KNEE JOINT PAIN

The knee is the largest joint in the body and normally one of the most stable. It has large ligaments which control its movement and large muscles to give it power and stability. Despite the strength of the knee it is often injured because of the very large forces placed on it in sports and recreational activities. Physiotherapists are closely involved in knee assessment and treatment.

There are many causes of knee pain, varying with the age of the person and the activities they pursue. Your physiotherapist can diagnose and treat your knee problem effectively.

Patello-femoral syndrome or anterior knee pain
The patello-femoral joint is between the knee cap and the front surface of the thigh bone at the knee. The kneecap tracks in the groove on the front of the thigh bone and a disturbance in the balance of the knee muscles can allow the kneecap to track more to the outside.

This can increase the pressure on the joint areas and cause pain. Any changes in the cartilage behind the kneecap can also contribute. A softening of the cartilage of the back of the kneecap is known as chondromalacia patella.

Physios can treat weakness of the quadriceps muscles and stretch out any tight structures which contribute to the problem.

Recurrent patellar dislocation
The kneecap can dislocate sideways to the outside under certain conditions, such as lunging or twisting on the knee whilst weight bearing. This is more common in hypermobile people, especially young women. Physiotherapy is used to strengthen the quadriceps, regain joint movement and improve stability and control.

Collateral ligament sprains
The major ligaments at each side of the knee prevent the knee from being forced into an abnormal amount of knock-knee or bow-leg. Both the lateral (outside) ligament and the medial (inside) ligament can be sprained, with the medial ligament the more commonly affected.

Medial knee pain causes are usually sudden impacts on the outside of the knee such as in football or rugby.

Sprains will heal with correct management which varies from plaster of Paris to splints to reduced weight bearing for a while. Physiotherapy is often required to regain joint movement and strength and to rehabilitate the knee back to sporting or other activities.

Cruciate ligament sprains and cruciate rupture
The cruciate ligaments are major internal ligaments of the knee joint. They give back and forwards stability to the knee. The anterior cruciate ligament is damaged much more often than the posterior cruciate ligament.

If the anterior cruciate ligament is damaged or torn the knee becomes unstable when the person twists whilst weight bearing on the knee. Rehabilitation can improve knee function but if there are still problems then anterior cruciate ligament reconstruction is the most favoured option.

Osgood-Schlatter Syndrome
This is a problem of sporty teenagers. They develop pain on activity over the tibial tuberosity, the small bump below the knee cap on the front of the shin bone. The condition is caused by too much traction or pulling on this area while the person is growing rapidly. Rest and gradual physio rehabilitation are the treatments.

Jumper’s knee
This is a condition of athletes who perform jumping or changing direction rapidly. The patellar tendon attaches to the lower point of the patella and it is this area which becomes irritated and causes pain. Physiotherapy treatment can improve the symptoms and prevent the problem from becoming a chronic condition.

Osteoarthritis
Osteoarthritis is the most common joint condition in the world. Knees are commonly affected with the symptoms being pain, swelling, stiffness, reduced range of movement, reduced mobility and disability. Exercise is a core management strategy and physiotherapists can assess the knee and plan a treatment.

If conservative treatments are unsuccessful then total knee replacement is a option with very high quality of life improvements.

CITATION OF THE PHYSIOTHERAPY SITE
Retrieved March 7,2011.

Back Injuries

Your back is an intricate structure of bones, muscles, and other tissues extending from your neck to your pelvis. Back injuries can result from sports injuries, work around the house or in the garden, or a sudden jolt such as a car accident.

                              

                           

The lower back is the most common site of back injuries and back pain. Common back injuries include

• Sprains and strains

A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising and being unable to move your joint. You might feel a pop or tear when the injury happens.

A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling and trouble moving the muscle.
At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

• Herniated disks

Your backbone, or spine, is made up of 26 bones called vertebrae. In between them are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep them in place. A herniated disk is a disk that slips out of place or ruptures. If it presses on a nerve, it can cause back pain or sciatica.
Symptoms include

• Back pain that spreads to the buttocks and legs, when the herniated disk is in your lower back
• Neck pain that spreads to the shoulders and upper arms, when the herniated disk is in your upper back
• Tingling or numbness
• Muscle spasms or weakness

With treatment, most people recover. It can take a long time. Treatments include rest, pain and anti-inflammatory medicines, physical therapy and sometimes surgery. Losing weight can help, too.

• Fractured vertebrae

These injuries can cause pain and limit your movement. Treatments vary but might include medicines, icing, bed rest, physical therapy or surgery. You might be able to prevent some back injuries by maintaining a healthy weight, lifting objects with your legs and using lower-back support when you sit.


Retried from MEDLINEPLUS  March 04,2011.

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