A CLINICIAN’S PERSPECTIVE ON THE KNEE By:Vanessa Niemeyer, PT, DPT
What makes up the knee?
Your knee joint is made at the junction of your tibia (the long bone in your lower leg) and your femur (the long bone in your lower leg). Inside of this knee joint there are ligaments (ACL and PCL) and two cartilages (menisci). Surrounding the knee there ligaments (MCL and LCL). The patella (aka knee cap) sits on the femur and is attached to your tibia via the quadriceps tendon.
The quadricep is a group of 4 muscles that are located on the front of the thigh. These four muscles come together and cross over the knee cap and attach to the tibia. The hamstring is the main muscle group on the back of the thigh. Your hip muscles also come down to cross the knee joint to provide stability.
What are the most common injuries of the knee?
Knee injuries can be a result of overuse, trauma, repetition, quick/ sudden jerky movements, collision/ contact, and other mechanisms of injury. Common injuries to the knee include: ACL tear, meniscus tear, osteoarthritis, jumper’s knee, IT band syndrome, dislocated knee cap, fractures, sprains and strains.
How do I keep my knee healthy?
Warming up before participating in an activity has been scientifically proven to reduce injury.
Strengthening your quadricep, hamstring and hip muscles can assist in adding stability to your knee joint.
Ensuring full range of motion (ensuring that your knee can bend and straighten fully)
Cross train (Don’t stick to just one activity. Switch it up. Bike ride, walk, swim, lift weights, etc.) Overuse and repetition are linked with many injuries.
Maintain a healthy weight. The more that you weigh, the more stress that goes through your knees.
Stretching your quadriceps and hamstrings. This will ensure flexibility and an optimal length of your muscles. This is the most useful following a warm - up or following an activity. Stretching should occur when the muscles are warm.
Movement is key. Movement helps decrease stiffness, and keeps the components of the knee joint moving freely.
Know your limits. Remember that muscle soreness is okay. The sensation of muscles stretching is okay. Pain is not okay. Do not push through the pain.
Proper nutrition. Omega 3 fatty acids have been linked with reduced inflammation, whereas, sugar, red meat, and margarine have been linked with increased inflammation.
If something doesn’t feel right, it probably isn’t right. Get help sooner than later.
What about osteoarthritis?
Arthritis can occur at any joint space, including the knee. The knee is involved in walking, standing, stairs, squatting,and much more, which makes osteoarthritis at the knee joint fairly common. All activities which involve weight bearing through your legs put stress through your knee joint. This stress can lead to “wear and tear.”
Osteoarthritis is defined as the degeneration of cartilage between two bones (aka a joint space), and the tissue underlying the cartilage. This degeneration results in reduced joint space, inflammation, pain and stiffness at the involved joint. Occasionally, individuals will also develop bone spurs in the involved joints.
Symptoms:
Pain (especially following prolonged rest in the same position)
Stiffness (especially following prolonged rest)
Swelling (typically to the entire knee region)
Loss of range of motion
Impaired functional abilities to walk, perform stair negotiation and more
What about a torn meniscus?
You have two menisci in each knee (one on the inside and one on the outside). These menisci are designed to absorb shock, distribute the load, and add stability to the knee joint. A tear in the meniscus can occur with forced rotation through the knee (especially when weight is going through the knee).
Symptoms:
Pain (especially with weight bearing)
Limited range of motion (especially with extension)
Impaired function (difficulty pivoting, difficulty squatting, bending and standing on one leg)
Swelling (either inside, outside, or both regions)
Stiffness
What do I do if I have knee pain?
This answer strongly depends on when the pain started and what caused your pain. If you bumped your knee on the leg of your desk and it hurts, I would wait and see how the pain feels the next day. If you were tackled by somebody and your knee buckled in causing you to collapse, I would seek immediate medical attention. If you decide to “wait it out,” I generally do not recommend waiting for more than 2 - 3 days. If the pain is not getting better, seek medical attention. If you are not sure, get medical attention.
You can contact your physical therapist, PCP or orthopedic specialist for care. If it is an emergency, go to the emergency room or to an urgent care facility.
What to expect from my physical therapist:
An evaluation
Special testing to determine what structures may be involved
-Hands on tasks designed to target specific tissues
Resisted testing to determine what tissue may be involved
Gait assessment to analyze for potential deficits
Functional assessment to analyze for functional abilities and functional deficits
Strength testing to determine specific muscles that may need strengthened
Range of motion assessment: measurements will be taken as baselines
Treatment
Designed to target deficits
Designed to decrease pain
Designed to restore function
Designed to restore quality of life
Other
Treatment is specific to you and your specific condition
Modalities will be utilized to assist if necessary (such as: moist heat, cold pack, ultrasound, electrical stimulation and others)
Final Thoughts:
When comparing osteoarthritis to a meniscus tear, you can see (above) that many of the symptoms are similar in presentation. This makes it difficult for individuals to interpret. I strongly recommend seeking medical attention if you are in pain. A knee injury could be a result of trauma, overuse, and much more. There are many structures that encompass the knee joint which may be involved. Don’t ignore your pain, seek care.