Knee Injuries & Physiotherapy

Knee injuries are very common in athletes, the knee is a critical joint which lacks the support other joints, like the hips and shoulders do. The knee is also quite a complex structure, the bone of the upper leg (Femur) meets the bones of the lower leg (Tibia and Fibula) and the knee cap (Patella), with all three are connected by a mass of tendons, ligaments, cartilage, and Synovial fluid. There are a number of ways this structure can be damaged, and the result is instability and quite often pain whilst walking, standing, and running.

Commonly occurring knee injuries

• ACL injury (Anterior Cruciate Ligament Rupture) – ACL damage is quite common and occurs when the knee is used to make abrupt directional changes and turns. This ligament links the thigh and shin bones, and lies deep within the knee. It serves to maintain the limits of forward and rotary motion, and hence is key in keeping the structure as a whole stable. ACL injuries are common in sports, and often result form an abrupt landing after a jump or from hyperextension. Because it lies deep within the knee, ACL damage is usually associated with damage to other structures in the knee e.g. the medial ligament. The injury begins with an unpleasant snapping sensation within the knee, followed by pain which reflects the extent of the damage joint. Movement is severely limited as the knee joint becomes vastly unstable and painful, within hours bleeding within the joint will result in painful swelling.
• Runner’s Knee (Ilio Tibial Band Friction Sundrome) – Ironically enough, up to 10% of runners are affected by runner’s knee, while up to 25% of cyclists suffer the same injury. The Ilio Tibial Band is a length of fascia (fibrous tissue) which begins on the outer pelvis, running down the outer thigh, and into the shin (Tibia), and it is this which is damaged in the condition by fiction with the wide part of knee called the Lateral Epicondyle. The reason why runners and cyclists are affected is because of repeated load bearing, bending and extension of the leg. Pain begins on the outer part of the knee and is exacerbated by activities involving repeated bending and extension of the knee, quite often the pain is actually only present during these actions.
• Patella Fracture (Broken Knee Cap) – Fracturing your knee cap is quite a severe acute condition that will result in immediate pain and swelling. The later is actually a protective mechanism which limits movement and prevents further injury. A knee fracture typically presents after severe impact or trauma to the knee, and can be drastic enough that you feel a gap in your knee cap.

Physiotherapy and knee injuries

Careful rehabilitation of the knee is vital after injury to restore function. The complex nature of the structures in the knee means that it is easy to exacerbate injury by day to day movements, cause further injury, or, during the healing process misalign components of the knee as they recover. For these reasons, a knee injury will most certainly grant you a referral to a physiotherapist.

Conditions like Runner’s knee are investigated by a physio’s careful manipulation and palpation of a joint, in this injury for example, your therapist will be looking for a notable tenderness in the widest part of your knee, the Lateral Epicondyle. Other injuries, like knee factures for example, are easy to diagnose because of their acute nature, but rehabilitation becomes the tricky part as the injury often causes secondary damage to supporting knee structures which will need to be rehabilitated slowly.

Both ACL injuries and patellar fractures are acute conditions and tend to be dealt with medically or surgically first. The physio’s role in these can vary depending on the practitioner and the hospital. Some will participate in the early diagnosis because of their expertise in dealing with physical trauma, but mostly they will be called in during the longer rehabilitation phase. After immobilising the knee during patellar fractures for example, it is vital to restore functionality in all available planes of movement slowly and carefully, both to prevent future pathologies like osteoarthritis, and to allow you full use of your leg again. A physio will instruct initially in how to stretch and move the leg, often suggesting you wear a brace, and then introduce resistance training to strengthen the knee and supporting musculature.

The knee is a load bearing structure, and it is this characteristic which makes it both prone to injury and difficult to rehabilitate. This is where pool exercises are beneficial, allowing a broad range of movement with some resistance, but without the burden of bearing full weight. During the initial stages of injury, cold therapy (ice packs etc.) are used to limit bleeding within the joint, and later on a physiotherapist will often recommend the use of similar techniques to prevent further injury after exercise.

Runner’s knee is known to respond extremely well to physiotherapy which aims to both treat the injury and prevent future recurrence both by strengthening the knee and leg and by adjusting contributory postural and alignment issues. Runner’s knee is typically caused both by overuse and by poor technique, the latter of which can be worked on by the physio. Not unlike other knee injuries, the use of cold therapy, compression from knee support, and resistance training will all be used by your physio.

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