Knee pain can present with a variety of symptoms and can be caused by a sudden injury, overuse or by underlying conditions. Common symptoms of knee injuries can include pain, swelling, weakness and stiffness. Physiotherapy treatment and management can help with painful symptoms and pave the way back to activity.

The knee consists of two major joints, the tibiofemoral joint (where the thigh and shin bone meet) and the patellofemoral joint (knee cap and thigh bone).  A knee injury can affect any of the structures that support the joint including ligaments, tendons, bones or the cartilage that form the surfaces. Some of the more common knee pathologies include; Patellofemoral Pain Syndrome (PFPS), Osteoartritis (OA), ligament injuries and Iliotibial Band Syndrome (ITB Syndrome). In this post we explore the presentation and physiotherapy management of PFPS and OA in the general population.

Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain presenting from the patellofemoral joint itself, or surrounding soft tissues. Historically it has been referred to as anterior knee pain or runners knee but this can be  misleading as the pain can be felt in all aspects of the knee.

People usually present with the complaint of knee pain at the front of their knee cap  that is aggravated by activities such as: ascending/descending stairs, sitting with knees bent, kneeling, and squatting.

Patellofemoral Pain Syndrome can be due to impact along the knee, but it is more often a combination of several factors (multifactorial): overuse and overload of the patellofemoral joint, anatomical or biomechanical abnormalities, muscular weakness, imbalance or dysfunction. It’s more likely that PFPS will present if you have a sudden increase of activity or if you’re overtraining.

Physiotherapy gives you a platform to subside symptoms with a combination of treatment modalities such as;manual therapy, taping, orthotics and strengthening of muscles that support the knee primarily quadriceps and lateral hip muscle group.

Knee osteoarthritis (OA), is the most common form of arthritis in an aging population. It  is typically the result of wear and tear and progressive loss of articular cartilage. The most common symptoms are pain on activity that gradually gets worse, limited range of movement, stiffness, swelling, pain after prolonged sitting/rest and occasionally deformities around the knee.

The primary management for knee OA is advice from a physiotherapist on exercises that can help with pain and optimise function in the knee.

The physiotherapist’s  treatment includes a combination of  education around the condition, activity modification and forms of exercises that will encourage pain relief. Supervised exercises with a physiotherapist and a personalised home exercise program have been shown to have the best results.  A physiotherapist can show you exercises to strengthen the muscles around your joint, increase range of movement and reduce pain. Regular gentle exercise that you do on your own, such as walking, swimming or cycling, can be equally effective. An element of  weight loss is valuable in the management of knee OA. The best recommendation to achieve weight loss is with diet control and low-impact aerobic exercise.  Low-impact exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. This includes walking instead of running, cycling or water aerobics. There are various other forms of exercises that new research supports for long term management of OA, including Thai Chi and yoga. Tai chi and yoga involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, and research suggests that tai chi and yoga might reduce osteoarthritis pain and improve movement.

Physiotherapy has a pivotal role in the management and prevention of all knee pain, pathologies and injuries. The best outcomes involve a physiotherapy assessment for diagnosis, proper patient education around the condition and personalised strengthening exercises that focus on achieving the patient's goal.