Knee pain comes in all shapes and sizes and can be debilitating. The knee is a simple joint with a complex network of muscles and soft tissue structures. The main (non-muscular) soft tissue structures include:
The Cruciate ligaments - Thick bands inside the knee joint connecting femur to tibia - Anterior (ACL) and Posterior (PCL) ligaments
The Collateral ligaments - thick bands running along either side of the knee - Medial (MCL) and Lateral (LCL) ligaments
The Menisci - Medial and Lateral, Fibrocartilagenous discs between the femur and tibia.
The Patellar Tendon - A thick tendon attaching the quadricep muscles to the tibia crossing the knee, also contains the knee cap inside
The joint capsule of the knee surrounds and supports the joint as it acts as a hinge to bend and straighten the leg. Alongside these major structures, there are many other sensitive structures that make up the joint capsule, which can be easily irritated. The synovial membrane, which wraps around the knee, the fat pads and bursas in the knee which act to aid smooth movement of the tendons around the joint and then the glute, quad, calf, and hamstring muscle groups which all have an impact on the joint.
How can a Physiotherapist help diagnose my knee pain?
So your knee hurts? The first thing to do is get it assessed. As a physiotherapist, my job is to find the cause of the injury and to help you understand why it has happened.
Is there a mechanical cause for your injury? What has changed recently? Have you started a new form of exercise? Have you recently upped your intensity? Or reduced it, dramatically? The knee is a particularly interesting joint because of its position in the body, it will easily be affected by both the hip and ankle joints so they are always good places to start. Identifying the structure that is causing the pain is one thing, but understanding the reason WHY this structure is now painful is important. Has and overactivity or inactivity of something else led to a mechanical overload of this now injured structure?
Example: knee pain is commonly triggered by a movement pattern i.e. squatting. Everyone is different, so the movement pattern of your squat will be unique to you. It is my job to optimise that and ensure its pain-free! As you squat, you will load certain structures and the balance of your weight may cause you to overload certain a structure during this movement, causing pain. Changing the loading of your squat will change the muscle activity, the movement pattern and potentially your pain.
How can physiotherapy exercises relieve my knee pain?
Once the source of the pain has been identified I often opt for the combination of simple movement drills, strengthening exercises, and advice. Understanding your biomechanics and then using them to your advantage is crucial. If you are overloading a structure beyond its capability it will winge and moan so you have two choices. Either reduce the overload by adapting the movement pattern, or strengthen the structure to cope with the demand.
Core strength, hip, and ankle mobility are often overlooked elements in knee pain. Having Good core strength with good hip and ankle stability will also provide stability to the knee. Glute strength, especially gluteus medius and minimus is vital to healthy knees as it will help guide and control the knee once it’s bent and under load (i.e squatting and lunging)
Here are two great exercises for anterior knee pain
Anterior knee pain is pain that appears at the front of the knee, often associated with squatting or lunging. Exercises wise I would recommend starting with an isometric contraction, in a pain-free range as to not aggravate the structure but to activate the surrounding muscles to start strengthening.
So number one is…. The ‘Wall-Sit’ - try 3x30sec holds
Number two...
After the isometric exercises, if tolerable, I will then aim to get an eccentric exercise in to help strengthen and lengthen the structures at the front of the knee. The irritability of the structure will dictate the difficulty of the exercise.
A good entry-level option is… The ‘Heels-Up Squat’ - Try 3x8-10 reps 4seconds on the way down, 1 second on the way up
Two great exercises for hip and ankle stability
As mentioned above your hip and ankle stability will play a key role in your knee pain and future injury prevention so here are two of my favourites
‘The ankle clock’ - Brilliant for strengthening the muscles in the hip knee and ankle for strength as well as the stability
Backward reach x5
Forward reach x5
Side to side reach x10
‘The single-leg Forward Lean and Reach’ - great for loading the hamstrings, and training decelaration by hinging the hips back. This will also test the standing-leg and core stability by shifting your weight and centre of gravity. Cone reaches x15
So whats next?
Knowing the issue is only half of the problem, you have to do something about it. Knee pain can limit so many of life’s simple pleasures, from walking, sitting, standing to running and often the key to being pain-free is so close. My advice is to keep your exercise consistent but to keep it varied. Too much of anything can lead to issues down the line. Repetitive movements are often causes of mechanical overload and pain, especially if done with poor control.
Remember to consider the body as a whole, and not to just focus one or two parts. Keeping your trunk, hips and ankles strong and stable as well as the muscles around your knees is essential for injury prevention!
If you are struggling with knee pain whether it be exercise-induced, or just something completely out of the blue, book in for physiotherapy in Highbury & Islington now to have it assessed, treated, and do something about it, today!