Learn About Your Knee – How does my knee work

Your knees play a key role in how you move about on a daily basis, how you play sport, how you exercise, how you work and how you get on with all the activities of life!

If your knees are working well and pain free, then you probably haven’t given them a second thought. On the other hand, if your knees are giving you problems, then it can make the even simplest of tasks seem impossibly hard and painful.

But don’t despair!! This guide contains all the knee- knowledge you need to know (and if you happen to need more, then you can always talk to one of our experienced physios directly)!

So, how does my knee work?

Your knee bends and straightens, or opens and shuts, much like a hinge on a door. Simple, or so it would seem. The knee is actually comprised of two main joints:

  • The tibiofemoral joint where the thigh bone (femur) and shin bone (tibia) meet.
  • The patellofemoral joint where the knee cap moves with the thigh bone.
  • There is also a third joint, just below the knee on the outside where the fibula and the tibia meet, called the tibiofibular joint. It can also have an impact on how the knee moves.

Instead of a straight open-close movement, our knees also have a slight amount rotation through movement. This helps the knee to ‘lock’ when straight to give more support when we put weight through it, for example when walking.

The knee will ‘unlock’ it for movements such as bending, sitting and jumping.

Muscles around the knee: 

  • Quadriceps: straightens the knee and are the muscles on the front of your thigh.
  • Hamstrings: bends your knee and are the muscles on the back on your thigh.
  • Calves (gastrocnemius): helps to bend your knee and are the muscles on the back of your lower leg.
  • Gluteals: helps to control your knee and are the muscles in your buttocks and don’t connect directly to your knee.

If you really want some in-depth detail on knee anatomy, then check out this page here:
https://www.physio-pedia.com/Knee

For most of us though, what we will go through will be more than enough.

What does my knee actually do?

While your knee is a relatively simple joint, it performs a lot complicated tasks.

From running, squatting, lifting, kneeling, twisting, going up or down stairs, and even just walking, there are a lot of processes at play. And your knee does this whilst carrying the weight of your body!

And a lot of the time just on one leg (for example when walking, a large part of your time walking is on one leg)!

Whilst walking down the street, our knees bear three to five times our body weight. With running and jumping this will be even higher.

You knee needs really good muscles around it to help support, shock absorb and guide the movement.

What problems can happen in my knee?

Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase the chances of having a knee problem.

  • Acute Knee Injuries:
    • Acute injuries are the most common cause of knee problems.
    • Sudden (acute) injuries may be caused by a direct blow to the knee or from abnormal twisting, bending the knee or falling on the knee.
  • Overuse Knee Injuries:
    • Overuse injuries occur with repetitive activities or repeated or prolonged pressure on the knee.
    • Activities such as stair climbing, bicycle riding, jogging, or jumping stress joints and other tissues and can lead to irritation and inflammation.
    • Over a long period of time this may lead to wear and tear around the knee and be a cause of osteo-arthritis.
  • Knee Osteo-Arthritis (OA):
    • Knee osteo-arthritis (OA) is the wearing of the articular cartilage that is the sponge like material between the two bony ends of the femur and tibia bones.
    • This happens gradually over time. Having a trauma or injury earlier in life can accelerate wear and tear of the knee, as can being over-weight, or even your genetics can leave you more likely to get OA of the knee.
    • The good news is that knee OA can be helped by Physio and following the right advice and exercises.
  • Age:
    • The chances of developing OA increases as we age. Most people over the age of 60 will have some level of OA, it just depends on the joints affected and the severity.
    • The changes that occur as we age increase the likelihood of OA being present, but the severity and pain of the OA affected joint seems to be more related to other factors including injury, obesity, genetics and joint biomechanical and anatomical factors.
    • As we age, the tissues surrounding the joints (tendons, ligaments, cartilage, bone and muscles) contribute to the development of OA due to changes within the cells themselves. These changes can lead to development of products that can change the mechanical properties of the tissues within the joint.
    • Due to this, OA is a condition that can also be seen in people as young as 20 or 30 years old. Changes in the ligaments, tendons, muscles, cartilage or bone due to trauma, injury or repetitive use, can start the changes we see as we age, and contribute to the development of OA.
    • It has been shown though that the development of OA in younger populations is much slower, meaning that at least for a while, the ability of the body to change and adapt to injury is much more efficient in younger populations than adult populations.

How Physiotherapy can help knee injuries:

Your myPhysioSA physiotherapist can examine your knee to determine the type, extent and causes of your injury.

Your Physiotherapist can discuss the injury with you and estimate the time it will take to recover. This will vary from weeks to months, depending on the severity of the injury.

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of a repeat of the injury.

In this video, myPhysioSA Physiotherapist, Josh Stewart, explains what could be causing your knee pain. Josh uses a knee model to explain what different areas of your knee and what knee pain symptoms they can give.

Take Home Message

Your Knee:

  • Bends and straightens to provided movement for everyday activities
  • Takes your bodyweight
  • Needs strong muscles to support it
  • Can get injured, but with the right advice, treatment and exercises, it will normally make a good recovery

Traumatic Knee Injuries

What happens when things go wrong? Acute and traumatic knee injuries

At some point, you can probably remember watching footy (or some form of sport) and have seen a player get tackled or twist and go down clutching their knee.

This is known as an acute or traumatic knee injury, and is something that happens suddenly and quickly and normally with quite a bit of force.

These types of injuries can be nasty and require a lot of rehabilitation and time.

Typical structure that can be damaged in an acute injury are:

  • Ligament: connects bone to bone and gives your knee joint stability.
    • Anterior Cruciate ligament (ACL) is a common ligament injury and one you have most likely heard of.
    • Posterior Cruciate (PCL), Medial Collateral (MCL) and Lateral Collateral (LCL) are other ligaments that can have damage.
  • Meniscus: is the cartilage in the joint and can also have bruising, swelling or tears, most often with a knee twist or buckle.
  • Bone: may also be bruised (this can be quite sore), the joint surface may be damaged, or the bone itself may be fractured.
  • Dislocation: is where your knee joint no longer sits in the right position. This can happen at your patella (knee cap or patella femoral joint) and in some severs cases the main knee joint can dislocate. A subluxation is a partial dislocation where joint moves out of position a little bit but then goes back into place.
  • Muscle: your muscles around you knee can be overstretched or overworked and sustain a strain or tear.

myPhysioSA Mount Barker Partner Physiotherapist David Wilson discusses knee sports injuries & strains. He covers the different types ligament strains and ruptures, along with cartilage (meniscal) tears, and the recommended management of each.

What is an ACL knee injury?

The anterior cruciate ligament (ACL) binds the back of the thigh bone (femur) to the front of the shin bone (tibia) and prevents excessive forwards sliding of your knee.

ACL injury is a common injury in football and other fast-paced sports due to the amount of force that can occur with tacking, contact and twisting and turning sharply.

If the ACL is ruptured the knee becomes unstable and feels like if it is “giving out”.

Instability is graded according to the amount of functional control of movement, so partial tears commonly can be rehabilitated with exercises and do not require reconstructive surgery.

If the ligament is completely ruptured, then this often requires surgery in order to get back to fast-paced sports.

If you have and ACL knee injury, you are likely to experience the following symptoms:

  • A feeling of initial instability, followed by a lot of swelling, you knee would often ‘blow up’ or swell quite quickly (within minutes) of the injury happening.
  • Pain immediately after the injury (although there is some variation in the amount of pain).
  • You may have felt or heard a pop or crack at the time of injury (but this doesn’t mean it is your ACL if you heard something).
  • You might find it really hard to fully straighten and bend your knee, or to even put weight on it.

ACL injuries are serious and don’t just go away. If you think you have an ACL injury, you need to get it checked out by a physiotherapist, GP or orthopaedic surgeon.

You can also read our information on what to do in an acute knee injury and what management options there are for acute knee injuries.

Other ligament injuries

Now we wouldn’t want the ACL to steal all the limelight, you have other ligaments in your knee too:

  • Posterior cruciate ligament (PCL) – back of the knee
  • Medial Collateral ligament (MCL) – inside of the knee
  • Lateral Collateral ligament (LCL) – outside of the knee

If you twist your knee suddenly, you could also damage these ligaments.

You might experience:

  • A feeling if instability, as if the knee can move where is shouldn’t go
  • Immediate acute pain with a continuing dull ache
  • Swelling or puffiness around your knee
  • Difficulty straightening your knee
  • Difficulty walking in the first few days to a week

PCL, MCL and LCL injuries tend not to be as serious as ACL injuries, but still need a lot rehabilitation to help get you back to sport.

Meniscal injuries

Your meniscus is another word for the cartilage in your knee. You have a medial (inside) and lateral (outside meniscus).

They are ‘C-shaped’ cartilage that helps to cushion impact and keep the knee more stable.

Your meniscus can be damaged with twisting your knee, usually with your weight on your knee.

Pivoting to turn and take off is an example of this.

With a meniscal injury, you may feel:

  • Pain right over the joint line
  • Swelling through your knee
  • Difficulty bending or straightening your knee

What should I do when I have injured my knee? Is ice or heat best?

Here are 5 Simple Steps to start you on your way to recovery after a knee injury:

  1. RICER
  2. Weight-bearing on injured leg as tolerated (if limping the next day should seek physio intervention)
  3. If purely sore with no limp then do simple gentle exercises
  4. Need to be pain free walk before attempting jog
  5. Start training, with a graded return to sport
had a hip or knee replacement

What are the 5 key steps to follow after an acute knee injury?

RICER

This is an acronym for acute injury management and stand for: Rest, Ice, Compression, Elevation and Referral.

The universal goal of all the elements of RICER is swelling and pain management and should be performed for up to 72 hours.

  • Rest reduced the chance of further harm to your knee by continuing to perform the movements/activities of the sport. Also an elevated heart rate (if you continue to play sport) can cause increased swelling to the area.
  • Ice is a great way at reducing pain, and it may also help to reduce swelling around your knee.
  • Compression through compression bandages and
  • Elevation above the level of your heart both aim to limit and reduce swelling around you knee.
  • Referral is made when immediate intervention is thought necessary i.e. fracture, ACL injury.
    • Referral to a physiotherapist is also recommended if the following day you are still limping or cannot bend or straighten you knee fully.
    • A limp/partial weight-bearing with crutches is acceptable for 24 hours, however full weight-bearing should be achieved following this.
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Weight-bearing on injured leg as tolerated (if limping the next day should seek physio intervention)

If you are just sore with no limp, then we suggest performing some gentle exercises like Inner Range Quadriceps (IRQ) and ¼ squat exercises on the injured knee.

These exercises are not aimed at being difficult, painful nor building massive amounts of muscle. The aim is to slowly initiate movement again.

You need to be able to walk pain free before attempting any jogging/running

Return to jogging and sport

This is all relies on your management of the injured knee.

If you followed the steps above, we suggest that you can attempt light jogging when your knee is no longer painful to walk on.

From this stage, return to sport would be graded, and should be able to perform all task in training (jogging, sprinting, change of direction, game-related activities) pain free prior to game play.

If you are unsure any of these steps or concerned at any stage of your injury, the team here at myPhysioSA would be thrilled to help and get you back into your sport.

Key Points to Remember:

  • Don’t forget that if you want to prevent further knee injuries then you need to get into a sports performance and injury prevention program.
  • Simply put, a program that is done 2-3 per week that focuses on knee and hip strength and control, agility, power and speed.
  • This program needs to be developed specifically to your sport and weaknesses.
  • Get in touch with us at myPhysioSA and we can get you started on a targeted program for your specific needs.

Take Home Message

  • Acute injuries happen suddenly and often at speed or with force
  • May damage some your knee structures (ligament, meniscus, muscle, joint)
  • It is key to have the correct diagnosis for the right treatment and exercise

Knee pain with running

Do you love to run?

Running is a popular and inexpensive way to keep fit and active.

But do you get knee pain when you run?

Or maybe you really want to get into running but knee pain is stopping you in your tracks?

Then this is the right info for you!

Whilst there are many positives to running, there are injures that can occur from running.

There are a few things that might contribute to your running knee pain:

  • running too often and not having enough recovery time
  • running too far too soon and not gradually building up your distance and speed
  • problems with your running style and biomechanics
  • not having the correct footwear

Most regular runners will experience some sort of running related knee pain at some point.

What are the common running knee injuries?

Here are a few of the most common culprits:

  • Runners knee
    • Runner’s knee (ITB friction syndrome) causes a pain on the outside of your knee.
    • The tight band down the outside of your thigh known as the ITB (ilio-tibial band) becomes too taunt and increased rubbing or friction over the knee joint results in pain and inflammation.
    • You may find that this is worse running downhill or going downstairs.

Find more detailed information on Runner’s knee below:

  • Anterior knee pain – patella-femoral
    • Anterior knee pain can occur when the knee cap does no slide properly in the groove and starts to irritate the smooth lining underneath. Poor running style and weak muscles can be the cause of such an injury, but things like tape or a knee brace can be helpful.
  • Anterior knee pain – patella tendon or Jumper’s Knee
    • At the very front of your knee below you knee cap you will find your patella tendon. This is a strong and thick tendon that attaches your quadriceps muscles to your knee (specifically the tibia).
    • Sometimes this tendon can get either compressed or overloaded and start to change the way it works. Often (but not always) this can cause you pain just under your knee cap (also called your patella).
    • It can be hard to run with an acute episode of patella tendonitis and if it continues to stick around we often call it patella tendinopathy.

Find more detailed information on Anterior knee pain see below:

  • Overload
    • This can happen when you overtrain or have too much repetition. That basically means that you have been running too long and too often without enough downtime to allow your knee to recover properly.
  • Muscle strains
    • Your calf muscles, hamstring muscles and quadriceps muscles all connect to your knee.
    • A normal strain means that some of the fibres (of the muscle and/or tendon) are affected. The way the muscle contracts and the how much power it can produce can be limited this can cause pain around your knee and stop you from running.
    • Strains of the tendons or muscles normally occur with quick explosive movements such as sprinting or faster running. It can also happen with overstretching, such as slipping over, or overextending your stride.
    • Strains are a soft tissue injury and can take between 2-8 weeks to heal typically.

How do I help my running injury?

For all of these injuries it is important that you take a little time off running, use the RICE principles in the first 48-72 hours (Rest, Ice, Compression, Elevation).

Then see a Physiotherapist who can help identify what the causing factors are and help you to correct them with a combination of hands on treatment, stretching and exercises.

Hopefully you will be able to return to your running in the near future with renewed enthusiasm and stronger legs.

Run strong!

Runner’s Knee:

What you need to know about runners knee or ITB friction syndrome:

It’s a common condition with runners, hiking and cycling.

It tends to appear with a sudden increase in training load.

Occurs when the attachment of the band continuously rubs against the outside of the femur bone with training.

Common signs and symptoms of runners knee or ITB friction syndrome include:

  • Pain with running, repeated knee bending
  • Tenderness over the lateral part of the knee
  • Tightness of the iliotibial band – the outside part of your thigh. It’s normal to be tight, but sometimes it can get extra tight
  • Weakness of hip stabilisers
  • Flat feet, causing the leg to turn in

To reduce your knee pain, you need to address all the areas contributing to your pain.

What can you do to help runners knee or ITB friction syndrome?

  1. Reduce the current training load and avoid painful movements
  2. Physiotherapy, stretching, massage and self-massage with foam roller to address tight muscles
  3. Icing and anti-inflammatory medications to settle the pain

In the longer term you need to:

  • Work on progressive strengthening of the core and hip stabilisers, through exercises, for example Pilates and specific Physiotherapy exercises.
  • Address foot biomechanics ie orthotics, and ensure you have the correct footwear.
  • Gradual progression back into training (don’t run on consecutive days, have a day in between for rest) and avoid hill running.

What is patella femoral anterior knee pain (kneecap pain)?

The kneecap (patella) is a bone that sits on the front of your knee. It joins your large thigh muscles to the top of your shins.

The patella fits and tracks in a groove between where your thigh bone (femur) meets the shin bone (tibia).

Kneecap pain is a dull pain felt around the patella, due to irritation of the soft tissues in the front of the knee.

It is usually the result of overuse or sudden increases in activity levels.

Kneecap pain can affect any age group, but can also be present with changes in growth and so can affect children and teenagers.

What are the symptoms of kneecap or patella femoral pain?

  • Tenderness about the kneecap
  • Pain builds during activity/sport
  • Worse with running activities/stairs/slopes
  • Crepitus (a crackling sound) will sometimes happen when squatting
  • The knee may stiffen if you have been sitting for a while

What can cause kneecap or patella femoral pain?

There can be many causes and contributing factors of Kneecap (patella femoral) pain including:

  1. Flat feet
  2. Poor muscular control at the hip and knee
  3. Tightness of the lateral thigh muscles
  4. Tight calves or a stiff ankle
  5. Growth spurt in children or adolescents
  6. Overload – ie too much activity too quickly

How is kneecap pain treated?

A Physiotherapist is the best choice for assessing and recommending treatment for kneecap or patella femoral pain.

Physiotherapists will look for the causes and then target treatment at addressing these:

  • Correct poor foot biomechanics with orthotics.
  • Teach exercise to help with strength and control about the knee and hip.
  • Give advice on return back to activity and load managing.

Patella tendonopathy or Jumpers knee

You might be wondering what is jumpers knee? Essentially it’s a term that relates to pain coming from the front of the knee, most often from the patella tendon.

As the name suggests, many people that develop jumpers knee (patella tendinopathy) probably have overloaded their tendon through activities such as jumping.

If you are high jumper, triple jumper or play in team sports like basketball, netball, volleyball and football, this is an injury that may affect you.

But this is not always the case, plenty of average Joes can also develop patella tendon issues too, and it requires a skilled physiotherapist to identify the problem and get you back on track with education, treatment and exercises.

Pain occurs when the patella tendon becomes overloaded by excessive activity or through poor technique.

If you think back to the anatomy part earlier in this blog, Tendons attach muscle to bone, and in the case of the patella tendon it attaches your large quadriceps muscle to the lower leg.

The patella tendon needs to be able to transmit the strength from the muscle to the bone and to absorb and handle load through jumping, running, walking etc.

However, when the tendon is overloaded, it essentially becomes ‘unhappy’ and part of the tendon changes (not the whole tendon) and becomes more sensitive, draws more water to it and so becomes thicker, and doesn’t handle transmitting the forces or loads as well.

When this happens it can, but not always, cause you pain.

Common signs and symptoms of jumpers knee or patella tendinopathy:

As there is no damage to the knee joint itself, swelling is very uncommon in this condition. If anything, you might get a bit of thickening through the patella tendon.

Pain generally quite localised to the patella tendon. If you have pain on the tendon, as well as other parts of the knee, you may have multiple causes of your knee pain.

As the name suggests it is triggered by activities like jumping, but also with running, squatting, climbing stairs and walking on inclines or hills. It can be quite a sharp pain while you are doing the movement, but can give you an ache thereafter.

What can be done to stop the pain?

Seeing an experienced physiotherapist is one of the best ways forward.

A Physiotherapist will have a look at the mechanics of how you move and jump, strength of your muscles around hip, knee and ankle, and management strategies to continue to play your sport.

As this injury is a long term loading issue, you will need to offload the tendon and modify your sport or activities.

This may mean reducing your training load, or even as drastic as stopping you from playing to let it settle down.

But you can discuss this with the physio and work out the best plan to move forward for you.

Once it has settled, you can start to introduce more training. In the meantime, specific exercises will be given to help settle the tendon down.

But be mindful that this takes time to improve and change the tendon, it will not happen overnight and it will require change in your activities, treatment sessions, home exercises and so forth for you to get the best outcome.

Osteoarthritis of the knee (OA)

Have you been told that you have knee Osteoarthritis (OA)?

Or does Osteoarthritis run in your family?

Or are you getting some nagging knee pain?

Then this is the right info for you.

Nagging knee pain effects as much 25% of the population over the age of 50.

The most common cause of nagging knee pain in the over 50’s population is osteoarthritis (OA).

In fact, OA affects approximately 2 million Australians, and for many its impact is severe and disabling.

Here is all the facts and information you need to know and some lifestyle changes that you can make to help you manage your knee Osteoarthritis as best as you can.

Osteoarthritis (OA) is a condition that affects your joints, it can effect a lot of people as they get older.

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Below is an excerpt from Arthritis Australia – to read the full information sheet about Osteoarthritis, click here.

What is osteoarthritis (OA)?

In normal joints, a firm, rubbery material called cartilage covers the end of the bones.

Healthy cartilage provides a smooth, gliding surface for joint motion and provides shock absorption to the joint.

Osteoarthritis (OA) is a process degenerative breakdown of the structure of the cartilage which results in a reduced capacity of the cartilage to provide shock absorption and smooth joint movement.

Typically, OA of the knee will present as pain, swelling and stiffness of the knee that tends to develop over time, rather than being associated with a particular incident.

OA is a condition that affects the whole joint including bone, cartilage, ligaments and muscles.

Osteoarthritis may include:

  • inflammation of the tissue around a joint
  • damage to joint cartilage – this is the protective cushion on the ends of your bones which allows a joint to move smoothly
  • bony spurs growing around the edge of a joint
  • deterioration of ligaments (the tough bands that hold your joint together) and tendons (cords that attach muscles to bones)

Osteoarthritis can affect any joint but occurs most often in the knees, hips, finger joints and big toe.

Osteoarthritis can develop at any age but tends to be more common in people aged over 40 years or those who have had joint injuries.

Osteoarthritis is different to osteoporosis. Osteoporosis is a condition where the bones become fragile and brittle, causing them to break more easily.

What are the symptoms?

  • The symptoms of OA vary from person to person
  • Your symptoms will also depend on which joints are affected
  • OA tends to come on slowly, over months or even years
  • The most common symptoms are pain and stiffness of the joints
  • These sensations are usually worst with activity initially but can be more constant the longer you have it
  • These symptoms may affect your ability to do normal daily activities, such as walking, climbing stairs and opening jars
  • Other symptoms may include clicking noises, grating sensations, or a loss of flexibility in a joint

How can I find out if OA is the cause of my nagging knee pain?

The diagnosis of OA is most commonly made by an experienced health professional based on your symptoms and a thorough examination in the clinic.

In most cases further investigations such as an x-ray are not required.

Research studies demonstrate a poor relationship between changes that can be seen on scans and the degree of symptoms that you are experiencing.

What causes knee arthritis?

Research shows there are some things that may put you at more risk of developing OA in your knees:

  • being overweight
  • having a previous knee injury
  • jobs involving kneeling, climbing and squatting
  • a family history of OA

Arthritis Australia has a lot of information about the different types of arthritis on their website, including symptoms and treatment options. Click here to visit

OA is not hereditary but if you have a family history – this can make you more at risk.

Is there anything that I can do about my nagging arthritis knee pain?

Absolutely.

Thankfully, the vast majority of people struggling with OA of the knee respond well to simple conservative management and are able to limit the impact that OA has on their lives.

Evidence based, conservative management strategies are best described as pharmacological and non-pharmacological.

Of course the pharmacological aspects of management- the use of medications and supplements- are best discussed with your GP and pharmacist.

Allied health professionals, such as your physiotherapist, exercise physiologist and dietician are well positioned to help you with the non-pharmacological aspects of management- education, exercise, weight loss, and the uses of aides and braces.

  • Education: having a thorough understanding of your knee problem empowers you to make the best decisions possible when it come to the management of your knee.
  • Weight loss: even when we perform everyday activities such as simple walking or climbing the stairs, our knees have to handle forces several times our own body weight.
    • Small reductions in weight can result in significant reductions in the forces that are transmitted across out knee joint.
    • In fact, weight loss of 5% in previously overweight people with OA related knee pain has been demonstrated to significantly reduce their pain and stiffness.
  • Exercise: regular exercise incorporating aspects of cardiovascular training, strength training, and stretching/mobility exercises are vital for the health and function of your knee.
    • However; it is vital that your exercise program is tailored to your specific requirements to get the best results. What works well for one person is often quite provocative of knee problems in another.
    • In general terms, steering towards exercise that does not expose the joints to high impact loads is beneficial, for example; swimming and water based exercise, riding, and rowing. Strengthening of the muscles around the hip, thigh, and lower leg helps to ‘shield’ the knee joint from impact forces that might otherwise provoke it.
  • Braces: the use of a knee brace can help to unload the sensitive areas within the knee and may allow you to perform tasks such as walking and squatting more comfortably.
    • It is important that you are properly assessed and fitted to ensure you get maximum benefit from the brace and that you don’t waste your money on a brace that is ineffective and unsuited to your needs.

There is no cure for OA but there are several things you can do to help manage this condition if you are diagnosed.

Simple lifestyle changes, such as the following, can help:

  • Eat a balanced diet so that you can maintain a healthy weight. Being overweight can put excess load through the weight bearing joints, especially the hips and knees.
  • Keeping your joints moving and your muscles stronger is an essential component of managing OA. The best kind of exercise is the exercise you most enjoy doing and are therefore most likely to continue. Ideally you should be doing 30 min of exercise most days. If you find it difficult to do 30 min consecutively you can split it up into 10 min or 15 min blocks throughout the day. Some of the exercises that can be effective include Walking, Cycling, Swimming, Aqua Aerobics, Thai Chi, Pilates, Bowls or Gym Exercises.
  • Talk to your family about your condition. Let them know how it is affecting young how makes you feel. It is also useful to share your experiences with others who have similar symptoms.
  • Get enough good quality sleep. The effect that getting regular good quality sleep on your body is often underrated. Sleep helps with your ability to heal and to manage pain.

If you would like more specific advice on how to manage your OA, we would recommend you book an appointment with a physiotherapist.

At myPhysioSA, our Physiotherapist treat and help many people with knee OA. We know how to assess your knee function and strength and the right treatment techniques and exercises to help you get the best out of your knee.

We run in Adelaide Hydrotherapy pool sessions led by Physiotherapists. This is a great way to get your knee moving in a low impact environment.

Once you are moving a little better, our Exercise Physiologists lead classes that are specifically designed to help you improve your knee movement, strength and control. The Exercise Physiologist can monitor your progress and add in or change movements and exercise to help you maximise your improvement.

References: Arthritis Australia
https://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2015/Condition%20specific/Osteoarthritis.pdf

Below are some great tips and advice to help you manage your knee arthritis

If you have painful arthritis in both your hips and knees, then here are simple exercises you can start doing seated at home.

Arthritis gives joint pain and a proven way to help is to keep the arthritic joint moving to keep the joint lubricated and then to strengthen the muscles that support the affected joint.

If you have ongoing knee pain then you should watch this video by Stephen our Exercise Physiologist at Mount Barker Adelaide.

Stephen shows you how to strengthen the muscles around your knee and hip to help ease knee pain. These exercise are easy to do at home and don’t require any equipment.

It is a fact that the best ways to help ongoing knee pain is to exercise and strengthen around the knee and lose a few kilo’s of weight. This videos shows you how to start doing the right exercises correctly, so get started now!

Knee pain can stop you from doing many things that you need or love to do, it effects your walking, ability to climb stairs and even sleep, and it can make you grumpy! So how do you help your knee pain?

If you are unsure what the best option is to finally get it fixed, then listen to Josh explain what Physiotherapy can offer to help your knee pain.

If you are over forty years of age and having daily nagging knee pain and are getting either pain at night, stiffness in the morning or pain with walking and/or stairs then this advice is perfect for you.

There is no need to keep putting up with knee pain and missing out on what you need to be doing.

Getting your knee pain diagnosed by a Professional is the best starting point for finding a solution and having a plan to get you back to all the activities you need to be doing again.

Knee pain can have many causes from wear and tear, poor knee cap biomechanics, to even having dodgy feet! Having thorough testing and then a simple explanation that you can understand is the key to taking control of your knee pain and learning what you can do that really helps.

If you have knee or hip arthritis then try these easy basic exercises to keep your joints moving.

If you have arthritis of the knee or hip then a great way to help your pain and get the joints moving again is to try these easy seated exercises.

Arthritis gives joint pain and a proven way to help is to keep the arthritic joint moving to keep the joint lubricated and then to strengthen the muscles that support the affected joint.

Stephen, a myPhysioSA Exercise Physiologist, demonstrates some easy exercises for targeting your hip and knee areas that can be done whilst seated.

Even if your knee or hip arthritis is painful, you may still be able to do these exercises pain free and get a real benefit, give them a try!

Why does my knee click?

Clicking and grinding of knees during movement such as walking up and down stairs can be very annoying.

But it doesn’t always mean there is something majorly wrong going on.

It could just be air pockets being released from the joint capsule or the underside of your kneecap grinding on the surface of your knee due to an imbalance in your thigh muscles.

knee-pain-thumbnail-14

This is quite common and the clicking doesn’t always cause pain, but it may still be beneficial to see a physiotherapist for advice, treatment and exercises.

Overtime the grinding and clicking can cause damage to the underside of the kneecap and lead to pain with kneeling, walking up and down inclines, etc.

A myPhysioSA Physiotherapist will be able to treat the knee by releasing tight structures around the knee and give advice about what exercises to do to strengthen potentially weak muscles and stretches to lengthen tight muscles.

It is when the clicking and grinding of knees becomes painful, we start to get more worried.

It could mean when you are moving your knee, it is flicking over something that shouldn’t be there.

Meniscus tears are a common injury which can be associated with clicking of the knee and pain.

They can be painful with being on your feet all day, walking up and down stairs, twisting and turning to even just bending your knee.

If this occurs, it would be best to see a physiotherapist to assess what is wrong with your knee.

With a minor meniscus tear, physiotherapy and activity management can work quite well to settle the knee down and minimise the painful click.

Once the knee settles, physiotherapists can guide you to strengthen around your knees, ankles and hips to offload and potentially prevent further injury or pain in the future.

had a knee or hip replacement

Unfortunately, there are times when a physio can’t fix your painful clicking knee caused by a meniscal tear, and this is where an orthopaedic surgeon may be needed.

In a simple and relatively non-invasive surgery, the surgeon may elect to arthroscopically stitch up and repair the damaged meniscus, or shave away the damage or frayed sections.

By taking away the injured part, it will stop the knee from rubbing on that location and stop the clicking and pain.

Physiotherapy is quite important after the surgery too to help reduce the swelling and start to get the muscles activated and strong again.

As a result, it can be a good idea to see a physio about your clicking knee to assess what treatment plan is needed for you.

Children & Adolescent Knee Pain

Do you have children or teenagers that play sport and are active?

Or maybe they are not active at all?

The good news is that children and adolescents are generally pretty fit and healthy and don’t tend to typically get a lot of knee issues.

However, it can happen and if a child or teenager in your family is suffering from knee pain or is very active with sport, then this is the right page for you.

Anterior Knee pain

If your child or teenager does get knee pain, typically it will present as pain at the front of the knee.

If there has been no traumatic injury (such as a fall or twist) then it is unlikely to be a tear to any of the major structures of the knee.

However, you should still take it seriously as there can be different causes that need different treatments and approaches to allow you child to improve.

Growth related conditions

Osgood Schlatter’s Disease is not a disease in the typical sense, it’s not something that you catch like measles.

It is a growth related change to the area of bone where the patella tendon attaches onto the tibia bone. This area is one of the many growth plate areas in children and adolescents.

It wouldn’t look a lot different if you could see it, it would look just normal bone and it would still be hard to touch, but because it is generating the growth of the bone it has less ability to withstand repetitive loads.

So the tendon pulling on this area over and over can cause the bone to become sore. See the graphic below:

This typically happens around 13-16 years of age and tends to affect more males then females.

knee-pain-thumbnail-16

You would normally be very sore right over the red dot – this corresponds to the tibial tuberosity. If you have Osgood Schlatter’s, this area:

  • Will be tender to touch,
  • will become more prominent and can appear inflamed
  • will get sore with sport or running, jumping and impact activities
  • will normally improve with rest

What can I if I have Osgood-Schlatters?

Physiotherapy can help by offloading the front of the knee though various ways.

One way that can work effectively is to tape or brace the front of the knee. This can help your pain immediately and allow you to continue to exercise to some degree.

However, it is generally a short term solution.

Physiotherapists can also look at how you are bending your knee and how you are absorbing shock when landing and help you to improve your knee biomechanics to decrease the load on the front of the knee.

Building up strength in other parts of your muscles is also good for this. This a longer term solution.

Home exercises to stretch out certain muscle groups and strengthen others will also help you to manage the problem.

How long does it take to get better?

With the above treatment your symptoms can completely resolve or get a lot better in 4-6 weeks.

But if you are still growing, there is a chance it could flare up again, or that the symptoms might not settle down at all until you have stopped growing from this growth plate.

This could be a year or so from the time you first noticed symptoms.

Sinding Larrson Johannsen Syndrome is also a similar condition to Osgood Schlatters, however the point where the overload on the bone occurs is at inferior pole of the patella (the bottom part of the kneecap).

The duration and treatments are similar to Osgood Schlatters.

During growth spurts in childhood and adolescence, you may experience pain and discomfort related to the changes that the body is going through in order to grow.

What is growing pain?

Growing pain can occur in rapidly growing children or teenagers.

The inflammation of the growth plate is caused by traction of the soft tissue structure such as muscles and tendons pulling on the plate in the nearby bone, just like we talked about above.

You may also get pain form the soft tissue (that’s ligament, tendons, muscles and even nerves) surrounding joints and bone. Your bones are the parts that generate all the growth, the rest of your body has to play catch up and adapt to the new growth and size.

Where do you get growing pain?

Common sites of growing pains include the:

  • heel bone
  • front of the shin
  • bottom of the knee cap
  • front of the pelvis or the sit bones

What triggers growing pains?

These pains can be aggravated by an increase in your child’s activity levels combined with the rate of bone growth.

Children can also experience growing pains when they are in a growth spurt and their muscles become tight as they are trying to keep up with the rapid growth of the body structures.

The normal progression of growth occurs between the ages of 10 and 18 and after the growth plates fuse the pain resolves.

Managing activities levels

Exacerbations of this growing pain can occur, usually at times of rapid growth or times of increased load or activity.

It is important to track your child’s height monthly, and be aware of these times of rapid growth.

During an aggravation use ice massage on the growth plate and associated tendon regularly, reduce the child’s activity load to appropriate levels depending on the degree of pain using taping and bracing as guided by your physiotherapist.

What else can I do that helps?

Massage, foam rolling and trigger point release can help relieve the stress of growing pains, and should be done daily.

During times of no pain, children should use stretching to increase the length on their muscles attaching to the affected joint plate.

Make sure you have regular check-ups with your physiotherapist, especially when symptoms change or you cannot settle an exacerbation quickly.

Do you need a scan or investigations for your knee?

This is a great question, because you have probably heard a lot of other people tell you about their knee x-ray or MRI and how bad (or good) it was.

The implication is often that you have to have a scan to really know what is going on, but is that actually true?

In a lot of cases, you most likely don’t need a scan to have a good idea of what is happening with your knee, particularly if you are being helped in your recovery by a good physiotherapist.

Now that doesn’t mean that scans are not needed or that they are not useful.

What it does mean is that a good physiotherapist (or GP, sports physician, orthopaedic surgeon), can often make a very good diagnosis of your knee problem based on your knee symptoms, what aggravates it, and how it happened.

The other side to this question, is that scans don’t always show exactly what is going on either.

They can be helpful in certain situations and can confirm or rule out possibilities.

Scans show structure, but they don’t show your pain

This is important to realise. A hypothetical example might be: a scan might show a strained ligament, but your pain might be coming from the way your knee drifts inwards when you run.

Working with a physiotherapist to identify this and getting help to retrain your movement pattern is the solution, not going into a brace or having surgery.

So what types of scans are there for the knee?

Real-Time Ultrasound: to put it simply, ultrasound uses high frequency sound waves (too high for human ears to hear) to look at soft tissue near the skin. It can’t look past or underneath bone. But it is good for soft tissue injuries such as muscle, tendon, and some ligaments.

X-ray: you are probably familiar with an x-ray, it uses a small dose of electromagnetic radiation to produce the image. It is good for looking at bone and joint structure. It the go to choice to identify or rule out most fractures and to look at general knee joint condition.

X-rays do not show good images of soft tissue.

CT scan: is a series of x-rays all together that give a more detailed picture of bone and joint surfaces and some soft tissue. They are generally not used in knees as often as the other imaging techniques.

MRI: Magnetic Resonance Imaging: uses a series of magnets to produce a series of images –that means that there is no radiation. MRI’s can identify ligament, soft tissue, meniscus and structures within the knee joint well. For traumatic injuries it will often be the scan of choice.

So when do I really need a scan?

Traumatic and unstable knee: if you have had a twist, fall or sudden injury to your knee (a traumatic injury) and your knee in collapsing, giving way or unsteady, or you can’t walk or weight bear through that knee after 24 hours, then a scan may be warranted.

O if you are experiencing severe, unrelenting pain even though there was no trauma or obvious reason for you pain, then you may need a scan.

If your knee symptoms are not getting better in the expected timeframe despite good physiotherapy input and appropriate exercises and treatment, or your symptoms are continually worsening, then a scan may also be appropriate.

How do I go about getting a scan?

The best way is to talk to your physiotherapist or GP and discuss the pros and cons of getting a scan.

Most times you will need a GP or orthopaedic specialist to refer you for the most appropriate scan for you and the cost will depend on a number of different factors.

What treatment options are there for traumatic knee injuries and how long does it take to rehabilitate?

In this area we will talk about what the options are for you if you have suffered an acute knee injury and you have been given a diagnosis and you are wondering what is the best way to get your knee back to the best possible condition.

Anterior Cruciate Ligament

If you have torn your ACL, then you are in for a lengthy recovery. The standard approach is a surgical repair of the ligament where an orthopaedic surgeon will replace your ACL with a graft under surgery.

There are many different ways of doing this. Orthopaedic surgeons in Adelaide tend to use the hamstring graft method, but there are other options.

Surgery is typically the way forward if you are wanting to get back to playing sport and being able to twist, turn and pivot on your knee.

Recovery normally takes 12 months of intensive physiotherapy, exercises and progressive rehabilitation – so be prepared for the long haul.

If you have injured your knee ACL ligament, then you should watch this video for advice on surgical options

Tim Bass, a Partner myPhysioSA Physiotherapist at our Payneham and Mount Barker clinics, interviews Dr Justin Webb, an Adelaide Orthopaedic Surgeon, on his experience with diagnosing knee injuries and his particular area of interest, knee ACL ligament ruptures.

Dr Webb explains the different knee ligaments that can damaged, how best to assess and diagnose a ligament injury.

He then discusses the main options for surgical repair and why he chooses one type of surgery over another.

Dr Webb performs both hamstring and patella tendon graft knee surgeries, choosing the best option for the athlete.

Dr Webb is an Orthopaedic Surgeon at Orthopaedics SA, and specialises in knee ACL surgery.

Visit his profile at his website here.

ACL surgery may not be needed if you don’t want to get back to high levels of physical activity.

There is some value to the idea of giving your knee 3-6 months of conservative rehabilitation to see how it progresses.

Some people have found that if they can get their leg muscles working well enough, their knee doesn’t feel weak or unstable and they can manage to do most things (but not high level sport or high load twisting, change of direction running and so forth).

The take home message here is to discuss your option with your physiotherapist, GP and orthopaedic surgeon.

Whatever the case you will need to work hard at your rehabilitation to help your knee recover to the best level that it can.

Posterior Cruciate Ligament Tears

PCL tears generally don’t require surgery, at least not straight away.

If you have an isolated PCL tear (meaning no other injuries), then conservative management would be the most common outcome. This means working closely with a physiotherapist and potentially an Exercise Physiologist to build up your muscles and control of your knee.

This often takes between 3-9 months of hard work, but generally this is enough to get you back to high level sport.

If for some reason this isn’t possible, or there are other factors such as other injuries to the knee, then surgery to attach a new graft for the PCL can be done.

This would be similar to ACL operations and require approximately 12 months of rehabilitation post-op.

Medial and lateral collateral Ligament Tears

These are the ligaments on the outside (LCL) and inside (MCL) of your knee.

Even with full tears, it would be unusual for you to undergo surgery. Conservative management, meaning lots of physio, specific exercises and gym work is what is needed, and most times is very successful. Even so, it may take 6-12 weeks to make a full recovery and return to sport.

Mensical Tear (traumatic)

This is where you may have twisted and rotated on your knee and suddenly have a lot of pain and swelling in your knee.

Scans might indicate that you have a meniscal tear (as long as it all fits in with the right symptoms).

Surgery can be an option here, particularly if your knee can’t fully extend. This is an important function for the knee (full knee extension) and needs to have surgical help if the knee can’t straighten on its own.

If your knee continues to collapse or feel unsteady, or you can’t get back to running or impact activities because the knee is too sore or symptoms aren’t settling down, then this may be another case where surgery is indicated.

Meniscal surgery generally involves an arthroscopic procedure, meaning the surgeon can look into your knee with a little camera (scope) without having to make a big incision and open up the knee (a much more complicated procedure). In the case of a meniscal operation, the surgeon has an instrument that can trim or repair the affected part of the meniscus.

Not all meniscal tears need surgery though. If you can fully straighten your knee and can start some gentle exercises (maybe a week or so after the injury and with physio guidance) without flaring up your symptoms too much or creating more swelling, you may make a really good improvement with conservative management over the course of 6-12 weeks.

Patella dislocation (acute)

If you have experienced a patella dislocation, you will know that it is very painful (probably an understatement).

It is where the kneecap (or patella) moves out to the side and doesn’t sit in the right position (ie dislocated). This happens mostly with a traumatic incident – a knock in sport, or sharp twisting or rotation of the knee.

A lot of the time the kneecap will pop back into the right position on it’s own. If it does this, then great. If not then you might need help in an emergency department or paramedics to help it to relocate.

Normally an x-ray is taken to make sure there is no fracture associated with the traumatic event.

Otherwise normally no surgery is required unless it becomes a pattern and you have repeated dislocations.

Fracture of the patella, tibia or femur

Fractures of the knee will often require orthopaedic specialist input and may need surgery. It will depend completely on the site and severity of the fracture.

What happens if I am going in for knee surgery?

Are you booked in for knee surgery? These knee exercises are useful to do before having a total knee replacement, ACL reconstruction or even a knee arthroscope.

Michael, a myPhysioSA Payneham Physiotherapist, explains why you should do exercises prior to surgery and gives 3 starting exercises for you to try.

Here are some specific exercises that could be helpful in the lead up for ACL surgery:

What exercises can I work on after surgery with my ACL?

You will need a lot of guidance from your surgeon and your physiotherapist. It will depend on the type of ACL surgery.

Here is a video that explains a brief outline of the 12 months of an ACL rehab program.

If you are having a knee ACL reconstruction surgery you need to know the best ACL rehab plan.

We talk you through what the 12 months of rehab will entail, along with a month by month summary of what you can expect to be doing until full return to sport, usually at the 12 month mark.

A myPhysioSA ACL rehab program would be specific to the demands of your sport, which is a key element to remember for a successful return to your particular sport.

This plan has been highly researched and is a proven program for preparing your knee and whole body for the rigors of return back to your sport.

ACL rehab is a long process that involves many different facets, gaining strength is only one aspect to focus on. There are many other aspects that need to be addressed if you want a successful return to sport. A lot of clients believe that once they are running with no pain, they are finished with rehab.

However, the end stages of rehab are perhaps the most important, to help reduce the chance of re-injury, increase the chance of a successful return to sport and possibly reduce the likelihood of osteoarthritis later in life.

Here are four areas of ACL rehab that are used in conjunction with strength training to get you back to where you want to be.

These should be done in conjunction with guidance from your physiotherapist and are more end stage exercises – so 6 months or more after ACL surgery.

  1. Proprioception
  2. Agility
  3. Plyometrics
  4. Sport Specific Activities

PROPRIOCEPTION

Proprioceptive training is important to help activate other structures in the knee joint that will produce compensatory muscle activation and ultimately assist with joint stability.

It has been shown that proprioceptive deficits can be present up to a year post ACLR, showing that this type training needs to continue well after a return to sport to help prevent re-injury.

Proprioception involves balance exercises to help teach your body where it is in space and hence give better stability and strength during unexpected or quick movements.

Below is an example of high level proprioceptive training, where the athlete is balancing on one leg on a bosu ball for added dynamic movement, whilst throwing a ball. This detracts the focus from the knee whilst still creating a challenging environment.

Tips for exercising during winter: Exercise Physiologist Adelaide

AGILITY

Agility drills are another important aspect of ACL rehab. It allows you to start to adjust to sports specific activities by breaking them down into bite size chunks.

For example, changing direction, acceleration, deceleration, quick stops and take offs. Training this is important as there are few sports that simply involve running in a straight line continuously.

In the picture below this soccer player is using a ladder for quick feet drills. They use a grapevine movement to increase the twisting and turning motion at the knee joint. Focus here is on speed and accuracy.

PLYOMETRICS

Plyometrics works to improve neuromuscular control, which can then become learned skills that transfers to return to competitive play.

Research has shown us that when plyometric training is combined with strength training, there is less re-occurrence of injury and a greater percentage of players that return to the same level sport prior to injury.

Plyometric activities involve explosive movements where muscles exert maximum force in short intervals of time, with the goal of increasing power (speed-strength).

Below is an example where the athlete does an explosive single hop for distance.

Focus here is not only on distance but also the control of taking off and landing.

SPORTS SPECIFIC ACTIVITIES

Working closely with your physio is very important for a successful return to your sport. Your physio can work with you to develop a program that specifically relates to your sport, being it AFL, netball, soccer, gymnastics or crossfit.

Your ACL works dynamically, to assist in stabilising the knee joint when you perform any twisting, turning or cutting motions. Therefore, it is important to train, when the time is right, in a manner that will mimic your sport’s functional demands.

In these later stages of rehab, your physio will be closely monitoring how your ACLR side is going compared to your other side.

Tests such as the hop for distance, as shown above for the plyometric training, are important to help us gauge when you are ready to return to sport. Studies tell us that your ACLR knee needs to be within 10% of your other knee to achieve a successful return to sport.

Once this is achieved, an integrated plan can be developed to help increase your sport fitness, getting you ready to start your season at the peak of your training.

If you want to get back on track with your ACL rehab and get back to doing what you love sooner, please contact us and book an appointment with our specialised physios.

Knee taping

Is something that physiotherapist can use to help you with your knee rehabilitation.

Titled myPhysioSA Sports Physiotherapist, Rohan Hattotuwa, demonstrates and gives tips/advice on the correct way to give support to a knee that has instability or is recovering from a ligament or other knee injury.

Watch Rohan as he tapes a knee step by step, starting from where to put the anchors, what type of tape is best to use, and which ligaments the taping can be adjusted to support.

He gives tips and advice from his years of experience dealing with knee sports injuries, helping to get sportspeople back to doing what they love quicker.

Watch his two videos below:

What treatment options are there for general knee pain?

Physiotherapy of course!

Physio should be your first choice to help guide you to recovery from having knee pain.

Below are some other tips and advice that one of our myPhysioSA Physio’s might teach you:

Knee Osteoarthritis Treatment Advice

Management plans for OA should include physical activity, lifestyle change, weight loss if required and possibly medication to reduce inflammation and pain symptoms.

There are a number of treatment options that can help you manage and improve your OA symptoms. What treatment option may be best depends on the type of symptoms.

For example, if you have no pain, but your knee joint can’t bend and flex as well as what you would like, then there is no use putting you on pain medication or sending off for an injection.

What you may need is a structured plan set out by a physiotherapist who can manipulate the joint and structures around it to get more bend.

Similarly, if you are having large amounts of pain, swelling and tenderness in the joint, then you may need to get your pain management under control before adding in any new, vigorous physical activity that could stir pain up more.

Plans must be individual to the person, and their symptoms.

Physiotherapy (Physiotherapy, Occupational Therapy, Exercise Physiology)

Most people with OA will be asked by their health professional to start moving.

Everyone has heard this old saying;
“If you don’t use it, you’ll lose it!”

And nothing could be more true when it comes to moving your body when you have OA. Now some people may be worried that moving the joint will case their OA to become worse, but this couldn’t be further from the truth.

Exercising has been proven to be the most effective non-medication form of treatment for decreasing pain and improving movement in OA affected joints.

Moving the joint will enable a few things to occur:

  1. Moving the joint will help reduce the stiffness you receive. You have to remember that the joint is made up of more than just bone and cartilage. The muscles, tendons and ligaments surrounding the joint can contribute to a joint’s stiffness, and therefore can also contribute to decreasing stiffness within the joint.
  2. Moving the joint will improve the strength and endurance of muscles and tendons surrounding the joint, improving their function that will directly impact the joint function also.
  3. Moving the joint will improve flexibility and mobility, meaning your body is able to change positions more efficiently. This can help with strength and balance, two key components to maintain and improve as we age.
  4. Seeing a physiotherapist, occupational therapist or exercise physiologist that can move the joint for you may help improve stiffness and tenderness in the joint. It’s hard to stretch by yourself sometimes, and if you are struggling to get into positions in the first place, having someone do this for you can save a lot of hassle, and speed up your improvement.
  5. Moving the joint can help to decrease the speed that joint tissues age, reducing the speed of degeneration in your joint.

It may be necessary for you to also change the way you move to try to help avoid put more pressure through a joint.

Talk to a Physiotherapist today (physiotherapy, occupational therapy or exercise physiology) to go through a physical examination and talk through is any movement changes will help you.

Medication

Medication is an important part of a treatment plan for someone who is experiencing pain, swelling and tenderness in the OA affected joint.

Medication is usually taken to help pain, and this is needed in some people who may find just moving the joint without any extra load quite painful to do.

Some people don’t like taking pain medication as they feel it is just “masking the pain” and that “damage is still occurring”. However, this is not true.

Pain medication is designed to reduce the amount of pain you feel, absolutely. However, the idea is to make a movement less painful in order to be able to move the joint more, as we know that moving a joint has multiple health and symptom benefits for those suffering from OA.

For example, if you can only walk 25m before pain in your knee becomes too much and you have to sit, it will be hard to gain much health and physical benefits from this, as 25m is a short distance. But, if with pain medication, you can extend that out to 100 or 200m, then that is a 4 – 8 x improvement on your physical capabilities!

That means the body has more chance to adapt and change, and we have more opportunity to strengthen the joint and improve mobility before pain symptoms become too much.

Pain medication is designed to help someone improve physical and daily function. If we can do this, then the idea is that eventually, the pain will start to reduce enough that you need less pain medication to complete the same amount of physical work.

There are a few types of pain medication that can be prescribed to people suffering from OA:

  • Acetaminophen (brand name Tylenol)
    • This pain medication is used to help get relief from headaches, migraines, minor aches and pains, low to moderate arthritis pain, muscular aches, toothaches and menstrual cramps. The medication does not work as well if inflammation and swelling are the main cause of your pain. It works similar to aspirin.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) (Ibuprofen, naproxen sodium)
    • These types of medication can usually be bought over the counter and include oral and gel medications. If a stronger dose is needed, then stronger NSAIDS can be prescribed by your GP.
    • These work by reducing inflammation (duh, it’s in the name!), but do this by reducing the production of prostaglandins. This is an enzyme in the body that promotes inflammation within the body.
  • Duloxetine (Anti-depressant medication)
    • This is a medication normally used to treat depression, but has been found to improve pain for people living with OA.
    • Some people don’t like the idea of taking a medication used for depression, but please understand that it is the process within the body that the medication changes that causes an improvement in pain.
    • It is therefore an effective medication when used in the right circumstances.
    • Now all medication has the potential to have side effects for people.
    • So, it is always important to speak with your Dr or pharmacist first before looking to change or start a new medication. Don’t change the doses yourself, but be aware and monitor and report side affects you may be feeling.
    • There are many types of medications that all do similar things, and you may need to try a few before you find one that suits your body. This is doubly important if already taking other long-term medication, as some medications can clash and cause side effects.
  • Steroid Injections
    • A steroid, or cortisone/corticosteroid, injection contains a strong anti-inflammatory medication that may help to settle pain that is not changing with physiotherapy management or that is hindering you from completing an exercise program or functioning with daily life.
    • A cortisone injection may be administered for certain conditions to relieve pain, such as for bursitis, OA, mild trigger finger or low back pain, but injections of cortisone and an anaesthetic such as lidocaine can sometimes be used to confirm a diagnosis.
    • Corticosteroid injections are commonly delivered by a specialist under a guided ultrasound to ensure the correct structure is targeted. Corticosteroid, as well as a local anaesthetic (such as lidocaine), may simultaneously be drawn into a syringe, which is then inserted into the tissue where the solution is injected.
    • The needle is withdrawn and a sterile bandage is applied to the injection site. At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take up to 14 days for someone to notice a change in symptoms.
    • A steroid injection can be used to help reduce inflammation in the short term, but for longer term benefit physiotherapy and active management strategies are most important.
    • With some conditions, the symptoms of the condition recur after a few weeks or months.
    • In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.

Surgery

Now there may come a time where no amount of conservative management or medication can help your function, or help reduce pain that you receive. A good indicator to know whether surgery may be the best option for you to consider is if you are waking up during the night due to pain in the affected joint.

Sleep is a huge part of the bodies recovery system, and if your pain is disrupting that significantly, then the joint may need to be replaced.

Now it is very important to state that surgery should never be your first option with a progressive condition such as OA.

Trying to manage your symptoms with physical therapy and medication is always the best option first, because once you opt in for surgery, you can’t change this.

With physical therapy and medication, if this doesn’t work, then surgery can always be the next option.

So when should I get surgery to help my OA?

There are a few types of surgery that you can opt for, and if you have OA, chances are it can be operated on regardless of the amount of degeneration. But do you really need to?

Multiple studies have shown that conservative management of OA (exercise, lifestyle change and medication), is just as effective as having arthroscopic surgery (keyhole surgery where they smooth out cartilage and remove debris within the joint).

People tend to forget that having surgery is not an easy process for the body to go through either. If you have to be put under anaesthetic, your body has to recover from coming out of this, as well as the trauma of the surgery itself.

Surgery may aim to help improve symptoms and function in a joint, but straight after surgery, the body needs to recover and heal from the invasive techniques that surgery inevitably involves. This takes time, and some people think it will be a quick and easy fix.

Now the hard part about this is actually getting in to see someone about surgery. If you have private health, this can be a relatively smooth experience, and you can be ready to go with your operation within a few weeks of getting a referral.

However, if you need to move through the public system, the waiting times for joint replacements can be quite long (12-24 months). So it is important to discuss all your options with your Dr and physical therapist before deciding what cause of action is best for you.

If everyone agrees that surgery is the best option, so what now?

It is important to continue to move and stay active right up until your surgery for the following reasons:

  • Firstly, your body is designed to move, and exercise provides natural lubrication to the joint, and keeps the tissues as flexible as possible
  • ‘If you don’t use it you lose it!’ Exercise keeps the muscle nice and strong
  • It will address and improve any unhelpful postures and movement patterns, which we want to minimise post-surgery
  • It keeps the rest of your body fit and healthy and aims to prevent your function from getting worse leading up to surgery
  • It better prepares you for what to expect post-surgery so there are no surprises
  • It reduces the risk of falls

In a nut shell, the better your muscles are working before surgery, the easier it will be to get them going again afterwards, and that means you can get back to your daily activities sooner.

A physiotherapist or exercise physiologist can set up some pre-surgery exercises that are specific for you.

Types of Surgery

Arthroscopic Surgery – This type of surgery is a type of “exploratory” surgery and is mainly used to confirm or further investigate a diagnosis that has been made through the previous diagnostic tests.

Essentially, the surgeon will make a small incision near the joint, and then using a small camera called an arthroscope, will insert this into the joint. The camera will then display what it sees onto a television screen that the surgeon can look at.

The surgeon will move the camera around to have a look at as much of the joint and surrounding structures (ligaments, tendons, cartilage) as possible, and then make a diagnosis based on what they see.

Now in the same surgery, if the surgeon deems it necessary, they can use the same incision, or make another small incision, and try to repair or clear away damage that has occurred in the joint.

For example, if the patient reports having pain on the left side of their knee every time they bend it, and the surgery sees that the cartilage has a tear in the left side that gets caught every time the knee bends, then they may choose to repair the tear and smooth the cartilage to allow the knee to bend without pain developing.

Arthroscopic surgery can be theoretically used on any joint in the body, but the most common joints examined are:

  • Knees
  • Hips
  • Shoulders
  • Elbows
  • Ankles
  • Wrists

Now as much as arthroscopic surgery is deemed less invasive as open surgery, it still requires you to go into a hospital and be placed under anaesthetic.

There will be a recovery time after the surgery and it is still important to complete appropriate exercises and activity given from your physical therapist right up to and after your surgery.

Total Joint Replacement and Partial Joint Replacement surgery

Total Joint or Part-joint replacement surgery is used to replace arthritic or damaged structures in the joint with a plastic, metal or ceramic device called a prosthesis. The prosthesis is moulded and shaped to replicate the anatomy of a ‘normal’ and healthy joint.

  • Total joint replacement surgery usually takes a few hours to perform, and the techniques and ways that the surgeon replaces the joint will change according to the type of joint they are working on, and the amount, type and area of damage within the joint.
    • With a Total Joint Replacement, the surgeon will remove damaged cartilage and bone and replace it with a prosthesis. A Total Joint Replacement refers to the fact the surgeon will likely replace both sides of the joint, rather than just one.
  • A Partial Joint replacement only occurs in the knee and refers to when a surgeon replaces only one part of the joint. The surgeon has the option to replace the medial (inside), lateral (outside) or the patella (knee cap) portion of the knee joint as part of the surgery.
    • This type of surgery can only be done when one part of your knee joint is causing the issue. If the rest of the joint is healthy, there is no need to replace the whole joint.
    • Partial Joint replacements are still an invasive, open surgery, but is quicker and the patient loses less blood during the surgery, meaning they have less recovery time post-surgery.
    • Partial joint replacements are more often seen in younger populations where degenerative changes in the joint have occurred due to trauma or injury.

Take Home Message

There is a structured process put in place by both Dr’s and physical therapists to determine whether you:

  • Have osteoarthritis in a joint
  • The severity of degeneration within the joint
  • The current strength and function of the joint
  • How the joint limits your day to day function
  • Signs and symptoms individual to you

Once these things have all been taken into account, further diagnostic tools may be used to gain a better understanding of the amount and areas of degeneration within a joint before a management plan is set out.

The management plan will be specific to your current level of function and movement/symptom based goals. This management plan could include one or many of the following things:

  • Physical Activity
  • Joint Manipulation
  • Medication
  • Injections
  • Surgery

It’s important to know that because OA is a progressive disease, the management plan put in place may be progressive as well. What works or has worked in the past for function and symptoms management may not work as OA progresses. This is when further interventions such as injections or surgery may be the best option.

Gain multiple opinions from differing medical and health professionals before consenting to having surgery. It is important that you know and understand all the options you have in front of you. Better to make an informed decision rather than a rash decision based on one opinion.

OA is not a life threatening condition, so take your time in processing a diagnosis and figuring out a management plan that works for you.

Here is a link that provides more information on knee arthroscopy. Why it would be performed, how it is done and what’s involved in recovery are all discussed – https://orthoinfo.aaos.org/en/treatment/arthroscopy/

Here is a link that provides more information on joint replacement surgery. Why it would be performed, how it is done and what’s involved in recovery are all discussed – https://orthoinfo.aaos.org/en/treatment/total-joint-replacement/

Hip & Knee Arthritis Classes

If you have hip & knee arthritis then you should be doing regular strength and flexibility exercises which are proven by research to help manage the symptoms of arthritis and improve the ease of your daily activities.

Stephen, an Exercise Physiologist, at myPhysioSA explains all about our unique Arthritis classes at our Payneham and Mount Barker clinics.

They are for people who have knee or hip arthritis that want to manage it better, or people who are preparing for upcoming surgery or have just had surgery and want to maximise their results.

The classes run for a 10 week block and include a Physiotherapy assessment at the beginning and the end, with a home exercise program included.

Call us on 1300 189 289 to enquire now!

Patella/ Quads Tendonopathy Treatment Advice

Normally you develop a tendon issue, if you have overloaded it with extra activity or intensity.

The tendon becomes reactive, painful and sometimes swollen.

To start to settle it you need to unload the knee by reducing or stopping (if required) your running/sport.

Using ice three times per day for 15 minutes can be very useful.

Watch our video below on how to use ice massage for helping your knee tendonopathy by Massage Therapist Ellie:

Taping or bracing the patella and/or tendon

How to put on a knee patella strap or brace for sport?

David Wilson, Partner myPhysioSA Physiotherapist, shows how to fit a patella knee brace for sport.

Kneecap (patella) pain is very common in children. Once it has been correctly assessed by a Physiotherapist, it may be suggested that they wear a patella brace for sport, along with starting on the best strength exercise program.

There are many types and brands of patella straps. It is a matter of trying one on, then squating or jumping and then seeing which one is the most effective for reducing your pain.

Remember that wearing a brace or strap is only a temporary help, it doesnt fix your problem, it just dulls the pain whilst you are using it!

A proper diagnosis and then recommended exercise rehab plan is really what you need!

This is what myPhysioSA Physios do best.

Patellofemoral (knee cap) Treatment Advice

Do you have pain in the front of your knee?

Also called Runners knee or Patellofemoral knee pain.

Kevin, an experienced Physiotherapist in Adelaide, explains all about front of knee pain, the causes and then gives you 3 great exercises that you can start doing right away that will help.

Don’t let knee pain stop you from doing what you love.

Watch Kevin’s video below to get all the advice and a detailed explanation of each recommended exercise for you to start doing right now.

Try these starter knee exercises until you can get an appointment with us.

We can then customise the exercises and give more specific exercises that will address your specific contributing factors and fast track your recovery.

ITB Friction Syndrome Treatment Advice

What can you do to help runners knee or ITB friction syndrome?

  • Reduce the current training load and avoid painful movements
  • Physiotherapy, stretching, massage and self-massage with foam roller to address tight muscles
  • Icing and anti-inflammatory medications to settle the pain

In the longer term you need to:

  • Work on progressive strengthening of the core and hip stabilisers, through exercises, for example Pilates and specific Physiotherapy exercises.
  • Address foot biomechanics ie orthotics, and ensure you have the correct footwear.
  • Gradual progression back into training (don’t run on consecutive days, have a day in between for rest) and avoid hill running .

How to foam roller your ITB

Learn how a Physio teaches using a foam roller to release leg muscle tightness.

Physio Ellen shows how to roller your leg muscles including your thigh muscles, ITB and groin muscles.

Using a foam roller can be a great way to loosen tight muscles and fascia in the legs.

Can be used for sports recovery or if you just feel tight.

myPhysioSA Adelaide: Payneham & Mount Barker

ITB Stretch

Lie on your side and grab your top ankle with one hand to pull your foot towards your buttock keeping your lower back neutral.

Place your bottom foot on the knee of the top leg pulling your knee down until you feel a gentle stretch on the lateral side and the front of the elevated leg.

Hold the stretch for 60 seconds and return to initial position.

Images courtesy of Physiotec

Patella instability (repeated dislocations) Treatment Advice

Acute patella dislocation is a common knee injury which typically occurs in young and physically active individuals, and is associated with a high rate of recurrent patella instability, instability symptoms and eventually patellofemoral osteoarthritis.

A variable amount of anatomic abnormalities may be involved in patients with primary patella dislocation.

Usually, conservative treatment is the initial management.

Surgical intervention is required for patients who are at a high risk of re-dislocation or when conservative management has failed.

It usually follows a trauma sustained during physical or sports activity, especially in subjects with underlying predisposing factors of patella instability.

The initial approach to the dislocation of the patella is the reduction of the dislocation and the pharmacological management of pain and inflammation.

Surgery after the first episode is controversial, even in patients who have a clear high risk of recurrence.

Early immobilization of the knee and the use of crutches is always to be provided immediately after the reduction.

Conservative management following the first episode of a patella dislocation is recommended when imaging does not detect chondral lesions, osteochondral fragments or serious injuries of the parapatella ligament complex.

Physiotherapy is recommended for guiding the rehab plan.

Once the knee has healed over a 3-6 week period, the immobilising brace will be removed and then gain normal movement and strength of the knee and leg needs to begin.

The exercises will need to be customised to you and taught thoroughly so as to be safe and effective.

Please see a Physiotherapist for these!

Exercises for Patella tendonopathy

Do you have knee patella tendonopathy?

First we need to settle the acute pain by trialling the below static or isometric exercises. Use ice 15 minutes after doing the exercises.

Then, once the symptoms have improved well after 1-2 weeks, you need to start a strengthening program.

Acute Phase Exercise

Then try this easy exercise to help ease your pain. Michael, a myPhysioSA Senior Physiotherapist in Payneham Adelaide, demonstrates this exercise that you can get started doing right away.

Patella tendonitis is common in sports people , runners and walkers. It is usually painful just below the knee cap, on the patella tendon. It usually gives morning pain and stiffness which eases once warmed up.

This is the first exercise to start, then once the pain starts to settle over a few days to weeks, then a strengthening phase needs to be started.

Strength Phase Exercises

Do these daily.

Make sure you have no pain whilst doing them.

If you do, do a smaller movement and keep the repetitions low , then slowly build them up.

Leg extension with band

Sit on the edge of a table, bed or chair and tie one end of a band around your ankle and the other end around the leg of the table.

You want to tie the band so there is no slack (or minor slack) at the beginning of the movement.

Extend your knee against the resistance of the band.

2×10 reps daily

Hip thrust

Sit down on the floor with your upper back on a bench as a pivot point.

Push the hips up by squeezing the glutes so your thighs are in line with the torso.

At the high point, your knees should be at 90°.

2×10 reps daily

Single leg squat

Begin by standing upright on one leg.

Push your hips backward like if you’re going to sit down and bend your knee into a single leg squat position.

Slowly return to the starting position.

Keep your knee aligned with the centre of your foot.

2×10 reps daily

Images courtesy of Physiotec

Exercises for Patellofemoral Pain

Do you have pain in the front of your knee?

Also called Runners knee or Patellofemoral knee pain.

Kevin, an experienced Physiotherapist in Adelaide, explains all about front of knee pain, the causes and then gives you 3 great exercises that you can start doing right away that will help.

Don’t let knee pain stop you from doing what you love.

Watch Kevin’s video below to get all the advice and a detailed explanation of each recommended exercise for you to start doing right now.

Try these starter knee exercises until you can get an appointment with us.

We can then customise the exercises and give more specific exercises that will address your specific contributing factors and fast track your recovery.

Here are some more home exercises to try:

Leg extension with band

Sit on the edge of a table, bed or chair and tie one end of a band around your ankle and the other end around the leg of the table.

You want to tie the band so there is no slack (or minor slack) at the beginning of the movement.

Extend your knee against the resistance of the band.

2×10 reps daily

Hip thrust

Sit down on the floor with your upper back on a bench as a pivot point.

Push the hips up by squeezing the glutes so your thighs are in line with the torso.

At the high point, your knees should be at 90°.

2×10 reps daily

Sidestep with band

Start in a squat position with a band around your ankles.

Keeping the band taut at all times, step to the side.

Push the knees out while taking the steps so they don’t cave in.

Each step is about 50% of the starting position stance.

2×10 reps daily

Images courtesy of Physiotec

Exercises for knee osteoarthritis

There is extensive research out there that has shown the benefits exercise and activity has on improving pain, reducing swelling and increasing function for those people with osteoarthritis.

As stated, everyone’s symptoms of pain or discomfort with movement is different, so it is important to have a good understanding of what you feel you can and can’t do from a movement perspective, and discuss this with your health professional.

However, even if movement is causing you significant discomfort, there will always be some exercises that you can complete that will be manageable.

We can’t stress to you the importance of moving the affected joint. By not moving the joint, you won’t activate the muscles surrounding it, and then when you are required to move it, the muscles and tendons will be very stiff, causing pain themselves.

You then add that on top of the pain you receive from the degeneration in the joint, and you’re going to have a very grumpy joint!

Strength = function, and function = happiness

Gaining muscular strength is paramount in any OA management plan. The health benefits of getting strong are numerous, and can help not only your OA symptoms, but other health conditions also.

By strengthening your muscles, you not only help create joint protection and support, but you help reduce the risk of falls, improve range of motion and increase daily function. Muscles are part of everything we do.

They make our bodies move, and when trained appropriately, make our bodies more efficient and stable.

It is important that you are strong in both your upper and lower parts of your body, even if your OA is only affecting one joint.

Having the strength to be able to push yourself up off a chair if you can’t stand normally due to pain is important.

Having the strength to get up off the ground without using your arms if your shoulder is painful is important also!

Strength training should be specific to your needs, but everyone, especially as we age, should aim to get stronger throughout their whole body.

If you have knee or hip arthritis then try these easy basic exercises to keep your joints moving.

If you have arthritis of the knee or hip then a great way to help your pain and get the joints moving again is to try these easy seated exercises.

Arthritis gives joint pain and a proven way to help is to keep the arthritic joint moving to keep the joint lubricated and then to strengthen the muscles that support the affected joint.

Stephen, a myPhysioSA Exercise Physiologist, demonstrates some easy exercises for targeting your hip and knee areas that can be done whilst seated.

Even if your knee or hip arthritis is painful, you may still be able to do these exercises pain free and get a real benefit, give them a try!

Best knee exercises to do at home

Stephen shows you how to strengthen the muscles around your knee and hip to help ease knee pain. These exercise are easy to do at home and don’t require any equipment.

It is a fact that the best ways to help ongoing knee pain is to exercise and strengthen around the knee and lose a few kilo’s of weight. This videos shows you how to start doing the right exercises correctly, so get started now!

Knee Exercises for Pre-Surgery

Try these exercises leading up to your knee surgery.

These knee exercises are useful to do before having a total knee replacement, ACL reconstruction or even a knee arthroscope.

Michael, a myPhysioSA Payneham Physiotherapist, explains why you should do exercises prior to surgery and gives 3 starting exercises for you to try.

myPhysioSA Payneham & Mount Barker

Hip & Knee Arthritis Classes

If you have hip & knee arthritis then you should be doing regular strength and flexibility exercises which are proven by research to help manage the symptoms of arthritis and improve the ease of your daily activities.

Stephen, an Exercise Physiologist, at myPhysioSA explains all about our unique Arthritis classes at our Payneham and Mount Barker clinics.

They are for people who have knee or hip arthritis that want to manage it better, or people who are preparing for upcoming surgery or have just had surgery and want to maximise their results.

The classes run for a 10 week block and include a Physiotherapy assessment at the beginning and the end, with a home exercise program included.

Call us on 1300 189 289 to enquire now!

When should I return to sport following a knee injury?

Return to running and cutting sports needs to be well planned and your rehab needs to have progressed well.

The below mile stones through rehab need to be met before a full return to sport is recommended.

Functional Tests of the knee:

  • Full hip and knee range of movement
  • Hopping and landing L = R knee
  • Squatting pain free with good technique
  • Going up and down stairs one at a time then two at a time
  • Running straight ahead
  • Running and decelerating
  • Running and twisting
  • One-legged hop over 5 metres L=R
  • Jumping is pain free

Once all these can be demonstrated at training then you should be to train at 100%.

After a week of full training, you are hopefully ready to return to playing again.

But pace yourself!

You can try the below taping techniques for extra support when returning back to sport:

What tells you that you need to consider a total knee replacement?

There are a few signs that indicate you are nearly ready for a new knee joint.

Some of them include:

  • Night pain giving you trouble sleeping
  • Functional restriction, including walking, stairs, squatting, driving
  • Not responding to conservative management of Physiotherapy and exercises

Knee Exercises for Pre-Surgery

Try these exercises leading up to your knee surgery.

These knee exercises are useful to do before having a total knee replacement, ACL reconstruction or even a knee arthroscope.

Michael, a myPhysioSA Payneham Physiotherapist, explains why you should do exercises prior to surgery and gives 3 starting exercises for you to try.

myPhysioSA Payneham & Mount Barker