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West Hill Physiotherapy, Tower Road, Dartford, Kent, DA1 2EU [See map]
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Knee pain

Patella-femoral Joint (PFJ) pain

PFJ pain refers to pain and irritation originating from the knee cap (patella). The patella sits in a small groove on the thigh bone. The patella acts like a pulley to increase the mechanical force generated by the thigh muscles as they contract to straighten the knee. Pain can arise from the PFJ when there is an uneven pull on the patella from the muscles or when the thigh muscles become excessively tight which causes compression of the patella into the groove it sits on.

PFJ maltracking and chondromalacia patellae

Tightness from the structures on the outside of the knee and weakness from muscles on the inside of the knee can cause the patella to become tilted and therefore not track centrally as the muscles pull on it. One common reason for this occurrence is imbalance in the hip muscles. The powerful hip (gluteal) muscles can become weak through inactivity/sitting too much. This creates an imbalance and the muscles at the front of the hip (the hip flexors) become excessively tight. Tightness and weakness from the muscles in the hip upset the mechanical load through the knee during activities such as ascending and descending stairs. The outside thigh muscles and structure called the ilio-tibial band which runs down the outside of the thigh from the hip to the knee pull the patella out of position.

The patella is covered by articular cartilage which allows friction-free movement to occur between the patella and groove in the thigh bone (the trochlea notch). Uneven wearing of this cartilage can occur if the knee cap has been tilted for a long time and can slowly erode away. This can gradually give rise to pain. Wearing of the cartilage in the patella is a condition called chondromalacia patellae. Typically people with PFJ pain, PFJ maltracking and chondromalacia patella may experience pain and difficulty getting up off the floor, getting out of a chair and when climbing and descending stairs. They may also notice a clicking or grinding sensation in the knee when performing these movement. The pain can vary between an ache and to soreness to sharp pain. They may also experience a generalised ache in the knee during long periods of sitting down.

The aim with physiotherapy is to try and normalise the mechanical load through the knee and encourage the patella to pull more centrally. Emphasis is placed on improving flexibility through the hip and thigh muscles and then working on strengthening of the thigh and gluteal muscles. Soft tissue release to the tight muscles and ilio-tibial band can provide effective pain relief. Occasionally taping can be used to help correct the alignment of the patella and reduce pain during daily activities on the knee.

Patellafemoral pain syndrome �Runners knee�

This term refers to pain around the knee cap (patella) and is normally felt with activities such as walking down stairs, running and occasionally cycling. There are several causes for the pain ranging from misalignment of the knee cap on the thigh bone due to an imbalance in the muscles around the knee, softening of the cartilage underneath the knee cap (chondromalacia patellae) and biomechanical problems at the hip and ankle causing overload to the knee cap and knee.

The key to addressing this problem is to identify the cause and tailor an exercise and rehabilitation programme to re-balance the muscles acting on the knee. This may include stretching and strengthen exercises to the hips, knees and ankles, improving core stability strength and addressing technical issues such as running technique, foot ware and training volume.

Ilio-tibial band friction syndrome (ITBS)

This is probably the most common knee complaint leading up to the London marathon. ITBS is swelling, irritation, and pain on the outer side of the knee. The ilio-tibial band is a layer of tissue on the outside of the thigh. It connects a muscle in your hip to the shinbone in your lower leg. The ilio-tibial band can get irritated from rubbing over the end of the thighbone near the knee. This happens most often from running or cycling. Pain is usually worse with downhill running and increases throughout the course of the run or during a cycle ride.

Treatment is aimed at correcting any biomechanical faults which may be causing overload to the ilio-tibial band as it attaches into the knee. Biomechanical faults can include weakness in the hip muscles, quadriceps, hamstrings, poor worn trainers and training errors causing overload. ITBS can also be caused by leg length discrepancy and imbalance around the pelvis.

Post-operative knee arthroscopy

An arthroscopy is �key hole� surgery to the knee. There can be many reasons why your orthopaedic consultant recommended the surgery for you. Common reasons for knee arthroscopy include exploration of the joint for diagnosis, repair/trim damaged cartilage, removal of loose bodies within the knee cavity, cartilage implementation and micro fracture.

Symptoms vary greatly between patients following an arthroscopy. Some are able to fully weight bear and some have weight bearing restrictions imposed on them by their consultant depending on the procedure that was carried out. It is very common to have a degree of stiffness in the knee, some swelling and discomfort after your surgery. Normally this settles within a few weeks and many patients do not require any physiotherapy intervention as exercises are routinely given out before or after their surgery.

Occasionally patients can struggle following their procedure and it can be useful when this is the case to seek the advice of a physiotherapist. We can help you to understand why your pain may be persisting and help guide you through the rehabilitation process to enable you to achieve your goals.

Pre-operative total knee replacement

If you are currently waiting to have a total knee replacement it can be a good idea to come and have a couple of sessions of physiotherapy a few months beforehand. One of the best ways to speed up your recovery after your operation is to strengthen and improve the flexibility in the muscles around your knee prior to having surgery.

Getting used to performing a regular exercise routine for your knee will stand you in good stead for your rehab following your knee replacement. The benefits of having stronger muscles before your surgery generally mean less post-operative pain and improved mobility. In our experience, having more flexibility in your muscles before your surgery will reduce post-operative stiffness and allow quicker gains in achieving functional range of movement in your new joint.

It is common place for patients to have a lot of questions regarding their pending surgery and there isn�t always enough time to discuss things in length with the consultant beforehand. People often comment that their anxiety levels significantly reduce once they have a better idea of what to expect after their surgery. Having the time to sit down with someone who really understands the whole process from surgery to recovery can be a real benefit.

Post-operative total knee replacement

We have many years of experience in helping people recover following their joint replacement surgery. As well as helping you to understand and progress your exercises, we can tailor your rehabilitation to meet your own specific goals. We are also really �hands-on� and utilise techniques such as scar tissue mobilisation and massage to reduce stiffness, increase range of movement and improve circulation to enhance healing.

For more information or to book an appointment please call 01322 275 402 or email info@westhillphysio.co.uk. Alternatively please feel free to complete the form below.
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