Are You Suffering From a Knee Injury?
Knee Physical Therapy Can Get You Back on Your Feet
The knee is a hinge joint that flexes and extends. While it has fairly simple mechanics, it is responsible for creating and absorbing forces that come from walking, running, jumping, going up and down stairs, getting on and off the floor and much more. Because it is involved in so many of the movements we perform throughout our day it is susceptible to injury and discomfort caused by long term accumulation of stress or a sudden uncontrolled force. Whether you are experiencing new knee pain or have been living with it for some time, a physical therapist can help get to the root cause and improve your knee symptoms.
LET’S EXAMINE THE KNEE MORE CLOSELY
The knee joint is where the cartilage-covered ends of the thigh bone (femur) and lower leg bone (tibia) meet. The patella, also known as the kneecap, sits at the front of the joint within the tendon of the large quadriceps muscle and acts as a fulcrum to increase the power of these large thigh muscles. Two moon-shaped menisci cushion the joint on the medial and lateral sides.
Four main ligaments provide stability to this knee joint. The medial collateral ligament (MCL) runs up and down on the inside of the knee to prevent the knee from buckling inward. The lateral collateral ligament (LCL) runs up and down on the outside of the knee to prevent the joint from buckling outward. The anterior cruciate ligament (ACL) runs through the center of the joint from the tibia to the femur and primarily restrains anterior translation of either bone though acts to restrain excess movement in other planes as well. Finally, the posterior collateral ligament (PCL) similarly runs between the tibia and femur and primarily restrains posterior translation of either bone.
The hamstring muscles and calf muscle in the back attach near either side of the knee joint to help flex the knee while the quadriceps muscles extend the joint and run across the front of the knee attaching below it. The adductor muscle group which attaches near the groin runs down the inside of the leg and attaches above and below the knee.
WHAT KNEE CONDITIONS CAN PHYSICAL THERAPY TREAT?
Muscle Strain: When overstretched, overused or contracted against a sudden load, a muscle strain can occur as muscle fibers or the musculotendinous junction are torn or injured. A muscle strain in the hamstring or calf muscles in the back or the quadriceps muscles in the front can cause pain near the knee joint. Muscle strains can range from mild to severe depending on how much of the muscle is affected. You may experience pain, swelling, tenderness or bruising with pain during muscle contraction.
Ligament Sprains/Tears: ligaments are bands of collagen tissue that support bones, joints and organs. As outlined above there are four main ligaments in the knee joint. Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament sprain depending on how many fibers are torn.
MCL Sprain/Tear: An injury to this ligament often occurs during sudden bending, twisting or direction changes or when the outside of the knee is hit such as during a football tackle. Initially pain and tenderness on the inside of the knee may be felt and swelling and stiffness may develop later on. If the sprain is severe enough the knee joint may eventually feel unstable.
LCL Sprain/Tear: Sharp turns with a planted foot, sudden hyperextension of the joint, or a hit on the inside of the knee can all cause a sprain to the LCL. Pain, swelling and tenderness on the outside of the knee are common. Depending on the severity you may also experience locking or catching and possibly giving way during movement.
ACL Sprain/Tear: This ligament can be injured from a direct hit to the knee such as during a soccer game or if the upper leg suddenly twists while the foot is planted. Sometimes landing on a hyperextended knee or stopping momentum suddenly can also injure the ACL. A sharp intense pain and an audible pop may occur at the moment of injury. You may be unable to support any weight through the joint immediately and swelling typically develops shortly after.
PCL Sprain/Tear: Injury to the PCL most often occurs when a sudden force shifts the lower leg bone backwards under the upper thigh bone. Knee injuries that damage the PCL often injure other ligaments or cartilage in the knee and sometimes a small fragment of bone can break free. Swelling and stiffness are common with this injury. Pain may be felt inside the knee joint or at the back of the knee and made worse with squatting, running, or climbing stairs.
Iliotibial (IT) Band Syndrome: The IT Band is a thick band of tissue that runs along the outside of the leg from the pelvis to the knee. Irritation and inflammation around this band can occur from repetitive straightening and bending during activities such as running and cycling. Stabbing or stinging pain felt along the outside of the knee is often felt when going from a sitting to a standing position or following continuous activities such as walking or stair climbing.
Tendinopathies: Tendons are the thick, fibrous bands or cords that attach muscle fibers to bones. Pain felt outside of a joint at the end of a muscle which is exacerbated by movement may be tendonitis or tendinopathy. In the knee, this most commonly occurs at the hamstring tendons where they attach on either side of the knee posteriorly and in the patellar tendon below the patella. The most common cause of inflammation and irritation in the tendon is repetitive overuse. Often biomechanical or movement errors, muscle strength and length asymmetries or insufficiencies are an underlying cause. Pain is usually described as a dull ache that can interfere with your activities. Tenderness, mild swelling and general weakness may also be present.
Patellofemoral Pain Syndrome: This condition refers to pain at the front of the knee felt under or around the patella. It is worse with activity and sometimes after sitting for long periods of time with a bent knee. It is a common cause of knee pain and often occurs in response to an increase in activity that occurs faster than the tissues of the knee can adapt.
Osteoarthritis: Arthritis can occur in any joint. In the knee, osteoarthritis refers to breakdown of the cartilage that covers the ends of each bony surface and a loss of synovial fluid that lubricates the joint. This results in rubbing of bony surfaces together causing pain and stiffness. In severe cases a total knee arthroplasty (replacement) may be performed by a surgeon. While physical therapists cannot reverse the OA itself, physical therapy has proven to be an effective treatment modality for arthritis. Restoration of optimal joint movement, addressing biomechanics and movement pattern inefficiencies, maximizing muscle strength and education on possible activity modifications are all helpful.
Meniscal Tear: Tears of either meniscus can be “acute”, meaning it occurred as the result of a sudden injury or “degenerative”, meaning it occurred over time. Acute injury to these cartilaginous discs often occurs when the upper leg is twisted or turned while the knee is bent and the foot is planted. Symptoms of a meniscal tear include a sharp intense pain in the knee and difficulty walking or going up and down stairs. If this is an acute injury a pop or tearing sensation may occur and swelling typically develops within about 24 hours. Some meniscus tears can cause a locking or catching sensation that restricts fully bending or straightening the knee.
HOW WILL YOUR PHYSICAL THERAPIST TREAT YOUR LEG?
Initially your PT will assess your knee to determine the cause and contributing factors to your symptoms and then will begin a customized treatment plan to get you back on your feet.
If you are being treated for an acute injury such as a tear or strain, your physical therapist will educate you on how to protect these newly healing tissues. Treatment may include compression or bracing, offloading the injured area through crutches, modalities such as ice, ultrasound or electrical stimulation to reduce pain and swelling and activity modification.
In well-healed tissues, chronic injuries like tendinopathy or IT band syndrome, your physical therapy program will focus not only on reducing or eliminating localized symptoms but on addressing factors that contributed to the onset of the symptoms. Often injuries or pain in the knee are caused by repeating faulty movement patterns or having an imbalance of muscle strength and length to carry out a task such as walking, running, cutting, or jumping optimally and with good mechanics.
While some knee injuries may require intervention by a doctor or surgeon, a physical therapist should always be a primary member of your care team. A physical therapist at Evolve can help you get on the road to recovery. Our therapists do not just treat symptoms, but we get to the root of the cause. We strive to enable our patients to live pain free, and prevent the recurrence of related issues. Click here for more information about knee physical therapy .
About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics-
There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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