Knee pain is one of the most common musculoskeletal problems Physiotherapy doctors get in their clinical practice. Pain in the knee joint can occur due to various reasons. It can occur due to mechanical causes, any kind of trauma, pathology, aging, etc.
What can cause Knee Pain?
This is a frequent source of knee pain. Injuries to the tendons surrounding the patella (e.g., suprapatellar, infrapatellar, quadriceps expansion, lesions at the tibial tuberosity), patellar fractures, and articular cartilage damage can lead to inflammation, swelling, limited motion, and pain. Pain intensity may vary when climbing stairs or squatting.
Patellar or quadriceps tendonitis, commonly known as “Jumper’s Knee,” often results from overuse due to repetitive jumping. This condition can cause pain between the kneecap and the shin, affecting one’s ability to run, ski, cycle, and participate in jumping sports.
Also called “Housemaid’s Knee,” this condition is caused by long-term kneeling or frequent mild trauma to the front of the knee. Symptoms include warmth and redness around the knee, and pain and swelling that worsen when kneeling or bending.
Anterior Cruciate Ligament (ACL) tears are particularly prevalent in individuals who engage in sports like basketball and soccer, which demand sudden changes in direction. Pain, swelling, and walking difficulties are common symptoms.
Iliotibial band friction syndrome
This condition occurs when the iliotibial band becomes so tight that it rubs against the outer surface of the femur. Marathon runners and cyclists often experience anterior knee pain due to iliotibial band syndrome.
Osteoarthritis is the most common form of arthritis affecting the knee. This degenerative condition involves the gradual breakdown of joint cartilage and often affects older and middle-aged adults. Excessive stress on the joint from repeated injuries or being overweight can contribute to osteoarthritis. Rheumatoid arthritis, which often affects younger individuals, can also cause knee pain by inflaming the joint and eroding the cartilage.
The synovial plicae are folds of synovial membrane found in the knee joint. Under normal circumstances, these plicae are thin and flexible, allowing for smooth joint movement. However, in some cases, persistent irritation can cause the plicae, particularly the medial plica, to thicken and become fibrotic. This results in the formation of an inelastic, fibrotic band around the patella, leading to a condition known as Plica Syndrome.
Fat Pad Syndrome
Fat Pad Syndrome, also known as Hoffa’s Syndrome or infrapatellar fat pad impingement, occurs when the infrapatellar fat pad, a cushioning tissue located below the kneecap, becomes irritated or inflamed. This can be a result of direct trauma to the knee, overuse, or repetitive stress on the joint during sports or physical activities.
This inflammation or stress injury affects the apophyses (attachment sites for muscles and tendons) near or on the growth plates in children and adolescents. Apophysitis can result from repetitive overuse behaviors like running, jumping, and throwing, or from sudden trauma. Osgood-Schlatter’s Disease and Sinding-Larsen-Johansson Syndrome are two common types of apophysitis. Rapid growth, stiff and inflexible muscles and tendons, and playing through pain can all increase the risk of apophysitis.
Read more: Arthritis in knee
Patellofemoral pain, often referred to as “runner’s knee,” is a general term used to describe pain in the front of the knee and around the patella or kneecap. This pain may be caused by various conditions that affect the patellofemoral joint, including:
- Traumatic Patellar Chondromalacia: This condition occurs when the cartilage under the kneecap is damaged or softened due to trauma or injury. The resulting friction between the kneecap and the femur can cause pain and inflammation.
- Tight medial and lateral retinacula or patellar pressure syndrome: The retinacula are bands of connective tissue that help stabilize the patella. When these bands become tight or imbalanced, they can exert excessive pressure on the patella, leading to discomfort and pain.
- Symptomatic bipartite patella: This is a congenital condition in which the patella develops into two separate pieces rather than fusing into a single bone. In some cases, this can cause pain and inflammation in the patellofemoral joint.
- Osteochondritis dissecans of the patella or femoral trochlea: This condition occurs when a small piece of bone or cartilage in the joint becomes damaged or separated from the underlying bone. This can lead to pain, inflammation, and instability in the patellofemoral joint.
Physiotherapy is an evidence-based treatment protocol for treating various kinds of knee pain. A sports physiotherapist or a physiotherapy doctor practicing in the musculoskeletal area can provide immediate relief from knee pain.
What are the most common causes of knee pain?
The most common causes of knee pain include trauma (e.g., tendon injuries, patellar fractures, and cartilage damage), tendonitis, prepatellar bursitis, ACL injuries, iliotibial band friction syndrome, arthritis (osteoarthritis and rheumatoid arthritis), plica syndrome, fat pad syndrome, apophysitis, and patellofemoral pain from various conditions.
How can I differentiate between various types of knee pain?
Differentiating between types of knee pain often depends on factors like the location of the pain, the nature of the pain (sharp, dull, constant, or intermittent), activities that aggravate the pain, and the presence of other symptoms like swelling, redness, or limited mobility. A doctor or physiotherapist can help diagnose the cause of knee pain based on these factors and clinical examination.
When should I consult a doctor or physiotherapist for knee pain?
Consult a doctor or physiotherapist if your knee pain is severe, persistent, or worsening; if you experience swelling, redness, or warmth around the knee; if you have difficulty bearing weight on the affected leg; or if your knee appears deformed or has limited range of motion.
To prevent knee pain, maintain a healthy weight, strengthen the muscles around the knee, engage in regular flexibility exercises, wear appropriate footwear, practice proper technique when participating in sports, and avoid overuse or sudden increases in training intensity.
What are some conservative treatment options for knee pain?
Conservative treatment options for knee pain include rest, ice, compression, elevation (RICE), over-the-counter pain relievers, anti-inflammatory medications, and physiotherapy.
How can physiotherapy help with knee pain relief and recovery?
Physiotherapy can help by identifying the cause of the pain, providing personalized treatment plans that may include manual therapy, exercises to strengthen and stretch the muscles around the knee, and advice on activity modification or proper footwear.
What are some at-home remedies or exercises to help manage knee pain?
At-home remedies include applying ice packs, taking over-the-counter pain relievers, and practicing gentle range of motion exercises or stretches. Consult with a physiotherapist for specific exercises tailored to your condition.
How long does it typically take to recover from common knee injuries, such as ACL tears or tendonitis?
Recovery times vary depending on the severity of the injury and the individual. Mild cases of tendonitis may improve within a few weeks, while more severe cases can take months. ACL tears often require surgery and may take six to twelve months to recover fully.
When is surgery necessary for knee pain, and what are the common surgical procedures for knee issues?
Surgery may be necessary if conservative treatments have failed or if the injury is severe, such as in the case of an ACL tear or advanced arthritis. Common surgical procedures include arthroscopy, ligament reconstruction, meniscectomy, and joint replacement.
How can I reduce the risk of developing knee arthritis or other degenerative joint conditions?
Maintain a healthy weight, engage in regular low-impact exercise, strengthen the muscles surrounding the knee, practice proper biomechanics during physical activities, and address any existing knee injuries promptly to reduce the risk of developing arthritis or other degenerative joint conditions.
- Brukner, P., & Khan, K. (2017). Brukner & Khan’s Clinical Sports Medicine: Injuries (5th ed.). McGraw-Hill Education.
- Magee, D. J. (2014). Orthopedic Physical Assessment (6th ed.). Elsevier.
- American Academy of Orthopaedic Surgeons. (n.d.). Knee Pain. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/knee-pain/
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Knee Problems. Retrieved from https://www.niams.nih.gov/health-topics/knee-problems
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