Knee Pain

By Tim Wall MS/ATC

Knee Pain Diagnosis

 

Knee pain is one of the most common orthopedic issues experienced by so many people.  JOI Rehab wants to help you if you have pain in your knees and return you to the activities that you love!

The most common type of injuries we see at JOI are as follows:

Degenerative Knee Arthritis or Osteoarthritis

Basically this is the degree that your cartilage is wearing off the end of each bone at the knee. This erosion can lead to a change of alignment at the knee. This is referred to either knocked knees or bowlegged in layman’s terms.  There are many conservative approaches to the treatment of this disease in the knee.

Osteoarthritis of the knee can be a debilitating injury, but it can be treated by an orthopedic surgeon.

Image of Knee with Osteoarthritis

Causes and Risk Factors Related to Knee Pain

The causes of knee pain are very diverse and varying.

Aging: As we age the cartilage that surrounds and cushions the knee begins to wear away in the joint. As our cushioning layer of cartilage becomes less and less than your pain will increase. This condition can worsen until it’s bone on bone.

Trauma: Force to the knee that over powers the structure and leads to injury. An example is an ACL tear. During activity if the knee joint is extended forcefully like being tackled in football and the joint is also twisted than the ACL can rupture.

Weakness. If your muscles that support the knee are not strong than your knee will lack control and stability. Certainly as we age we start to lose muscle mass and strength.  It is important to stay active with exercises like biking or swimming which are safer for your joints.  It also is important to do strengthening exercises for the quad muscle and more importantly the VMO or the muscle on the inside of your leg.

 

Knee Pain Biomechanics

A classic example is that females usually have wider hips. Since female’s hips are wider it can cause the angle of the knee cap to not follow is normal path with movement of the knee.

Overuse: If the knee joint is continually pushed past its limit of tolerance than a physical breakdown will result leading to pain.

Obesity: The more load that the knee is forced to carry the more the negative stress on the joint.  It is estimated that 2 to 3 times your body weight is on your knee’s when climbing stairs.

High Impact Activity: As with obesity the more stress of high load activity you put on your joint the more chance of injury.  Lower impact activities such as biking or swimming would be better.

Knee Pain Test

JOI Describes the Various Knee Pain Tests and Diagnostic Tools X-ray:

Classic tool that can help show the level of loss of cartilage in the joint. X-ray can help to show if there is alignment issues with the knee cap.  An x-ray is to diagnose fractures and the extent of arthritis or the loss of joint space in the bones or joint.

knee joint pain

Image of an X-ray of the Knee

MRI:

Produces an image of all the soft tissue structures of the knee joint to allow diagnosis of an tear. Considered the new standard for diagnosis.  Each MRI has a different signal strength and clarity.  Patients who are claustrophobic may choose an open MRI.

Manual Special Tests of the Knee

Both your orthopedic MD and Physical Therapist at JOI can perform specific joint movements that can help to identify pathology. One such example is a Lachman’s test. This test is used to detect an ACL tear. To perform this test, the knee is slightly flexed lying down. Next the upper leg is stabilized and force is applied to the lower leg in a specific upward angle. If the lower leg shifts up than there may be a tear. Every ligament of the knee has a specific test to check its viability.  Here are some of the other tests:

McMurray, Anterior Drawer, Posterior Drawer, Pivot Shift, Appley’s Compression and Distraction Test,  Varus, Valgus, and Clark’s Tests.

JOI Knee Pain Treatment Plans

Arthritic Knees:

Your physician will do an examination of your knee with x-rays.  Depending on the type and severity of the arthritis, your MD with provide a treatment plan for you.  They may prescribe anti-inflammatory or other medications. Possibly a knee brace to include Unloader(OA) brace to support the knee. Also, physical therapy for an improvement in mobility and strength.  Laser, modalities and other treatments for pain control. Activity modification to include swimming and stationary cycling is also a good idea. In addition, injections to the knee may be considered. If you to have pain without benefit from conservative care, a total joint replacement may be considered.

JOI Knee Anatomy

Structure of the human knee joint

ACL Tear:

In this paragraph, we will explain an ACL Reconstruction treatment plan.  The ACL ligament in the knee provides stability to the knee joint.  It is the ligament which is the most often torn in sports.

Physical Therapy prior to surgery for ROM, strength and the reduction of swelling. Surgery is the option to repair the torn ligament with either an autograft (own tissue) of allograft (cadaver). Initial PT starts 2 days after surgery. Post OP bracing right after surgery with progression to a functional brace as the rehab progresses. After about 5 months’ return to jogging and sports activity around 9-12 months.

Meniscal Tear:

A meniscus tear, either medial (on the inside) or lateral (on the outside) is also referred to as cartilage tears.  They usually produce swelling and a locking or catching sensation in the knee.  Pain is reproduced with squatting or the bending of the knee.

Conservative treatment with Physical Therapy to advance strength and functional activity. Initial stages with modalities to control pain/inflammation to include laser. Surgical intervention if conservative treatment fails. The recovery time is usually about 6-10 weeks if with only arthroscopic debridement.

Patella Femoral Inflammation:

This condition treatment usually starts with an anti-inflammatory medication and physical therapy.  Therapy consists of modalities to include laser for pain/inflammation control. It is important for the initial avoidance of squatting, steps and kneeling activity that place negative pressure on knee cap. Bracing can help control the motion and position of the knee cap. Taping can also be helpful to improve the tracking of the patella. Specific strengthening exercises for the quadriceps muscles with emphasis on the VMO. Also, stretching to focus on the ITB band and hamstring muscles.  McConnell Taping or a Shield’s brace can help decrease pain when the patella is tracking poorly.

Shields Brace

Shield Brace

In the final stages of rehab, there is a focus on eccentric strength and movement and return to sport activities.

Image of hamstring stretch

Image of hamstring stretch

If you have knee pain after a mechanism of trauma, you should be properly evaluated by an MD. Further damage can occur if your treatment is improper. Therefore, if your knee motion is not correct, this could then eventually impact your hip or back.

JOI Offers Conservative Physical Therapy Approaches for Treating Knee Pain

It is not uncommon for people of various age groups to have knee pain. There are several different ways to treat pain in the knee in physical therapy. Strengthening is very important in order to obtain a full recovery. Range-of-motion is also a typically way to treat those who are having painful knee symptoms. JOI Physicians may also choose to do knee injections.  Injections can certainly decrease the pain and inflammation and certainly help! Lastly and perhaps most importantly is keeping up with your health. Weight loss and a healthy BMI are always recommendations in the treatment of knee pain.

Related Articles

If you would like to learn more about knee pain, please read the 5 knee symptoms you should not ignore or knee pain can’t wait.

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By: Tim Wall, MS, ATC


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