Knee Injuries

Anyone can be a victim of a knee injury; whether you are a professional athlete, a weekend fitness buff or someone just busy carrying out your day-to-day activities. The knee joint is unique in that it carries body weight at the same time as it provides flexibility and mobility. It is formed by the femur, the tibia and the patella and held together by muscles, ligaments and tendons.This construction predisposes the joint to risk of injury from sudden movement and repeated wear and tear.

4 Common Causes of Knee Injuries

Ligament Sprains – ligaments are bands of strong tissue that stabilize the knee joint together. Over-stretching can cause the ligament fibre to tear and bleed into the surrounding tissues, causing pain,swelling and a feeling of ‘giving way’. Severe tears may require surgery.
Cartilage Tears – cartilage also helps stabilize and protect the knee joint. Pressure from twisting and turning during weight-bearing exercise like squash may tear the cartilage, causing pain, swelling and locking of the knee joint.
Tendon Strains – tendons are cord-like bands that connect muscle to bone. The patellar tendon connects the kneecap (patella) to the tibia (shin). Patellar tendonitis or ‘jumper’s knee’ is inflammation of the patellar tendon. This is an overuse injury commonly caused by repeated jumping, as in basketball.
Patello-Femoral Syndrome – excessive friction between the surface of the patello-femoral joint(kneecap) and the femur (thigh) can result in knee pain. It may have a number of causes and should be assessed by your physiotherapist.

Other Common Causes of Knee Injuries

Knee injuries can be caused by trauma, such as an accident or a fall, or even by a sudden increase in your daily activities. Other injuries develop over time, from factors including structural problems within the joint itself, incorrect athletic training methods or technique, and poor equipment.

Footwear – a new pair of athletic shoes or a change to heels instead of flats can affect the way you walk and, in turn, can place stress on the muscles and tendons around the knee joint.
Frequency and intensity of a regular activity – Any change such as jogging or playing tennis on a different surface can affect the knee joint. For example, simply moving the activity from a soft track or clay court to a hard surface such as a road or hard courtcan add stress to the knee joint and increases the risk of injury.
Compensation for an injury elsewhere. A blister on your foot, for example, may cause you to change the way you step to minimize the pain, thus placing a strain on the knee.

How to Treat Knee Pain

Physiotherapists work closely with doctors, surgeons and sports specialists to provide effective care and assist recovery. A physiotherapist will assess your knee to determine the source of the problem and to develop an individual treatment program. Depending upon the type and degree of injury, the program may include:

Applying ice to control swelling;
Stretching exercises to regain flexibility around the joint. The most common stretches are for the hamstring, quadriceps, gastrocnemius (calf), iliotibial band and groin (hip adductor), hip flexors and buttocks; and
Strength training to build up the muscle. If you are involved in organized athletics, the physiotherapist may also want to work with your coach to ensure a safe return to your sport. Strengthening exercises are specific to the injury, but would include the quads,hamstrings; hip adductors and abductor muscles

Knee strengthening exercises after a knee injury

Returning to Activity

A physiotherapist can provide a program to help prevent re-injury as you return to normal activities. A key element of that program is to return to your regular activity levels gradually. Don’t try to do too much too soon! After a break in routine – whether as a result of an illness or accident, the seasonal nature of the activity or even a holiday – you can’t just jump back in at full speed. Instead, build up gradually to your previous level of activity.

Another element of the rehabilitation program is to retrain balance and coordination. A knee injury involves more than just stress and strain to the soft tissue. It also affects the tiny receptors in the muscles, ligaments and tendons that‘tell’ you where your knee is positioned. These receptors send signals to correct balance or shift weight. When they’re damaged, the messages are interrupted and you are more likely to stumble and/or turn an ankle. Your physiotherapist will provide you with an exercise program that will include retraining the receptors as you strengthen the muscles strength around the damaged tissues.

The Canadian Physiotherapy Association (CPA) recommends the following S.M.A.R.T. tips (Stretch, Move, Add it up, Reduce strain, Talk to a physiotherapist) to prevent knee injuries:

Stretch – before, during and after activity. Stretching – as a warm-up, as a break during repetitive movements and as a cool-down – helps you to move easily, keeps your muscles flexible and relaxed, your joints mobile and relieves tension and strain.
Move – today for tomorrow. Get moving. Keep moving. Stay moving. Through the seasons. Through life. Maintain good general fitness and lower body strength.
Add it up – an hour is power. To gain mobility, plan activities throughout your day that keep you moving for periods of at least 10 minutes. To maintain your mobility, make every movement count. Add up all you do in a day and aim for a minimum of 60 minutes of movement every day.•Reduce strain– vary activities and use proper biomechanics to achieve a good balance of muscle development. For example, where possible, don’t twist your trunk first when turning– instead point your feet in the direction that you want to go to and let your body follow.
Talk to a physiotherapist – if your knee swells after a twist, gives way or locks, have it checked before you return to sport. Our physiotherapists in Thornhill can assess the joint and build a step-by-step return to activity with you.

What the Research Says

For pain around the kneecap (patellofemoral pain), an international expert consensus recommends exercise therapy as the main treatment, especially a combination of hip and knee strengthening. Combined treatments and foot orthoses are also recommended. Mobilizing the kneecap, knee or lower back on its own, and electrical treatments, are not recommended (Collins et al., 2018).

For meniscus tears that develop with age rather than from a sudden injury, a randomized trial of 140 adults with an average age of about 50 found that 12 weeks of supervised exercise gave knee results after 2 years that were no different from arthroscopic surgery to trim the meniscus. The exercise group also gained thigh strength early on, and only 19% later went on to have surgery (Kise et al., 2016). A sudden injury with fast swelling, locking or a knee that gives way should still be checked promptly, because some ligament and meniscus injuries need a surgical opinion.

Key Takeaways

Most knee pain responds well to a targeted exercise program.
For kneecap pain, hip and knee strengthening together is the recommended starting point.
Age-related meniscus tears often do as well with exercise as with surgery.
A knee that swells quickly, locks or gives way after an injury should be assessed promptly.
After any break from activity, build back up gradually.

Related Conditions

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References

Collins, N. J., Barton, C. J., van Middelkoop, M., Callaghan, M. J., Rathleff, M. S., Vicenzino, B. T., et al. (2018). 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. British Journal of Sports Medicine, 52(18), 1170-1178. https://doi.org/10.1136/bjsports-2018-099397

Kise, N. J., Risberg, M. A., Stensrud, S., Ranstam, J., Engebretsen, L., & Roos, E. M. (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 354, i3740. https://doi.org/10.1136/bmj.i3740

4 Causes of Knee Injuries & How to Treat Them