A Pain In The Knee…

The knee is the second most common joint at which New Zealander’s suffer pain or injury.

Often if you have had a knee injury, it is fairly easy for a health professional to diagnose the problem and let you know how long it will take to heal and how it can be treated.

Knee pain that comes on gradually and slowly worsens can be a bit more puzzling and often people put off getting it seen to in the hope it will ‘sort itself out’.

So what could be causing your troublesome knee pain? Below is some information on the more common causes of knee pain of insidious onset for adults and ideas of what may help to get it sorted!

Patellofemoral syndrome (PFS)
PFS is an issue of maltracking of the kneecap, similar to when your clothes drawer gets stuck when you are trying to slide it into the chest!

Your kneecap sits in a groove on the front of the leg and should slide smoothly up and down in this groove as your knee bends and straightens. If your kneecap sits slightly out of alignment, it can cause unwanted pressure at the surrounding structures which provokes pain, usually in the front of the knee.

Pain associated with PFS is usually brought on by activities which are associated with higher loading through the patellofemoral joint including walking, running, climbing down stairs, and getting in and out of the car. Prolonged sitting can also be painful. Sometimes people also describe a feeling of instability in their knee, and worry it may give way on them.

Physiotherapists can undertake a comprehensive assessment to work out the reason your kneecap is not tracking correctly and once the causative factors are addressed, often your knee pain resolves. These factors are often related to: muscle imbalances (i.e. weak or tight muscles around the hips, knees or ankles); or poor foot position (i.e. flat arches). Often a simple strapping technique can be applied to remind your kneecap where it is supposed to track and eliminate your pain while you work on the factors which are causing the problem.

Iliotibial Band (ITB) Syndrome
A common runner’s problem! The ITB runs from the hip bone, along the outer aspect of the thigh to the outer shin and when it becomes tight or irritated it provokes pain, usually on the outer aspect of the knee. Pain is most likely to come on when you walk or run, especially downhill, and may even stop you from running altogether due to the pain.

On assessment, we would look to confirm whether the ITB is causing your knee pain, and then work out why it has become dysfunctional. Similar to PFS, the root of the problem is often muscle imbalances, foot posture issues, poor running technique and sometimes a change to your training regime which the body has not coped with!

Physio’s can provide exercises to correct the problem, advice on your running technique and discuss adjusting your training programme to prevent the problem worsening. We can also offer advice on how to prevent ITB syndrome from reoccurring.

Baker’s Cyst
A baker’s cyst (or popliteal cyst) is a fluid-filled cyst located behind your knee which often arises in association with a joint problem such as a cartilage tear or arthritis. You may experience a bulge of swelling along the crease behind the knee with pain provocation in the same area especially when you bend the knee (which compresses the cyst). Treatment is directed at addressing the cause of the Baker’s cyst, however rest and elevation may help. Occasionally the cysts are aspirated (drained).

Osteoarthritis (OA)
OA is the most common form of arthritis, and involves the wearing down of the cartilage that covers your joints. Your cartilage acts as a shock absorber and when it becomes thin and rough through previous injuries or ‘wear and tear’ it may begin to cause pain.

The knee is one of the most common joints to be affected by OA. People usually describe aching pain which is typically aggravated by weight-bearing and relieved by rest; and stiffness especially on waking or after prolonged periods of inactivity, which usually eases with movement. Some people experience giving way or locking of their knee, mild swelling which comes and goes, and even a grinding or grating feeling when moving the affected knee.

Occasionally the thigh muscles begin to waste away as you start to favour other muscles because of the pain. An x-ray is the only diagnostic test which can confirm the presence of OA. There is a lot of research showing that there are many things you can do to manage OA including: application of heat or ice depending on your preference (making sure to protect the skin before application with a towel); muscle strengthening to offload the joint; assessment of your footwear and foot position; and weight management.

It is a good idea to get knee pain seen to as soon as it starts to affect your ability to do the activities you want to be able to do. Often the longer you leave it the more difficult it can be to rectify, but after a proper assessment you should understand what is causing your pain, and have some strategies you can use to help get rid of it!

At Active+ we want to help you make sure you look and feel great –so to help you with this, we have created (exclusive to GrownUps members) a FREE GrownUps Warrant of Fitness assessment with one of our expert physiotherapists, to assess your current physical levels, and based on the results they will make recommendations on what you could do to make improvements in your physical health and fitness.

It’s time to give your body some love with the help of our Warrant of Fitness for GrownUps, and get back to feeling and looking great!