Knee pain: causes, symptoms and remedies

Knee pain is a common complaint affecting people of all ages. Gonalgia is the medical term used to indicate painful symptoms related to the knee, which can be caused by an injury, such as a detached crossed ligament, or “torn” cartilage. Some pathological conditions, such as arthritis can also cause knee pain and inflammation.

There is a wide variety of patients visiting a physiotherapy clinic with knee problems: from those with a prosthetic knee to a professional sports person with chronic irritation of the patellar tendon.

Many types of knee pain respond well to physiotherapy treatments and the use of knee braces which can help relieve the pain. However, in some cases the knee may require surgical intervention, and so pain in this area should never be underestimated.

Furthermore, the knee is closely tied to the functionality of other joints in the lower limbs and therefore should always be evaluated together with these.

The knee: anatomy notes

The joints

The knee is a mobile trocho-ginglymus or pivotal hinge joint, which in turn is made up of 3 joints:

• Tibiofemoral joint
• Patello-femoral (or femoro-patellar) joint
• Proximal tibiofibular joint

Due to the shape of the joint surfaces, the menisci are needed to ensure functional stability. The meniscus is a medial capsuloligamentous complex (collateral and cruciate ligaments) and a differentiated muscular system.

The ligaments

The collateral and cruciate ligaments guide and stabilise the knee: they guarantee the optimal position of the femoral condyles with respect to the tibial plateau and the menisci.

There are two collateral ligaments:

• The medial collateral ligament: wide and connected to the medial meniscus and capsule.
• The lateral collateral ligament: this has a rounded C-shape and is highly resistant, without connections to the medial meniscus.

The muscles

The main muscles of the knee are:

• The quadriceps femoris, made up of the rectus femoris, the vastus intermedius, the vastus lateralis, and the vastus medialis. The latter has an important role as the patella stabiliser, and therefore its rehabilitation plays an essential part in patellofemoral pain syndrome.
• The posterior thigh compartment, made up of the ischiocrural muscles (the femoris biceps, the semitendinosus and the semimembranosus).
• The adductor muscles making up the internal part.
• The tensor fascia lata on the external part of the thigh.

Symptoms and possible causes of knee pain

The symptoms a patient can have with knee pain can vary: the pain may be felt at the front (above or below the knee cap/patella), to the side or internally, or behind the knee (in the popliteal fossa).

In some cases, the patient may feel pain that is spread “across the entire knee”.

This pain may be felt during or after a specific movement: in fact the patient may feel the pain while walking or running, when crouching or when holding a flexed position (e.g. sitting in the car or at the table). At times pain may only be felt when walking downhill or when walking up the stairs. The knee may also be swollen or lose mobility.

The possible causes of knee pain, in the absence of sprain or contusion, are:

• Arthritis of the knee
• Patellofemoral pain syndrome
• Iliotibial band syndrome
• Bursitis (goosefoot bursitis, prepatellar bursitis or infrapatellar bursitis)
• Patellar tendinopathy
• Worn meniscus
• Baker’s cysts
• Hoffa pad inflammation
• Joint stiffness (also as a result of surgery)
• Retractions/Trigger points in the quadriceps
• Distal tendinopathy of the femoral bicep
• Hip problems
• Stiffness of the ankle
• Incorrect foot support

 Knee pain remedies

In the case of knee sprain trauma, with consequent pain and swelling, the first step to take is to arrange to see an Orthopaedic specialist for a correct diagnosis. The specialist will carry out some clinical examinations and may prescribe some instrumental tests (such as MRI) to reach a firm diagnosis.

In these cases, the initial phase involves trying to reduce the inflammation and oedema with the RICE (rest, ice, compression, elevation) protocol.

In the absence of trauma, the doctor and physiotherapist will decide on the most suitable rehabilitation plan, depending on the cause of pain. The most common procedures chosen by the physiotherapist are:

–        Instrumental physiotherapy to reduce inflammation, improve any calcification, and stimulate tissue regeneration (TECAR, LASER, shock wave)

–        Manual therapy to eliminate joint stiffness

–        Exercises to strengthen and lengthen muscles

In more detail:        Patellofemoral pain syndrome

Patellofemoral pain syndrome is the most common problem of overload on the lower limb. Numerous clinical studies show that with a multi-structural rehabilitation plan, many of these patients become asymptomatic.

Patellofemoral pain syndrome is nothing more than an irritation caused by overload of the local structures in the area of the knee. Created due to an altered joint mechanism between the patella and the femur.

When treating Patellofemoral pain syndrome, a multi-factor approach is essential.

Here are some of the most common treatments used to deal with Patellofemoral pain syndrome:

• Quadriceps training (in particular of the vastus medialis oblique)
• Training of the posterior gluteus medius
• Training of the Tibialis Posterior muscle and the Peroneus Longus muscle
• Passive mobilisation of the patella
• Passive mobilisation of the hip and foot
• Patella taping and bandaging
• Stretching
• Plantar foot supports/insoles to correct the position of the foot

Conclusions

In the case of knee pain, a prompt diagnosis is the first step.

In the event of trauma or sprain, it will be up to the Orthopaedic specialist to evaluate whether there are injuries to ligaments or the meniscus, and then decide whether to opt for surgical treatment or physiotherapy.

In the absence of acute trauma, the physiotherapy-rehabilitation plan is the recommended route, where personalised therapeutic exercise is the most important part of the treatment.