At first it was just a niggle in your knee when you climbed stairs or were squatting. Then the pain and stiffness became more than a niggle and you began to feel it when walking, sitting and resting.
You may be hearing popping or cracking sounds in your knee, and notice that your knee “gives out” every now and again.
The knee is an amazing but complicated joint and knee pain is one of the most common reasons that people visit a physiotherapist.
Pain behind the kneecap is commonly called runner’s knee because it is often seen in athletes and people with an active lifestyle, although it can also be seen in everyone from the young adolescents during growth spurts to elderly people.
The medical term is patellofemoral pain syndrome. It is pain behind the kneecap where your patella (kneecap) slides along the groove in your femur (thighbone) beneath.
Pain and stiffness occurs when the kneecap does not slide smoothly and misaligns causing it to rub against your femur. Repeated mis-tracking causes pain, stiffness, and ultimately can cause damage to your kneecap joint surface.
Knee pain is most commonly noticed during activities that involve knee bending, jarring or weight bearing.
People most at risk are those whose sport or activity includes running, jumping or the need to land in a squatting position. Sports most commonly associated with knee pain include running, netball, volleyball, basketball, tennis, skiing and cycling. Many tradies such as tilers and carpet layers also have problems.
Causes of Runner’s Knee
Overuse – increased activity or increased duration and intensity of the activity
Changes in footwear or playing surfaces
Tight outer thigh muscles and weaker inner thigh muscles causing the kneecap to be pulled to one side
A twisting injury
Flat feet and lack of arch support
Weak hip control muscles
First aid for Runner’s Knee
Generally, knee pain is gradual onset, which means it gradually increases in severity over time.
As with most injuries, the best initial first aid is rest, ice packs (15 minutes at a time every 2-3 hours), and taking anti-inflammatory painkillers such as ibuprofen.
You do not need a referral from a doctor to see a physiotherapist. If the pain is moderate, then you can seek treatment with your Physiotherapist immediately.
Physiotherapy is a proven treatment for runner’s knee. Your physiotherapist may initially tape or strap your kneecap to help pull it back into alignment and reduce pain.
Massage and joint mobilisation techniques are also commonly used to reduce swelling and restore movement.
You will be prescribed exercises to stretch and strengthen muscles that may be contributing to the problem. These exercises will change as you heal and will gradually increase in intensity to match your recovery.
If you wish to continue exercising to maintain your fitness during your treatment, then explore swimming, deep-water running and low-impact gym equipment such as elliptical trainers.
Depending on your knee pain cause, you may also be advised to explore arch supports, orthotics or different footwear. You may also require postural or technique correction in your chosen sport to stop problems from recurring, as well as a strength and conditioning plan to get you back to full competitive fitness.
In our experience, over 90% of runner’s knee physiotherapy clients will be pain free within six weeks of starting treatment. However, for severely damaged joints or arthritic joints, surgery may be required.
Things to Remember
Runner’s knee or patellofemoral pain syndrome is a common cause of knee pain.
It is a gradual onset injury and is most commonly noticed during activities that involve knee bending, jarring or weight bearing.
Physiotherapy is a proven method to speed healing, and prevent recurrence of knee pain.
Future management may also involve assessment of your gait and posture during exercise, and prescription of arch support or custom made orthotics.
A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).
The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”
According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”
Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery.
Patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.
According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; 130318220107009 DOI: 10.1056/NEJMoa1301408
If you want to steer clear of lower back pain, remember this: Arch is good, flat is bad.
Back pain is anything but rare; only headaches and colds are more common. According to the National Institute of Neurological Diseases and Stroke, Americans spend more than $50 billion each year on lower back pain, which is the No. 1 cause of job-related disability in the country and one of the leading contributors to missed time from work.
There’s acute lower back pain, sometimes intense but generally short-lived discomfort resulting from injury to the lower back incurred during sustained physical activity (playing sports, doing yard work) or by a sudden jolt (being in a vehicle collision). But it’s chronic lower back pain, the kind that lasts for more than three months, that is more debilitating and more difficult to treat.
Much of that chronic pain is caused by damage to the discs — the spongy, multi-function structures that lie between the spine’s vertebrae — in the lower part of the back right above the pelvis known as the lumbar region. And much of that damage is caused by poor body mechanics — the way people stand, walk, lift, carry, reach, bend, sit and sleep — in which the back is too often flat, not arched.
“The key to avoiding lower back pain is keeping pressure off your lower lumbar discs,” said Tadhg O’Gara, M.D., an orthopaedic surgeon at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “That means keeping an arch to your lower back.”
The intervertebral discs, essentially the spine’s shock absorbers, are under constant pressure, especially in the lower back, which supports the weight of the upper body. The five vertebrae in the lumbar region are naturally arched toward the front of the body, so bending forward compresses the front of these disks, which over time can force them out of position to press on one or more of the nerves emanating from the spinal cord. This condition — known as a bulging, herniated or ruptured disc — can cause pain in the lower back and elsewhere, especially the buttocks, thighs and even below the knee (sciatica). And that pain can be severe.
“People who haven’t had lower back pain don’t re alize how painful it is,” O’Gara said. “And many health care providers don’t realize how painful it is.”
So how is chronic lower back pain treated?
“The first thing to figure out is what exactly is causing the pain, because that determines what approach to take with treatment,” said Kristopher Karvelas, M.D., assistant professor of physical medicine and rehabilitation at Wake Forest Baptist. “That’s not always easy. Pain is usually related to the discs, but other causes of low back pain have overlapping symptoms and pain patterns.”
Basic diagnostic methods include physical examination, review of the patient’s medical history and patient descriptions of the onset, location, severity and duration of the pain and of any limitations in movement. Imaging techniques such as X-rays, MRI and CT scans also can be employed to pinpoint the source of pain.
Once the reason behind the pain is determined, the most frequently prescribed treatment is physical therapy, not surgery.
“I typically reserve surgery for patients who have a medical need other than pain,” Karvelas said. “There’s a large toolbox that we can go to for patients, and surgery is the last tool.”
Depending on the individual patient’s condition, physical therapy programs usually include exercises designed to strengthen back and abdominal muscles and to promote proper posture and balance. These can include stretching, swimming, walking and even yoga. But education also is a key element.
“Patients need to recognize that posture and activity are crucial in relieving and preventing back pain,” Karvelas said. “They need to learn what exercises to do on their own and how to do them properly to prevent future flare-ups.
“We can help resolve acute back pain episodes, but when we are talking about chronic back pain, the pain may never resolve completely. However, we do use a team approach to treat patients and teach people how to cope with their pain effectively.
Wearing a knee brace has been shown to “significantly improve the pain and symptoms” of a type of osteoarthritis affecting the kneecap, according to a new study.
Arthritis Research UK-funded researchers at The University of Manchester claim their findings, presented at the Osteoarthritis Research Society International meeting in Philadelphia have enormous potential for treating this common joint condition effectively — as well as providing a simple and cheap alternative to painkillers.
Osteoarthritis of the knee affects around six million people in the UK and is increasing as the population ages and becomes more obese. Current treatments are limited to pain relief and joint replacement.
Osteoarthritis of the knee affecting the kneecap (patellofemoral osteoarthritis) accounts for about 20% of patients with knee pain. They typically experience pain that is made worse by going up and down stairs, kneeling, squatting and prolonged sitting.
“There’s a pressing need for non-surgical interventions for knee osteoarthritis, and little attention has been paid to treatments particularly aimed at the kneecap (the patellofemoral joint), a major source of knee pain,” explained Dr Michael Callaghan, research associate in rehabilitation science at the University of Manchester.
“We’ve shown that something as simple as a lightweight knee brace can dramatically improve the symptoms and function for people with this particular type of knee osteoarthritis.”
The research team conducted a randomised controlled trial of a lightweight lycra flexible knee brace fitted around the knee with a support strap for the kneecap. One hundred and 26 patients between the ages of 40 and 70 were treated over a 12-week period. All had suffered from arthritic knee pain for the previous three months.
They were randomly allocated to either immediate brace treatment or delayed treatment (i.e. after six weeks.) Both groups of patients eventually wore the brace for a period of 12 weeks and averaged roughly seven hours a day.
After six weeks of brace wearing there were significant improvements between the brace wearing group and the no treatment group in scores for pain, symptoms, knee stiffness, muscle strength and function. After 12 weeks there were significant improvements in these scores for all patients compared to when they started.
“Patients repeatedly told us that wearing the brace made their knee feel more secure, stable, and supported,” Dr Callaghan added. “Our theory is that these sensations gave the patient confidence to move the knee more normally and this helped in improving muscle strength, knee function and symptoms.”
Professor Alan Silman, medical director of Arthritis Research UK, which funded the trial, said: “Osteoarthritis of the knee is a painful disorder that affects millions of people in the UK, causing pain and reducing activities. We know that in patients with arthritis, the knee joint is frequently out of normal alignment, which might be an underlying cause of the problem, as well as making it worse.
“By using a simple brace, the researchers have been able not only to correct the alignment but achieve a very worthwhile benefit in terms of reducing pain and function. This approach is a real advance over relying on pain killers and has the potential to reduce the end for joint surgery and replacement, procedures often employed when the symptoms become uncontrollable.”
The ROAM (Research into Osteoarthritis in Manchester) project has run three trials at The University of Manchester and the University of Salford.