Knee pain can take many forms. From acute soft tissue injuries to muscles and ligaments in the knee to degenerative issues of the knee joint including osteoarthritis. Education, advice and management will likely differ based on the diagnosis. Common conditions seen by physiotherapists include, but are not limited to Anterior cruciate ligament (ACL) tears, Medial collateral ligament (MCL), meniscus tears, patellar subluxation, fractures, patellofemoral pain, patella tendinopathy and osteoarthritis.
ACL - For ACL ruptures studies have shown 5 weeks of intensive prehabilitation physiotherapy prior to surgical reconstruction led to improved functional knee scores and quality of life scores after surgery, which still remained at 2 years after surgery, suggesting that physiotherapy prior to surgery is important for optimal outcomes. Physiotherapy aims were to regain full knee range of movement and up to 90% strength of the quads and hamstring as compared to the non-injured leg.
Following ACL or any other knee ligament injury, whether managed non-surgically or surgically physiotherapy is generally always recommended. Rehabilitation is commonly recommended for up to 9-12 months in order to achieve end-stage goals and guide for return to sports. Physiotherapy will include re-gaining up to at least 90% strength of the quadriceps and other key lower limb muscles including the gluteals. Physiotherapy will also work on control of single leg movement patterns and landing patterns when jumping, hopping and changing direction to enable full and safe return to sport (see here).
For kneecap pain (Patellofemoral pain) international guidelines support physiotherapy as the treatment of choice and suggest at least 6-8 weeks of treatment targeting the hip and knee muscles in addition to education and control of the entire leg during functional tasks. This high quality study concluded that physiotherapy consisting of quadriceps and hip strengthening exercises over six weeks significantly reduced pain and improved function and recovery rates compared with no treatment. Patients were also instructed to complete the strength program at home for 3 months alongside physiotherapy for maximum benefit.
Patella tendinopathy is a condition affecting the tendon at the front of the knee, below the kneecap (patella). Studies recommend physiotherapy including porgressive and gradual loading of the tendon with strength based exercises, in addition to addressing other areas of strength and control deficit in the whole leg. Education regarding avoiding aggravating activities, load management and keeping an activity diary is also key in these clients. Many different loading exercise programs have been suggested and studies for patella tendinopathy, none with clear benefit over the other. The key appears to be a progresive 12 week course of physiotherapy strengthening exercises, whilst following a pain monitoring model with use of an activity and pain diary throughout (see here)
There is substantial and growing evidence supporting physiotherapy in the treatment of the various acute knee conditions mentioned above. There is also growing evidence of the efficacy of physiotherapy to manage knee osteoarthritis and improve both function and pain. This can lead to reduced days sick from work, reduced dependency on painkillers and reduced reliance on orthopaedic procedures such as a total knee replacement surgery. Treatment for knee pain will depend on assessment findings, but will commonly include an individualized exercise programme incorporating strengthening of the knee and hip muscles, balance and control exercises, in addition to manual therapy if required. If you’d like to know more contact us to ask how we can help with your specific case.
