direction such as on the football field or netball court is the cause of the injury. Impact
injures such as from a tackle can also sprain the ligaments. Ligaments can sustain a partial or
complete rupture. These injuries are quite easy to diagnose due to the extent of swelling which is
typically proportionate to the extent of ligament injury, cause of injury and suddenness of the onset
of pain.
Physiotherapy treatment involves good diagnosis and controlling the swelling and pain through ice
and compression. Management will then take the conservative (non-operative) or operative path,
depending on the severity of the ligament injury as assessed for joint stability and scans, feelings of
weakness and giving way and high pain levels persisting after the first 3-4 weeks.
Both management options require a very intensive rehabilitation phase to address good knee
mobility, stability, strength of the leg and pelvis and sensory information levels to the brain.
Cartilage (meniscal) tears
Each knee contains two menisci (or discs of cartilage) between the two joint surfaces. Their main
function is to distribute the weight evenly in the leg as a shock absorber would in a car and to
prevent damage to the knee joint.
These menisci are susceptible to tears in sports involving swift changes of direction. This usually
occurs on a bent knee whilst the foot is anchored to the ground. This sort of injury typically involves
the knee ligaments also.
Often, meniscus can erode and commonly become torn in people over 40 years of age.
Meniscus injuries cause pain along the knee joint, particularly on a bent knee. It is difficult to sit on
your haunches with knees bent due to pain. Locking and clicking of the knee are also other common
complaints and there is usually swelling at the knee joint.
Sports Physiotherapists are typically the first to pick these injuries up through excellent diagnostic testing
of the knee joint. Dependent on the degree of symptoms, referral onto an Orthopaedic surgeon
for keyhole surgery can be indicated (arthroscopy). This is a quick day procedure which involves
trimming and cleaning out the knee where the meniscus is torn. Outcomes are excellent for this
surgery. Post surgery, your physiotherapist will start deep tissue massage and an exercise program
to strengthen the muscular support around the knee can better long term prognosis for a return to
activity and sport.
Patello-femoral pain ( anterior knee pain) or ‘Runner’s Knee’
This pain occurs as a result of changes to the alignment and also under surface of the knee cap or
patella. It is caused by the imbalance of muscular control of the knee cap arising form the thigh
muscles or quadriceps. There is often other factors also at play, such as poor foot positions such as
over pronation, tight calf muscles or poor strength of the hip and pelvis needed for stability of the
leg.
Pain is felt at the front of the knee, and can be either achy such as with prolonged sitting postures
with the knees bent, or sharp such as when walking up stairs or running.
Physiotherapy treatment of this injury requires excellent assessment of the entire pelvis-hip-knee-ankle chain
for weaknesses and changes in alignment. Pain and swelling is managed early. Massage, taping and an
exercise program to restore good balance is essential medium to long term.
Osteoarthritis
As with the hip, osteoarthritis is common in the knee joint. This is because it does an awful lot of
work for you every day. This can cause erosion and slow wear and tear of the joint surface made of
cartilage.
Pain from osteoarthritis can be very mild to debilitating and total or partial knee replacements
surgically are a common consideration when life becomes limited by pain and lack of mobility. This
is in the most extreme of cases and most people with osteoarthritis of the knee can manage with a
good balance or, rest and exercise, stronger muscles to support the knee joint and keeping their
weight down.
Physiotherapy treatment of the arthritic knee involves restoring good alignment of the knee and
will often involve taking a look further up the chain to the pelvis and hip. Gentle mobilisation and
massage to restore better movement of the knee and knee cap and a strengthening program is
also typical. A good balance between some exercise but not too much is really the key.
Iliotibial band syndrome
The iliotibial band (ITB) is a superficial muscle and tissue that runs down the outside of the thigh
from the pelvis to the outer knee, attaching to the knee cap. Its role is stabilise the knee and the hip
when weight-bearing and is under great loads when running or cycling. It is the one of the leading
causes of both hip and knee pain in runners and walkers.
Pain is typically localised to the outer knee or hip. There can be further pain in the front of the knee
in and around the patella as the positioning and movement of the patella or knee cap is altered due
to the ITB tightness.
Physiotherapy treatment of this injury includes deep tissue massage of the ITB, thigh and buttock
muscles. This along with a home program of stretches can lengthen the muscle and cause less
friction on the outer knee and pulling of the patella into a poor alignment. Medium to long term
management involves a strict pelvic, hip and Pilates and core stability program core stability program. This can ensure good muscular
balance about the hip and knee to prevent further tightening or overuse of the ITB tissue when back to running or cycling.
