The knees support the majority of your weight, so it is not hard to accept that it is the most commonly injured joint in the body. Knee pain can be a result of overuse, traumatic strain /sprain, or other inflammatory conditions such as osteoarthritis. Injury to the knee can cause loss of motion, decreased muscle control, and impaired strength and endurance loss of the muscles that support the knee.
Many of the millions of people dealing with knee pain will see a physical therapist at some point in their journey toward pain relief. A physical therapist is a highly educated, licensed professional who treats a wide variety of injuries, diseases and chronic conditions.
The main goal of physical therapy is to improve your daily quality of life by decreasing your pain and increasing your mobility. If you have pain or difficulty getting up and down from a chair, walking the distance of a grocery store, going up and down stairs, or have been avoiding some of these activities due to pain, stiffness or weakness, it is likely that physical therapy can help.
Anatomy of the Knee
The human knee is a hinge joint that is comprised of the tibia (shin) and the femur (thigh). The patella, or kneecap, is located in the front of the knee. The knee is supported by four ligaments. Two shock absorbers, each called a meniscus, are found within the knee.
Pain in the knee can be caused by repetitive trauma and strain or injury. Occasionally it occurs for no apparent reason. When knee pain occurs, you may experience functional limitations that include difficulty walking, rising from sitting, or ascending and descending stairs.
- Cartilage is a slippery substance on the ends of the bones in the knee. It lets the bones rub or pass smoothly over one another as the leg bends and straightens.
- The menisci act as cushions between the femur and tibia that also act as shock absorbers.
- Ligaments hold the bones together and give the knee its stability. Damage to the ligaments can result from overuse, as in sports, or from a traumatic injury.
- Tendons are the connective tissues that attach the muscles in the leg to the bones they control.
What Type of Knee Pain Do You Have?
The type of knee pain one may experience has much to do with the construction of the joint itself. In short, there’s a lot going on in there. And because we’re bipedal – we stand on two feet – we put a lot of stress in the form of weight and movement on this large hinge-like joint. Each component of the knee’s complex structure serves an important function.
When any are compromised, they can contribute to pain in the joint. In the broadest terms, knee pain is:
- Acute pain comes on suddenly as with an injury from a twist or fall.
- Chronic pain lasts at least months and commonly indefinitely and arises from degenerative joint diseases like osteoarthritis.
- Sub-acute pain lasts weeks or more, such as from inflammation of tendons or the bursae.
Knees can hurt for many reasons.
Some of the most common causes of knee pain include:
- Trauma-based injuries, like a ligament tear or bone fracture.
- Ongoing wear and tear or overuse injuries (the pain may result from repeated smaller tears in muscle or tendon, for example).
- Tendonitis or inflammation of the tendons of the knee.
- Bursitis – a condition that occurs when bursae become painfully inflamed.
- Other medical conditions, including autoimmune conditions like lupus, cysts and gout.
- Problems with other joints, like the hips, that also cause knee discomfort.
How Will Your Physical Therapist Diagnose Your Condition?
Your physical therapist will make a diagnosis based on your symptoms, medical history, and a thorough examination. X-ray and magnetic resonance imaging (MRI) results may also be used to complete the diagnosis.
To help diagnose your condition, your physical therapist may ask you questions like these:
- Where is the pain?
- Did you twist your knee?
- Did you feel a “tearing” sensation at the time of injury?
- Do you notice swelling?
- Does your knee joint “catch” or “lock”?
- Do you have difficulty walking up and down stairs?
- Do you have difficulty sitting with your knee bent for long periods?
- Does your pain increase when you straighten or bend your knee?
- Does your knee hurt if you have to twist or turn quickly?
The physical therapist will perform tests to find out whether you have:
- Pain or discomfort with bending or straightening your knee
- Tenderness at the knee joint
- Limited motion in your knee
- Weakness in the muscles around your knee
- Difficulty putting weight on your knee when standing or walking
The physical therapist also is concerned about how well you are able to use your injured knee in daily life. To assess this, the therapist may use such tests as a single-limb hop test, a 6-minute walk test, or a timed up and go test.
What to Expect From Physical Therapy for Knee Pain
Based on the findings of your evaluation, your physical therapist will develop a customized rehabilitation program to ensure a safe return to your desired activities. Some general treatment techniques may include:
- Pain management. Your physical therapist may provide treatments using different “modalities” such as ice, heat, ultrasound, or electrical stimulation to help decrease pain and swelling.
- Manual therapy. Your therapist will apply manual (hands-on) therapy to gently guide movement of the knee area to restore joint and tissue mobility.
- Therapeutic exercises. Your physical therapist will prescribe specific strengthening, flexibility, and endurance exercises to address your specific needs and goals.
- Functional exercises. You will learn individualized exercises designed to help you return to your home, work, and sport activities. These also may include balance and coordination exercises.
- Self-care instruction. Your physical therapist will teach you ways to manage your pain at home, and design a safe and effective home-exercise program based on your specific condition, which you can continue long after your formal physical therapy sessions have ended. You also will learn how to avoid placing unnecessary forces on the knee during your daily activities for years to come.
How Can a Physical Therapist Help Before & After Surgery?
Your physical therapist, in consultation with your surgeon, will be able to tell you how much activity you can do depending on the type of knee surgery (such as total knee replacement) you undergo. Your therapist and surgeon also might have you participate in physical therapy prior to surgery to increase your strength and motion. This can sometimes help with recovery after surgery.
Following surgery, your physical therapist will design a personalized rehabilitation program for you and help you gain the strength, movement, and endurance you need to return to performing the daily activities you did before.