Physiotherapy for Knee Injuries

The knee is a joint that commonly causes problems for all ages: whether it is a knee injury in a young sportsman or wear and tear in older patients. Pain can be felt in and around the knee.

Read about how our physiotherapists have helped people with knee pain.

The Knee

Is made up of two joints:

(1) Tibial femoral joint

This is the main knee joint. The thigh bone (femur) sits ontop of the shin bone (tibia). Between these two bones are two menisci , medial and lateral. Meniscus is a thick pad of cartilage which forms a smooth surface which allows the two bones to move on each other without rubbing, for example when you bend your knee, and they also help with shock absorbency, for example when walking.

A joint capsule surrounds the tibial femoral joint which contains fluid that’s acts as lubrication to the joint. This capsule is reinforced by two ligaments on the outside known as the medial and lateral collateral ligaments. There are also two ligaments within the knee joint called the anterior and posterior cruciate ligaments. Both the collateral and cruciate ligaments provide stability and strength to the knee joint.

 

(2) Patella-femoral joint

The knee cap (patella) sits in a groove on top of the thigh bone (femur). The knee cap moves up and down within the groove as you bend and straighten your knee. The knee cap actually sits within a large tendon, which is the end part of your quadriceps thigh muscle. Above the knee cap this tendon is called the quadriceps tendon, below the knee cap it is called the patella tendon.

 

The knee joint is also surrounding by many fluid filled sacks, called bursa. Bursa provide a gliding surface to help stop the rubbing (friction) of muscle tendons on the knee bones.

Structures which can cause knee pain

These can become bruised or torn especially in twisting injuries in skiing and football. A physiotherapist can diagnose and treat meniscal injuries. However there are some cases where further tests are required, such as MRI scan, and you may require surgery (menisectomy). We would able to advise you on this following a physiotherapy assessment.

Symptoms of a meniscal injury:

These can be over stretched or torn often in twisting injury or a side on injury, for example getting kicked in football on the side of the knee causing the knee to buckle. The medial collateral ligament is more commonly injured than the lateral collateral ligament. A physiotherapist can diagnose and treat a collateral ligament injury by optimising ligament healing and advising you through all the stages of rehabilitation, including return to sport. Physiotherapist will grade a collateral ligament injury on a scale from I (mild, incomplete tear), II (moderate, incomplete tear), III (ruptured) and this will influence physiotherapy treatment and your recovery time. Your physiotherapist will advise you, based on assessment findings, if you require further tests, such as MRI scan or referral to an orthopaedic consultant via your GP.

Symptoms of a collateral ligament injury:

These can be over stretched or torn often in twisting injury or a front on injury. The anterior cruciate ligament (ACL) is more commonly injured than the posterior cruciate ligament (PCL). A physiotherapist can diagnose and treat cruciate ligament injuries by optimising ligament healing and advising you through all the stages of rehabilitation, including return to sport. These are also graded from I to III, see collateral ligament section. Your physiotherapist will advise you, based on assessment findings, if you require further tests, such as MRI scan or referral to an orthopaedic consultant via your GP. You may require reconstructive surgery if you have completely ruptured a ligament, however physiotherapy is essential after such surgery to get you back to your normal activities.

Symptoms of a cruciate ligament injury:

The knee is a common site for osteoarthritis (OA), and is caused by degeneration of the meniscus. This may be due to age or excessive wear and tear due to work or lifestyle habits, or even previous knee injury such as a fracture (broken bone). OA can occur between the thigh bone (femur) and shin bone (tibia) but it can also occur behind the knee cap (patella). OA is not a ‘curable’ condition however knee physiotherapy can improve your symptoms of pain and stiffness, and advise you how best to manage your condition including managing flare ups, keeping your knee strong and moving well. Flare ups are episodes where you knee pain gets worse but then settles down again. Physiotherapists can also advise if you are suitable or not for a knee joint injection such as corticosteroid. Sometimes when OA affects your function too much a knee replacement maybe required. Physiotherapy can help delay the need for a replacement but also help rehabilitate you after such an operation.  

Symptoms of osteoarthritis:

The cartilage behind the knee cap (patella) is the thickest in the body and allows the knee cap to glide smoothly within its groove on the thigh bone (femur) as you bend and straighten your knee. However this cartilage can become irritated, inflamed and painful. This may be from overuse for example excessive kneeling or maybe due to a poor movement pattern of the knee cap caused by an imbalance (tight, weak, over activity of muscles) in the muscles that guide the movement. Physiotherapy can reduce the pain and teach you how to retrain the muscles to guide the knee cap correctly with exercises and taping. This condition is known as chondromalacia patella. It is common in teenage girls and runners.

Symptoms of patella femoral joint syndrome:

Knee bursitis commonly occurs on the inside of the knee (anserine bursitis) and the front of the kneecap (housemaid's knee or patellar bursitis). It can develop for what appears to be no reason or after activity such as excessive kneeling. It can also occur due to poor knee biomechanics, such as over straightening the knee whilst standing. A physiotherapy assessment can diagnose bursitis but also the cause of the problem, appropriate treatment can then occur.

Symptoms of patella femoral joint syndrome: