Knee pain can occur from multiple sources, and can be the result of a traumatic event, repetitive stress, poor loading mechanics, or can occur from no apparent cause. It can also be referred pain, stemming from areas such as the hip, sacroiliac joint, or lumbar spine. Proper treatment for knee pain begins with a clinical evaluation by a skilled physical therapist, including a thorough subjective examination to learn about the patient’s history and pain presentation, and then an objective evaluation looking at functional movement performance and selective tissue tension testing to determine what the painful source to the knee pain is. Common diagnoses for knee pain include patellofemoral pain syndrome (PFPS), knee osteoarthritis, and meniscus lesions (meniscal tears).
Patellofemoral Pain Syndrome
Patellofemoral pain syndrome accounts for approximately 25% of all knee pain complaints seen in outpatient orthopaedic clinics. It is defined as pain around, or underneath (retropatellar) the kneecap (aka patella), and typically increases with increased stresses of the kneecap, such as going down stairs, running, squatting, and sitting with the knee bent for long-durations. It has been known to be one of the most difficult areas to treat in orthopaedics, with high incidence of recurrence and chronic symptoms. Recent research states the importance of treating PFPS through regional interdependence, meaning treating areas distant to the painful area (such as the hip, knee joint, ankle/foot, lumbar spine), which may be contributing to the onset and/or chronicity of the kneecap pain. Examples of conditions that may contribute to PFPS include chronic low back pain and core weakness, hip weakness, knee joint stiffness, ankle stiffness (possibly from an chronic ankle sprain), decreased big toe mobility (i.e. bunion), among others. Problems in these areas changes how the person functions on the affected leg, changing the mechanics around the kneecap and possibly leading towards patellofemoral pain. Treatment aimed at improving those distant areas while retraining functional movement patterns has been shown to decrease pain and dysfunction in patients with PFPS.
Knee osteoarthritis (OA) is pain and inflammation that is associated with a progressive loss in articular cartilage in the knee. Increased risks for knee OA include the female sex, obesity, diet, occupation, past history of knee trauma, bone density, and decreased quadriceps strength. With the general population becoming older, and obesity becoming more prevalent, risks for knee OA in people have increased. Knee OA is associated with pain during squatting, stairs, increased walking, morning pain/stiffness, warmth to palpate the knee and knee joint swelling, and improvements in symptoms with rest and/or anti-inflammatories. Conservative therapy aimed at improving knee range of motion, increasing strength, decreasing inflammation, and retraining functional movements to decrease the stress through the knee joint have been shown to be beneficial in managing knee pain from arthritis. Moderate activity loading is important for overall joint health and strength, so proper dosage of activity along with an appropriate weight-loss program can help improve the stresses at the knee and improve pain and function.
Meniscus Lesions (Meniscal Tears)
The lateral and medial meniscus of the knee increase the concavity of the knee joint for joint stability, help with shock absorption, and aid in lubrication and load transmission at the knee. They increase the surface area of the knee joint, so loss of the meniscus increases risk for future arthritic changes at the knee joint. They can become torn from a traumatic event to the knee, such as a twist/torsion activity, or become torn over age, known as a degenerative meniscal lesion. Clinical practice guidelines recently showed conservative therapy for meniscal lesions is as good as surgery in rehabilitation success. Also, a physical therapy evaluation is as good at determining if a patient has a meniscal lesion as an MRI. Symptoms associated with possible meniscal lesions include pain with squatting/loading activities, twisting/torsion activities, catchiness/clicking/popping in the knee, knee joint swelling, and painful/decreased knee range of motion. Conservative therapy focuses on normalizing knee range of motion, progressive functional strengthening exercises, manual therapy to nociceptive ligaments that attach the meniscus to the lower leg (i.e. tibia), and proprioceptive exercises for increasing stability around the lower leg. The majority of patients with suspected meniscal lesions progress well with conservative therapy, being able to avoid costly imaging and surgery, while maintaining high levels of function.
Physical Therapy and Treatment
Conservative treatment for most knee injuries is beneficial to improve pain and function. At Life’s Work Physical Therapy, we pride ourselves in our ability to properly differential diagnose your knee condition, in order to develop an individualized treatment plan aimed to successfully return you back to your functional activities. Our therapists are specifically trained in orthopaedic manual physical therapy, and understand proper treatment progressions that are research-based and cutting-edge. If you are experiencing knee pain, which affects your ability to normally function, contact Life’s Work Physical Therapy and get your knee evaluated today.