Almost every activity we do with our legs involves the knee joint. The knee joint is constantly working to allow us to walk, sit, stand, go up and downstairs, not to mention higher-level activities like running, jumping, and pivoting. It is no wonder that knee pain is one of the most common injuries we treat at Next Level. When healthy and strong, the knee functions as a feat of engineering. But injuries to the knee can result in debilitating pain that can affect our ability to perform even the smallest of tasks. And I should know - I have 2 meniscus tears in each of my knees! Let’s take a deeper dive into the causes and possible solutions for your knee pain.
We will start with a quick anatomy lesson. The knee consists of bones, tendons, ligaments, cartilage, and other tissues. The knee joint is controlled by strong muscles like your calf, quadriceps, and hamstring muscles. Most people know the knee as being primarily a hinge joint in the middle of the leg which allows us to bend and straighten the leg. But the knee is not a “one-trick pony.” It also controls a small amount of rotational and side-to-side motion and its quality of movement is directly related to the function of your toes, feet, ankles, hip, and even low back. But before we go down that rabbit hole, let’s discuss the 3 most common causes of knee pain.
The 3 Most Common Knee Injuries
There are 4 major ligaments of the knee - the ACL (Anterior Cruciate Ligament), PCL (Posterior Cruciate Ligament), MCL (Medial Cruciate Ligament) and LCL (Lateral Cruciate Ligament). These ligaments are made of tough, fibrous tissue; connect the upper and lower leg bones; and function to control and stabilize the knee joint.
What Ligament injuries feel like:
A ligament can be caused by both direct blows (or contact injuries) and non-contact injuries. Most often, someone struggling with a ligament sprain will feel sudden and severe pain and instability (a feeling of giving way). Severe sprains and tears decrease your ability to bear weight on the injured leg. Patients most commonly report hearing a snap or pop at the time of the injury and incur immediate swelling.
Healing a ligament injury:
The first step is to seek medical attention to determine the severity of your injury. Using the RICE method (Rest, Ice, Compression and Elevation) is beneficial for both severe and mild injuries. More serious cases will require physical therapy and perhaps surgery. Physical therapy goals include reducing pain and inflammation, gradually increasing range of motion, strengthening the surrounding muscles and tissues to help support the affected ligament and eventually increasing the ligament’s ability to absorb and control loading and tensile forces. Once this is achieved the focus turns toward the quality of movement at the knee joint with complex, full body movements.
The menisci are cushions of cartilage between the Femur (or upper thigh bone) and Tibia (the lower leg bone. Each knee has 2 menisci (the medial meniscus and lateral meniscus) that work as shock absorbers and also provide stability at the knee. Injuries to these structures typically occur during a sudden pivot or change of direction at the knee joint, with heavy compressive loads through the knee or even due to a weakening of the meniscus and arthritic conditions of the knee.
What a meniscus tear feels like: Pain can be a little more diffuse and dull as well as bouts of severe sharp pain. Meniscus pain can also fluctuate in location, but typically will center in the joint line or around the kneecap. Many patients report popping or a click at the time of injury. Patients with meniscus tears will often feel pain with walking up stairs, pivoting and in more severe cases with simple weight-bearing. Oftentimes patients will experience a locking or buckling of the knee joint.
Healing a Meniscus tear:
Healing is directly dependent on the location, type and severity of the meniscus tear. Tears at the periphery of the meniscus tend to heal quicker and with more conservative measures. Bucket handle tears that cause consistent knee buckling, or large tears may require surgical intervention. The RICE method as mentioned above is useful to decrease acute inflammation. After the acute phase, the goal is to support the meniscus to allow it ample time to heal. Therapists will provide light stretching and mobility exercises to maintain and improve range of motion and milk out joint swelling. Strengthening and stability exercises are also introduced to decrease the demand and forces on the meniscus. Your physical therapist may also use taping techniques to support the meniscus. Laser therapy has also proven to be a valuable tool to reduce pain, increase healing blood flow to the area and improve function.
This injury occurs when the tendon that connects the kneecap (patella) to the Tibia (lower leg bone) becomes inflamed. This injury is sometimes referred to as “jumper’s knee” as the injury often occurs from excess stress placed on the knee after landing from a jumping motion.
What Patellar Tendonitis feels like:
Typically, pain with patellar tendonitis occurs in the fibrous portion of the tendon just below the kneecap and is made worse with running, jumping, squatting, and walking downstairs. Patellar tendonitis can also lead to Chondromalacia Patellae - a painful condition caused by increased friction on the femur (thigh bone) and the patella. Patellar pain can occur in front of, on the side, or even in the back of the knee cap.
Healing Patellar Tendonitis:
It’s very important to receive prompt medical care if a person suspects they have patellar tendonitis. Without proper treatment, the tendon is likely to become weaker making it difficult for the patient to perform even basic movements such as climbing stairs. Physical therapy is focused on reducing inflammation, decreasing pain, increasing strength and improving tissue pliability. Patellar tendon straps and taping may also be introduced to support the patellar tendon, stabilize the kneecap and decrease pain.
If you or someone you love is struggling with knee pain, we encourage you to reach out to us today at Next Level Physical Therapy for help (661-383-9828). Remember, you don’t “KNEEd” to be in pain… we are here to help.