The Knee:
The knee is a complex joint which makes it easy to injure. It is made up of bone, ligament, cartilage, tendon and fluid. It works as a hinge joint, flexing and extending and allowing minimal rotation.
Knee Osteoarthritis:
This is a common condition in which the natural cushioning between joints (cartilage) is worn away, causing the bones of the joint to rub more closely resulting in pain, swelling, stiffness and decreased flexibility. Aging, increased weight, genetics, sports and repetitive stress and trauma are all contributing factors.
Patellofemoral pain syndrome:
This is a common condition in young and old people, particularly active people with pain felt behind the kneecap where it attaches to the femur (thigh bone). Due to poor kneecap alignment, greater pressure is felt resulting in pain. Weak muscles often caused by tight hips and glutes, as well as poor foot posture (rolling in) contribute to a lateral deviation of the patella and consequent discomfort. Pain is at its worst when navigating stairs, squatting, kneeling, hopping and running.
Iliotibial Syndrome:
The iliotibial (ITB) band is a thick, fibrous band of connective tissue that runs along the outside of the thigh from the pelvis to the knee. ITB syndrome is an overuse injury caused by one or more problems including poor footwear, training errors, training surfaces, leg length discrepancy, muscle tightness and underlying mechanical issues such as hip tightness or overpronation (feet rolling in). Pain is felt on the outside of the knee.
Patellar Tendinopathy:
The patella tendon is located just below the kneecap and inserts into the leg (tibia). The patella tendon transfers loading from the quadriceps with a small amount of knee bend. Due to excessive loading and strain, the tendon is susceptible to tear and damage which will progressively get worse causing pain. Patellar tendinopathy is common in active people involved in high impact activities such as running and jumping with pain being felt at the front of the knee.
What treatment is available?
Treatment for knee pain involves a detailed history of activity levels, training and footwear and a biomechanical assessment to determine the underlying causes. Tailored exercise programs are usually prescribed to help stretch and strengthen muscles. Ultrasound therapy and taping are used initially when inflammation and pain are significant. This is done in conjuction with a footwear review and if foot posture is a significant contributing factor, orthotics are recommended. Self management strategies such as foam rolling, icing and the use of anti inflammatories are also advised. If muscle tightness is a large causative factor, shockwave therapy is strongly recommended to improve range of motion and muscle flexibility. Hyaluronic (joint lubricating) and Cortisone injections and orthopaedic referral are advised when all conservative therapies have been exhausted.