Knee pain is an increasingly common condition that affects all ages of Australians.
The following blog will cover some of the most common conditions that may be causing chronic knee pain. We’ll also cover the symptoms you may experience, why this condition occurs and how it might be treated.
Osteoarthritis is the most common cause of knee pain in older adults and describes a condition where the cartilage in a joint becomes worn out. This results in a bone on bone articulation where the surfaces do not glide over each other smoothly as they should.
Osteoarthritis can be graded into five different stages, ranging from normal to severe.
People with osteoarthritis of the knee will often experiencing aching knees, knees stiffness, and loss of flexibility. When the joint is moved through its range of motion, cracking or ‘crepitus’ will often be heard.
Currently, there is no perfect treatment for osteoarthritis, and surgery is often required to reduce pain. A total knee replacement may be required for patients with severe enough osteoarthritis. This requires and extensive rehabilitation process. However, if you are experiencing severe enough pain and loss of quality of life due to osteoarthritis, this may be the better option for you.
Patellofemoral pain or ‘runners knee’, is the most common cause of knee pain in the younger population. This condition is particularly prevalent in young females. Patellofemoral pain typically presents as pain at the front of the knee which is aggravated by activities such as travelling up or down stairs, kneeling, or squatting.
Knees like to work in a straight line, and patellofemoral pain is often a result of knee malalignment. This can cause the patella, or ‘kneecap’, to no longer sit nicely in the patella groove.
This can be caused by a variety of factors, including weakness at the hip, flat feet, or even muscular imbalance of the quadricep muscles. A detailed assessment is often required to figure out which are the biggest factors causing your condition, and which of these will be the best to treat. Often involving both a physio and a podiatrist is the best bet to improve your patellofemoral pain as quickly as possible.
Osgood schlatters is a common condition found in active males aged between 10-15 years and active females aged between 8-14 years old. This condition is caused by repetitive stress and overload of the tibial tuberosity, which can be seen in the diagram to the right. Repetitive stress and overload of the tibial tuberosity is caused by overuse of the quadriceps, that pulls on the patella tendon, which inserts onto the tibial tuberosity.
The tibial tuberosity is a growth plate that does not fuse to the rest of the tibia until around the age of 15. This is why the site is more vulnerable to becoming inflamed when a high load is placed on it between the ages we mentioned earlier. Children with a very active lifestyle, including lots of running and jumping are prone to developing osgood schlatters.
The good news is, when treated correctly with conservative treatments, such as activity modification, icing, stretching and exercises, symptoms can often be completely relieved within a month or two.
However, if osgood schlatters is left untreated, it may take up to two years for symptoms to subside.
Iliotibial Band Syndrome
Iliotibial band (ITB) syndrome generally presents as pain on the lateral side, or outside of the knee, just above the joint line.
This is considered a compression injury of the ITB due to weakness of the hip abductor muscles. The ITB is a band of fascial tissue that runs from the outside of the hip down to the outside of the knee, and is responsible for helping stabilise the knee during running. Weakness of the hip abductors can cause the femur to meet the tibia at an abnormal angle, which can place compression on the distal aspect of the ITB closest to the knee joint. This can be seen in the images below – the first image indicates the site of pain, and the second image shows how weakness of the hip abductors can alter the knee joint.
Treatment of ITB syndrome will initially involve activity modification and RICE whilst the injury is in the acute phase. Treatment will then focus on foam rolling, massage, and strengthening of the hip abductor muscles to alter your knee biomechanics during gait.
This approach to treatment will ensure that you do not develop this condition again when you return to running or sport.
Fat Pad Syndrome
Fat pad syndrome refers to inflammation of the infrapatellar fat pad, which can result in pain at the front of the knee.
The infrapatellar fat pad sits behind the patella, which can be seen in the diagram to the right.
Very little is known about the development of fat pad syndrome, other than it is common in active young women, and that overload of this structure can cause the tissue to become hypertrophic, or thickened, resulting in chronic inflammation.
Treatments often are similar to how other conditions of the knee are treated, ensuring that no malalignment or weakness is present at first. If this fails, corticosteroid injections may be trialled to reduce pain and inflammation. If all conservative management fails, surgery is a last resort.
Medial Knee Pain
Pain at the medial knee is a very common presentation we see at our clinic. We’ve grouped this symptom together as there are a range of conditions that can cause pain at the inside of the knee.
Some of these, such as osteoarthritis, have already been discussed. However, others can include previous damage to the medial cruciate ligament (MCL), or damage to the meniscus. Medial knee pain can also be due to bursitis, or inflammation of a bursa in the knee. If you have medial knee pain present, it is best to come visit us so that this can be investigated further.
Acute Knee Injuries
You may have noticed that this blog has not covered acute knee injuries, such as an anterior cruciate ligament (ACL) rupture, an MCL rupture, meniscus tear, patella dislocation, or the countless other acute injuries that can occur at the knee. Whilst we as podiatrists will assist in the rehabilitation of these injuries, they will generally be diagnosed either at emergency or by a physiotherapist, who will take care of your rehabilitation plan and advise you if podiatry is required. If you suspect you have any of these injuries, you should visit the emergency room or your GP immediately.
How the foot and orthotics are used to treat knee conditions
As we touched on earlier, knees like to work in straight lines, and the position of the foot can have a large effect on if this is being achieved or not, and in multiple planes. For example, when the foot pronates as is shown in the diagram below; the tibia internally rotates, putting stress on the knee and potentially creating malalignment of the patella.
People with flat feet naturally sit in a more pronated position than people with neutral feet, and whilst this is not always a problem in itself, it can be a cause of knee pain, so it is important to address this when treating knee pain. By correcting the position of the foot, we can achieve a better position at the knee and correct patella malalignment, reducing knee pain significantly. This can be achieved through orthotic therapy. To read more on orthotics, check out our blog at “Orthotics 101: Your Guide to Everything Orthotics“.
We hope this overview of knee pain has helped you! If you are suffering from knee pain, don’t hesitate to book an appointment with us today, so we can get you back on track! Call us on 03 9432 2689 or book online here.