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Knee Injuries

Knee Injuries

The knee joint is active during almost all forms of sport and exercise. Whether going for a gentle walk or skiing in the Alps, forces will be passing through the joint with the potential to cause injury. Due to the high activity of the knee joint any injury and pain is particularly troublesome, affecting everyday life and not just your sporting ambitions.

About the Knee

The knee joins the thigh bone (femur) to the shin bone (tibia). The kneecap (patella) and the second bone of the lower leg (fibula) also form part of the joint. Four ligaments work to keep the knee stable.

The Anterior Cruciate Ligament (ACL) is connected to the femur and tibia in the front part of the joint, this prevents the lower leg from sliding forward. ACL injuries can be caused with a change of direction, deceleration and landing from a jump. Many high profile football players have suffered from this injury.

To prevent the tibia from sliding backwards the Posterior Cruciate Ligament (PCL) is located behind the ACL and again connects to the femur and tibia. A blow to the front of the knee can cause PCL injuries.

There are ligaments on either side of the knee joint, with the Medial Collateral Ligament (MCL) on the inside and the Lateral Collateral Ligament (LCL) on the outside.  These ligaments help to prevent sideways movement at the joint; the MCL is more commonly injured from any movement which forces the foot outwards and knee in. Where the femur and tibia meet there is a layer cartilage called meniscus. This absorbs some of the force which passes through the joint and protects the bones. The degeneration of this meniscus is the cause of pain and stiffness suffered by people with Osteoarthritis. The structure of the knee and the large forces passing through the joint make it susceptible to injury.

Types of Knee Injuries

Knee injuries can occur following a variety of reasons, whether it is as a result of sport, a fall or even due to a degenerative condition.

Some of the more common knee injuries include:

Patella Tendonitis: The kneecap (patella) is connected to the shin bone via the patella tendon. It is part of the mechanism which straightens the leg and is often seen with people who carry out repetitive jumping actions. In fact patella tendonitis is sometimes referred to as ‘jumper’s knee’. The tendon becomes damaged and inflamed causing pain, especially when jumping or kneeling. A crunching sensation may occur with movement of the joint.

Osteoarthritis: This is the most common form of arthritis in the UK. It affects the joints, most commonly at the knee, hip, spine and hands. Osteoarthritis occurs due to the protective cartilage becoming damaged and thinning, in severe cases the cartilage no longer covers the end of the bones and they begin to rub together. 

Meniscal Tears: Meniscus is the c-shaped cartilage that helps to protect the joint. This can be damaged by knee movement, such as a squat and twist during sport, or in older people as themeniscus becoming damaged due to it thinning and weakening over time. Meniscus tears can also occur at the same time as injury to the ACL and MCL.

Ligament Damage: Ligaments are the tough bands of tissue connecting the bones within the joint and are responsible for stabilisation, allowing you to walk, run and jump. It is a common knee injury experienced by both professionals and amateurs alike, with the ACL being the most prone to injury. Any damage here can vary in severity and graded one to three, with one being a minor sprain and three being a complete rupture or tear of the ligament.

Knee Ligament Injuries

Knee Ligament Injuries

The knee has four major ligaments which allow the knee to move and also promote stability in that of the medial collateral ligament (MCL), anterior cruciate ligament (ACL), lateral collateral ligament (LCL) and posterior cruciate ligament (PCL). These can become sprained or torn, especially when taking part in sports with varying degrees of severity.

Knee ligament injuries will generally result in pain and swelling around the affected area, as well as an inability to move the joint fully. There are three different grades of injury depending on the nature of the injury which will influence the treatment options available to you.

ACL: This is a section of tough tissue that connects the shin and thigh bones within the knee. The ligament provides the joint with stability and controls the forward and backward movement of the bottom half of the leg.

LCL: The Lateral Collateral Ligament (LCL) is located on the outside of the knee, linking the shin bone to the thigh. It effectively offers stability and stops your knee from moving too far outwards.

MCL: The MCL is located on the exterior of the joint and goes from the femur to the tibia. The role of this ligament is to protect the joint from knocks, and it also prevents the knee from moving too far at each side. This type of knee ligament damage is common in football and rugby, where players have to endure tackles throughout a game.

PCL: This ligament is also within the joint and joins the tibia and the femur. Its role is to control how the knee moves backward and forward.

Causes

ACL: Damage to the ACL is the most common type of knee ligament injury and is often suffered by sports people (40% incurred following participation in extreme sports). An injury to this ligament can occur if the bottom section of the knee is twisted, the leg is extended in front too much, landing awkwardly from a jump, have a sudden stop or change of direction or collide with another player. ACL injuries are headline news in professional sport. You just have to run a search in Google to find all the Premier League players past and present who have succumbed to such an injury along with their respective rehabilitation which can be anything up to 9 months. It is also big news in the United States with American Footballers.

LCL: Knee ligament damage in this area is not as common as it is with the MCL. In order to injure this ligament you need to suffer a knock to the inside of the knee. This is less likely, as the area is generally protected by the other leg.

MCL: This type of ligament damage is almost always caused by playing a sport, especially football, either through a collision (the leg is stretched out and the outside gets knocked), force applied by an opponent or studs getting caught in the turf.

PCL: This area is larger and more durable than the ACL, resulting in fewer injuries. However, it’s also commonly caused through a car accident due to the shin hitting the dashboard.

Symptoms

ACL: An anterior cruciate ligament rupture often presents itself as knee pain, a ‘snapping’ or ‘popping’ sensation, tenderness plus swelling and difficulty in walking within 24 hours of the injury occurring. If left untreated the knee may remain unstable, and you may risk more extensive damage to the meniscus (the soft cartilage) within the knee, so it is important to seek medical advice as soon as possible. Using a knee support is advisable until you have a firm diagnosis of your particular grade of ACL injury.

LCL: Following a first degree sprain you experience swelling and area on the outside of the knee joint may painful to touch. Mobility may also be compromised, especially where stability of the knee joint is required such as getting in or out of a chair. Where a second degree sprain has been diagnosed the ligament itself will be torn and as a result will be painful and stability will be compromised. As this is a more severe injury recovery times will be longer. A grade three rupture of the ligament is the most severe diagnosis with stability of the knee joint fully compromised which can affect your ability to remain mobile given there is nothing stopping your knee from moving outwards.

MCL: Depending on extent of the mcl injury you will notice certain symptoms. First-degree sprains will result in some pain; second-degree sprains will be more painful to the touch and possibly also swollen; and third degree pains will immobilise your leg completely.

PCL: The difficulty with this type of injury is that it can be hard to diagnose. There are very few obvious symptoms. A posterior cruciate ligament injury is not generally associated with swelling or pain around the knee, which is usually an indication of Anterior Cruciate Ligament damage. The most common symptoms of a PCL tear are previous knee trauma and instability or unsteadiness around the knee. This ligament is not essential to operate normally, which is why many people can have this injury but it’s not diagnosed. However, if these injuries are not treated they can cause further problems in the future, such as osteoarthritis.

Diagnosis

ACL: Most acl knee injury can be diagnosed through a thorough examination by a doctor, who will typically compare the injured knee to the uninjured one. In certain cases further tests to rule out an associated broken bone will be undertaken. This might be an x-ray or an MRI scan which can provide a high resolution image showing the extent of the knee ligament damage. There are varying degrees of severity, from grade one to a grade three with the treatment options offered varying as a result. A grade one is a mild sprain and will repair itself following a few days of rest. A grade two results in a minor tear of the ligament which can take a number of weeks to heal and should be combined with physiotherapy to help strengthen the joint once again prior to restarting your activity. A grade three is a complete rupture of the ligament which can require surgery to remedy, though conservative treatment is available through physiotherapy and the use of a knee brace for additional stability.

LCL: It is very difficult to self-diagnosis an LCL injury without a scan as it can be difficult to pinpoint the ligament at fault. You will know when you have suffered a serious injury, in which case you should seek medical attention where a doctor or clinician may perform a varus stress test to help diagnose the problem.

MCL: Regardless of the level, you should see a doctor at the earliest opportunity as they can recommend pain-relief solutions. This will often include applying ice regularly to the affected area. Try doing this for 20 minutes every few hours, but don’t put the ice directly on your skin (wrap it in a towel or cloth). Keep your knee elevated and rest it as much as possible.

PCL: In order to diagnose this type of knee ligament damage, a specialist will generally undertake a number of physical checks. For confirmation of diagnosis, or to assess the severity of the injury, an X-ray or an MRI scan can also be beneficial.

Management

ACL: When managing an ACL injury there are a number of options depending on your circumstances but you are able to opt for either surgical or (a number of different) non-surgical options.

  • Grade 1: Non-surgical options may be appropriate where minor damage is sustained. Once the swelling has subsided, a gentle programme of rehabilitation can be commenced, typically including some gentle strengthen exercises to improve the strength of the muscles in the leg. The stronger your quad muscles the less strain on your knees. After a few weeks you should be able to return to your chosen support.
  • Grade 2: Depending on the circumstances of the patient in terms of age, activity level, desired activity level, location of the ligament tear etc it may be recommended to either opt for non-surgical or surgical. In a grade 2 the ligament is not ruptured and is still attached, therefore with a dynamic ligament knee brace you can work to heal the ligament conservatively. Alternatively surgery may be offered to repair the tear.
  • Grade 3: Surgery is typically offered in this case, though for elderly or sedentary patients (or where the knee has retained its basic stability) non-surgical solutions may be considered such as wearing of a special brace or knee support to keep the area stable and lessen the risk of further knee ligament damage. Reconstruction of the ACL is often recommended however in order to regain total knee function. They will require reconstruction using a tissue graft, which will normally be taken from either the patellar tendon (the tendon between the knee and shin bones) or the hamstring. The site of the graft will depend on the individual patient. This graft is effectively ‘scaffolding’, supporting the growth of a new ligament. After surgery, the patient will undertake an intensive period of physical therapy and rehabilitation. It may be six months or more before an athlete is able to return to training.

LCL: Management of an LCL injury will be determined by the extent of the injury:

  • Grade 1: Sporting activities will need to be avoided for about three weeks following a first degree sprain whilst you undertake a period of strengthening exercises.
  • Grade 2: Those who have suffered a second degree sprain will require a longer period of recovery, usually between six and eight weeks. Often it will be necessary for a physiotherapist to oversee rehabilitation to prevent further knee ligament damage when returning to normal activities.
  • Grade 3: Third degree lateral collateral ligament sprains may need to be surgically repaired and as such recovery time can be much longer.

Bracing can also be used as part of your overall recovery, though the brace you select will depend on the grade of injury incurred. For minor injuries a soft support can be used, ensuring you select one with straps which act as external ligaments to offer additional stability when active. Following a grade three tear and surgery you may first be placed in a range of motion brace which restricts your movement and ensures you don't cause any damage post surgery. After this initial period you may consider wearing a rigid brace, especially for extreme sports, which offers stability and protects the knee joint against impact, perfect if you were to come off your bike.

MCL: Management of an MCL injury will be determined by the extent of the injury:

  • Grade 1: For first-degree sprains you should wait about three weeks before attempting your usual sports.
  • Grade 2: Second-degree sprains take around eight weeks to heal and you will probably be advised to see a physiotherapist to prevent the mcl knee injury from reoccurring.
  • Grade 3: If you have a third-degree sprain, then you will need surgery to repair your ligaments and will need to wear a knee support for a while afterwards.

If you play a lot of sports, then it can be virtually impossible to avoid certain injuries and this is one of them. You will probably throw yourself wholeheartedly into your sports and it is difficult to avoid collisions, however accidental. Sports such as football, rugby and American football are extremely physical and the chances of injury are fairly high. During rehabilitation and when returning to sports, some form of knee support brace might be beneficial. This will help to stabilise the joint and protect it from any further injury.

PCL: The treatment programme for a PCL tear will depend on the severity of the injury:

  • Grade 1 & 2: For minor to moderate knee ligament damage there should be no need for surgery. Strengthening and movement exercises will help to build up the capabilities of the ligament and reduce the risk of future injuries. If this fails to resolve the situation or further damage occurs, surgery may be necessary.
  • Grade 3: More severe damage to the ligament will probably require reconstruction surgery. After surgery, the joint will need to be immobilised with a knee brace. Once the joint has recovered from the operation, treatment from a physiotherapist will help a patient to regain strength in the area.

Following treatment for a pcl knee injury, it’s generally acceptable to resume sports or training in around four to six weeks. However, this will depend on the guidance of your physiotherapist or sports injury specialist. It will also be based on the degree of damage to other parts of the knee or any instability felt in the joint. Patients should exercise caution when first returning to physical activity and are advised to wear some form of knee support or brace to protect the area from further damage.

Knee Osteoarthritis

Knee Osteoarthritis

Osteoarthritis can affect various joints in the body causing them to become stiff and painful. The knee joint is particularly at risk because, in addition to being the largest, it is also the most complex joint. The symptoms of the condition can develop slowly, and can be different at different times of the day or when you are engaging in different activities.

Women are twice as likely as men to have the condition. Usually both knees are affected. People in their late 50s are more commonly affected than younger people. There are certain factors that make it more likely that you will get knee osteoarthritis — the most important of which is being overweight. Other risk factors include previous injuries such as a torn ligament or meniscus that might have occurred during sporting activities and having undergone a menisectomy, which is a surgical procedure to remove damaged cartilage.

People, particularly women, who have nodal osteoarthritis, a condition that runs in families, often develop knee osteoarthritis and require a knee brace as they get older. Finally, people who lift heavy weights and athletes whose activities place a lot of stress on the knees are at a higher risk of developing the condition.

Causes

There are a number of factors that are understood to increase some people’s chances of developing the condition osteoarthritis, although not much is known about the precise causes.

Problems that can be a precursor include:

  • Those with tendon or ligament issues
  • Cartilage damage which prevents the smooth movement of the joint
  • The presence of inflammation in the bone or without the bone itself
  • Knee osteoarthritis may cause bony lumps or osteophytes to form, causing the bones to stick out and the joints to become misshapen. Pain and stiffness develops as the bones become thick and broad, movement becomes difficult. Inflammation can also cause a build-up of fluid within the knee joint, which can subsequently swell.

Some things that are known to contribute to the development of knee osteoarthritis are:

Injury to the knee joint: Sometimes overusing the joint following an operation or injury can prevent proper healing and may contribute to osteoarthritis.

Pre-existing condition: Those who have gout, rheumatoid arthritis or another similar condition can be at a greater risk of developing osteoarthritis.

Age: Older people are at an increased risk of developing osteoarthritis as muscles weaken and there is wear and tear within the joints.

Genetic factors: A pre-disposition to osteoarthritis can be seen to run in families. So far however, no specific gene has been identified. Scientists believe that there may be a number of smaller genetic factors responsible, which means a definitive genetic test is unlikely in the near future.

Weight: Being very overweight can put a lot of extra strain on the knee joint and may eventually lead to osteoarthritis.

Unfortunately, there is little that can be done to prevent arthritis from developing. However, people are able to significantly reduce their level of personal risk and minimise their chances of developing the condition through various means.

Symptoms

Symptoms of knee osteoarthritis may be different from person to person. The level of damage does not appear to correlate to the severity of symptoms. Sometime mild damage can lead to significant symptoms, while more noticeable damage causes few issues. Of course the reverse can also be the case. Many people with knee osteoarthritis may need to wear a knee brace.

Low level damage will normally occur in the joints on a daily basis. Symptoms of this are rarely experienced however, as the body is able to easily repair itself. Where the body cannot repair this damage, osteoarthritis can develop.

Diagnosis

If someone suspects they have developed knee osteoarthritis, then a visit to their GP can help to establish a diagnosis. The chances of developing this debilitating condition increase with age, especially after 45 years, so age will be one of the biggest factors taken into consideration before a diagnosis is normally made. Having said that, young people can still get knee osteoarthritis, but it is much less common.

There is no one single test to diagnose knee osteoarthritis, so risk factors and symptoms are assessed, together with a physical examination. Your doctor will look to see if there are any bony growths on the knee, any swelling or creaking sensations, as well as how stable the joint appears and how easy it moves.

In some cases, your doctor may decide to refer you for an X-ray. This can help to determine if there is any reduced space between the knee joints as a result of cartilage loss. An X-ray may also show if there is any extra bone growth or unusual appearances on the surface of the joint, as well as calcification of the cartilage. Blood tests may also be taken to rule out other conditions.

Whilst knee osteoarthritis can be very painful and there is no cure, fortunately there are different forms of treatment that can be used by sufferers to assist with relieving symptoms. Medication to reduce inflammation and pain is commonly used and knee support bands can help to increase mobility.

Management

Although there is no cure for knee osteoarthritis, there are a number of things that sufferers can do to manage the condition and reduce pain and inflammation in the joint. The most important factor in minimising the effects of osteoarthritis is to achieve and maintain an appropriate weight so as not to put too much stress on the joint.

Self care: The person who must take the most responsibility for managing knee osteoarthritis is you. This means that you should never ignore the importance of managing your long-term condition properly and dealing with even minor ailments effectively and as they occur to ensure that they do not get any worse. Self-care is about you looking after yourself, while being supported by professionals who are involved in your care. It is not simply about managing your condition, either. It involves maintaining general emotional and physical health, staying fit, and doing all you can to prevent accidents and illnesses. You should try to eat healthily and exercise, both to maintain or reduce your weight and to keep your muscles strong.

Exercise: This may seem counter-intuitive when knee osteoarthritis is causing severe pain, but in fact the more the joint is kept mobile, the better the results will be. Inactivity allows the joint to seize up, so you should use an appropriate knee brace and take part in some gentle exercise. A sports physiotherapist can guide you through some practical exercises which will increase mobility and reduce pain and inflammation.

Wearing appropriate footwear: Many sufferers find that pain management is helped through appropriate footwear. Flat shoes with thick, cushioned soles act as shock absorbers and protect the knee joint from jarring and jolting. When they are used in conjunction with a good-quality knee brace, many sufferers are able to participate in gentle low-impact exercise routines.

Pain relief: Doctors can prescribe pain relief in severe cases where knee osteoarthritis is keeping sufferers awake at night with pain. Generally, most sufferers are able to manage the condition with over-the-counter painkillers such as paracetamol and ibuprofen. Stronger painkillers such as codeine can help with more severe pain, but the benefits must be weighed against the side effects, as these medicines can cause drowsiness and interfere with the patient’s ability to drive.

Steroid injections: People with very severe osteoarthritis can benefit from a steroid injection into the joint which can dramatically reduce inflammation. Your medical practitioner will advise you if this is the case. More extreme cases may require surgical intervention to clean the affected joint, or even replace it entirely, but this is relatively rare.

Knee Brace: There are now a number of knee brace products on the market which are designed to manage osteoarthritis, working to unload the pressure on the affected side of the joint which can reduce pain levels and enhance mobility, as well as delaying the potential need for surgery. Braces such as the Unloader One have been clinically proven in their attempts to slow down the degradation of cartilage within the knee joint, improve the mobility of a patient and delay the need for surgery. It is worth noting that these types of products are dependent on the type of osteoarthritis suffered and you should consult with a medical professional before making a purchase. Most sufferers of knee osteoarthritis find that gentle exercise, a sensible diet and a good knee brace allows them to manage the condition without too much pain or discomfort.

Stay in regular contact with the medical team responsible for your care to ensure that any changes in your condition are noticed and managed effectively. This may involve changes to your medication but, whatever you are prescribed, remember to take it even if you start to feel better. Some medicines will only need to be taken when you are suffering pain but others will only work properly if you take them continuously.

Jumpers Knee (Patella Tendonitis)

Jumpers Knee (Patella Tendonitis)

Pain below the kneecap, particularly when it comes on gradually and becomes worse following activity, can be a sign of patella tendonitis. The patella tendon connects the kneecap to the shinbone and is affected by movement of the quadriceps muscle in the thigh.

Causes

Overuse of the tendon through running and jumping can cause severe pain and damage to the patella tendon.

Symptoms

One of the first symptoms of jumpers knee (more commonly known as patella tendonitis) is knee pain. The pain usually comes on gradually becoming worse throughout the day and is exacerbated by repetitive jumping and running. This is the reason why so many athletes rely on knee support products to minimise the effects of the jarring movements on the knee.

Many sufferers continue to exercise even after first experiencing knee pain, but this can cause severe damage to the tendon and should be avoided. Initially uncomfortable rather than painful, any signs of pain below the knee should be taken seriously in order to avoid more serious injury and possible tearing, which will take much longer to heal.

Patella tendinopathy results when small tears cause degeneration of the patella tendon. The tendon loses elasticity and is unable to function normally, causing knee pain and swelling in the area just below the kneecap. Often it is possible to see the thickened tendon which will appear much more pronounced on the damaged side.

Diagnosis

Never ignore knee pain as it could be a sign of tendon injury and continuing to exercise is almost certain to cause further problems. Prevention is always better than cure, so sports enthusiasts are advised to use knee support as a preventative measure where the knee is subjected to excess strain.

If you are unsure about your injury or have felt pain for a significant amount of time you should seek medical advice where examinations will allow them to determine the extent of the damage and the appropriate level of treatment required.

Management

It is quite unusual for the tendon to actually become inflamed and so anti-inflammatory drugs are of little help. Most sufferers are advised to use a knee support product in the form of a tendon strap which limits the load placed on the overworked tendon and can minimise the symptoms of the condition.

Rest is absolutely essential in order to achieve a desirable outcome. Most doctors and medical practitioners advise a period of at least three months to allow the tendon to repair and regenerate sufficiently for exercise to resume. Unfortunately many sufferers ignore the early warning symptoms of knee pain and continue to follow their exercise regimes causing more severe damage.

Swimming and low-impact exercises in water can be carried out without putting strain on the patella tendon, but all high-impact exercise should be discontinued while healing takes place. In severe cases it is possible to undergo an injection into the kneecap. More extreme damage may require surgery but this does not always guarantee a favourable outcome.

Runners Knee

Runners Knee

Runners knee, also known as iliotibial band friction syndrome, is a common over-use injury that affects long-distance runners. It is particularly common in people who spend a lot of time running downhill because of the stresses that downhill running places on the knee joint.

Causes

The source of pain can often be a misalignment of the patella when active. The resting position of the patella can increase the likelihood of the suffering from runners knee.

This can often refer to as being a predisposed complaint however physiotherapy is recommended in order to strengthen the surrounding muscles so that the patella can become realigned.

If you suffer from weaker quads then this can have an impact on the patella when active since the iliotibial band runs down the outside of the thigh, therefore it may begin to pull the knee cap towards the outside of the leg should the band be tight.

Your alignment in general can influence injuries and where the knee is concerned this refers to not only the knee joint but the hip and pelvis and even the feet. In the event that your hip or pelvis is misaligned then this can impact on the muscles and compromise the mechanics of the knee joint.

Finally, your feet can play a huge role in this and how you walk. Rolling your feet / ankles as you walk can place undue stress on the knee joint and over a period of time can lead to these types of conditions.

The aforementioned causes of runners knee can be translated into a sporting context with changes in your load, biomechanics, footwear and training surfaces all having an impact.

Load refers to the type of running you’re undertaking and ensuring that you minimise the variables as changing too many in session can have a detrimental effect on the body. This can refer to doing speed and distance training simultaneously or terrain and speed training. It is also important to take rest weeks so that the body doesn’t burnout. This all refers to your training programme, especially important when planning to run something like a marathon.

Your running technique has a major impact on avoiding injuries in general, not just concerned with runners knee. If your technique is poor then you run the risk of injuring yourself long term, so keep an eye on this and look to train yourself out of any bad habits you may have picked up. To do this you can run in the gyms in front of a mirror to assess your technique, take a video of yourself in action or refer to a physiotherapist work on alignment.

You need to be wearing the right footwear for your chosen sport. When it comes to running footwear is a big part of your gear in selecting the right shoe for your needs and ensure that they remain in top condition since you are supposed to change your shoes every 500 miles.

Finally, you should take a look at the running surface you ae using. Running on solid ground can have an adverse effect on the joints and the increased amount of pressure on the knees. This also refers to the gradients of your routes as if you are used to flat ground and revert to hill training then your body may not be adapted for this, resulting in injury.

Symptoms

The most obvious sign of ITBFS is knee pain that occurs during your workouts, and stops shortly after you stop moving. Some people find that this knee pain is reduced if they warm up and then stretch before they go running, or if they wear a knee support. However ITBFS is not something that should simply be 'trained through'.

Diagnosis

It is important to get a proper diagnosis and to work with a doctor or physiotherapist to make sure that the underlying cause of the pain is removed.

Management

In most cases, runners knee can be cured with physiotherapy, the use of contrast bathing to reduce inflammation and promote healing, and the use of a knee strap or support to prevent further pronation.

Some physiotherapists feel that using a foam roller can help to manage ITBFS, but this is a more controversial treatment, as there are others who are concerned that foam rolling - while good for relieving short-term symptoms, could cause more harm in the long term.

The use of non-steroidal anti-inflammatory drugs can provide short-term pain relief, and can make it easier for patients to engage in active recovery. Exercises that reduce the friction between the ITB and the Lateral Epicondyle in the thigh can alleviate the symptoms or reduce the likelihood of ITBFS from occurring in the first place.

Knee bracing is also an option, specifically those which are designed to manage the position of the patella. There are a number of options available in the market, simply check the indications for use before making a purchase to ensure you select the right one. If you are unsure which one to select then speak with your physiotherapist.

The condition itself can be quite painful, especially when active, therefore you may wish to use painkillers and anti-inflammatories to help with your overall mobility. The latter also works to manage inflammation and swelling which is one of the main sources of pain.

Meniscus Tear

Meniscus Tear

A torn cartilage is a common sporting injury. The knee joint bends and as it does the thigh bone moves over the top of the shin bone. The cartilage that cushions these two bones at the knee joint can tear. This cartilage consists of two shock-absorbing discs. They are crescent-shaped and are located on the outside and inside edges of the knee between the femur or thigh bone and the tibia or shin bone. These discs are known as menisci. The medial meniscus is on the inside of the knee and the lateral meniscus is on the outside.

Causes

Meniscal injuries are usually caused when the knee is rotated sharply or twisted whilst the foot is planted on the ground and does not swivel with the knee. This type of injury often occurs during sporting activities such as football.

In older people, a meniscal injury can be caused by general wear and tear. As we age, the menisci become worn and may tear easily.

Symptoms

Symptoms include knee pain along the inside or outside of the knee joint, depending on which meniscal has been damaged. The knee joint may appear to click, catch or even lock. There may be some swelling and the knee may feel unstable or even give way. Sometimes, after the knee pain and swelling has subsided, the injury settles down without causing further problems. However, if the tear in the knee cartilage causes the knee to lock or give way, surgery is often required. This usually involves the removal of as little of the damaged meniscus as possible in order to minimise the likelihood of arthritis developing in the knee joint.

Diagnosis

Diagnosis of a meniscus injury normally follow 3 stages:

Patient history: Understanding how the injury happened, what the patient felt and their background in terms of previous injuries etc.

Physical examination: A review of the knee and undertaking certain exercises to see what the patient can and can’t do.

MRI Scan: Finally, a scan of the knee will be able to determine whether a meniscus injury is present, the extent of the injury and the location on the knee (as this will determine the type of surgery which may be required).

Management

If you are unlucky enough to suffer from a torn cartilage in the knee, there are a number of steps you can take. Initially, apply an ice pack to the injured area to help the swelling subside. Wearing a knee support will help to stabilize the knee. A knee support can give the wearer increased confidence that the knee will not give way, which is particularly important if they wish to resume their sporting activities.

Unfortunately, these injuries are very difficult to guard against with 100 per cent success.

Some people feel more secure if they wear a knee support, particularly if they have previously injured their knee. Keeping the muscles around the knee strong will also help. Strengthening the quadriceps and hamstring muscles in order to protect the knee joint is the most effective action you can take to avoid developing knee pain through this injury.

Infrapatella Fat Pad Impingement

Infrapatella Fat Pad Impingement

One common type of knee pain is called infrapatella fat pad impingement. The infrapatella fat pad is just below your kneecap and is a mass of soft fatty tissue. It is sometimes known just as the fat pad or the Hoffa’s fat pad.

Your patellar tendon is what connects your kneecap to your thigh bone, and the infrapatella fat pad is just behind this. You may start to notice knee pain when impingement of the fat pad occurs — this is when the fat pad becomes pinched in between your thigh bone and your kneecap.

Causes

It is relatively easy to do this as it can be caused by a wide range of everyday activities and certain sports and exercises. Forcing your knee beyond its fully straightened position is one such activity (and is often associated with weightlifters who lift weights with their legs straight). But it can also be caused by falling awkwardly on to your knee or banging your knee against a hard object.

Symptoms

If this happens, then you are very likely to experience quite unpleasant knee pain. Your fat pad is a very sensitive area of your body and is vulnerable to changes. You will probably notice that your knee feels very sore and tender and it may also be swollen.

Diagnosis

With treatment typically in the form of physiotherapy you can either book a session directly in a private capacity of via the NHS would require a referral from your GP.

Management

The good news is that a physiotherapist can help to restore your knee to its former condition through a series of exercises. They can also show you how your alignment and posture can make a difference to your condition and how some simple adjustments will help to alleviate the pain.

Your physiotherapist may also recommend a knee support while you are experiencing knee pain. This will help to strengthen and support your joint as it heals and can make doing the exercises a little more comfortable. It will also help you to feel psychologically more able to use your knee, as wearing a support often makes people more comfortable putting weight on the affected area.

Iliotibial Band (ITB) Friction Syndrome

Iliotibial Band (ITB) Friction Syndrome

Iliotibial band (or ITB) friction syndrome is a condition caused by over-use and primarily affects long distance runners. The iliotibial band is a thick band of tissue that runs down the outside of your thighs, from your buttocks to your tibia (shin bone). It is used to help you straighten your knee, and also for moving your hip out sideways. ITBFS occurs when there is repeated friction between your iliotibial band and the lateral femoral epicondyle - the prominence of bone at the lower end of your thigh.

Causes

You are more likely to suffer from ITBFS if you are not particularly flexible, you have poor core stability, or your gait is inefficient.

Symptoms

Some people try to compensate for their knee pain by adjusting their gait or shortening their steps. This can make things worse in the long run. ITBS usually causes pain on the outside of the knee, and this pain starts out as a dull ache that is present only during exercise. However, if you keep on performing the exercises that cause the pain, then it can get worse and last for longer. Severe cases of ITBS can cause pain when you are simply walking or trying to climb stairs.

Diagnosis

Typically diagnosis of ITBS will come in one of three ways:

  • Physical examination (ober test)
  • Patient interview
  • MRI scanning

This will allow a doctor to identify the injury, the extent of the damage and ultimately the course of action to be taken.

Management

The best way to manage ITBFS is through rest and stretching, and wearing a support while you are exercising. If you find that this does not help your pain, you should seek medical advice. A physiotherapist or doctor will be able to give you better guidance. Some people find that using foam rollers can help with their ITBS, but not all doctors agree with this form of treatment. Foam roller treatments can offer short term relief of ITBFS, but it is not a good long-term solution because it can cause damage to the soft tissues. Repeated compression of the small bursa and surrounding fat pads could actually do more harm than good in the long term.

Do not ignore knee pain, tight quads or any other discomfort that occurs when exercising. If wearing a knee support does not alleviate your pain, speak to a doctor immediately and stop the activity that is causing the pain. Most people can manage their ITBFS and make a full recovery which allows them to go back to their chosen sport. However, treating this knee pain is not something that you should try to do alone. Professional advice from a coach, physiotherapist or doctor will ensure a speedier recovery.

Osgood Schlatters Disease

Osgood Schlatters Disease

Attributed to overuse, it more commonly affects males and is particularly prevalent amongst young sportspeople between the ages of nine and 14. It can cause severe knee pain and often means having to take a break from sporting activities, although wearing a good knee support can help.

The condition is a type of Traction Apophysitis and affects the Tibial Tuberosity - the lump felt just under the kneecap. This lumpy part is an Apophyisis, or a part of bone where tendons and muscles attach. The thigh muscles, quadriceps, are attached to this area.

Causes

When teenagers do repetitive sporting activity their relatively soft bones can be affected by the contraction of the thigh muscles. If the bone is not given enough time to adapt and rest, the Tibial Tuberosity becomes swollen and painful. Suffering a kick to the area can also cause swelling and lead to osgood schlatters. Some people can also suffer from an avulsion fracture, which is where the strong quadriceps actually cause the Tibial Tuberosity to come apart from the shinbone.

Symptoms

Knee pain is the main symptom of the condition, both during activity and when the tibial tuberosity is touched.

Diagnosis

A doctor will perform a physical examination of the knee where they will be looking for the source of the pain and any tenderness or swelling which comes with this. In the event of requiring further examination an x-ray may be taken to look at the bones of the knee and leg and look to identify the source of the pain.

Management

The symptoms of osgoods can continue for more than a year. Taking a break from sporting activities is needed, although the condition may not be totally resolved until the area of bone is fully mature when a person reaches around 16-years-old. Even when osgoods appears to be under control, it can be a good idea to get professional advice before returning to sport. It is also advisable to wear a knee support to prevent further problems.

The only treatment recommended by all practitioners is total rest until the knee pain has gone. Ice packs can help to ease symptoms, as can wearing a knee support. This should then be worn afterwards to reduce stress on the area. A knee strap, for example, will reduce the force on the Tibial tuberosity from the patella tendon.

Osteochondritis Dissecans (OCD)

Osteochondritis Dissecans (OCD)

Knee joint pain can be caused by a number of different reasons. The condition known as osteochondritis dissecans (OCD) occurs when small fragments of bone come away from your knee join. It can progress fairly quickly, causing degeneration in your knee.

Causes

At the moment, nobody knows exactly what causes it, but it is believed to result from a previous injury or trauma, or from an insufficient blood supply. It is quite common among teenagers, though does often abate later in life. The symptoms cause knee pain, and a good knee support can help to alleviate this.

Symptoms

The knee pain tends to be localised in OCD, with swelling sometimes also present. Occasionally the knee will lock or give way. In severe cases certain motions and activity can exacerbate the knee pain, such as twisting movements, and some sufferers report a clunking sound when they straighten or bend their knee.

Your doctor should refer you for an x-ray or MRI scan which can help to give an effective diagnosis and also establish how back the fragmenting of the bone is. This will also help to determine the most appropriate type of treatment.

Diagnosis

To begin with a doctor will perform a physical examination of the joint to identify the source of the pain and the impact on the patient.

Secondly an x-ray of MRI may be taken in order to look for the OCD lesion, it’s size and location.

Management

Some types of OCD knee require surgery, whereby the joint is restored and any loose fragments are removed. After surgery you may still experience some knee pain. This can be lessened by applying ice to the area - wrapped in a towel - for 20 minutes at a time every few hours. You will also need a programme of rehabilitation, which your surgeon can recommend. You will need to follow these to the letter, as certain weight-bearing exercises will be forbidden for a while. The usual regime is to carry out some non-weight bearing exercises in a swimming pool.

Other types of OCD knee can be left to heal themselves. This is usually appropriate for younger patients, as most adults will need surgery. In these cases, the patient will need to follow a recommended programme of recovery, which might mean making certain adjustments to their lifestyle and sporting activity for several weeks.

After surgery or recovery it is always a good idea to ease gently back into your previous activities, allowing your body the time it needs to acclimatise to the necessary motion once again. Follow your doctor's advice about when to return to exercise and what type of activities to avoid for a while. There are numerous videos online of how the surgical procedure is performed.

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (or PFPS) is a condition where pain is felt in the kneecap bone, known as the patella. It is a fairly common condition, with around a third of young adults experiencing it at some point. Anyone can get this syndrome, including children from the age of about five onwards.

It is also known as Anterior Knee Pain, Patellafemoral Maltracking or Chondromalacia Patella and usually occurs without any specific damage, such as a knock, fall or blow. Simple treatments such as medication, exercise, knee support aids and physiotherapy can be used to relieve the symptoms.

Causes

PFPS can occur for a wide range of reasons. Overuse of the knee is one of the most common reasons, especially through playing sports that put pressure on the kneecap. In some cases, an individual may have an alignment problem in the knee, which may cause the patella to rub on the lower femur, rather than glide over it. This may be due to the way the knee has developed or an imbalance in the muscles surrounding the knee. Anterior knee pain from PFPS may also result from having flat feet, which puts pressure on the knee, or the use of shoes with hard soles. Knee injuries or reduced muscle strength in the leg can also contribute to this painful knee condition.

A doctor can normally diagnose PFPS based on the symptoms, as well as examination of the knee. In most cases, blood tests and X-rays are only used to rule out other conditions.

Symptoms

Knee pain is the main symptom. It is usually felt at the front of the knee and behind the kneecap. Pain can come and go, but can be so severe that every day movements such as walking up and down steps can be difficult. A dull ache may also be experienced after periods of rest. Playing sports may make the pain worse. In some cases, a scratching or grating sound can be heard from the knee, when bending or straightening it. This is due to changes in the surface of the cartilage surrounding the patella and is known as crepitus.

Diagnosis

In the vast majority of cases a doctor will be able to identify the problem through a physical examination. In the event that this is not possible then an x-ray can be taken in order review the structure of the knee.

Management

Treatment for the knee pain associated with PFPS depends on the severity of the symptoms and may be tailored to short-term or long-term application. In the short term, many patients are advised to rest the knee and avoid over-use. Painkillers may be prescribed to reduce symptoms. In the long term, the underlying causes of the pain are tackled, such as trying to strengthen muscles or easing foot problems. Physiotherapy is often given and suitable footwear is recommended. Knee support products such as taping of the patella or a special brace to reduce pain are considered helpful by many sufferers.

Surgery is rarely required in most instances. Where it is necessary, it is normally to help correct alignment of the patella by releasing a tight ligament. In most cases, sufferers get better in a matter of a few months, and make a full recovery with non-surgical treatments.

Patella Fracture

Patella Fracture

A fracture or broken knee cap is a surprisingly common injury. The knee cap, or patella, acts as a shield in front of the ligaments, tendons and bony structures of the knee joint and is susceptible to damage.

Causes

Most fractures and breaks are the result of an injury or fall, although it is also possible for a break to occur due to a sudden contraction of the quadriceps.

Symptoms

The first and most noticeable symptom of a patella fracture is extreme knee pain. There may be some faintness, dizziness and even sickness caused by the shock of the break, but this is not always apparent. The joint needs to be protected by some form of knee support before consulting a medical practitioner, who will usually perform an x-ray to confirm the diagnosis.

Diagnosis

A patella fracture or break can be a simple hairline fracture, a complete break or even a complex break where the patella is shattered into several pieces. The type and severity of the fracture will determine the appropriate treatment. If the break is complex, it may require surgery.

Management

Once the severity of the injury has been diagnosed, the usual course of action is to encase the knee in a plaster cast for around six weeks to allow healing to take place. More severe breaks will require surgical intervention so that the shattered knee cap can be held together with wire to enable healing. In extreme cases, the patella may need to be removed altogether to avoid further knee pain in the future.

The severity of the fracture or break will dictate the period of immobility of the leg. Once the initial healing has taken place, it is important to undergo physiotherapy in order to restore mobility and function to the injured leg. During this phase of treatment, a good-quality knee support can provide warmth and support and prevent further injuries from occurring. Some physiotherapists prefer to remove the plaster cast after two to three weeks and replace it with a knee support in the form of a dedicated knee brace. Knee pain can be controlled by over-the-counter painkillers.

Gentle exercise in water helps to improve mobility without placing undue strain or weight on the knee joint and can help to minimise the risk of further injuries. It is important to follow the physiotherapist’s instructions to avoid doing too much too soon, which could have an impact upon the healing process and could lead to arthritis in the knee in the future.

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