Knee injuries may be caused by many activities and sports as various structures are stressed beyond their tolerance. Knee pain can be divided into two main types, that which occurs within the knee joint and pain from structures outside the joint. Internal joint pain is caused by damage to the joint surfaces of the Femur and Tibia, the anterior and posterior cruciate ligaments and the menisci. The joint lining known as the capsule may be included and the ligaments on the sides of the joint are included because of their stabilization of the joint. Outside the knee joint is the separate patella-femoral joint between the kneecap and the Femur, the patella tendon, the quadriceps and hamstring muscles and their tendons. Perth Physiotherapy and Sports Injuries Centre can help you with the diagnosis and treatment of knee injuries.


CAUSES OF KNEE INJURIES


Under-training

During training, our body adapts to the increased load of the activity by thickening and strengthening tissues to cope with the increased strains. If a tissue such as a muscle, ligament or even bone, is heavily or repeatedly loaded, for example when sprinting but has not had enough training to allow it to cope with these loads, it will tear. An example would be the office worker who plays football at the weekend but has not trained during the week and then tears a hamstring muscle.

Over-training

Knee InjuriesOur body adapts to the increased load of training by thickening and strengthening tissues to cope with the increased strains. If a tissue such as a muscle, ligament or even bone is heavily or repeatedly loaded without enough time to recover and heal, it will break down and tear. Over-training and over-use causing knee pain, occurs in repetitive sports such as distance running, hurdles, football and over-zealous training in any other leg based sport. Patello-femoral joint arthritis and patella tendon tendinopathy are common with faulty mechanics and overuse.

Impact

During an impact there is generally a crush effect which breaks the structures at the point of pressure but the knee may also be twisted and bent, tearing the joint ligaments, resulting in instant swelling and acute pain. The knee cap may also be knocked sideways causing a subluxation or dislocation. These injuries are common in all football codes, netball, basketball and hockey. The impact may be by another player, a fall or twist.

Overload

All our tissues are elastic to a degree and when properly trained are strong and resilient. When there is a sudden acceleration or deceleration which stresses tissues to a load greater than they can cope with, they will pull apart and we call this a sprain, strain or tear. Most tears are partial tears, known as strains but some tissues completely tear and we call this a rupture. Overload injuries particularly to the cruciate ligaments, menisci, hamstring muscles and their attachments, often occur during tennis, squash, all football codes, skiing and snowboarding due to:-

  • Inadequate warm up.
  • Inappropriate training and conditioning.
  • Faulty biomechanics such as weakness or arch structure, lack of muscle flexibility, joint stiffness and previous injury which has become chronic due to abnormal repair.

Referred Pain

Lumbar facet joints, discs, the hip joint, muscles and other structures, are affected by our positions and movements and the pain may be referred into the knee. Your Physiotherapist will identify whether the damaged structure causing the pain is in the knee or referring the pain from an external structure.


SYMPTOMS OF KNEE INJURIES


The symptoms are different depending on the type of injury. There may be stiffness and ache in a gradual onset over use injury, for example during training and perhaps severe pain with a direct injury. With slow onset training injuries, the pain and stiffness is generally mild initially, while acute, strong pain occurs with tears and ruptures. The more severe the initial pain and swelling, the greater the likelihood severe damage has occurred.


DIAGNOSIS OF KNEE INJURIES


The diagnosis of the structure damaged and the choice of treatment will need to be made by your Physiotherapist. A thorough examination is sufficient to diagnose most problems and other investigations such as x-rays, ultrasound, CT or MRI scans will be arranged if extra information is required.


TREATMENT OF KNEE INJURIES


Knee injuries heal best when treatment has begun as soon as practical following injury. The sports person must immediately stop the sport and avoid any movement which produces the pain. In the case of sudden onset pain, the RICE protocol should commence.This is:-

  • Rest:                 Rest from aggravating movements to reduce further bleeding and injury.

  • Ice:                    Real ice wrapped in a wet towel and applied to the injury for thirty minutes.

  • Compression: The knee may be bandaged to reduce swelling but not bandaged during sleep.

  • Elevation:        The leg may be elevated to an angle of 45 degrees, to drain swelling from the knee.

Advice regarding the injury diagnosis

  • Medications: Pain killers may be needed initially and anti-inflammatories may be used after 48 hours, when bleeding has stopped.
  • Compression bandaging

Direct Physiotherapy Treatment

  • Ice
  • Ultrasound and other electrotherapy
  • Stretches
  • Soft tissue treatment
  • Joint mobilisation
  • Exercises to regain strength and movement

Physiotherapy Management of return to sport

  • Correction of biomechanical anomalies
  • Technique modification
  • Provision of orthotics and footwear advice
  • Provision of a return to sport plan

Management may require the use of crutches or a walking stick to reduce the load on the tissues. As the injury begins healing, the Physiotherapist will advise a graduated return to exercise program, without an increase in symptoms. Depending on which tissues are injured, there will be stretches, strengthening and mobility exercises, to return full function and reduce the chance of the injury recurring.

In the event of a severe injury where Physiotherapy is not appropriate, the patient will be referred directly to a doctor and on to the appropriate professional for further investigation and treatment. In the event surgery is required, Physiotherapy rehabilitation will be arranged afterward.


PROGNOSIS OF KNEE INJURIES


Knee Injuries recover well with Physiotherapy management. Pain reief and inflammation reduction may take between one and six weeks depending on the injury, with the goal of achieving painless and full function, with a minimal chance of a recurrence in the future.

Early treatment will provide the fastest and best quality healing. Phone now on (08) 9481 7677 for an assessment and immediate treatment at Perth Physiotherapy and Sports Injuries Centre.

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