The knee is a relatively simple joint, however it still has a lot going on under the hood. A number of ligaments, tendons, a large blended joint capsule and, of course, the patella/kneecap. Knee issues and injuries are relatively common, and in this article I would like break down some of the more common presentations we see here at Inspired Physiotherapy.
1. Patellafemoral issues / malt racking
The knee cap (patella) requires balanced development of the quadriceps (thigh) muscles, particularly of the vastus laterals (VL) and the vastus medialis oblique (VMO), in order to ‘track’ or move correctly when the joint of the knee is flexing and extending. Commonly, the VMO (inner quad) is weaker than the VL (outer quad), which can cause the patella to follow a path it was not designed to. This in turn can cause inflammation, cartilage wear, and pain.
Treatment is often quite simple – support the patella in a better position while strengthening the VMO and addressing surrounding musculature as required. Physiotherapists achieve this through supportive braces or taping of the knee, as well as activation and strengthening exercises.
2. ACL rupture
The Anterior Cruciate Ligament is one of the ligaments that lies within the knee joint and prevents the tibia, or shin bone, slipping forward past the femur. It is often ruptured when planting and twisting, such as a ‘cutting’ manoeuvre in ball sports, or the stop start play style seen in basketball and netball.
It is usually quite obvious that the ACL has ruptured, often there is an audible ‘snap’ and significant pain. Quite often the affected individual will crumple like a sack of potatoes. Large amounts of swelling around the knee joint is common. Instability and pain in the knee is commonly experienced after an ACL rupture, especially when turning or twisting.
ACL rupture most often results in surgical repair. Physiotherapists assist in returning range of motion, strength and basic function prior to surgery, as well as rehabilitation post surgery.
3. Meniscus Injuries
The meniscus is the cartilage that supports the knee joint, so that the bones are protected. There is a lateral and medial meniscus in both knees. The meniscus is usually damaged through traumatic injury (i.e. knee twisting injuries from sport) or degeneration (i.e. wear and tear as we age).
Clicking, catching or locking of the knee can be indicative of a meniscus injury. Tenderness along the joint line, pain on squatting or other significant flexion (knee bending) events, and swelling can also be present.
The location of a meniscus tear can greatly influence its capacity for healing – parts of the meniscus do not have much blood flow to support tissue healing. Physiotherapy can assist in reducing inflammation, strengthening the supporting musculature, and decrease chances of re injury. Large tears or those not responding to conservative management may require surgical treatment.
If you have any further questions regarding knee injuries or if physiotherapy can help in your particular situation, give us a call on (02) 9674 5596.
Chris Mooney, Physiotherapist