Knee pain can be classified as any pain at the front, inside, outside or behind the knee.
It could range from being sharp with certain movements or positions, or a dull ache or tightness that may be associated with stiffness or inflammation. Some people also complain of a clicking or “locking” knee.
Knee pain could be a direct result of a fall, twist or awkward landing, sudden increases in training load or activity, or underlying osteoarthritic or natural ageing changes that occur to cartilage with use.
After trauma or a fall it is important to assess the major ligaments, cartilage and the knee cap bone to confirm or deny any damage.
With pain that gradually builds over time it may be more likely associated with natural cartilage and bone changes that occur with time, or poor strength and control of muscles around the knee.
After an injury if you are experiencing pain and/or limping then it is important to have your knee examined as soon as possible. Swelling may impact how accurately the knee can be assessed in the initial appointment, however, great pain reduction can be achieved by administering crutches, massage, compression and solid advice regarding how to best look after your knee in the coming days. If your physiotherapist believes you need to have an MRI or an X-Ray, then a referral can be written in the initial assessment as well. They will also be able to advise whether or not you may qualify for a bulk billed MRI via your GP.
If your physiotherapist agrees that osteoarthritis is likely to be the main reason for your knee pain, then a period of conservative management is usually encouraged. This period of time can be agreed upon together between the patient and physio depending on goals, level of pain, age and knee movement.
Commencing a tailored muscle activation and strengthening program has the best evidence supporting long term outcomes for people with osteoarthritis of the knee. A combination of home exercises, stationary bike, swimming, Pilates based exercises and gym based exercises are all good options. It is important to speak to your physiotherapist about what the best option is for you, and have a personalised program developed that meets your functional level.
The team at CSSM have developed years of experience with assessing and treating knee pain. When indicated, we can conduct strength testing using a force gauge and gym equipment including a leg press, leg extension and a squat rack. We can analyse your walking technique on our modern treadmill video analysis system, or simply watch with our trained eye how you perform your daily movements such as squatting or walking up and down stairs.
We keep our assessments functional and individualised. Our main priority is identifying your needs and goals and keeping these at the forefront of our mind in every session.
We develop rehabilitation programs that align with our patients’ interests and lifestyle. Whether that be a home exercise program, gym based program or Clinical Pilates program, we will offer you the different options and identify what suits you best.
Content for this page on Knee Injuries was prepared by Camberwell Sports and Spinal Medicine Physiotherapist, Kobi Phelan. Kobi has a clinical interest in knee injury and rehabilitation, particularly sporting injuries involving ACL and ligament injuries.
In the event of a serious knee injury or in cases of severe knee osteoarthritis surgery may be an option, however, it is more commonly becoming a less likely option. The decision to pursue the surgical pathway vs the conservative option is always a hotly debated topic no matter the region of injury. Ultimately, the decision comes down to numerous factors, and best practice recommends the decision is collaborative between the health practitioner and the patient.
There are some key factors that will determine the likelihood of success/failure of conservative management that must be taken into consideration. These factors include, but are not limited to; age, mechanism of injury and subsequent loss of function, lifestyle and desired health goals, sporting and occupational variables, duration of symptoms and magnitude of injury.
Therefore, depending on the type of injury, how it has been sustained and how it is affecting daily life, the decision for surgical repair should be made in the best interest of the patient that will allow them to achieve their most desired outcome. Furthermore, if the decision for surgery is agreed upon, the importance of a pre-operative physiotherapy program cannot be understated as it can facilitate better outcomes post-operatively.
Imaging can play an important role in providing further information to the clinical presentation of each knee injury. There are different types of scans available for the knee including MRI, x-ray and ultrasound. A scan essentially is a photo of what is going on within the joint, therefore it is important to denote which findings are clinically relevant and which provide valuable information that will guide management. Often scans are a poor indicator of pain and prognosis.
Depending on your suspected injury, the type of scan you may need will vary as certain structures become vulnerable in different types of injuries as well as different mechanisms of injury. An x-ray will provide valuable information of bony pathologies that may be associated with falls that can lead to fractures. MRIs and ultrasound will provide further information about soft tissue structures within the joint such as ligament injuries (eg. ACL injury). Ultrasound is used for looking at soft tissue structures outside the joint such as bursitis or tendon injuries.
As physiotherapists we will always advocate to our patients to maintain their activity levels where they can, however pushing through pain or higher levels of discomfort that results in a significant ache or worsening pain AFTER exercise is not recommended. Some awareness of mild discomfort during exercise or strength work is ok if this settles fairly instantly after activity is ceased. Some exercise such as running, long walks or high impact gym classes may be restricted in the short term whilst the knee is recovering. Your physiotherapist can help identify lower impact options such as swimming, cycling or non-weight bearing strength exercises that you can use as a substitute to keep the body moving in the meantime.
The need for a brace or support for your knee injury depends on the nature of the injury, the stage of healing and your tolerance of the injury itself.
For many injuries the use of a brace is not necessary. In some cases, just some taping to the knee may be all that is required or nothing at all.
For more serious injuries bracing may be necessary in the early stages of management or after surgery. However, this will be coordinated by your practitioner.
The use of anti-inflammatories is increasingly becoming debated. Our body’s natural healing properties use inflammation to facilitate recovery and the reliance on anti-inflammatory medication can be seen to interrupt this valuable healing property. In the case of knee injuries, it depends on the situation of your injury. There is a grey area in the research regarding the effectiveness of anti-inflammatories on muscle and tendon injuries, and whether it may slightly impede recovery. However, if there is persistent swelling or osteoarthritic changes/pain within the joint itself, anti-inflammatories may provide relief for these conditions given the constant irritation of local nerves in the area.
As physiotherapists it is important to note that we are not experts in the prescription of medication. Any information given is advice that should be followed up with your GP if you have any further questions or concerns.
To make an appointment for treatment of your knee injury you do not need a referral.
Appointments can be made with any of our team by calling the clinic directly. Alternatively you can make an appointment via our online portal at our website – www.cssm.com.au