A PHYSICAL THERAPIST'S GUIDE TO KNEE INJURIES

Learn Conditions, Injuries and Physical Therapy Treatments for Knee Pain

WHAT CAN CAUSE KNEE PAIN AND HOW CAN PHYSICAL THERAPY HELP?

What Type of Knee Injury Causes Knee Pain? 

Knee pain as a result from an injury can cause major disruptions to your personal and work life.  When the knee hurts, there are 4 major tissue types that contain specific anatomical parts of the knee that can be injured and cause knee pain. 

1) Ligament Tears Cause Knee Pain

Knee pain can be caused by an injury to the knee ligaments and are associated with joint instability. Knee ligament injuries are usually traumatic in nature and occur suddenly. They occur when a high force is applied to the knee and the ligaments become "stained" trying to keep the joint together.  Knee pain and injury will depend on the amount, direction and speed of force placed through the foot or knee.

Knee pain can be caused by contact or non-contact injuries.  The difference is during contact knee injuries, there is an external force being applied to the knee joint that overloads the strength of the ligament fibers.

Knee pain occurs in non-contact injuries when the force from the ground during twisting and cutting motions caused a tearing of the ligament fibers. This is observed when a player is running, cutting or landing and the knee ligaments buckle and the player has immediate and sever knee pain.

Knee pain on the inside ligament of the knee comes from a Medial Collateral Ligament (MCL) tear or sprain. The MCL is torn during contact injuries when the force from a hit comes on the outside of the  knee pushing the knee inwards and causing moderate to severe knee pain.

Knee pain on the outside ligament of the knee comes from a Lateral Collateral Ligament (LCL) tear or sprain. The LCL is torn during contact injuries when the force from a hit comes on the inside of the  knee pushing the knee outwards and causing moderate to severe knee pain.

Knee pain inside of the knee comes from an Anterior Cruciate Ligament (ACL) tear or sprain. The ACL is torn during contact and non-contact injuries when the rotational or hyperextension force causes the knee to twist leading to sudden knee pain.

2) Meniscus Tears Cause Knee Pain

A meniscus is a commonly injured structure inside of the knee and can cause various amounts of knee pain.  Where as ligament injuries are associated with instability, meniscus injuries are associated with locking.

The two knee menisci are inside of the knee joint on the inside (medial) and outside (lateral).  The meniscus can be torn from a contact injury, twisting motion or from wear and tear or degeneration. Often times the meniscus can block or lock the knee from moving thought it's normal range of motion.

The knee menisci are made up of the cartilage similar to the ear and have a very low blood supply making it difficult for them to self-repair.  Small meniscal tears do very well with physical therapy because they do not get inflamed as much do to their low blood supply.  In larger types of meniscal tears in patient sunder 40 years old, surgical meniscal repair is the optimal treatment choice to pressure the knee and prevent degenerative knee pain with aging.

Symptoms for this type of knee injury often include a sharp pinching knee pain with standing and twisting. The medial meniscus is on the inside of the knee between the femur (thigh bone) and tibia (shin bone). The lateral meniscus is on the outside of the knee between the femur (thigh bone) and tibia (shin bone).

There are 6 classifications for meniscal tears all of which cause knee pain.

3) Soft Tissue Injuries Cause Knee Pain

Soft tissue is abundant around the knee and includes numerous muscles and tendons which are responsible for the movement and power of the knee, hip and ankle joints.

Muscular Imbalances

Tendonitis is an acute irritation to a tendon and is characterized by a burning pain that occurs when the muscle and tendon are activated for use in normal life or sporting activities.

Tendinopathy is a chronic condition that occurs as local blood supply and nutrients to the tendon are diminished and the tendon actually becomes degenerative.  The tendon’s ability to work is compromised and scar tissue develops in place of healthy tendon tissue.

Knee Joint Irritation

The inside of the knee joint is lined with a synovial membrane which is responsible for producing the lubricant for the knee joint.  When the synovial membrane becomes irritated due to a number of different reasons, the synovial fluid becomes thick and viscous which results in pain and inflammation of the knee

4) Bone Damage Causes Knee Pain

Arthritis is a common condition in the knee that occurs due to chronic synovitis of the knee and changes to the synovial fluid.   The chemistry gradually causes damage to the articular cartilage by eroding the joint surfaces.

Knee Joint Replacement is a controlled fracture of both the femur and tibia. Physician's remove portions of the bones and replace them with titanium implants.

Fractures can occur in either the femur or tibia and are usually the results of traumatic injury.

A bone bruise occur when there is a significant compression of the femur and tibia together.  This occurs either through high impact vertical loading like landing on the ground with one leg or when the ligaments are actually torn causing the bones to move farther than normal.  When the bones ‘slip out of place’, they impact each other and cause a “bone bruise”.

 

Evaluate My Knee Pain

PHYSICAL THERAPY TREATMENT FOR KNEE PAIN

Physical therapists help people with ankle sprains recover more quickly than they would without treatment. The time it takes to heal an ankle sprain varies, but results can often be achieved in 2 to 8 weeks. Your physical therapist will work with you to design a specific treatment program that meets your needs and goals.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

Rest the area by avoiding any activity that causes pain.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Consult with a physician for further services, such as medication or diagnostic tests.
Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.
Use crutches or other walking aids to help alleviate pain and support balance.
Wrap your ankle or use an ankle brace for support and to prevent swelling.
These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.  

Your physical therapist will work with you to:

Reduce Pain and Swelling. You will learn how to avoid or modify your daily and sports activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your ankle and foot, and progress to “active” exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.

Improve Strength. Ankle sprains may be related to weak, injured, or uncoordinated leg muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength. These may include using cuff weights, stretch bands, and weight-lifting equipment.

Improve Endurance. Regaining your muscular endurance in the ankle and leg is important after an injury. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.

Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance ability.

Restore Agility. Speed and accuracy of leg movement is important in athletics and in many daily activities. Your physical therapist will help you regain these skills in preparation for a return to sports and to your daily routine.

Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to Activities. Your physical therapist will discuss activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

If Surgery Is Necessary

Surgery is not commonly required for ankle sprains. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

WHAT KIND OF PHYSICAL THERAPIST DO I NEED?
All physical therapists are prepared through education and experience to treat patients who have an ankle sprain. You may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopaedic focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with ankle sprain.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading