knee pain and management 

Knees are beautiful things. Granted, some are more beautiful to look at than others, although they all provide wonderful benefits. Primarily, they allow legs to bend in the middle. Pretty essential when sitting down on a chair or climbing stairs. 
The knee joint is pretty complex, even though it is a ‘simple’ hinge joint. From the location and function of the knee cap to the intricate collection of ligaments and tendons both inside and out there is a lot of potential for pain. 
A painful knee can range from an intermittent niggle to a debilitating pain that robs the owner of mobility. Any knee pain can potentially progress to something that threatens ongoing pain free mobility and should be taken seriously. Immediate assessment and treatment is required. There are of course, as always, some steps (sorry!) that can be taken to promote good knee health. 
 
Firstly, remember – knee pain is rarely indicative of or caused by arthritis! In fact, there is rarely something terribly wrong with your knees. They are fairly bullet proof - the forces necessary to do some damage are huge! The main culprit in the vast majority of cases is biomechanics - the way your knees move. The Moballise Physiotherapy Clinic will help you to identify the underlying cause and put together a management plan to assist you in resolving your symptoms and staying pain free. 
There are many reasons why your knees may begin to hurt. Due to the mechanics of the knee joint and the forces that are passed across it when the surrounding muscles contract, it is unsurprising that they 'flare up' at some point. Knee pain through teenage years is incredibly common, as is knee pain in men throughout their middle to late twenties. Occupations that require a lot of kneeling down can also aggravate the knees and cause ongoing pain even outside of work. All of these examples can be reduced with good, effective management of the symptoms. 
Some common causes of pain and the ideal management of the symptoms are listed below. In most cases knee pain is caused by increased inflammation and will respond very well to effective management of the inflammation itself. Begin by attempting self management and, if needed, please contact us for some further FREE advice. 
Many of the painful symptoms experienced at the knee joint are from the presence of inflammation. Any signs of inflammation should be addressed immediately, with the appropriate treatment applied, on experiencing painful symptoms around the knee, especially where there is no obvious reason for the symptoms. Where indicated, seek immediate professional assessment. 

conditions 

Sprains 

A sprain of the knee occurs when the joint is overstretched or twisted excessively under stress. Sprains affect the ligaments in and around the joint. In the knee there are four primary ligaments - MCL, LCL, ACL & PCL. The medial (MCL) and lateral (LCL) collateral ligaments keep the knee joint in place from the inside and outside. 
 
The anterior (ACL) & posterior (PCL) cruciate ligaments prevent forwards, backwards and rotational movement of the joint. If these movements are taken beyond their normal range of movement with sufficient force then damage to the associated ligament can occur. 

Advised management 

The way to approach treatment of a sprain depends upon the severity. Sprains can be classified in three stages 
 
Grade I - mild sprain - this identifies damage to the soft tissue although it is minor. Normal activity can potentially continue during recovery and rehabilitation. 
Grade II - partial tear - this represents significant damage to the ligament. There is a risk of further injury and worsening of the condition of the injury site. Further aggravation of the ligament should be avoided until professional opinion and treatment is sought. 
Grade III - complete rupture - if a complete rupture of the ligament is suspected then all activity that places stress on the affected joint must stop immediately. Ligament rupture will manifest itself as severe joint instability. It requires immediate medical attention and may result in surgical repair. 

Tendonitis 

Tendons attach muscles to bones. They are the connective tissue that runs throughout the length of the muscles and, when the muscle fibres diminish, result in a thick 'rope' of tissue. 
 
If there is excessive passive tension within the attached muscle or the muscle is contracted frequently over prolonged periods of time then aggravation of the tendon, especially at its bony connection site can occur. this can lead to inflammation, pain and severe loss of function. 

Advised management 

Whenever there is an 'itis' at the end of a word used to form a diagnosis it identifies the presence of inflammation. 
 
Consequently, a tendonitis can be treated in the same way as general inflammation, although all of the treatment should be directed towards the affected area. Try to maintain normal activity throughout the treatment course to maintain fitness levels and raise the chances of successful rehabilitation into normal function. 

Osgood-Schlatter's disease 

This is a specific condition that primarily affects teenagers and young adults. As previously mentioned, there is a tendon that exits the muscles along the front of the thigh. This tendon the runs across the knee joint and attaches onto the bone underneath the knee. 
 
This section of the shin bone is right at the end of the bone and very close to, if not within the 'growth plate' of the knee. During puberty and the well described 'growth spurt' of youth, the bones tend to grow faster than the muscles and this, along with increased activity levels associated with this period of life, increase the tension through the muscles of the thigh. This increased tension is passed onto the attachment site into the bone by the tendon and results in painful aggravation of the muscular attachment site. 

Advised management 

Osgood-Schlatter's disease is an inflammatory condition resulting from aggravation of the tendinous thigh muscle insertion onto the bone below the knee. 
 
This painful condition can lead to the bony attachment being pulled out of shape and leaving a lasting 'lump' on the front of the shin bone. The affected site should be treated in the same way as general inflammation. In addition, further aggravation of the inflamed site should be avoided by limiting physical activity intensity to that which is comfortable to avoid bony deformity occurring. 

Bursitis 

Wherever the ropes of the body (ligaments and tendons) pass close to bony prominences, of which there are many around the knee, they are cushioned by bags of fluid. These bags are called bursae (singular: bursa) and their only job in the body is to prevent aggravation or wear and tear. 
 
Unfortunately these bursae themselves can become aggravated by excessive demands being placed upon them. This may be because of an increase in unaccustomed activity or due to the accumulated passive tension in the associated muscle placing increased pressure or stress upon the bursa resulting in aggravation and inflammation. 

Advised management 

Bursitis signifies an inflammation of one of the many bursae around the knee joint. Because the knee is such a bony joint there are many bursae around it for cushioning against the high forces placed across it. 
 
As is clear from the suffix 'itis' on the end of the diagnosis bursitis, this is an inflammatory condition and can be treated in the same way as general inflammation. Where possible without further aggravating the symptoms, normal activity should be continued to aid successful rehabilitation. 

Osteoarthritis 

Osteoarthritis is a degenerative and incurable joint condition that manifests itself in the knee joint as pain and stiffness accompanied by mild swelling. It is more common in older populations, although it has been recorded in younger individuals. There are many aches and pains associated with the knee joint that are inaccurately attributed to arthritis. 
 
The appearance of osteo-arthritic presentation alone on Xray and MRI scans is increasingly accepted as NOT being indicative of painful symptoms. It is very usually possible that conservative interventions such as physiotherapy are highly effective in resolving painful symptoms that used to be attributed to arthritic joint degeneration. 

Advised management 

Treatment of osteo-arthritis depends upon the stage of deterioration in the joint and the extent to which the arthritic degeneration is related to the painful symptoms experienced. 
 
Whilst activity may feel counter-intuitive mobility is an incredibly important factor in easing the symptoms of osteo-arthritis. Sufficient pain management should be sought to continue with normal activities of daily living as much as is practicable. Heat therapy and cryotherapy can be very effective in both relieving the general symptoms and management of the aggravation of symptoms following physical activity. 
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