Knee Injuries

 

Sinding-Larsen-Johansson Disease

Pain at the attachment of the patellar tendon to the patella can often be due to the condition known as Sinding-Larsen-Johansson Disease. This condition is most often noticed during a growth spurt early in the second decade of life. There is a higher prevalence in boys, but this may be due to a greater involvement in sport. Like the more common Osgood Schlatters’ Disease, it is characterised by

• Pain that is dull, superficial and localised to the tendon attachment.
• Usually has a gradual onset but may be associated with a traumatic event.
• Tends to be aggravated by activities such as running, kneeling, kicking, squatting and jumping.
• The pain tends to linger for some time after activity and eases with rest.
• The area is usually tender to touch and pain can be elicited by resisting contraction of the quadriceps.

Sinding-Laresen-Johansson Disease. The bone is inflamed at the attachment of the patellar tendon to the patella.

TREATMENT

As with all sporting conditions, correct diagnosis and treatment should be encouraged. The primary treatments for this condition are:-

• Stop the aggravating activities
• Ice applied after any pain producing activity
• Gentle stretching of the quadriceps but not to the point of pain
• Supportive tapes or straps may be of assistance
• Other forms of physiotherapy such as ultrasound or electrotherapy may also be helpful
• It is also important to educate the player about their condition and the probability of a complete recovery.

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan. Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Patello-Femoral Pain 

What is it?

• The patellofemoral joint is the articulation between the thigh bone (femur) and the  knee cap (patella)
• Usually the kneecap sits in a groove at the end of the femur, sliding up and down on a smooth surface as the knee bends and straightens. Pain may occur if this lining is damaged or an imbalance in the muscles develops, pulling the kneecap onto one surface more than the other (lateral tracking). This can lead to irritation of the underside lining of the kneecap and cause pain.

 

What do I look for?

• The symptoms usually consist of an ache or sharp pain in around the kneecap, which is aggravated by running, squatting, stairs and standing up after a period of immobility
• People of all age may present with patellofemoral pain

 

What causes it?

• Imbalances between the quadriceps muscles
• Muscle imbalances in the lumbo-pelvic region
• Poor foot posture
• Recent knee pain/trauma

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Patello-Femoral Dysfunction

Do your knees crackle and crunch when you squat down?

 Are they painful when you are running?

 Do you have pain climbing up and down stairs?

 Do your knees hurt when you stand up after watching a movie? 

If you answered “yes” to these questions there is a good chance you are suffering from patellofemoral dysfunction. This occurs when your kneecap does not track smoothly through its groove at the front of the thighbone (femur). This produces uneven wear behind the kneecap and quite often inflammation and pain results.

The maltracking may be a result of weak thigh or buttock muscles, tight muscles and tendons on the outside of your leg, poor foot posture/flat feet, wear and tear/arthritis or a combination of any of these factors. The problem occurs over a large age range from children to middle age and often occurs due to a change in activity levels.

Pain that often seems unshakeable – that you may have put down to age (or with children, growing pains), can often be improved markedly and even eradicated with careful assessment and treatment by your Physiotherapist.

Your Physiotherapist is able to assess the position of the kneecap with different movements and various positions of the knee. This, along with assessments of muscle strength, muscle length and foot posture, enables the therapist to determine the most effective form of treatment for you.

Treatment consists of measure to settle pain and help to realign the kneecap as it runs up and down at the front of the knee. This is done mainly through exercise and stretching.

Strapping tape is used to help hold the kneecap in position while a person perfects their exercise regime and regains the required strength. Arch supports (orthotics) are occasionally used to correct the position of the feet to ensure good alignment of the lower limbs. The entire process is essentially pain free and you may not require any time away from your normal sport-exercise program.

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan. Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

Patello-Femoral Syndrome

Arguably one of the most common musculo-Skeletal problems in our country is Patello-Femoral Syndrome  and can be resolved quickly and easily with Physiotherapy.

Sometimes called “ Movie Goers Knee” Suffers are commonly heard to say;

“My knees hurt when I stand up after watching a movie”

“My knees crackle and crunch when I squat down”

“I get pain in my knees climbing up and down stairs”

If any of these symptroms sound familiar, there is a good chance you are suffering from patellofemoral dysfunction.

The most common Patellofemoral problem occurs when your kneecap does not track evenly through its groove at the front of the femur.

This produces uneven pressure on this joint and quite often inflammation and pain behind the kneecap results.

The “maltracking” may be a result of weak thigh muscles in particular Vastus Medialis Obliqus (VMO), poor foot posture/flat feet,muscle tightness or imbalance around the knee or hip, wear and tear or a combination of any of these factors.

The problem can occur at any age, but is most commonly seen in young women (especially around the age of 14), and post knee surgery or injury.

As girls go through puberty, and also changes in their activity level, it is common to have a muscle imbalance around the knee.

It is also very common after any knee injury or surgey, as the swelling can weaken the key muscle that supports the Patella.

You may have put down to age (or with children, growing pains), can often be improved markedly and even eradicated with careful assessment and treatment by your Physiotherapist.

Your Physiotherapist is able to assess the kneecap with different movements and various positions of the knee. This, along with assessments of muscle strength, muscle length and foot posture, enables the Physiotherapist to determine the most effective form of treatment for you.

Treatment involves; settling the pain, exercises and stretching, and strapping tape to support the patella, while their exercises regain the required strength and co-ordination.

Arch supports (orthotics) from your Podiatrist are often used to correct the position of the feet.

The entire process is essentially pain free and may not require any time away from your normal sport-exercise program.

This approach has a success rate approaching 90%, but if symptoms persist, surgical assistance may be required.

For more information contact us.

Patella Tendinosis

What is it?

• The Patella tendon is the tendon that joins the knee cap to the shin bone
• With overuse of the quadriceps muscles and this tendon the tendon can become inflamed and painful.

 

What do I look for?

• Dull pain at the base of the knee cap or the prominence on shin bone (tibial tubercle), where the tendon attach.
• Tightness and/or tenderness in the quadriceps muscle
• Pain with running, squatting, jumping, kneeling and/or kicking
• Often starts gradually over a period of a few weeks and increases over time.
• Soreness lasting after activity and is eased with rest.
• What causes it?
• Tightness in the quadriceps muscles
• Overuse of the quadriceps muscles
• Overtraining

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

 For more information contact us.

 

Osgood-Schlatters Disease

Pain at the attachment of the quadriceps tendon to the tibia can often be due to the condition known as Osgood-Schlatters Disease. This condition is most often noticed during a growth spurt early in the second decade of life.

There is a higher prevalence in boys but this may be due to a greater involvement in sport. It is characterised by: 

-Pain that is dull, superficial and localised to the tendon attachment.

-Usually has a gradual onset but may be associated with a traumatic event.

-Tends to be aggravated by activities such as running, kneeling, kicking, squatting and jumping.

-The pain tends to linger for some time after activity and eases with rest.

-The area is usually tender to touch and pain can be elicited by resisting contraction of the quadriceps.

Osgood-Schlatters Disease. The bone is inflamed and broken up at the attachment of the patellar tendon to the shin bone. 

TREATMENT

As with all sporting conditions, correct diagnosis and treatment should be encouraged. The primary treatments for this condition are:

-Stop the offending activities.

-Ice applied after any pain-producing activity.

-Gentle stretching of the quadriceps but not to the point of pain.

-Supportive tapes or straps may be of assistance.

Other forms of physiotherapy such as ultrasound or electrotherapy may also be helpful.

It is also important to educate the player to their condition and the probability of a complete recovery.

For more information contact us.

 

Meniscal Tear

What is a Meniscus?

The meniscus are made up of tough cartilage that cushion the knee joint. The medial meniscus rests on the medial plateau of the tibia, and the lateral meniscus rests on the lateral plateau. The menisci help to distribute the weight evenly through the joint.

 Outline of injury and cause

Tearing of the menisci can occur with forceful twisting of the knee especially when bent, or it may accompany other injuries like ligament strains. The medial meniscus is the most common meniscus injury, due to it being less mobile.

Signs and Symptoms

Pain in the joint of the knee, catching or locking in the joint. Some swelling may occur.

Rehabilitation/prevention

These injuries commonly result in Surgery, usually done via Arthroscope.

After repair, strengthen the muscles surrounding the knee to prevent injury from happening again. Having strong hamstrings and quadriceps help support the knee and prevent the twisting movement that may cause a meniscus tear. The muscles should be stretched regularly. Most meniscus tears heal fully with no long-term limitations.

Physiotherapists and Sports Medicine Doctors/Physicians regularly deal with this major injury.

Our Centres and the Physiotherapists, and Sports Medicine Doctors regularly diagnose and treat Meniscal injuries, before and after surgery, and are critical in getting athletes back to normal after this injury.

When do you see someone for help?

 Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Medial Co-Lateral Ligament Sprains

The stability of a joint is increased by the presence of a joint capsule made up of connective tissue, thickened at points of stress to form ligaments. The ends of the ligaments attach to bone.

The Medial Co-Lateral ligament (or MCL) is a broad, flat band situated on the inside of the knee. It is approximately 10cm long and is attached to the femur at its proximal end and to the tibia at its distal insertion.

MECHANISM OF INJURY

Injury to the MCL usually occurs as a result of a “valgus stress” or pressure from the outside of the partially flexed knee forcing it to bend inward. Therefore, stressing it beyond its capacity. A low rugby tackle for instance is a good example.

GRADES

MCL tears are classified on the basis of their severity:

GRADE ONE – (mild, first degree)

 GRADE TWO – (moderate, second degree)

 GRADE THREE – (complete, third degree)

Grade One –

With grade one MCL tear there is local tenderness on the inside of the knee but usually no swelling.

 Grade Two –

A grade two MCL tear is produced by a more severe stress and when the knee is examined it is acutely painful to touch and a small amount of swelling may be present.

Grade Three –

 In a grade three tear of the MCL the patient often complains of instability or a “wobbly knee”. The amount of pain is variable and frequently not as severe as one would expect given the nature of the injury.

TREATMENT

Initial management of a ligament injury involves first aid treatment to minimise bleeding and swelling around the joint. If instability is present, then surgery or bracing may be required.

For Grade I and II sprains, the principles of treatment involve promoting tissue healing, mobilisation to prevent joint stiffness, protection to avoid further damage and muscle strengthening to provide stability to the joint.

The treatment of a Grade III sprain (complete ligament tear) may be either surgical or conservative. The joint is then fully or partially immobilised to protect the repaired ligament, usually for a period of approximately six weeks.

For more information contact us.

 

Knee Osteoarthritis

What is it?

This condition refers to degeneration of the knee joint surfaces and often a loss of space between the thigh and shin bones.

What do I look for?

• Pain and tenderness to touch in the knee region
• Swelling worsening with activity or at the end of the day.
• Reduction in the range of movement in the knee
• Weakness and/or imbalances in the knee muscles
• Pain with walking, squatting, kneeling and /or stairs
• History of a previous knee injury/pathology

 

What causes it?

• General wear and tear to the joint with use over the years

• Previous injury to the knee

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Iliotibial Band Friction Syndrome 2

What is it?

The iliotibial band is a strong band of connective tissue that runs from the hip region on the outside of the thigh and attaches onto the outside part of the shin bone.

Where this band passes over the base of the thigh bone friction between the bone and the ITB occurs. With activities involving repeated bending of the knee this excessive friction can lead to inflammation of the structures between the ITB and thigh bone.

 What do I look for?

• The symptoms usually consist of an ache or sharp pain in the outer region of the knee and thigh.
• Usually aggravated by activities such as running, especially downhill

 

What causes it?

• Muscle imbalances in the lumbo-pelvic and thigh region
• Overtraining, especially running downhill

 

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.

 

Iliotibial Band Friction Syndrome

The iliotibial band (ITB) is a thick strip of fibrous tissue that passes down the outside of the thigh and attaches just below the outside of the knee.

During running the ITB repeatedly rubs over the outside bony prominence of the knee. This may lead to an inflammatory response. It is characterised by:-

-Pain on the outside of the knee while running.

-Immediate relief on cessation of running.

-Tenderness of the ITB near the knee.

TREATMENT

As with all sporting conditions, correct diagnosis and treatment should be encouraged.

The primary treatments for this condition are:

-Rest from the pain producing activities.

-Electrophysical modalities.

-Gentle stretching of the ITB, hamstring and calf muscles but not to the point of pain.

-Correction of biomechanical abnormalities and attention to the shoe.

-Possible anti-inflammatory medication and corticosteroid injection.

 

For more information contact us.

 

I Think I Have Done My Knee

With running, cricket and all the football codes commencing their seasons, you are sure to have patients limp in saying “I THINK I’VE DONE MY KNEE!”

Working out just what the diagnosis is when they have “done” their knee is a challenging task, let alone knowing about the latest management.

With such rapid advancements in the treatment of knee injuries in high profile sports, it is difficult to know the best options.

Accurate diagnosis is critical, and needs to be addressed in two distinct areas; pathology, and structure.

Firstly, a fracture and sinister pathology should be ruled out, then the inflammatory process needs early active management. This includes early use of medication, “RICER”, and physiotherapy for the best possible results.

The structure that has been injured is harder to determine, and requires specific examination. The way the injury occurred can give significant clues to the diagnosis:

• A gradual build-up of pain may point to patello-femoral or cartilage problems.
• An impact injury may point to collateral ligament damage.
• A non-contact injury may be cruciate ligaments or muscle/tendon damage.
• Did the person hear/feel a crunch, pop, snap, click as the injury occurred?

 

Observation can provide clues such as any obvious deformities, swelling, and bruising. Palpation for tenderness, particularly over the joint line can also provide information on swelling and cartilage damage. Restriction of joint movement as well as the integrity of muscles and tendons, provides further clues.

Tests for ligamentous integrity and cartilage damage provide a picture of possible instability.

These orthopaedic tests are not the ‘be all and end all’ and should always be backed up by appropriate referral and diagnostic testing for confirmation.

A systematic approach to assessment of knee injuries can provide the answers you need to make an accurate diagnosis, good management, and correct referral to Physiotherapist, Sports Physician and if required, Orthopaedic Surgeon.

For more information contact us.

 

Hydrotherapy For Hips And Knees

A recent review of Literature and research into the effects of Hydrotherapy in Hip and Knee pain found the following:

 Hydrotherapy is Beneficial Prior to Surgery

• In 2009 Gill et al found that land based and pool based exercise can improve both pain and physical function in patients with OA of the hip or knee.
• Those participants who completed the pool based exercise had less pain immediately after the session and the next day, compared to the land based exercise group.
• Providing home based exercises outlined by a physiotherapist was found to give further improvement.
• This can provide significant benefits for patients who are trying to delay the need for a joint replacement, but also for those awaiting surgery.

 

Hydrotherapy is Beneficial Immediately after Joint Replacemet

• In 2009 Rahmann et al identified the benefits of commencing hydrotherapy exercise immediately after hip and knee replacement surgery.
• Hydrotherapy assisted joint range of movement, pain and reduced swelling.
• It was proposed that this occurred due to changes in the autonomic and circulatory systems when in water.
• It was found that specific hydrotherapy exercises guided by a physiotherapistprovided better results than increased treatment on the ward or generalised hydrotherapy.
• Improved mobility after 14 days was noted in the specific hydrotherapy groupcompared to the groups who had not received the hydrotherapy program.
• No adverse effects were reported throughout the study and appropriate care was taken with all surgical wounds.
• The conclusions from the research indicate that patients can gain a significantadvantage to their recovery when commencing hydrotherapy after a joint replacement.

 

Our Physiotherapists would be happy to discuss any of your patients hydrotherapy needs.

It is advised that anyone undertaking a Hydrotherapy program undergo a full assessment prior to commencing in the pool, and receive an individualised program provided by their Physiotherapist.

References

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 388-394

Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 745 -755

 

Exercise For Knee Pain

Functional Strength Training Improves Knee Stability Following Meniscectomy

• In 2009 Ericsson et al studied the effects of functional exercises on performance and muscle strength after meniscectomy, they reported that 4 years after meniscectomy many people still had muscular and functional deficits.
• They outlined a series of functional exercises that were completed 3 times per week, they emphasised neuromuscular control and functional strength
• It has previously been reported that muscular co-activation minimises shear forces at the joint and therefore reduces pressure on the meniscus
• Positive effects were reported after 4 months of functional exercise
• Individually tailored exercises prescribed by a physiotherapist had beneficial effects on neuromuscular control and therefore functional knee stability
• They hypothesised that “If functional strength and knee stability could be restored, the possibility for the patients to be physically active would increase and in addition, the risk of developing knee osteoarthritis may decrease.

 

Exercise and knee osteoarthritis: benefit or hazard?

• A review article by Bosomworth in 2009 found “there is outstanding evidence for the benefit of exercise therapy in knee OA and some indication that it is underused as a treatment modality”
• The research reviewed showed that those with knee OA who exercise to a moderate level can expect a reduction in knee pain and disability
• Research has also found that those who exercise regularly do not increase their risk of knee OA especially in the absence of trauma
• One of the studies reviewed found that land based exercises can have a similar  effect to non-steroidal anti-inflammatory drugs
• There was found to be an increased risk of OA in those who were involved incompetitive sports or who had obesity, trauma, occupational stress and alignment problems of the lower limbs
• Sedentary people received benefit from exercise when it was completed in aprogressive and structured way

 

Overall, exercise can lower the incidence of disability, pain and improve functional capacity in those with signs of knee OA.

 

References

Ericsson YB, Dahlberg LE, Roos EM. Effects of functional exercise training on performance and muscle strength after meniscectomy: a randomized trial. Scand J Med Sci Sports 2009; 19: 156 – 165

Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? Can Fam Physician 2009; 55: 871 – 878

 

Cartilage Damage Of The Knee

A torn cartilage/meniscus is a very common knee injury. It can happen while playing sport, at work and also while doing household activities.

CAUSES

The tear more often than not occurs when we twist on the knee with the foot firmly anchored on the ground. The amount of pain caused by a meniscal tear can vary. With a small meniscal tear, there may be no pain/or very little at the time of injury. However there will be swelling and an increase in discomfort over the following 24-48 hours.

People who sustain a more severe meniscal tear (sometimes called a ‘bucket handle tear’) will have pain at the time of injury, with a restriction of knee movement. Swelling will occur in the next few hours and sometimes intermittent locking can occur. The locking is due to the torn flap getting caught between the two main bones of the knee, and will normally spontaneously unlock when the flap of cartilage becomes released (untrapped).

WHAT ARE THEY AND WHAT DO THEY LOOK LIKE?

The menisci are two half moon shaped cartilages that make the two main bones of the knee (the femur, the top bone and the tibia, the bottom bone) congruent (fit together). They attach to the top of the tibia and generally have a poor blood supply.

 CLINICAL SIGNS

The most important signs of meniscal tear is joint line tenderness with the presence of joint effusion (swelling). There is also normally a restriction of ‘range of movement’ of the knee joint and/or intermittent locking of the knee may occur.

TREATMENT

Management of meniscal tears depends on the severity of the condition. A small or minor tear may be treated conservatively, i.e. physiotherapy combined with the G.P. A large tear (bucket handle) that is causing locking will require surgery followed by rehabilitation by your Physiotherapist. Surgery is normally arthroscopic surgery (keyhole surgery) where the aim is to keep as much of the menisci in the knee as possible, only removing the bit that is damaged. Some menisci are suitable for repair where the surgeon sews the menisci back together. This is not done often due to the poor blood supply to the menisci.

REHABILITATION AFTER MENISCAL SURGERY

The rehabilitation should start before surgery is performed. This is important, to reduce pain and swelling, while maintaining range of motion and muscle strength. Your Physiotherapist will start your rehabilitation before surgery and continue it after surgery.

The rehabilitation principles following arthroscopic surgery are:

• To control pain and swelling.
• To regain pain-free range of motion.
• Graduated weight bearing.
• Progressive strengthening of surrounding musculature.
• Return to functional activities.

 

For more information contact us.

 

Anterior Cruciate Ligament

Damage to the Anterior Cruciate Ligament of the knee is one of the most highly publicised injuries in Sport.

These injuries can be associated with dramatic footage of the injury occurring.

They are injuries that often result in the Surgery known as: Knee Reconstruction.

Physiotherapists and Sports Medicine Doctors/Physicians regularly deal with this major injury.

Our Centres and the Physiotherapists, and Sports Medicine Doctors regularly diagnose and treat Anterior Cruciate Ligament injuries, before and after surgery, and are critical in getting athletes back to normal after this injury.

Adolescent Knee Pain

What is it?

• In adolescents bones are still maturing. With repeated overuse of a muscle, the point where the muscles’ tendon attaches onto the bone often becomes inflamed.
• In young athletes two common examples of this occur in the knee region, they are Osgood-Schlatter and Sinding-Larsen-Johansson syndromes

 

What do I look for?

• Dull pain at the base of the knee cap or the prominences on shin bone (tibialtubercle), where the tendons attach
• Tightness and/or tenderness in the quadriceps muscle
• Pain with running, squatting, jumping, kneeling and/or kicking
• Often starts gradually over a period of a few weeks and increases over time
• Soreness lasting after activity and is eased with rest

 

What causes it?

• Sudden growth spurt
• Tightness in the quadriceps muscles
• Overtraining

 

Although this condition is often self-limiting and will usually improve with rest and with increasing age, over time you may have some additional problems if left untreated

There are a variety of treatments, strapping techniques and appropriate stretches and exercises that can help with and a graded return to training and sport.

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

For more information contact us.