Knee pain can occur for many reasons. From acute injuries to ligaments in the knee to degenerative issues of the knee joint including osteoarthritis and meniscus (cartilage) tears. Education, advice and management are likely to differ based on the diagnosis. Common conditions seen at North shore physiotherapy include, but are not limited to Anterior cruciate ligament (ACL) tears, Medial collateral ligament (MCL), meniscus tears, patellar subluxation, fractures, patellofemoral pain, patella tendinopathy and osteoarthritis. Our lead physiotherapist Chris spent 4 years in the UK working as a hip and knee advanced practice physiotherapist so you are in good hands.
For ACL injuries, studies have shown that 5 weeks of intensive physiotherapy prior to surgical reconstruction (“prehab”) led to improved knee function and quality of life after surgery, which remained at 2 years post-surgery, demonstrating the importance of physiotherapy prior to surgery.
Following any knee ligament injury, whether managed non-surgically or surgically physiotherapy is generally recommended. Rehabilitation will include re-gaining strength of the quadriceps and other key lower limb muscles. Physiotherapy will also work on control of single leg movement and landing patterns when jumping, hopping and changing direction to enable full and safe return to sport (see here).
For kneecap pain (Patellofemoral) international guidelines support physiotherapy as the gold standard method of management, suggesting at least 6-8 weeks of treatment targeting the hip and knee muscles in addition to education and control of the entire leg during functional tasks.
There is substantial and growing evidence supporting physiotherapy in the treatment of both degenerative and traumatic meniscus tears in being as effective as surgery for knee pain. The meniscus has a crucial role in providing stability and reducing impact on the bone surfaces above and below, therefore preserving it, where possible, is always the best option.
For degenerative meniscal tears keyhole surgery was shown to be no more effective than placebo surgery at 5 year and may have even led to slight increased risk of development of osteoarthritis (see here). It has long been considered within orthopaedics that knee surgery is best reserved for younger patients with traumatic tears with mechanical symptoms, which is the case in some circumstances. However, this recent study of young patients between 18-45 demonstrated similar perceptions of symptoms, knee function and ability to participate in sports at 24-month follow-up, indicating that physiotherapy, plus the option for delayed surgery is an option for these patients also. Treatment for meniscal tears will typically include an individualized exercise programme incorporating strengthening of the knee and hip muscles, balance and control exercises. In addition to this education and activity modification advice will be required.
