Knee Pain
Your knees put up with a lot! They are used in walking, running, stairs, hunkering down, kneeling. If you’re involved in sport the knee twists, turns, pivots, jumps and lands often at speed. Our knees rely on good joint surfaces, ligaments and surrounding muscles to stay healthy and allow us to do these activities. So if any of these structures are affected by wear and tear, sudden injury or doing the same movement over and over again knee pain can happen. This can affect simple things like coming down the stairs and to making you feel a bit vulnerable on higher level activities like turning to get a ball or jumping up.
You will feel knee pain usually in the inside or front of the knee and less commonly at the back or the outside of the knee. Several structures can be involved at the same time. Sometimes people have to get surgery to fix a problem and when this happens your rehab is really important to get the most out of your surgery – the surgeons will also say this! Let’s see which one is most relevant to you and how we can help you get better.
Osteoarthritis
Where are the symptoms and what does it feel like? You may feel pain and stiffness (usually at the front or inside of the knee) and it gets harder to move the knee into certain positions. This can start gradually and then get worse as more wear and tear develops. The knee might feel stiff and sore first thing in the morning but then eases off after you move around for a bit or after a warm shower. If you do a lot of activity in the day it can get sore particularly if you are walking a lot, on hills, stairs or hunkering down. It can get sore at night which can really affect your sleep. Some patients say they can tell if the weather is due to get colder as their knees start getting sore!
How did it happen? Wear and tear tends to occur as we get older. The cartilage that cover the ends of the bones where they meet and provides cushionning starts to wear away and this results in less shock absorption. Even though it can affect any joint in the body the knee and hip are common areas as they are joints that bear a lot of weight.
What is it stopping you from doing? When wear and tear is mild it can be more of a nuisance than anything. You can still do a lot of your normal activities but you might have to ease off on certain things like fully squatting down or jumping.
When it gets worse it can affect your walking, your ability to climb stairs, get up off low seats and it can keep you awake at night. It can really impact sports like running, tennis and football.
How can we get you better? Although we can’t reverse wear and tear in the knee there are things that can make the symptoms feel much better particularly in the early stages. We can show you how to keep the knee flexible and strong to cope better with your activities. We can also advise you on braces, footwear and extra support like insoles which can really help to give more support to the knee to make your activities less painful and more enjoyable.
Sometimes the wear and tear gets too advanced bad and the knee has to be replaced by surgery – for more on this see below.
Rehab for Total Knee Replacement
What are the symptoms and what does it feel like? You may experience a dull ache or feeling of stiffness around your knee post-surgery. You may have swelling which is pretty normal. Usually you are on crutches for several weeks to help with walking and balance. You can feel quite vulnerable after surgery but this will get much better as you get more confidence moving around.
How did it happen? You have a knee replacement usually due to severe wear and tear in the joint which was causing pain and affecting your activities and quality of life.
What Is it stopping you from doing? Any surgery will usually require you to restrict or limit your normal activities for a period of time and then gradually start adding in activities as the new knee gets stronger and more flexible. Returning to activities and sport too quickly after surgery and not completing rehab can leave you with pain and less ability to do the things you want to do.
How can we get you better? Depending on what surgery you had we will work with you and your surgeon to get your knee gradually moving and strong, get you walking properly, improve your balance and get you back to those activities that you miss.
What about doing rehab before my surgery? Rehabilitation prior to any surgery – also called “prehab” - is just as important as your rehab after surgery. We know that people who work on their movement and strength before their surgery have less pain and recover more quickly especially in the early stages. We can show you how to do this.
Other knee surgeries
Other common knee surgeries include cruciate repair, knee arthroscopy and cartilage repair, partial knee replacement, patella tendon release. There is usually a period after surgery where your movement may be limited and/or you are on crutches. Sometimes you might have to wear a post op brace.
Rehab post surgery tends to go in stages. Each surgery has a different recovery period and post op guidelines. We will work with you and your surgeon to get through these stages and get you back to full recovery, safely.
Pain around the front of the knee/ knee cap area
Where are the symptoms and what does it feel like? You can feel pain or swelling around the kneecap or just below it into the tendon. The knee might feel stiff in the morning or getting up after a period of rest.
How did it happen? These conditions are often called runners knee or jumpers knee usually because they happen when there is a lot of repetitive loading on the kneecap. It can happen with cycling or a job where you are up and down on your hunkers a lot. Sometimes it can happen because of muscle imbalances in the thigh – some muscles are too tight or too weak. Sometimes there can be a bit of wear and tear behind the kneecap.
What is it stopping you from doing? Simple things like squatting down, going up and down stairs (especially downstairs) can be sore. It can get sore when you are repeating the same bending movement in the knee like cycling, hill walking, running and any sports that involve jumping, like basketball, or lunging, like tennis.
How can we get you better? We will find out if certain muscles are too tight or weak causing stress on the kneecap. Sometimes the kneecap joint and muscles around it are stiff and we can loosen them up. If the tendon is involved we’ll get that stronger so it can cope with higher level activities like jumping etc. If you need taping or a brace to take some of the load off the kneecap we’ll do that too!
Pain around the inside of the knee
Where are the symptoms and what does it feel like? Pain in the inside of the knee is the most common area to feel pain – it can be due to wear and tear in the joint (as we spoke about above) or it can come from a cartilage tear or ligament tear. Depending on the extent of the injury you can feel pain and swelling in the inside of the knee and you might feel a bit unstable walking on it and feel that you need a crutch for support.
How did it happen? Cartilage and medial ligament tears usually occur from a sudden twist to the knee, for example playing rugby where your foot is planted on the ground but you twist suddenly from your body above it. This is also a common injury in skiing for the same reason as your foot is fixed in a boot. You can injure the ligament and the cartilage together or separately and if the twist is bad you might injure your cruciate aswell.
What is it stopping you from doing? Medial ligament and cartilage tears can make you feel quite vulnerable when you have to do any twisting movements like turning suddenly. So this will affect the majority of sports. Generally you will feel more confident when moving in straight lines.
How can we get you better? We will test the knee to assess what structures might be injured. Most injuries like these do get better with treatment and rehab so we will show you how to get your knee really strong and able to cope again with twisting and turning activities. If we suspect further injury in the joint, like say a cruciate tear, or if we feel you need a surgical opinion then we can organise that for you.