Knee injuries are some of the most common injuries within the population. They can affect younger people through Osgood-Schlatter disease. They can impact active people in their 20’s and 30’s, who can suffer from an ACL injury. Of course, those in the older demographic are susceptible to more chronic injuries like Osteoarthritis. As you can see, whether you are young, old or somewhere in between, it’s important you understand how to take care of your knees. 

What Types of Knee Injuries Are There?

The knee joint is a complex hinge joint, made up of your thigh bone and shinbone, and kneecap which also joins to the thigh bone. To keep the knee stable we have four major ligaments. These are the: 

• Anterior Cruciate Ligament (ACL)
• Medial Collateral Ligament (MCL)
• Lateral Collateral Ligament (LCL)
• Posterior Cruciate Ligament (PCL)

These ligaments are responsible for providing stability to the knee and stopping it from collapsing. However if injured, the recovery time can be long term, ranging from 6 weeks for a minor sprain, up to around 12-14 months for a full rupture with surgical repair. Some evidence and studies are starting to display the potential for non operative ligament repair, however, these studies are in early stages and the long term impacts still are not fully understood. 

As well as ligament injuries, there are other structures that are at risk within and around the knee, such as: 

• Muscles/Tendons: The hamstrings, quadriceps and calf muscles all have attachments around the knee and are susceptible to injury. The attachment to the knee is the part we call the tendon, which can also be impacted. Weak tendons and muscles can cause injuries like a tendinopathy, which is a tendon which has been overloaded and causing pain, or even patellofemoral pain syndrome, which is pain associated at one of the joints in our knee. Finally, people can also suffer from muscular strains and tears, which are very common in the athletic population. 
• Meniscus: The meniscus is cartilage which sits between our thigh bone and our shin bone. Sometimes this structure can tear and cause locking, clicking and popping sensations at the knee which can be painful. 
• Cartilage and Joints: Cartilage sits between our joint structures to ensure they can absorb force and glide smoothly. However, when osteoarthritis occurs, cartilage within the joint can become damaged and start to cause pain. There is also Patellofemoral pain syndrome, which is a common source of knee pain and is associated at one of the joints in our knee. It’s usually due to factors like poor muscular control and strength, as well as poor technique with landing, running etc.  
• Bones: Our bones are susceptible to injury mostly through overloading them. Injuries like stress fractures, Osgood Schlatter’s disease and medial tibial stress syndrome (shin splints) can be due to too much load placed upon our bony structures. 

Risk Factors for Knee Injuries 

Different injuries to the knee have different risk factors.

Ligament Injuries

ACL injury risk factors are arguably the most important to understand, as this ligament has the longest recovery time from knee injury. However, there have been many studies on the risk factors of ACL injuries, and the health science field is beginning to better understand how to minimise risk. 

Some risk factors which been identified include:

• Landing Biomechanics: An improper landing technique can put the ACL ligament and other knee ligaments into a compromised position. Landing with your hips too wide, or having excessive trunk movement after force release from a jump or rapid change of direction, can increase risk of ACL injury. This is part of the reason as to why professionals believe females are more susceptible to ACL injuries, as studies have shown they tend to have different landing patterns compared to men. 
• Overall Physical Structure: We are all built in different shapes and sizes, which can affect our overall structure. Studies have shown certain bony alignments and joint angles have increase likelihood of ACL injury. This places more importance upon injury prevention for these people. 

Muscles & Tendons

• Muscle tears and strains are more likely to occur in those with muscle imbalances between both sides of the body.
• Studies have demonstrated that those with a previous history of muscle injury can be twice as likely to injure their hamstring. 
• Muscle tendon injuries are susceptible to injury when too much load is being placed upon the tendon, and it can lead to pain and impaired function. 

Cartilage & Meniscus Injuries

• Conditions like osteoarthritis are more likely to impact the cartilage in the knee as we get older. Overtime, more degeneration MAY cause pain, but not always.
• History of high impact sports places more stress upon cartilage structures within the knee joint and are a risk factor for meniscus related injuries. 
• Poor muscular support around the knee joint can place undue stress on cartilage structures within the knee. The GLA:D program which we offer at Peak MSK Physio can help with this. 

Bone Injuries

• Injuries like Osgood-Schlatters disease and medial tibial stress syndrome are at risk when too much load is placed upon the bones that form our knee. For example, playing and training for basketball 5-6 days a week while being a growing child, can increase risk for Osgood-Schlatter disease. Excessive high impact physical activity can also lead to other bone related injuries, and not just Osgood Schlatter’s disease. 

Who can be affected by Knee Injuries?

Knee injuries can impact the lives of children, teenagers and adults. Whether you are physically active or not physically active at all, it’s likely at some point you will experience knee pain. Active people can have a tendency to do too much physical activity, and tip their body over the edge and risk injury. Inactive people generally don’t have a high enough level of strength and support around the knee, and can begin to experience pain when walking or getting out of a chair. 

What’s interesting in Australia, is that studies have shown that the biggest increase in knee injuries over the last few years has been to the ACL. 5-14 year old girls have had one of the highest increases in ACL injury rate in Australia, and it continues to grow. However, it is not only in this age group where ACL injuries are becoming more prevalent, as it’s also growing within the general population. It’s important to seek professional advice on how to minimise the risk for this injury, as well as what to do if unfortunately it does occur.  

How is Knee Pain Diagnosed?

Knee pain can be due to a variety of causes, and this increases the importance of having a professional diagnose the condition. As some knee injuries can take over 12 months to recover from, and can even be serious like infection, it would be best to have your injury looked at by a Physiotherapist or Osteopath to get the correct diagnosis. 

At Peak MSK Physio, our clinical team is trained in the examination, diagnosis and management of knee pain. We can help you better understand why your knee is hurting, and what you can do to feel like yourself again. In order to do so, this is where an accurate diagnosis is important. There are a variety of tests, imaging procedures and questions we can ask and utilise to gather YOUR diagnosis. With years of experience and training between the clinical team, you can trust them to help you and give you the right diagnosis and treatment of your knee injury. 

Treatments For Knee Pain

There are various different methods to treat the knee. Options for manual therapy include:

• Soft tissue massage
• Dry needling
• Mobilisation techniques
• Stretching
• Specific neuromuscular exercise

As well as manual therapy, management will include exercise rehabilitation to make sure the knee is well supported. A focus on the quadriceps, hamstrings, glutes and core will likely play a major role in most knee rehab programs. Having good balance and symmetry in your movement will be a key focus of the rehab also, making sure the exercises are performed with the right technique to replicate how we want you to move. 

Other aspects of management could include taping, ice and anti-inflammatory medication if deemed suitable for your specific injury. Your practitioner will advise you if referral to a specialist is required as part of your management plan.

Patello-femoral Pain Syndrome (PFPS), or "Runners Knee"

Patello-femoral Pain Syndrome (PFPS) is a common condition that affects the front of the knee and can be a cause of ongoing knee pain, especially in athletes. It can cause pain during activities such as running, jumping, or walking up or down stairs. Physiotherapists and osteopaths are trained in the management of knee pain, and can assist with your treatment of PFPS, helping to alleviate pain and improve mobility.

PFPS is often caused by overuse or improper tracking of the patella (kneecap) as it moves over the femur (thigh bone). This can cause irritation and inflammation of the surrounding tissues, resulting in pain and discomfort. Physical therapy for PFPS typically begins with a thorough physical examination. The clinician will assess the patient's range of motion, strength, and overall function. Based on the assessment findings, a customised treatment plan will be developed.

One of the primary goals of physical therapy for PFPS is to reduce pain and inflammation. Your physiotherapist and osteopath can do this by creating an exercise program specific to PFPS. Exercise has proven to be the most effective first line treatment for the condition. Your program will usually include exercises to target the quadriceps, hamstrings, and glutes, as well as the hip and core muscles. Strengthening these muscles can help to improve knee function and reduce the likelihood of further injury.

Additionally, manual therapy techniques such as massage, stretching, and joint mobilization may be used to help improve mobility at the patellofemoral joint. Taping att the knee can also be effective in the short term for pain relief. A physical therapist may also provide education on proper lower limb mechanics and activity modification. This can involve teaching patients how to perform exercises with proper form and technique, as well as strategies for avoiding aggravating activities.

PFPS can be helped by the guidance of a trained health professional. A skilled physical therapist can help to alleviate pain and improve mobility, as well as develop a comprehensive plan for preventing future injury. If you are experiencing knee pain or discomfort, book in to the clinic today so you can get your knee back on track.