Physical Therapy for Knee Pain

Who hasn’t experienced knee pain? It’s such a common complaint, anyone, young or old, athletic or sedentary, has probably experienced pain in at least one knee. Knee pain can be caused by an injury - such as a fracture or a torn ligament. Or it can be because of a biomechanical issue such as a tight hip or a flat foot. Medical conditions can also result in knee pain like arthritis and gout. The good news is, research and studies have shown that exercises and some home remedies are proven effective to prevent and minimize knee pain.

What can possibly cause your knee pain?

The knee is a complex part of your body. In fact, it is the largest joint in the body. It is made up of two bones to make up two joints that allow stability and flexibility to your body, while also being able to maintain a high amount of pressure from standing and carrying your weight. It is also made up of ligaments that further help in stability, and menisci that helps even out the weight of the body and reduce friction when bending and straightening the knee. Your knee pain can be because of three things:

Acute injury - such as fractures, ligament tears and meniscal tears.

Ligament tears - the most common torn ligament in the knee is the Anterior Cruciate Ligament (ACL). The ACL keeps the lower leg from sliding in a forward direction and prevents the knee from shifting during quick side to side motions. It is usually torn and injured when there is a direct blow to the knee or a sudden twist in the leg. Athletes involved in contact sports, and anything that involves high-velocity movement, is at risk for this injury. Recovery time takes up from 6 months to a year.
Meniscal tears - menisci are our shock absorbers. They can be torn along with the ACL when there is a sudden twisting motion. The most common one affected is the medial meniscus which is found in the inner part of the knee. When another ligament, the medial collateral ligament is torn along the medial meniscus and ACL, the patient is diagnosed to have the unhappy triad of the knee. This is considered as a severe injury and mostly needs surgery. Recovery time can take up between 6 months and a year.
Fracture - a fracture is any break in the continuity of the bone. Being an athlete involved in contact sports is a huge risk but other causes of a fracture are falls and vehicular accidents. A stress fracture or a broken bone requires a significant amount of force to happen, though.

Knee pain can also be a result of existing medical conditions like

Arthritis - there are over a hundred kinds of arthritis, but they all can affect your knee. Aside from knee pain, swelling and inflammation are common signs of arthritis. Osteoarthritis is the top cause of knee pain after age 50.
Osgood-schlatter disease - a medical condition usually seen in the young. It is especially common in teenagers and the pain comes and goes. Good exercise as maintenance treatment can prevent pain from recurring.
Patellofemoral pain syndrome is an umbrella term used to describe knee pain that has no concrete origin. It also describes pain caused by mechanical problems like:
1. Muscle imbalance or joint malalignment between the hip and knee - our lower extremity is called a closed kinematic chain. If there is a problem with the hip, it may manifest as knee pain. If there is a problem with your feet, it may manifest as knee pain. This happens because the hip, knee and ankle/foot are all connected and affect each other when we are standing, walking or running.
2. Tight iliotibial band - your iliotibial band is attached to the outside of your hip to the outside of your knee. When this band of tissue is tight, it pulls the kneecap to the side and causes pain because of malalignment.

Most knee pain causes can be addressed by physical therapy and diligent exercise. However, it can also be the cause of surgery. Knee surgery can either be a knee arthroscopy or a total knee replacement. An arthroscopy involves inserting a camera and small tool to correct injuries like a ligament or meniscal tear. Total knee replacement involves opening up the whole joint and replacing the two bones that make up the knee. This surgery is usually for more advanced conditions, such as arthritis.

Physical Therapy and Knee Pain

Before you go to any form of exercise, your physical therapist will thoroughly assess you. The knee is a very complicated joint and as we mentioned, pain in the knee does not always mean that the knee is the issue. It can be because of other joints such as the hip, ankle, or even your back!

Your PT’s assessment

Your first session is usually allocated for an assessment and evaluation, here’s what you can expect:

Gait Analysis - your physical therapist will likely analyze the way you walk. He or she will check how your knee pain affects your ambulation and will determine if you need assistive devices to relieve your pain.
Range of Motion and Muscle Testing - your therapist will also check your flexibility and strength. Remember that the root cause of some mechanical problems that cause knee pain are tightness and muscle weakness around the knee.
Balance Assessment - pain in the lower extremities will likely affect your balance. This is because your body’s priority is to protect the painful area. Unconsciously, you are avoiding putting weight on your painful knee and this will probably affect your balance. Your balance should return to normal when the pain goes away.
Special Tests - there are specialized tests that PTs are trained to use. This is to check for injuries within the joint without the need for imaging. This can be painful but your PT will only perform what is necessary.

What exercises should you expect?

Quad sets and straight leg raising - an exercise for the quadriceps, the set of muscles that directly controls your knee joint. This is an easy exercise but can be quite tiring when done for the first time and when there is still pain present.
Hip and core strengthening - to take load off of the knee, your body needs a bit more stability and strength. Exercising your hip and abdominal muscles helps establish a good core.
Stretching - your muscles have tightened up because of the knee pain. This is a natural response of your body because it will need to protect itself. Tightening your muscles is sort of like increasing your knee stability
Balance exercises - your balance should return to normal after eliminating the pain, but your body might not bounce back as soon as possible, so it’s still important to practice and challenge your balance.
How to prevent knee pain
1. Maintain good body weight - remember that your knees carry a lot of your body weight when standing, walking, running, jogging or just any bit of activity that doesn’t involve sitting down. Maintain a body weight that is appropriate for your age and height to prevent acquiring knee pain.
2. Invest in good shoes - sometimes when there is a problem with your foot, your knee takes the blame for it. Whatever happens to your ankle and foot affects your knee, so invest in a shoe that provides good stability to your arches!
3. Keep your core muscles strong and stretch - this is to avoid any mechanical issues to begin with. It will be hard to maintain a good exercise routine but remember that prevention is always better than surgery!
4. Avoid kneeling on hard surfaces - or if you must, use knee pads for protection.

Any physical therapist is well versed and trained in treating problems of the knee. Do not hesitate to ask your doctor for a referral!

For more information about knee physical therapy, visit-

https://evolveny.com/blogposts/2018/1/8/about-your-knee-pain-and-how-to-reduce-symptoms

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About Evolve Physical Therapy-

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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