Knee Pain

Most often people will seek medical help once they encounter pain in the knee which limits their normal daily activities.

Typical Knee Injuries

Common knee problems include the following:

Arthritis

Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away. It often affects middle-age and older people. Osteoarthritis may be affected by excess stress on the joint such as repeated injury or being overweight. Rheumatoid arthritis is another type of arthritis that can affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Compared to osteoarthritis, it can affect younger population as early as 30 years old.

Tendonitis

Inflammation of the tendons may result from overuse of a tendon during certain repetitive activities such as running, jumping, or cycling. In this case, the patellar tendon is commonly affected.

Sprained knee ligaments or strained muscles

A sprained knee ligaments or strained muscle is usually caused by a blow to the knee or a sudden twist of the knee that causes the ligament/muscle to overstretch. Few examples of these could be sprain of the collateral ligaments of even a quadricep muscle strain.

Torn cartilage

Any trauma to the knee has a possibility of tearing the menisci (pads of connective tissue that act as shock absorbers and also enhance stability), especially in contact sports where twisting movement is involved. Cartilage tears can often occur with sprains. Commonly affected area would be the anterior medial meniscus.

Physiotherapy

Most often people will seek medical help once they encounter pain in the knee which limits their normal daily activities. This pain is the first obstacle to tackle. When the pain in the knee is addressed, the next component would usually be strength. Muscle strength decline with bedrest in young adults showed knee extension strength reducing by 5-6% per week for the first few weeks, whereas older adults had 11-12% reduction in strength in 10 days of bedrest. In addition, balance must be addressed as well which can reduce the chances of future injuries from falls. 

To measure pain, the numerical rating scale is measured on a scale of 1 to 10, with 10 being the most pain felt and 1 being the least. For strength, dynamometry can be used, which measures the level of maximal force able to be exerted. This is done before the training session, comparing between the painful and non-painful leg and can be repeated after some time to measure strength changes. For balance, the star excursion balance test or SEBT is well-suited, which measures dynamic single leg balance. 

Depending on personal goals, the completion criteria will vary. For an athlete that wants to return to sports, more focused tests will need to be done to provide some assurance that he/she will be able to perform at their maximal capacity on the field. For the recreationally active population on the other hand, pain-free movements with comparably equal strength to the unaffected leg will be sufficient. 

Knee Sports Rehabilitation

The sports rehabilitation for any knee injury will begin as soon as phase 3. Upon discharging from physiotherapy after a knee injury, the patient is expected to be pain free and able to move through normal range of motion pain free as well. Also, the patient should be able to begin to increase the ability of the knee to take load, but with controlled movement.  In most knee injury cases, the sports rehabilitation phase will continue re-educating and activating the muscle which has experienced atrophy. This is followed by strengthening the weakened muscle along the knee joint. Flexibility and mobility exercises will be incorporated to maintain the joint range of motion and muscle flexibility. Balance and coordination exercises will be progressed from double leg to single leg to get the patient prepared for return to sport. The balance exercises help in enhancing the joint proprioception.

Here at Rehamed Therapy, the sports therapy program will focus on helping the patient return to sports confidently and in almost better condition than they initially were, before the injury. 

An important progression criteria is the strength test. The strength will be tested on the initial day of assessment and the test will be repeated continuously to progress the exercise. The balance test and MAT test are also used as progression criteria before the patient returns to sport. The therapist will run through the testing upon discharge, to ensure that the patient is fit to return.  

Prevention & Reconditioning

NIAMS recommends the following for people of all ages to prevent knee injury:

  • Before exercising, warm up and stretch the muscles in lowerlimb to reduce tension on tendons and relieve pressure on knee.
  • Strengthen leg muscles to help maintain stability in the knees. Balancing and neuromuscular training should be included in the program to prevent fall injuries and improve control of movements.
  • Avoid sudden changes in exercise intensity. Increase or decrease the force and duration gradually.
  • Wear shoes with good condition that fit properly to help maintain balance and leg alignment. Knee problems can be caused by flat or pronated feet (feet that roll inward). Special shoe inserts (orthotics) custom-molded to the shape of foot can help.
  • Maintain a healthy weight. During weight bearing activities such as walking, climbing stairs, getting in and out of a chair forces through the knee can be 2–3 times body weight. The higher a person’s weight the greater the load placed on the knee joints during weight bearing activities. Being overweight or obese stresses joints and increases the risk of osteoarthritis.
  • Before riding a bicycle make sure that the seat is high enough so that pedaling won’t put too much pressure on the knees.

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