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Anterior Crutiate Ligament (ACL) Injury/Tear
One of the most common knee injuries is an anterior cruciate ligament sprain or tear. Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their ACL. Tears in the ACL generally occur when placing excessive strain on the ACL. This usually happens suddenly in a specific accident, however, it may occur due to repetitive strain in some cases.
There are three main movements which place stress on the ACL:
• twisting the knee
• hyperextending the knee
• forward movement of the tibia on the femur
SYMPTOMS
• audible snap or tearing sound at time of injury
• increased pain, swelling and stiffness morning after activity
• pain felt deep within knee, difficult to localize
• feeling unstable (knee going out and back in), collapsing
• considerable swelling, bruising
How can physiotherapy help you?
An experienced Physical Therapist can generally diagnose an ACL tear through a thorough assessment. Once assessed, you will be given exercises and treatment to mobilize the knee joint, improve flexibility and strength, as well as improve lower limb balance. There are a variety of other methods such as ultrasound, taping and bracing which may used, but these will vary on a case-to-case basis.
Chondromalacia Patellae
The injury occurring in the patellofemoral joint goes by many other names besides Chondromalacia Patellae. You may have heard your injury referred to as Patellofemoral Pain Syndrome (PFPS), Patellofemoral Joint Syndrome (PFK), Anterior Knee Pain, or Runner’s Knee. This condition is seen particularly in runners, adolescents going through growth spurts, or older patients with degenerative joint changes.
Pain in this joint is usually result of inflammation or tissue damage to the patellofemoral joint structures. What is the patellofemoral joint? Here’s a visual: the knee cap sits in front of the femur forming a joint in which the bones are almost in contact with each other. The surface of each bone, however, is lined with cartilage to allow cushioning between the bones. This joint is called the patellofemoral joint. Usually, the patella aligns in the middle of the joint so any force applied during activity is evenly distributed, but in patients with Chondromalacia Patellae, the patella is generally misaligned relative to the femur, which places more stress on the patellofemoral joint. This is what causes the tissue damage or inflammation.
SYMPTOMS
• pain at front of the knee, and around/under the knee cap
• pain (in some cases) at back of the knee or inner/outer aspects
• ache which becomes sharper with activity
• ache/stiffness increasing with rest (at night or early morning) after activity
• pain when sitting with knee bent for long periods
• clicking or grinding sound when bending/straightening knee
• walk with limp, episodes of knee collapsing
How can physiotherapy help you?
The Physiotherapist will be able to diagnose Chondromalacia Patellae through a thorough assessment. After the assessment, the patient will be given progressive exercises to improve flexibility, balance and strength (focusing on VMO muscle). The Physiotherapist will help to manually mobilize the joint, as well as loosen contributing muscles. Taping or bracing may be recommended, as well as other treatments (i.e. electrotherapy) depending on the patient’s individual injury.
Iliotibial Band (ITB) Syndrome
Iliotibial Band (friction) Syndrome, or ITB Syndrome, is a condition which is common to runners and occurs due to overuse and/or poor technique. It typically causes pain at the outside of the knee where the iliotibial band (ITB) crosses the knee joint, but there can also be accompanying pain in the hip. ITB syndrome occurs when the iliotibial band rubs against a bony prominence at the outer aspect of the knee (the femoral epicondyle) and typically causes inflammation and/or damage to the ITB as well as local tissue.
SYMPTOMS
• Pain at outer aspect of knee or hip
• Ache which sharpens with activity
• Pain while bending/straightening knee (esp. when weight bearing)
• Worst pain in morning or after activity
• Knee stiffness, limping, collapsing
• Swelling
• Grinding sound when bending/straightening knee
How can physiotherapy help you?
A thorough assessment by the Physiotherapist will be able to detect ITB Syndrome. The treatment will focus on mobilizing the joint and the patient will receive exercises to improve flexibility, strength and balance in the knee. Exercises may also work on core stability and correcting strength imbalances. The PT will work to loosen the ITB muscle as well as other contributing/affected muscles. For some patients, an ITB Strap (to stabilise/compress during activity) may be recommended, as well as other treatment methods at the Physiotherapist’s discretion.
Knee Replacement Surgery
Total Knee Replacements, or Total Knee Arthroplasty, are performed by a surgeon to treat severe osteoarthritis, rheumatoid arthritis, ligament damage or infection, gout, avascular necrosis, bone dysplasis and some tumours.
Symptoms after the surgery may include:
• stiffness, ache, and soreness
• swelling
• pain in front, back or sides of knee (sometimes calf, ankle or foot)
• increased pain with weight bearing activity
(walking up hill, bending, straightening or twisting knee, climbing stairs, kneeling,
standing still)
• limping
• tenderness, bruising, pins and needles, numbness
How can physiotherapy help you?
The Physiotherapist, in partnership with the patient’s surgeon, will design a program to rehabilitate the patient and speed healing. This will include progressive exercises to improve flexibility, strength (esp. quad muscle), and balance in knee. The Physiotherapist will help to manually mobilize the joints and loosen tight muscles. A compression support may be recommended during activity. The Physiotherapist may also use other methods (i.e. heat, electrotherapy) on a case-by-case basis.
Lateral Collateral Ligament (LCL) Injury/Tear
An LCL tear or LCL sprain is a fairly common sporting injury where the Lateral Collateral Ligament, located at the outer side of the knee, is torn. The LCL is a very important ligament for the knee as it gives it stability. The LCL prevents excessive twisting and side-to-side movements of the knee. When these movements become more than the LCL can withstand, this results in the tearing. The injury can range from a small tear with minimal pain to a full LCL rupture.
SYMPTOMS
• audible snap or tearing sound at time of injury
• increased pain, swelling and stiffness after activity (first thing next morning)
• pain in outer aspect of knee
• rapid swelling, bruising
• feeling unstable (knee going out and back)
How can physiotherapy help?
An experienced Physiotherapist will be able to diagnose the LCL tear during a thorough assessment. The patient will receive exercises to improve flexibility, strength and balance in the knee. They may also prescribe crutches and/or taping and/or a bracing device. The Physiotherapist may work to manually mobilize the joint and ease off tight muscles.
Meniscal Tear (Lateral or Medial)
A meniscus tear involves the tearing of cartilage tissues within the knee joint located at the outer (lateral) or inner (medial) aspects of the knee. The knee joint is the union of two bones: the long thigh bone (femur) and the shin bone (tibia). Between the bone ends are 2 round discs made of cartilage called the medial and lateral meniscus. These discs act as shock-absorbers for the bones during weight-bearing activities. This injury occurs when excessive weight-bearing or twisting forces causes the meniscus to be torn or damaged so that the surface is no longer smooth. Meniscal tears are common in sports which require sudden changes in direction as well as twisting movements (i.e. soccer, football, basketball, skiing).
SYMPTOMS
• sudden, sharp pain at time of injury (sometimes audible sound and tearing sensation)
• pain with weight-bearing activity and twisting
• pain when climbing stairs, kneeling or squatting
• swelling and tenderness
• weak, unstable feeling
• clicking, locking, collapsing
How can physiotherapy help you?
The Physiotherapist will usually be able to diagnose a meniscus tear during a thorough assessment. The patient will receive progressive exercises to improve flexibility, balance and strength (especially VMO muscle). The Physiotherapist will work to mobilize the knee and may tape the knee or recommend the use of a brace/crutches. Other methods of treatment (i.e. ice, heat, electrotherapy) may be used by the Physiotherapist based on the specific injury.
Medial Collateral Ligament (MCL) Injury/Tear
An MCL Tear or Sprain, is a fairly common sporting injury which occurs when the Medial Collateral Ligament in the knee is torn. The tear generally occurs suddenly in an accident, though it may occur due to repetitive strain in some cases. Injury occurs during activities which place excessive strain on the MCL, generally involving one of these two main movements:
• twisting of the knee
• valgus forces on the knee
SYMPTOMS
• audible snap or tearing sound at time of injury
• increased pain, swelling and stiffness after activity (first thing next morning)
• pain at time of injury
• stiffness and bruising over coming days
• feeling unstable (knee going out and back)
How can physiotherapy help?
An experienced Physiotherapist will be able to diagnose the MCL tear during a thorough assessment. The patient will receive exercises to improve flexibility, strength and balance in the knee. They may also prescribe crutches and/or taping and/or a bracing device. The Physiotherapist may work to manually mobilize the joint and ease off tight muscles. There are various other methods (heat, ice, electrotherapy, etc) which the Physiotherapist may use, but these vary on a case-by-case basis.
Osgood Schlatters Disease
Osgood Schlatters disease is a relatively common knee condition which affects adolescents. It characterizes an injury to the growth plate at the top of the shin bone (tibia) just below the knee cap. Every time the quadriceps contracts, it pulls on the patella tendon which in turn pulls on the tibia’s growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur, resulting in pain and sometimes an increased bony prominence at the front of the shin. This will generally occur during the child’s growth spurt when bones grow longer, and muscles and tendons are tighter.
SYMPTOMS
• pain at the front of the knee beneath knee cap
• pain increases during activities with strong quad constractions
(i.e. squatting, going up and down stairs, running (esp. uphill, jumping)
• pain when kneeling
• increased or swollen bony prominence at top of shin bone
How can physiotherapy help you?
The Physiotherapist should be able to diagnose Osgood Schlatters Disease during a thorough assessment. They will provide education as well as exercises to address flexibility, strength and/or balance issues. The patient will be recommended various stretches and may be assisted with taping or bracing. There are various other methods (i.e. ice, electrotherapy) which the Physiotherapist may use, but these vary on a case-by-case basis.
Osteoarthritis of the Knee
Osteoarthritis is a degenerative,“wear and tear” d isease which involves wearing of the cartilage which covers the surfaces of the joint. Factors that can contribute to the development of arthritis are: repeated dislocations, fractures involving joint surfaces, repeated minor trauma, deformity, and prolonged everyday stresses (extra body weight, weight bearing through joints). The ligaments and muscles surrounding the affected joints may also be eventually involved as compensation or muscle wasting (from under use) takes place.
SYMPTOMS
• gradually develop over time
• may have little to no symptoms (in minor cases)
• knee pain during weight-bearing activity
• joint stiffness (after rest or first thing in morning)
• swelling, decreased flexibility
• joint pain
• grinding, clicking or locking sensation
• symptoms may increase with colder weather
• muscle wasting (esp. quads)
• visible deformity, limping
How can physiotherapy help you?
An experienced Physiotherapist will be able to detect and diagnose Osteoarthritis in the knee. They will prescribe exercise to improve strength, flexibility, core stability, and balance. Strengthening the muscles will decrease the stress on joints and prevent further deterioration. The Physiotherapist will also help to mobilize the knee joints to maintain functional range and decrease aching pain. They may prescribe a knee brace or compression device and/or taping. The Physiotherapist can also provide education and advice in regards to diet, supplements, walking/postural aids and lifestyle modification. Other treatments (i.e. heat, ice, electrotherapy) may be used on a case-by-case basis.
Patellar Tendonitis
Patellar tendonitis (aka Jumper’s Knee) ooccurs when there is tissue damage and inflammation to the patellar tendon causing pain in the front of the knee. It commonly occurs due to repetitive activities which place strain on the patellar tendon including running, jumping, hopping, squatting or kicking. It is also common for athletes who must jump and land often (i.e. basketball players).
SYMPTOMS
• gradual developing pain at the front of knee (just below knee cap)
• ache or stiffness increasing after rest following activity
• pain may decrease with activity
• pain aggravated by walking or standing
• pain when firmly pressing on patellar tendon
• knee weakness when jumping or running
How can physiotherapy help you?
An experienced Physiotherapist will be able to detect and diagnose Patellar Tendonitis. They will show exercises to improve strength, flexibility, core stability, and balance, as well as a variety of stretches to loosen the tight muscles. The Physiotherapist will likely also manually mobilize the knee joint. They may recommend a knee brace or protective taping. Some patients may be advised to use crutches. The Physiotherapist can also provide education and advice in regards to maintaining inflammation, modifying activities and returning to work/activity gradually. Other treatments (i.e. heat, ice, electrotherapy) may be used depending on each specific case.
Posterior Cruciate Ligament (PCL) Injury/Tear
A PCL injury is a fairly common sporting injury which generally shows tearing of the Posterior Cruciate Ligament, a stabilizing structure of the knee. When effective, the PCL prevents the knee from engaging in excessive twisting, straightening (hyperextension) and backward movement of tibia on the femur. When these movements become more excessive than the PCL can withstand, tearing occurs.
SYMPTOMS
• audible snap or tearing sounds at time of accident
• increase in pain, swelling and stiffness after rest following activity (next morning)
• pain felt deep in knee or back of knee, difficult to localize
• feeling of knee going out and back in
• knee feels unstable, minor collapse
• increasing bruising and stiffness
• knee giving way multiple times
How can physiotherapy help you?
A thorough examination from a physiotherapist should be enough to diagnose a PCL tear. The Physiotherapist will then prescribe specialized exercises to improve flexibility, strength, balance and control. They may also recommend hydrotherapy as part of the exercise program. The Physiotherapist will help with manual joint mobilization and may do some taping on the knee. They will likely prescribe a brace and educate on proper use. Some patients may be recommended to use crutches for a period. The Physiotherapist can also provide advice on managing inflammation, modifying activity and gradually reurning to sport or running. Additional treatments (i.e. ice, heat, ultrasound) may be used on a case-by-case basis.
Quadriceps (Quad) Tendinitis
Quadriceps (quad) tendinitis is a condition consisting of tissue damage and inflammation in the quadriceps region where the quads attach to the top of the knee cap. This injury causes pain in the front of the knee and just above the knee cap. The quads are responsible for straightening the knee during activity and controlling the bend of the knee during weight-bearing activity. This occurs during sprinting, jumping, hopping, squatting or kicking activities. During contraction of the quads, tension piles on the quadriceps tendon and when this is too much force or repetition, damage may occur.
SYMPTOMS
• gradual pain developing at front of knee just above knee cap
• ache or stiffness after rest following activity requiring strong quad contraction
• pain may lessen during activity
• swelling and feeling of weakness during activity
• pain on firmly pressing on quadriceps tendon
• limp when walking (esp. on uneven surfaces or hills)
• pain when stretching quads
How can physiotherapy help you?
A thorough subjective and objective assessment by a Physiotherapist will be able to diagnose quadriceps tendonitis. The Physiotherapist will provide exercises and stretches to improve strength, flexibility and even core stability. They may also provide manual joint mobilization and taping on the patella. They can also provide education regarding anti-inflammatory methods at home, modifying actives, proper footwear, and returning to activity/work. Additional methods of treatment (i.e. ice, heat, etc.) may be used depending on your specific case. |
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