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Knee Articles

Quadriceps Muscle Strains

Quadriceps Muscle Strains

This injury is commonly the result of quick sprints or quick stops while running. With a muscle strain, there is localized tenderness or a “bulge” in the tender area of the thigh. The pain is aggravated by lifting the thigh (a straight leg raise), ascending/descending stairs, or getting up from a seated position.

  • Possible Treatment Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

Meniscal Tears

Meniscal Tears

The menisci (plural for meniscus) are cartilage pads, which function to cushion the compressive loads in the knee. One or both of these pads can be torn which often occurs when the lower leg is forcefully bent and twisted. Signs and symptoms include joint line pain, locking and swelling of the knee. The tear often has a bucket handle or parrot beak shape. Treatment should consist of rest, ice, compression and elevation. Arthroscopic surgery is indicated for a large tear.

 
 

  • Possible Treatment Goals

    • Improve Balance
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

Anterior Cruciate Ligament (ACL) Tear

Anterior Cruciate Ligament (ACL) Tear

The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

  • Possible Treatment Goals

    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

Posterior Cruciate Ligament (PCL) Tear

Posterior Cruciate Ligament (PCL) Tear

The posterior cruciate ligament (PCL) is stronger and less commonly injured. Motor vehicle accident, when the knee(s) forcefully impact the car dashboard, is a common mechanism of injury. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. Surgery is not typically required.

 
 

  • Possible Treatment Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

Medial Collateral Ligament (MCL) Tear

Medial Collateral Ligament (MCL) Tear

MCL tears are common injuries. A forceful stress on the outside of the knee can cause a stretching and injury of the MCL. Signs and symptoms include knee pain at the inner aspect and swelling. Medial meniscal tears and ACL injury may occur with severe trauma (commonly occurs during football and soccer). Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Severe tears may require surgery.

 
 

  • Possible Treatment Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

Lateral Collateral Ligament (LCL) Tears

Lateral Collateral Ligament (LCL) Tears

Lateral collateral ligament tears (LCL) are less common. Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Surgery is uncommon.

 
 
 

  • Possible Treatment Goals

    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing
 

Anterior Knee Pain

Anterior Knee Pain

The patello-femoral joint (the joint between the kneecap and the thigh bone-called the femur) is a problematic area for many. Excessive forces on the underside of the kneecap (causing painful stress on the cartilage on the underside of the kneecap), quadriceps tendinitis/tendinosis and patellar tendonitis/tendinosis are three common causes of pain in the front of the knee. Chondromalacia (softening of the cartilage) patella is also a common diagnosis for anterior knee pain.

Overuse and poor hip strength are often associated with these conditions. These conditions can be managed with physical therapy, taping/bracing of the knee and hip, and with the appropriate eccentric and hip stabilization exercises per your therapist’s recommendations.

  • Possible Treatment Goals

    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

Patello-femoral Pain (Commonly Called Chondromalacia Patella)

Patello-femoral Pain (Commonly Called Chondromalacia Patella)

Chondromalacia meaning softening of the patellar cartilage, is a common misdiagnosis. Softening of the cartilage can only be detected by directly visualizing the cartilage during surgery. The correct diagnosis for pain and swelling originating from under the kneecap is Patello-femoral Pain.

Treatment includes pain relief with rest, ice, compression, and elevation. Swelling must be controlled. Anti-inflammatory medications, bracing, and physical therapy are often helpful. Progressive strengthening of the quadriceps is essential. Occasionally, foot orthoses may be helpful. Rarely, surgery is required to assist in realigning the kneecap by releasing the tight structures on the outside of the kneecap and reefing the inner structures.

    • Possible Treatment Goals

      • Improve Balance
      • Decrease Risk of Reoccurrence
      • Improve Fitness
      • Improve Function
      • Optimize Joint Alignment
      • Improve Muscle Strength and Power
      • Increase Oxygen to Tissues
      • Improve Proprioception
      • Improve Range of Motion
      • Self-care of Symptoms
      • Improve Tolerance for Prolonged Activities

Patellar Tendinitis (Jumper’s Knee)

Patellar Tendinitis (Jumper’s Knee)

Jumping sports (such as basketball and volleyball) put a huge load on the kneecap and attached tendons. Signs and symptoms of patellar tendonitis include pain to touch directly on the patellar tendon and occasionally, swelling. Treatment includes activity modification, and physical therapy.

Sinding-Larsen-Johansson is a specific disorder of the patellar tendon where it attaches to the base of the kneecap. In contrast, Osgood-Schlatter disease is a disorder of the tendon where it attaches at the tibial tuberosity of the leg. Both are common disorders in maturing teens. Treatment includes activity modification, physical therapy, and rarely surgical excision of the associated necrotic debris.

  • Possible Treatment Goals

    • Improve Balance
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

Knee Osteoarthritis

Knee Osteoarthritis

Osteoarthritis of the knee occurs when the cartilage coverings on the end of the femur and the top of the tibia wear out. The tibia has two special cartilage pads called menisci (one is called a meniscus). This cartilage becomes flattened, bone spurs form, the joint becomes inflamed, range of motion is lost, there is ensuing weakness, pain and difficulty with walking, climbing stairs, and getting in/out of chairs. Physical therapy can help with recovery of range of motion, strength, walking skills, and pain management. Aquatic therapy (often involving a customized exercise program) can be helpful.

After total knee replacement (also called a total knee arthroplasty), physical therapy helps with recovery of range of motion, pain management, strength, balance and walking skills, and endurance. Commonly, patients say, “Why did I have this surgery? I am worse off now.” You must be patient. Give yourself at least 3 months to recover.

For more info, see osteoarthritis.

  • Possible Treatment Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

Iliotibial Band Friction Syndrome (ITBS)

Iliotibial Band Friction Syndrome (ITBS)

The iliotibial band (ITB) is a long, flat and strong tendonous structure that originates from both the gluteus maximus and tensor facia lata (TFL) muscles at the hip and runs down the outside of the thigh. It inserts into the outer region of the shin bone just below the outside of the knee joint (formally called Gerdy’s tubercle of the lateral condyle of the tibia).

Iliotibial band friction syndrome (also known as iliotibial band syndrome or ITBS) is the inflammation and painful irritation of the iliotibial band where it passes over the lateral epicondyle of the femur, an area just above the outside of the knee joint.

 
 
 

ITBS is typically the result of repetitive bending and straightening of the knee. It is commonly seen in long-distance runners that bend and straighten their knee hundreds to thousands of times during an endurance run. Cyclists may develop ITBS because of poor bike setup. ITBS has been reported in fast-growing teens as well.

The cause of this painful syndrome is usually due to a combination of stresses on the ITB such as:

  • abnormal hip, knee, and/or foot mechanics (e.g. excessive pronation) during running.
  • repetitive overuse (for example rapid increases in the number of miles run.
  • poor hip muscle strength and/or endurance.
  • poor flexibility.
  • worn out shoes.
  • training on uneven surfaces.
  • improper bike fit for cyclists.

According to recent clinical research, hip weakness does not appear to be a cause of ITBS in runners, but more studies are necessary. Hip weakness is common though in teens.

Conservative treatment is recommended. A physical therapist will evaluate walking and running patterns (gait), bike fit, flexibility, strength, knee and foot mechanics. Treatment usually consists of patient education, rest, stretching, strengthening, a possible change of running shoes, and ice for acute episodes of inflammation.

  • Possible Treatment Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Improve Range of Motion
    • Improve Tolerance for Prolonged Activities

Knee Replacement

About Total Knee Replacement

Joint replacement is becoming more common, and hips and knees are the most commonly replaced joints. In 2006, 542,000 total knee replacements and 231,000 total hip replacements were performed.

The new joint, called a prosthesis, can be made of plastic, metal, or both. It may be cemented into place or uncemented. An uncemented prosthesis is designed so that bones will grow into it.

 
 
 

 

First made available in the late 1950s, early total knee replacements did a poor job of mimicking the natural motion of the knee. For that reason, these procedures resulted in high failure and complication rates. Advances in total knee replacement technology in the past 10 to 15 years have enhanced the design and fit of knee implants.

Total knee replacement is often the answer for people when x-rays and other tests show joint damage; when moderate-to-severe, persistent pain does not improve adequately with nonsurgical treatment; and when the limited range of motion in their knee joint diminishes their quality of life.

In the past, patients between 60 and 75 years of age were considered to be the best candidates for total knee replacement. Over the past two decades, however, that age range has broadened to include more patients older than 75, who are likely to have other health issues, and patients younger than 60, who are generally more physically active and whose implants will probably be exposed to greater mechanical stress.

About 90 percent of patients appear to experience rapid and substantial reduction in pain, feel better in general, and enjoy improved joint function. Although most total knee replacement surgeries are successful, failure does occur and revision is sometimes necessary. Risk factors include being younger than 55 years old, being male, being obese, and having osteoarthritis, infection, or other illnesses.

 

Physical Therapy Pre and Post Surgery

There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

  • Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist directed program could help you delay or avoid knee replacement.
  • Seeing a physical therapist before surgery and going through a “prehab” program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.
  • Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.

Give us a call to learn more about how we can help you.