Are you struggling with knee pain that’s making the favourite sport or activity difficult, or unpleasant?
Perhaps you’re finding it difficult to bend or crouch down and your knee keeps swelling?
Maybe you’ve been told by a surgeon that you should give up running and yet your knee isn’t so bad that it needs a replacement?
What is causing my knee pain?
Sometimes we may injury our knee through a traumatic event, for example, with a twist or fall that may rupture ligaments or quite a big tear in one of the gristle cartilages (menisci).
The majority of patients I see in clinic, however, have knee pain that has accrued over time and may be an overuse injury. There are many ways that knee pain can present.
Sometimes people will experience pain over the front part of the knee and the kneecap area, this associated with clicking or grinding within the knee. We call this patellofemoral pain.
Sometimes the pain may originate from the patella tendon, which is just below the kneecap and in runners, pain on the outside part of the knee, known as iliotibial band friction syndrome can be really frustrating.
Just thought I’d send you a grateful patient email.
You may remember you saw me back in October when I was suffering from a meniscus tear in my right knee and what turned out to be a cyst. We decided not to operate on the tear but we aspirated the cyst and injected the knee and I’ve been doing more core/stability exercises. That definitely seems to have been the right decision. I’ve been training without discomfort since the beginning of November and I finally began to post some decent results last month culminating in a victory on Monday in the M55 World Masters Cross Country Championships held in Poland.
Many thanks to you for your wise counsel.
How is the cause of knee pain assessed?
When you come to clinic, I’ll ask you questions about how you experience the knee, whether the knee has any mechanical symptoms, such as locking, swelling, lack of straightening, clicking, or grinding, and very importantly, I watch how you move.
Many people have biomechanical patterns are leading to overload within the knee. For example, a tendency to overstride and hyperextend might impinge the fat pad at the front of the knee.
If your glutes aren’t firing very well, you may drop your knee inwards as you drop at the hip, and that may lead to irritation behind the kneecap or overload of the hamstring tendons that insert on the inside of the knee known as the pes anserinus.
We’ll look to see if there are issues with stability within the ligaments of the knee, whether there are any signs of cartilage or meniscal tearing. We might decide to carry out an MRI scan to look, to see the status quo of the tissues within the knee and this will guide us further on your treatment.
What treatments are available for knee pain?
If we find that the likely cause of your problems is tendinopathy such as patellar tendinopathy, then you need a specific loading programme, including weights at the gym, and we might need to carry out other treatments such as shockwave therapy.
If you’re experiencing pain behind the back of the kneecap or in the fat pad area, again, physiotherapy to correct the biomechanics is very important.
We might also look at podiatry and a formal gait analysis examination (to see if you might benefit from orthotics). Very occasionally we’ll look at injection treatments such as a corticosteroid injection to settle down the areas of irritation. Iliotibial band syndrome and pes anserine bursitis, can normally be treated very effectively with physiotherapy and osteopathy and retraining your gait with an excellent running coach.
What can be done for osteoarthritis in my knee?
If you’ve been told that you have osteoarthritis (wear and tear arthritis) in the knee, there’s a lot that can be done to help.
Contrary to popular belief, exercise for arthritis is extremely helpful and exercise can help reduce pain by strengthening muscles, which better support joints, improve stability, and reduce the shock during impact activities.
Once you’re moving better, you have more confidence in the knee. And we know that front-of-the-knee pain, patellofemoral pain in particular, can often generate pain avoidance patterns, which need the help of an excellent physio to help you overcome.
Losing a bit of weight, (if you’re overweight) is helpful for knee arthritis and most importantly finding activities that will keep you strong and fit such as cycling and swimming, as opposed to necessarily running, will enable you to keep active, despite the bit of wear on your knee.
Many runners run with knee osteoarthritis (including myself) and a diagnosis of arthritis in your knee doesn’t mean to say, you have to stop all activity. If you have knee pain or knee arthritis, do book a consultation.