Knee Pain

Osteoarthritis of the knee occurs when the cartilage coverings on the end of the femur and the top of the tibia wear out. The tibia has two special cartilage pads called menisci (one is called a meniscus). This cartilage becomes flattened, bone spurs form, the joint becomes inflamed, range of motion is lost, there is ensuing weakness, pain and difficulty with walking, climbing stairs, and getting in/out of chairs. Physical therapy can help with recovery of range of motion, strength, walking skills, and pain management. Aquatic therapy (often involving a customized exercise program) can be helpful.

The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

The menisci (plural for meniscus) are cartilage pads, which function to cushion the compressive loads in the knee. One or both of these pads can be torn which often occurs when the lower leg is forcefully bent and twisted. Signs and symptoms include joint line pain, locking and swelling of the knee. The tear often has a bucket handle or parrot beak shape. Treatment should consist of rest, ice, compression and elevation. Arthroscopic surgery is indicated for a large tear.

Chondromalacia meaning softening of the patellar cartilage, is a common misdiagnosis. Softening of the cartilage can only be detected by directly visualizing the cartilage during surgery. The correct diagnosis for pain and swelling originating from under the kneecap is Patello-femoral Pain.

Treatment includes pain relief with rest, ice, compression, and elevation. Swelling must be controlled. Anti-inflammatory medications, bracing, and physical therapy are often helpful. Progressive strengthening of the quadriceps is essential. Occasionally, foot orthoses may be helpful. Rarely, surgery is required to assist in realigning the kneecap by releasing the tight structures on the outside of the kneecap and reefing the inner structures.

Total knee replacement is often the answer for people when x-rays and other tests show joint damage; when moderate-to-severe, persistent pain does not improve adequately with nonsurgical treatment; and when the limited range of motion in their knee joint diminishes their quality of life.

There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist directed program could help you delay or avoid knee replacement.

Seeing a physical therapist before surgery and going through a “prehab” program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.

Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.

Give us a call to learn more about how we can help you.