Is knee pain stopping you work, do sport, keep fit, disturbing your sleep, going for a walk or climbing stairs?
Have you been told ‘it is wear and tear’ or arthritis and there is nothing that can be done? Or are you waiting months for Physio or tests on the NHS?
At Physio-answers we see so many people who have got fed up with the affect that knee pain has on their lifestyle and no one they see seems very interested in doing much about it. But we think knee pain is a serious problem. If you cannot exercise or sleep properly your general health, mood and fitness will quickly deteriorate and that is important.
We have helped so many patients who had been turned away by other health professionals with tablets or a sheet of exercises.
At Physio-Answers we do so much more to help. Knee pain is helped with:
• Manual therapy
• Specific exercises
• Advice to keep things better.
Here are 5 things we often discuss with our knee patients that can make all the difference in keeping the joint stronger and more comfortable. This is obviously general advice and may not be relevant to all knee problems. For a specific diagnosis and treatment for your knee pain call to make an appointment now to see one of our experienced knee physios and get moving again!
The shoes we wear have an enormous influence on our foot position and stability and subsequently on the stresses put through the knee. Pain causes weakness so you may be slightly weak and unstable in the leg so putting more stress and movement through the knee. The right pair of shoes or trainers can help. A supportive lace up shoe or trainer is often best. Good support along the arch of the foot and a firm heel cup can help increase the stability of the leg and help the alignment.
Poor or incorrect footwear may exacerbate or even cause knee pain e.g.
E.g. very flat slip on shoes,
Old shoes that have deformed to your foot position
Very soft unsupportive trainers
Too stiff shoes
Shoes without a stiff sole from the heel to mid foot (if you can screw them in a ball they will not give support)
Orthotics may be required for more extreme foot issues but often the right pair of shoes can make all the difference
Note: If you do a lot of running or have an unusual foot position then it is worth going to a good trainer shop and have a biomechanical assessment on a treadmill to get the correct trainers for you.
Knee pain is often caused by inflammation of the joint or structures within or around the joint. This causes pain, sometimes heat and swelling and a reduction in the strength of some muscles.
Ice can really help reduce the inflammatory cycle. It is cheap and safe, easily accessible and easy to use.
Routine icing 2-3 times a day for 20 minutes is recommended and especially after exercise or when the pain is worse. Unlike the elite sportsmen you do not need to climb in a barrel of the stuff if you can’t take it! Instead wrap a damp cloth around the affected part, apply the ice or ice pack and bandage or tie on with some pressure. Leave on for no more than 20 minute. You will probably feel an immediate reduction in pain and a long term beneficial effect.
Try standing on your bad leg. Does it hurt? If not, try bending the knee? Now try with your bad knee? Does it hurt, wobble or make you lean over to balance?
Is the other side different? More strong and stable?
Adaptations to how you stand or walk is your body’s way of coping to help keep you balanced and walking and to try to reduce the pain but it is not helping in the long run. Often it puts such an increase in pressure on the good knee that it starts to hurt too!
There is no standard recipe of exercises as it totally depends on the patient and the knee problem. However it is safe to say that improving or at least maintaining the strength in the leg and hip muscles is vital to break the viscous cycle of pain and weakness recipe for correct exercise.
The exercises you choose should:
• Be pain free (you cannot strengthen the correct muscles with pain)
• Maintain the correct alignment through the knee (knee over the second toe)
• Be relevant to your fitness/strength level
• Should be functional (if you want to walk/run then the exercises should be weight bearing (unless too painful)
You should start with a slow shallow dip, keep the knee over the toe and concentrate on technique rather than ‘power’.
If an exercise feels wrong or is aggravating the pain then DO NOT CONTINUE. Check your technique and/or make it easier.
Word of warning: exercises like squats or lunges will worsen the problem if they are not done correctly. If any exercise is making the pain worse then stop and see us for help and advice
There are many knee supports braces and devices available to buy and they can be useful as long as they are suitable for the problem.
Types to choose from:
New types of tape have become available in recent years including K tape or Rock tape. The advantage of this is it is breathable, waterproof and stretches. Correctly applied the tape can alter the bio-mechanics of the knee and encourage certain muscles to work more so becomes part of the treatment as well as support.
The disadvantage is it must be applied correctly and this takes some skill and knowledge of the way the knee is working. However, some basic taping techniques which we often teach our patients can give some support. If it makes things worse then TAKE IT OFF!!
• Braces with metal supports: suitable for ligament instability
• Elastic or neoprene supports: Pull on: Give some light support, compression and warmth.
• Brace with cross over straps. Increased support than pull on brace
• Runner knee strap: goes under the knee cap to take stress off the patella tendon
• Full hinged knee braces. These are for major support with sports e.g. skiing to protect a ligament injury etc. and should be fitted properly.
Without a full diagnosis it is difficult to choose the best support but as an idea you should choose something that helps and has the least support. The more you brace a joint the less the muscles need to work, eventually causing more weakness.
Exercising and keeping fit
This is vital but some sports and exercises are particularly stressful to the knee.
If you are older or have had previous knee or leg injuries then it is probably best to avoid high impact or very repetitive weight bearing sports. Running in particular places a huge impact on the knees.
If there is residual wear and tear or instability from an old injury then this may cause knee problems. If so then try an exercise with less impact. Cycling, power walking, the cross trainer and possibly swimming (with care) are kinder to knees.
Our knees are not designed to be knelt on for long periods. Housemaid’s and vicar’s knee are variations of bursitis-when the cushions of fluid in the knee joint become inflamed from the pressure of kneeling. Jobs that require time spent on the knees, plumbing, carpet laying etc. can cause major problems later on. Knee pads, avoiding kneeling when possible etc. can help.
Nutrition and hydration
Good diet enables the healing process to take place. Vitamin C and D are important Lack of fluids also has a detrimental effect on tissues. Smoking affects collagen which is the basis of all tissues and is required to regenerate for healing.
A small increase in body-weight increases the stress enormously through the knee joint. Forces on your knee:
When you walk across level ground, the force on your knees is the equivalent of 1½ times your body weight. Running: the force goes up to 3x and above
Every extra pound you carry adds up to 3 pounds of pressure on your knee joints when you walk, and 10 pounds when you run.
But if exercising to lose weight is difficult due to the knee pain then the problem persists
Inflammation can cause pain even at rest and especially when the joint is immobile for a long time. Without movement the cartilage covering the ends of the bones does not get a fresh supply of fluid and nutrients causing pain and stiffness.
Having the knee in a comfortable supported position at night can help so start by putting a pillow between your knees if on your side or under your knees if on your back. It can reduce that early morning stiffness and allow you to sleep better
Here at Physio Answers, we offer a free, 10 minute physiotherapy ‘pre-assessment’ and discussion with the physiotherapist to see if physiotherapy is the right treatment for you. If you would like to find out more, you can visit our pre-assessment page here
Contact our Lewisham clinic based at Anytime
Fitness Birdwood Avenue Lewisham SE13 6UR.
Visit our physiotherapists based at our Leyton clinic -
300 High Road, Leyton, E10 5PW.
Find us at 36 Eastern
Esplanade, Southend, Essex, SS1 2ES.