Causes of knee pain and the role of a physiotherapist

Knee pain is a common complaint that affects people of all ages. It can result from various causes, ranging from acute injuries to chronic conditions. Understanding the causes of knee pain and the role of physiotherapy in its management is crucial for effective treatment and prevention.

Common Causes of Knee Pain:

Osteoarthritis: This degenerative joint disease is a leading cause of knee pain, especially in older adults. It involves the breakdown of cartilage in the knee joint, leading to pain, stiffness, and reduced function.

Patellofemoral Pain Syndrome: Often referred to as "runner's knee," this condition causes pain around or behind the kneecap, typically exacerbated by activities like climbing stairs or sitting for long periods.

Ligament Injuries: Tears or sprains of the knee ligaments, such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL), can cause significant pain and instability.

Meniscus Tears: The menisci are cartilage discs that act as shock absorbers in the knee. Tears can occur due to sudden twisting movements or degenerative changes.

Tendinitis: Inflammation of the tendons around the knee, such as patellar tendinitis (jumper's knee), can cause pain, especially during activities that stress the tendon.

Bursitis: Inflammation of the small fluid-filled sacs (bursae) that cushion the knee joint can lead to pain and swelling.

Iliotibial Band Syndrome: This condition causes pain on the outer side of the knee, often seen in runners and cyclists.

Rheumatoid Arthritis: This autoimmune condition can affect the knee joints, causing pain, swelling, and stiffness.

Gout: A form of arthritis caused by the buildup of uric acid crystals in the joint, which can affect the knee.

Referred Pain: Sometimes, knee pain can be referred from other areas, such as the hip or lower back.

Fractures: Broken bones in or around the knee joint can cause severe pain and impaired function.

Dislocations: The kneecap (patella) can become dislocated, causing pain and instability.

The Role of a Physiotherapist in Managing Knee Pain:

Physiotherapists play a crucial role in the assessment, treatment, and management of knee pain. Their approach typically involves:

Comprehensive Assessment:

A detailed history is taken to understand the nature and onset of pain. A physical examination is performed to assess the range of motion, strength, and stability.

Special tests are conducted to identify specific conditions (e.g., ligament integrity tests), and a functional assessment is used to evaluate how the knee pain affects daily activities.

Diagnosis: While physiotherapists don't provide medical diagnoses, they can identify the likely cause of knee pain based on their assessment. They may refer patients for imaging or to other specialists if necessary.

Pain Management:

Manual therapy techniques are used to reduce pain and improve joint mobility. Modalities such as ice, heat, dry needling, polychromatic light therapy, or electrical stimulation may be used for pain relief. Taping or bracing may provide support and reduce stress on painful structures.  Joint mobilization or manipulation can help improve knee mobility, while soft tissue techniques can address muscle tension or restrictions.

Exercise Prescription:

Strengthening exercises for muscles around the knee, particularly the quadriceps and hamstrings.

Flexibility exercises to improve the range of motion.

Balance and proprioception exercises to enhance stability.

Functional exercises that mimic daily activities or sport-specific movements.

Gait Analysis and Retraining: Assessing and correcting abnormal walking patterns that may be contributing to knee pain.

Biomechanical Assessment: Evaluating overall lower limb alignment and mechanics to identify and address factors contributing to knee pain.

Patient Education:

Explaining the cause of pain and the rehabilitation process is crucial for ensuring patient compliance with recovery.

Advice on activity modification to reduce stress on the knee

Teaching self-management strategies for pain relief and the prevention of the recurrence of their problem.

Postural Education: Advising on proper posture and ergonomics to reduce stress on the knees during daily activities.

Weight Management Advice: Counseling on the importance of maintaining a healthy weight to reduce stress on the knee joints.

Return to Sport or Activity Planning: Developing a graduated return to sport or activity program to ensure safe and effective recovery.

If pain cannot be managed with physiotherapy modalities or mobility does not improve, a referral to an orthopedic specialist may be recommended. Knee pain should not be endured, as an altered gait can have a cascade effect on the low back, hips, and even the ankles.