Knee Pain Treatment
The knee is a strong joint supported by powerful muscles that can span across the hip, knee and ankle. These muscles and the strong set of ligaments provide control and support to the knee joint. This enables this joint to tolerate load and generate large forces both when bearing weight such as running or landing for a jump, as well as when having the leg free in the air such as kicking a ball across the field.
The health of the knee joint and surrounding structures is maintained through regular movement and by maintaining the strength of the lower limb muscles (hip, thigh and lower leg), as well as caring for your general physical and psychological health. This includes, engaging in regular physical activity, maintaining healthy body weight, good sleep habits, as well as managing stress and mood.
Knee pain is a term that relates to pain around the front, back and side of the knee. It can sometimes refer down the leg and can also be associated with hip or back pain.
How common is it?
Knee pain is very common and can occur at any age although it is more common in very active people. Knee pain, especially when it is persistent and disabling, can negatively impact on engagement in activities of daily living such as walking, managing stairs, getting up from a chair or from the floor, sleep, physical activity and work. This can in turn hugely impact on a person’s psychological and physical health.
Pain around the knee may be related to sensitive tendons, muscles, bursa, the knee cap or the knee joint itself. Knee pain is rarely related to damaged structures unless there has been a traumatic injury. ACL tear or rupture, medial ligament strain, patellofemoral pain, tibiofemoral pain, iliotibial band syndrome, hamstring tendinopathy and Baker’s cyst. Knee pain usually presents when loading the knee such as standing, walking, running, walking down stairs, squatting, lunging and side stepping. It may also disrupt sleep.
Risk factors for knee pain
Knee pain can arise from a traumatic injury such as a hyperextension, or side impact injury to the knee structures which may result in ligament or bone damage. When this occurs pain and swelling presents immediately and the knee will be difficult to weight bear on. Risk factors for a traumatic injury include poor strength, coordination and conditioning of the lower limb muscles.
Common risk factors for knee pain that arises without a traumatic injury are: repeated loading activities (weight bearing sports), carrying excessive belly fat, muscle weakness of the thigh, calf and buttock muscles, inactivity and depressed mood. These factors can cause changes to the nervous system and the body’s chemistry, resulting in inflammation and making the knee joint’s structures very sensitive.
Risk factors for persistent knee pain can relate to a loss of confidence in the knee, over protecting the joint and avoidance of loading the sore leg. This can lead to weakness, unnecessary tension and joint sensitivity, resulting in more pain. Other factors such as carrying excessive belly fat and high levels of psychological distress are also known to influence recovery from knee pain.
Myths about knee pain
- Knee pain that is persistent means I’ve got arthritis
- Knee pain is caused by joint damage
- Pain going up steps and squatting means I should stop it
- Exercise and loading the knee joints makes them worse
- If my knee pain doesn’t go away I should get a scan
- If my knees are making noises and crackling they must be wearing out
- Knee osteoarthritis means a hip replacement is inevitable
- Once a person has had knee surgery, there is no need for physiotherapy
Facts about knee pain
- Knee pain is common without any damage to the joint
- Lots of findings on scans such as meniscal tears, joint narrowing and osteoarthritis are common in people without knee pain
- Leg muscle weakness, protective muscle guarding, lack of confidence of using the knee, and having fat around the belly are stronger predictors of pain and disability than joint changes on a scan
- Squatting and steps are great exercises to strengthen the knee as long as the exercises are built up slowly
- The stronger your muscles the less strain on the joint – your muscles act as shock absorbers. In fact, moving the joint and strengthening the muscles around the painful joint reduces pain and improves functional capacity
- Exercise that gradually loads the joint is not harmful for the joint
- Weight loss for people who are over-weight can significantly reduce knee pain, by reducing inflammation in the body and the load on the knee joint.
- Scans are usually only needed if you have had a traumatic injury
- Noisy knees are common and can improve with activity
- Lifestyle factors such as diet, sleep and general health are all important for knee pain.
- If you have had knee surgery, getting strong, mobile, confident, active and healthy is important for long term improvement.
Approaching knee pain
There are lots of effective treatments that our physiotherapists at Body Logic Physiotherapy can offer people with knee pain.
The first and most important thing for us is to take the time to hear your story and pain experience in your own words. We want to know how the pain began, how the pain feels to you, and how it impacts on all aspects of your life so we can help you get back doing what you like. We will also ask you about your sleep, activity levels, your lifestyle and goals, so we can help you get healthy and get back doing things that are important to you. We will also screen you to ensure your knee pain isn’t caused by serious health problems.
Assessment of the person with knee pain
Following this we will conduct a comprehensive examination. This will usually involve looking at where you hurt, how sensitive your knee is to touch, move, and load. We will look at the mobility of your knee, your ability to relax the knee muscles, as well as assessing the strength and endurance of your lower limb muscles. The examination and treatment will be tailored to each person’s pain and sensitivity levels.
Treatment of the person
with knee pain
Based on all the information from the examination we will explain to you in simple language the factors that are contributing to your pain, and discuss the best treatment options available to you.
If your pain is acute (sudden onset), the key is to help you to get comfortable and moving as this helps with recovery. We will also identify the factors that caused the knee pain and make a plan to prevent it in the future. If you have had a traumatic onset to knee pain we can assess you to determine whether you need a scan or not.
If your pain is persistent (longer than 6-12 weeks), we will work out a plan with you to help you take control of your pain and get back to living based on your goals. We are interested in coaching people to develop confidence to exercise and engage in regular physical activity, this can be done either in a group environment or in an individualised manner.
- Treatment often involves learning to relax tense muscles, regaining joint mobility if restricted, a graduated strengthening exercise program, and a plan to get you physically active based on your preference. It’s really important to get you fit, confident and strong as this results in pain relief and increased functional capacity.
- Addressing other factors such as sleep, mood, stress, dietary factors, if relevant, may also be important. We work with other health professionals where needed, to ensure your care is coordinated.
- We will identify your goals and ensure the treatment plan is directed towards these.
At Body Logic Physiotherapy we are not interested in ongoing band-aid treatments. Treatments such as manipulation, massage, needling, medication, and injections often only provide short-term pain relief. We know the best way to manage knee pain is to help you understand why you have pain, and set-up a treatment plan to address all modifiable factors contributing to your pain. This helps you get you back in control, moving, active and living again.
For some people this process may take 2-3 sessions, however for long term problems this may take up to 7-10 sessions over a 3-4 month period. We also offer supervised exercise rehabilitation classes and one-to-one sessions to support this process if needed.
A great example of treatment for knee pain at Body Logic Physiotherapy is the GLA:D program. GLA:D is an evidence-based program for people with hip and knee osteoarthritis pain and symptoms. GLA:D educates people about their pain and involves a 6 week progressive rehabilitation program. This approach has been shown to positively reduce pain, and the need for medication or surgery, whilst improving functional capacity.
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Additional Resources
‘If your knee hurts, keep exercising’: Why exercise is a great form of pain relief
