Knee Pain: Causes, Symptoms, Treatment and Exercises

Knee pain is one of the most common issues we hear about at Rebalance Sports Medicine.  Knees can be injured by trauma, repetitive strain or as a result of deficiencies in motor control and muscle balance.  In any case, it is important that you have your knee pain assessed by a medical professional be it a physiotherapist, chiropractor or Sports Medicine Physician.  It is important to seek treatment for your knee pain early as possible to avoid developing stubborn compensations strategies that make the rehab process longer and more challenging.

Why is the Knee Joint Unique?

The knee is constructed for a lifetime of weight bearing and weight transfer.  The joints that compose the knee include:

1. Tibiofemoral joint – thigh bone to shin bone
2. Patellofemoral joint – knee cap to thigh bone
3. Superior tibiofibular joint – on the outside of the shin just below the knee connecting the two lower shin bones to one another.

The knee joint is complex due to the meniscal (cartilage) structures that sit between the tibiofemoral joint. These two cartilaginous ring structures deepen the groove of the knee, providing joint lubrication, nutrition and also provide sensory feedback to our brains.  The meniscus can be injured with a sudden movement, poor mechanics, or can get worn down with age and with repetitive poor movement strategies.

Along with the meniscus there are several ligaments, muscles, tendons and bursae that are part of the knee complex and each of these structures can also be the cause of knee pain.

What are the Causes of Knee pain?

Ligaments Sprains

Ligaments connect bone to bone and surround joints to help with joint stability in order to prevent excess movement at the knee. When you sprain your knee, it can disrupt one or more of the ligaments. These ligaments are stretched when the knee is taken beyond its natural limits. This generally occurs as a result of a trauma or specific event but can also sometimes occur gradually when there are boney alignment and muscle imbalance issues. The four main ligaments of the knee are the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). It is always important to see a medical professional if you think you have sprained your knee.

Muscle Strains or Tendinopathy

There are numerous muscles that cross the knee on the front, back, sides and over the knee cap. When excessive demand is placed on one or more of these muscles they can become strained and an inflammatory response will ensue. This can happen instantly when injured or may occur over a period of time with repetitive loading in a dysfunctional manner. The part of the muscle that attaches to bone (the tendon) can also be injured in a similar fashion, either by a forceful contraction of the muscle or non-adapative repetitive loading. When the tendon goes through cycles where it is injured, then heals and then gets injured again, the cells within the tendon start to become unhealthy and can permanently die. This is why you should seek attention from a qualified professional such as a physiotherapist or chiropractor at the onset of any muscle or tendon injury. Your trusted health care provider will identify the root problem and help you build strength in your muscle and tendon to prevent re-injury in the future.

Knee Bursitis

Bursae are small fluid filled cavities that are specifically placed to prevent friction when muscles and tendons slide and glide over bone and other tissues. The bursae can get irritated and injured when there is overuse or excessive pressure on the knee joint. There are 11 bursae within the knee. Two of the most common areas of bursitis in the knee are: (1) the supra patellar area (above the kneecap) and the Pes anserine area (below and towards the inside of the knee). Although this condition can be extremely painful, it can be successfully managed through physiotherapy. Click here to learn more about Bursitis.

Meniscal Injuries

Injury to the meniscus can be degenerative developing over long periods of time or they can happen instantly with trauma most likely the result of an excessive twisting force on a bent knee. Common signs and symptoms of a meniscal injury include clicking and/or popping deep within the knee, locking of the knee (feeling like it is stuck and needs to be shaken out) in addition to pain on twisting, pivoting or walking on uneven surfaces. You also may notice some swelling and that you cannot fully straighten your knee when standing. Scientific studies indicate that the majority of meniscal lesions respond best to conservative management and not surgery. If you suspect you have injured your meniscus it will be important to get assessed by a physiotherapist or chiropractor to determine the best course of treatment. Click here to learn more about Meniscal Knee Injuries.

Patellofemoral Pain Syndrome

This is a generalized syndrome that is characterized by anterior (or front of knee) pain that is typically caused by mal-tracking of the knee cap along the grooves formed by the thigh bone. The knee cap is the largest sesamoid (or floating bone) in the body and has the thickest cartilage. The muscles and connective tissue that surround and attach to the knee cap will pull and guide it as we bend and straighten our knees (ideally through the centre of the groove). When there are muscle imbalances or dysfunctional foot, knee or hip alignment, and/or there are other factors that cause the knee cap to glide outside of the groove and tracks, knee pain will occur. This condition can be successfully managed through physiotherapy treatment but there is no quick fix. You will need to work diligently on your strength and flexibility program and may need to adapt your activities for a short while. Your physio may also guide you on how to slowly and gradually load your knee joint again so that you can build back up to your desired capacity. Click here to learn more about Patellofemoral Pain Syndrome.

Degenerative Changes

Osteoarthritis of the knee can occur as we get older and typically presents in middle to late aged individuals. The degenerative process and natural wearing of the knee joint can also occur earlier in the lifespan if there has been a traumatic injury to the knee or previous surgery. During this natural process of degeneration (similar to wrinkles that develop on our skin) the cartilage that lines the bones of the knee joint starts to thin and wear down. As the cartilage thins, there can be more pressure against the boney surfaces of the joint. The increased pressure can stimulate a response in the bone causing bone thickening as well as boney outgrowths (osteophytes). The sequela of events can lead to inflammation, pain and stiffness in the knee joint.  To prevent further wear and also to manage the pain and discomfort it is important that you keep the muscles that influence the knee strong and flexible. It also is helpful to maintain a healthy body mass and active lifestyle. Physiotherapists and chiropractors can help you overcome a flare up and can advise you on an individualized home program so that you can learn to manage your condition successfully. Click here to learn more about Osteoarthritis.

Chondromalacia Patella

As mentioned above the cartilage behind the kneecap is the thickest in the body. This is reflective of the amount of force and pressure that will be directed through the knee joint, quadriceps and through the knee cap during a lifetime. With this condition, the cartilage behind the knee cap begins to deteriorate and wear down. Typically, this process is instigated by poor alignment of the knee cap along the thigh bone in combination with repetitive loading activities. Often, muscle imbalances around the hip, feet and knee can be linked and correcting these imbalances can help to improve the alignment of the bones as well as the tracking of the knee cap. This treatment strategy can halt further progression of the condition and can keep symptoms under control while still being able to participate in the activities you love. Your trusted physiotherapist at Rebalance will help to assess your knee and develop an individualized treatment program that will get your knee cap back on track.

Lumbar Radiculopathy As A Cause of Knee Pain

In some instances, you may experience pain in your knee but the origin of the pain is stemming from your low back. There are nerves that exit your low back and travel down your leg to innervate the muscles, skin and tissues of the lower body. If one of those nerves is irritated or compressed, it can refer pain down your leg. There are specific nerves that can result in pain around the knee. If you have this condition, you may also experience pain and/or stiffness in your lower back and may even notice that specific back postures influence the knee pain. It is important that you have a thorough assessment from your trusted Physiotherapist or Chiropractor to determine the true source of your pain so that treatment can be geared to the right area of the body.

How can Physiotherapy, Chiropractic and Massage Therapy Help you Recover from Knee Pain?

A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your lifestyle goals, be it climbing the stairs pain free, running, skiing or something else that is important to you. Treatments with your trusted Physiotherapist or Chiropractor will often start with pain control strategies. Your therapist may use modalities such as laser, ultrasound, acupuncture or dry needling to help. Once your pain is under control, your Physiotherapist or chiropractor will use hands on techniques to improve mobility at your hip, knee or ankle joints through mobilizations and manipulations. They will also give you exercises that will maintain your treatment gains and help you build strength and control through your lower extremity. Soft tissue release is also an important aspect of care. Some of this will be done by your Physio or Chiro and in some cases, referral to a registered massage therapist may be necessary. Education regarding lifestyle modifications, pacing, posture re-education and gradual reintegration of activities will be covered. Your therapist may also recommend a knee brace or tape to support your knee and in some cases, orthotics can be recommended.  We also have the support of our recognized Sports Medicine Physicians for knowledge and information if your treatment is not progressing as you imagined. If your knee pain has not resolved in 1-2 weeks or is getting worse from its initial onset it is highly recommended that you seek the advice of a trusted Physiotherapist or Chiropractor who will conduct a thorough assessment and offer conservative treatment strategies that can help you get back on track again.

How Long Does it Take to Recover from Knee Pain?

Depending on the cause, severity, duration of the pain and your ability to get the proper treatment, recovery can take a few weeks up to a few months. In some cases, such as when there is a large meniscal tear or full ACL rupture, arthroscopic surgery may be required.  If surgery is required, it is always best to receive pre-surgical rehabilitation (prehab) and post surgical rehabilitation (rehab) to ensure your surgery is a success.  Remember to be patient and consistent with your prescribed home exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a Sports Medicine doctor for further investigations or alternate treatment options.

What are the Best Exercises to Help with your Knee Pain?

A well-rounded program should address hip, knee and ankle range of motion and will incorporate a graduated strengthening program. Exercises should always be individualized to your particular needs and goals.

Some of the most common exercises are linked below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after the movement. For motor control focussed exercises, it is important to perform these by in perfect form and in a slow and controlled fashion 2-3 sets of 10-15 repetitions.

Squat for strength and motor control

Lunge for strength and motor control

Clam shell for strength Link

Calf raises for strength and motor control

Bridge for strength and motor control

Step up and Step down for strength and motor control

Quadriceps stretch for flexibility

Hamstring stretch for flexibility

Calf stretch (two ways) for flexiblity

How to Treat Knee Pain at Home?

1. If you have acute pain in your knee, you may want to try ice first especially if there appears to be swelling or you recently hurt your knee in the last day or so. If the pain has been developing gradually over time, or has been lingering on and off for some time then heat might be the better choice. You may also choose to apply both intermittently as long as they help your symptoms and make you feel better after application. Remember to always protect your skin from the hot or cold temperatures by using a thin cloth or wet towel between the source of heat or cold and your skin. Always perform skin checks to ensure your skin is not getting irritated. Try not to leave the hot or cold on your skin for more than 10 minutes at a time and be sure to allow your skin to return to room temperature before you re-apply.
2. You should also try to understand the positions and activities that aggravate your knee pain. Try to modify these positions or avoid them temporarily until you can gradually reintroduce them back into your routine.
3. If you notice your knee mobility is starting to cease up, try working on your range of motion (ROM) with gentle movements.Bend and straighten your knee 10x every few hours within a pain free range so it does not become stiff.Perform some isometric (no movement at joint but muscles on) strengthening of the muscles.
   1. Isometric Quadriceps – Lying on your back, with a small towel rolled under your knee, press the back of the knee into the towel and tighten your quadriceps muscle group. Hold for 5 seconds, gently release and repeat.
   2. Isometric Hamstrings – Lying on your back, bend your knee so that your heel can be placed on the floor with your foot flexed, dig your heel into the ground as if you are pulling your heel towards your buttocks. You should feel some activation in your hamstrings muscle group. Hold for 5 secs and gently release. Repeat.
4. If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist and/or family doctor to help direct you.

If your knee pain continues, we highly recommend visiting a trusted physiotherapist or chiropractor so that they can conduct a thorough evaluation of your knee and determine a treatment plan that will help you get back on track quickly. The physiotherapists and chiropractors at Rebalance Sports Medicine have a great deal of experience and expertise with the knee and are here to help if you require it. Contact us to book your initial consultation today.