Meniscal tear

The menisci are two ‘cushions’within the knee to help support the joint and improve congruency in the joint. A torn meniscus can happen at any time. It normally occurs due to trauma when we are younger but can happen with simple activities, such as getting twisting when walking, as we get older. Symptoms often include pain around the joint especially on a full bend or extend. Swelling may also be present which will also affect have far the knee can extend. If a portion of the meniscus gets caught the knee will ‘lock’ wherein movement is very difficult and you often need a specific movement to unlock it. Treatment will initially involve relative rest and activity modification. This is to allow the swelling to settle. It is essential to keep the leg working correctly as muscles often ‘shut down’ in the presence of swelling and pain. Massage will also help to flush the swelling and release areas of compensatory tightness. If arthroscopy surgery is indicated to trim the torn meniscus post operative surgery will be required to get the knee integrated back into the body and working to 100%.

Patello Femoral Pain

Patellofemoral pain is a term for pain anywhere around or behind the knee cap. It often ‘creeps’ up upon us but may be as a secondary result of trauma to the hip, knee or foot. Symptoms consist primarily of pain, especially on bending and using the stairs. Swelling and tenderness around the area can also be present. The knee is a ‘slave’ to the hip above and the foot below, and it is often a problem in one of these two areas that leads us to feel symptoms in the knee region. When harmony between these joints is disrupted the knee cap becomes irritated as it grinds on the surface of the femur. Depending on how chronic the condition is, pain free results can usually be achieved quite quickly. Physiotherapy also plays a vital role in screening and therefore the prevention of knee pain arising in the first instance. Treatment should consist of a mixture of hands on releases and home exercises.

ACL Rupture

The ACL is an important ligament contributing to the stability of the knee. A rupture of this ligament is normally as a result of a single traumatic event and it is common to require surgical intervention to repair the ligament. It is however of paramount importance to assess why the knee didn’t manage to support the activity thus resulting in rupture of the ligament. Physiotherapy plays an integral role in both diagnosing the injury and the contributing area of weakness in the lower limb. A guided physiotherapy exercise programme is also imperative for post surgical recovery and longevity of the new ligament graft. Rehabilitation should include strength and mobility of not only the knee but of the whole leg, hip, core and trunk region.

Fat Pad Syndrome

Inflammation of the fat pad, which sits under the patella (knee cap), can be as a result of direct trauma to the area, as a result of knee arthroscopy, or micro trauma from repeated hyper extension of the knee when walking. Pain experienced is often poorly localised but swelling can be obvious under and around the patella. Symptoms often feel worse with prolonged standing, walking and descending the stairs. An in depth assessment of standing posture and single leg control is of paramount importance. Taping can assist initially but guided postural correction and corrective leg exercises are the better approach.

Runners Knee/ ITB Syndrome

‘Runners knee’ is inflammation of the lower end of the ITB (iliotibial band) as it crosses over the side of the femur at the knee joint. Repetitive friction causes irritation and subsequent pain as the knee bends and straightens. Symptoms are felt at end of range extension and normally arise after exercise has commenced and then will die down after the movement has ceased. It is often felt with running but can even be felt with walking and using the stairs. Runners knee is a biomechanical problem related to control and positioning of the leg in motion. Treatment therefore requires an assessment and corrective exercise treatment of the pelvis, hips and feet to ensure optimum stability of the leg. As the ITB is incredibly strong and thick, massage alone will not ease the problem, and can actually exaccerbate the issue if performed too forcefully.

Osgood Schlatters Disease

Osgood-Schlatter disease is actually not really a disease. It is an inflammation of the insertion of the patella tendon as it inserts near the growth plate of the shin bone (At the tibial tuberosity). This is where the thigh muscle attaches onto the shin below the knee. The condition usually occurs in younger active boys and girls coinciding with a period of growth and a high level of activity. It actually occurs more frequently in boys than in girls. The bones tend to grow a little quicker at certain periods of time and the attachment of the muscle onto a relatively immature tibial tuberosity can get inflamed. As well as getting inflammation of the tendon, small ‘avulsion’ fractures can occur. This is where a small piece of bone is pulled away from the tibia. This leads to excess bone growth in the tuberosity, thus producing a visible lump which can be extremely painful when hit or knocked. The primary symptom is pain over the tibial tuberosity that occurs during activities such as running, jumping, squatting, and especially going up and down stairs. Often this condition is treated poorly by physiotherapist and orthopods as the general idea is that youth wil “grow out of it” However, there is an enourmous amount that can be done to minimise pain, prevent development of a large lump, and get back to activity as seoon as possible. Treatment should include relative rest, ice, and oral anti inflammatories if required. Taping techniques can make an immediate difference to the pain levels with activity and can be used frequently. As much of the problem comes from tension in the muscles around the hip and knee, local tissue releases and stretches have an important role in correct rehabilitation. It is extremely important to make sure that there are no other factors involved in lower limb biomechanics that may be causing excessive load in the knees as this may hinder recovery. Often sufferers display weaknes sin the hips and core which must be addresses ad soon as possible. The condition usually resolves in a few months as growth settles.