Knee pain

The meniscus is a piece of cartilage in your knee that acts as a cushion between your thigh bone (femur) and shin bone (tibia). Each knee has two menisci - one on the inside (medial) and one on the outside (lateral). They help to distribute weight and reduce friction during movement, making it easier for your knee to function smoothly.

What is a Meniscus Injury?

A meniscus injury occurs when this cartilage tears. This can happen due to sudden movements, like twisting or turning your knee quickly, especially when your foot is planted on the ground. Meniscus tears are common in sports activities but can also happen from everyday activities, particularly if the cartilage weakens with age - this is known as a degenerative meniscal tear. In most cases, meniscal tears can be managed conservatively without the need for an operation. However, in some instances surgery may be required if the meniscus tear causes the knee to lock or if the severity of pain is impacting your quality of life. Your physiotherapist will discuss these options with you and help to guide you through the most appropriate treatment.

Symptoms of a Meniscus injury

If you have a meniscus tear, you might notice:

• Pain in your knee, especially when twisting or rotating it
• Swelling and stiffness
• Difficulty straightening your knee fully
• A popping sensation during the injury
• A feeling that your knee is locked in place or unable to move smoothly.

How is it diagnosed?

To diagnose a meniscus tear, your physiotherapist will:

1. Ask about your symptoms and how the injury occurred
2. Perform a physical examination, checking for pain, swelling, and range of motion
3. Consider whether imaging is indicated. However, this is not routinely done as physical examination is often just as effective in diagnosing meniscus injuries.

Treatment options

Treatment for a meniscus tear depends on the severity of the injury and your lifestyle needs. Here are common approaches:

• Protect, Optimise Load, Ice, Compression, Elevation (POLICE): These initial steps can help reduce pain and swelling. It is important to still gently move the knee and walk around as symptoms allow - completely offloading the knee can cause the joint to stiffen up and become even more painful. (Note: when icing the knee, do not put ice directly on the skin, and use for no longer than 10 minutes at a time).
• Exercise: This strengthens the muscles around your knee to better support your movement.
• Medication: Over-the-counter pain relievers can help manage pain and swelling in the first instance. Follow the instructions on the packet and speak to your GP if you are unsure what is safe for you to take. GPs can also prescribe stronger pain relief if appropriate.
• Surgery: In some cases, especially if the tear is large or causing significant symptoms, keyhole surgery might be necessary to repair or remove the damaged cartilage.

Preventing and managing flare-ups of Meniscus Injuries

To lower your risk of a meniscus injury, consider these tips:

• Stay active: Regular exercise can strengthen the muscles around your knee and support with weight management to reduce the amount of additional load the knee must absorb.
• Warm up and stretch: Before any physical activity, to prepare your muscles and joints.
• Wear appropriate footwear: Shoes that support your feet and knees properly.
• Avoid sudden twists and turns if the knee is already flared / irritable.

Please see the below links for general knee pain information and exercises, which are also relevant for those with a meniscus injury.

https://versusarthritis.org/about-arthritis/conditions/knee-pain/

https://versusarthritis.org/about-arthritis/exercising-with-arthritis/exercises-for-healthy-joints/exercises-for-the-knees/

Making a decision about knee osteoarthritis - NHS

Understanding Osteoarthritis of the Knee

Osteoarthritis (OA) is a common condition that affects the joints of the body, especially as people get older. It is common to experience OA changes to the knee as the knee is a load-bearing structure used in almost all our activities of daily living. A bit like grey hairs on the outside of our bodies, arthritic changes are a normal process of ageing which starts from around the age of 30. This occurs when cartilage - the smooth tissue that cushions the ends of your bones - reduces over time leading to pain, stiffness, and difficulty moving the knee. Although there is no cure for OA, research shows we can preserve the cartilage and delay the progression of OA through lifestyle modification and regular exercise.

What Causes Osteoarthritis?

Osteoarthritis can develop for several reasons, including:

• Age: Changes to the joint naturally increase as you get older.
• Joint Injury: Previous injuries, such as fractures or tears to structures such as the meniscus, can lead to OA later in life.
• Repetitive Stress: Activities that put a lot of stress on the knee, such as kneeling or heavy repetitive lifting, can contribute.
• Genetics: OA can run in families.
• Weight: Extra weight puts more pressure on your knees, increasing the risk of OA.

Symptoms of Osteoarthritis

Common signs of knee osteoarthritis include:

• Pain: Aching or sharp pain inside the joint, especially after activity or at the end of the day. You might feel this is more prominent on the inside of the knee but the whole knee can also be affected.
• Stiffness: Especially in the morning or after sitting for a while.
• Swelling: The knee may become swollen or feel warm to the touch.
• Decreased Range of Motion: Difficulty bending or straightening the knee.
• Grinding Sensation: You might feel or hear a grating sound when moving the knee.

Diagnosing Osteoarthritis

To diagnose knee osteoarthritis, your physiotherapist will:

1. Ask about your symptoms and medical history.
2. Perform a physical examination, checking for pain, swelling, and movement.
3. Routine imaging to diagnose osteoarthritis is not advised.

Treatment options

While there's no cure for osteoarthritis, there are many ways to manage the symptoms and improve your quality of life:

• Lifestyle Changes: Maintaining a healthy weight and staying active can help reduce stress on your knees and can generally help reduce inflammation in the body which may irritate the knee further.
• Exercise: Low-impact activities like walking, swimming, or cycling can strengthen the muscles around your knee and improve flexibility. Resistance exercises are considered the gold-standard in medical research for improving pain and mobility of the affected knee. See links below for further information.
• Medications: Over-the-counter pain relievers can help manage pain and inflammation. Follow the instructions on the packet and speak to your GP if you are unsure what is safe for you to take. GPs can also prescribe stronger pain relief if appropriate.
• Physiotherapy: A physiotherapist can teach you exercises to strengthen your knee and improve movement.
• Assistive Devices: Braces or shoe inserts can provide support and reduce pain.
• Injections: Corticosteroid or hyaluronic acid injections can provide temporary relief from pain and inflammation.
• Surgery: In severe cases, procedures like knee replacement surgery might be necessary to relieve pain and improve function.

Preventing Osteoarthritis

While you can't completely prevent osteoarthritis, you can reduce your risk by:

• Staying Active: Regular exercise helps keep your joints flexible and muscles strong.
• Maintaining a Healthy Weight: This reduces the stress on your knees.
• Protecting Your Joints: Using knee supports during activities which require lots of kneeling, for example, as well as avoiding high impact activities initially which might be too irritable.
• Pacing: Ensuring that the activity you do is evenly distributed across the week with days allowed for rest to avoid flare ups. Doing too much all at once can cause your knee pain to be worse.

Understanding osteoarthritis and how to manage it can help you stay active and maintain a good quality of life. Please see the below links for more information:

https://versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-knee/

https://www.versusarthritis.org/media/21787/kneepain-exercise-sheet.pdf

https://escape-pain.org/

Understanding Patellofemoral Joint Pain of the Knee

Patellofemoral joint pain is a common condition that affects the front of the knee and around the kneecap (patella). Patellofemoral joint pain can arise from degenerative changes to the patellofemoral joint (the cartilage underneath the kneecap) itself or due to muscular imbalances around the hip and knee which is often the most common cause.

What Causes Patellofemoral Joint Pain?

Several factors can lead to patellofemoral joint pain, including:

• Overuse: Repetitive activities like running, jumping, or squatting can strain the joint.
• Injury: Direct trauma to the knee, such as a fall or a blow, can cause pain.
• Patella maltracking: In rarer cases, the kneecap may not glide smoothly in the groove in which it sits which can cause irritation.
• Weak or Imbalanced Muscles: Weak thigh muscles or imbalances in muscle strength can affect how the kneecap moves.
• Flat Feet: This can change the way you walk and put extra stress on the knee if arch support is reduced.

Symptoms of Patellofemoral Joint Pain

Common symptoms include:

• Pain: A dull, aching pain in the front of the knee, around or behind the kneecap. It often worsens with activity.
• Swelling: Mild swelling around the knee.
• Grinding Sensation: A feeling of grinding or clicking when bending or straightening the knee.

Diagnosing Patellofemoral Joint Pain

To diagnose this condition, your physiotherapist will:

1. Ask about your symptoms and medical history.
2. Perform a physical examination, checking for pain, swelling, and knee movement, specifically strength of the hip and thigh muscles which help support the joint.

Further investigation (X-rays or MRI scans) can help to understand the structure of the knee if pain is failing to improve after extensive rehabilitation e.g. to check the alignment and condition of the kneecap and surrounding tissues.

Treatment options

Treating patellofemoral joint pain usually involves a combination of approaches to relieve pain and improve function:

• Rest and Ice: Resting the knee and applying ice can reduce pain and swelling after activity (do not use ice directly on the skin and no longer than 10 minutes at a time).
• Exercise: Specific exercises to strengthen the thigh muscles (especially the quadriceps and outside of the hip) and improve flexibility.
• Proper Footwear: Wearing supportive shoes or using orthotic inserts can help modify foot posture and reduce knee stress.
• Pain Relievers: Over-the-counter pain relievers can help manage pain and inflammation. Follow the instructions on the packet and speak to your GP if you are unsure what is safe for you to take. GPs can also prescribe stronger pain relief if appropriate.
• Bracing or Taping: Using a knee brace or taping the kneecap can provide extra support and offload discomfort felt over the knee during activity.
• Activity Modification: Temporarily reducing intensity and frequency of activities that cause pain and gradually returning to activity can help manage symptoms.
• Maintain a Healthy Weight: Reducing excess weight can lower the stress on your knees.

Understanding patellofemoral joint pain can help you take the right steps towards treatment and prevention. Please see the below links for more information: https://versusarthritis.org/about-arthritis/conditions/knee-pain/

Understanding Ligament Injuries of the Knee

Ligament injuries of the knee are common, especially among athletes and active individuals. Ligaments are strong bands of tissue that connect bones and provide stability to the joints. The knee has four main ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Each of these can be injured in isolation or together, depending on the nature of injury.

What causes ligament injuries?

Ligament injuries can occur due to:

• Sudden Changes in Direction: Quickly stopping or turning while running can strain ligaments.
• Direct Impact: A blow to the knee, often seen in contact sports, can damage ligaments.
• Landing Awkwardly: Coming down heavily on a single leg after a jump can injure the knee.

Types of ligament injuries

• ACL Injury: The ACL stops the shin bone moving forward. Injury often occurs during sports that involve sudden stops and changes in direction, such as rugby or football. Symptoms include a "popping" sound, severe pain, instant swelling and once subsided, instability.
• PCL Injury: The PCL stops the shin bone moving backward. Injury usually happens from a direct blow to the front of the knee or a fall on a bent knee. Symptoms include swelling, pain, and difficulty walking.
• MCL Injury: The MCL stops the knee moving inward. Injuries are common in sports and often caused by a blow to the outside of the knee. Symptoms include pain on the inside of the knee and swelling. Instability where the knee feels like it will collapse inward is common thereafter.
• LCL Injury: The LCL stops the knee moving outward. Injuries are less common but can occur from a blow to the inside of the knee. Symptoms include pain on the outside of the knee and instability where the knee feels like it will collapse outward is common thereafter.

Symptoms of ligament injuries

Common signs of a knee ligament injury include:

• Pain: Immediate and severe pain in the knee.
• Swelling: Swelling within the first 24 hours after the injury.
• Instability: Feeling like the knee is giving way or unable to support weight.
• Limited Range of Motion: Difficulty bending or straightening the knee.

Diagnosing ligament injuries

To diagnose a ligament injury, your physiotherapist will:

1. Ask about your symptoms and how the injury occurred.
2. Perform a physical examination, checking for pain, swelling, and instability of the knee joint.

MRI imaging can be helpful to check the extent of injury and to determine if other internal structures of the knee have been injured too, if pain is failing to improve after extensive rehabilitation.

Treatment options

Treatment depends on the severity of the injury:

• Rest, Ice, Compression, Elevation (RICE): These initial steps help reduce pain and swelling (do not use ice directly on the skin and no longer than 10 minutes at a time).
• Medication: Over-the-counter pain relievers can help manage pain and inflammation. Follow the instructions on the packet and speak to your GP if you are unsure what is safe for you to take. GPs can also prescribe stronger pain relief if appropriate.
• Physiotherapy: Exercises to strengthen the muscles around the knee and restore function.
• Bracing and surgery: A knee brace can provide support and stability. This may be helpful immediately after the injury whilst awaiting assessment. However, if you are not having  surgery, then you will be encouraged to wean off from this slowly as you get stronger. In severe cases, especially with complete tears, surgery may be necessary to repair or reconstruct the ligament. If surgery is indicated, then you will be placed in a brace after the operation.

Understanding ligament injuries can help you take the right steps towards treatment and prevention. Please see the below links for more information:

https://versusarthritis.org/about-arthritis/conditions/knee-pain/

https://www.nhs.uk/conditions/knee-ligament-surgery/