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?
- Trauma. It is the most common cause of Knee Pain. Tendinous lesions about the patella (Suprapatellar, Infrapatellar, Quadriceps expansion, Lesions at the tibial tuberosity), Patellar fracture, contusion, articular cartilage damage can result in inflammation, swelling, limited motion, and pain. The pain intensity can depend on stair climbing and during squatting.
- Tendonitis. Tendonitis of the patella or quadriceps tendons, sometimes it is called “Jumper’s Knee”. It typically occurs from overuse as the result of repetitive jumping. Runners, skiers, cyclists, and those involved in jumping sports and activities may develop. The pain is felt between the kneecap and shin.
- Prepatellar Bursitis. It is commonly known as “Housemaid’s Knee”. It is the result of prolonged kneeling or recurrent minor trauma to the anterior knee. The knee area is warm and red, kneeling or bending makes pain and swelling worse.
Figure: Bursa around the knee Joint
- ACL Injury. Tearing of the Anterior Cruciate Ligament is particularly common in people who play basketball, soccer, or other sports that require sudden changes in direction. Symptoms often include pain, swelling, and difficulty in walking.
- Iliotibial band friction syndrome. This occurs when the iliotibial band becomes so tight that it rubs against the outer portion of the femur. Marathon runners and cyclists are especially susceptible to iliotibial band syndrome that causes anterior knee pain.
- Arthritis. Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away. It often affects middle-aged and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.
- Plica Syndrome. Due to chronic irritation, the tissue around the patella becomes an in-elastic, fibrotic band that leads to tenderness and pain.
- Fat Pad Syndrome. This particular condition involves irritation of the infrapatellar fat pad from trauma or overuse.
- Apophysitis. Apophyses are the cartilage sites found throughout the body where muscles and tendons attach. Several apophyses are located in the hip and pelvic region. Apophysitis is an inflammation or stress injury to the areas on or around growth plates in children and adolescents. Apophysitis is usually caused by repetitive overuse activities like running, jumping, and throwing but can also occur as an acute injury with a fall or rapid, powerful movement. The two most common types of apophysitis are Osgood Schlatter’s Disease (bony area under the patella/knee cap) and Sinding-Larson-Johansson syndrome (bottom part of the patella/knee cap). The most common risk factors for apophysitis are periods of rapid growth where muscles and tendons can become tight and inflexible. Young athletes who play sports or perform repetitive activities such as running, jumping, or throwing and who often play through pain are also at risk. Symptoms of apophysitis can vary but there are a few key things to watch for, such as – pain that worsens during or after repetitive sports activities, swelling, tenderness, etc.
- Some of the conditions that may result in patellofemoral pains are –
- Traumatic Patellar Chondromalacia
- Tight medial and lateral retinacula or patellar pressure syndrome
- Symptomatic bipartite patella
- Osteochondritis dissecans of the patella or femoral trochlea
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.
- Therapeutic Exercise Foundation and Techniques by Carolyn Kisner, Lynn Allen Colby, 6th edition, Chapter 21
- A System of Orthopaedic Medicine, 3rd Edition. Author : Ludwig Ombregt. Page 675