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Author Topic: Physiotherapy/PT thread for knee pain  (Read 2195 times)

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Offline Prophylaxis

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Physiotherapy/PT thread for knee pain
« on: January 23, 2014, 04:41:12 AM »
The Kneeguru is an excellent resource and has given me an incredible wealth of knowledge. Now it's time for me to give a little back.

I'm a trained physiotherapist who works closely with elite sports teams.

I've created this thread with the intent of answering any questions you may have about any aches or pains you experience, specifically the knee. If you want to know what might be causing your pain, please feel free to post!

To help me narrow down the problem, it would be great if you could fill in the following format:

Body Chart: (Where exactly does it hurt?) in regards to the attached image - is pain above/below/outside/inside or over the kneecap.
How long have you had the pain for?
Age: (How old are you?)
Mechanism of injury: Did the pain occur during ONE particular event? Or can you think of nothing that brought it on?
Aggravating factors: What makes the pain worse?
Easing factors: What relieves the pain?
Any painful clicking/locking/giving way of the knee?

Based on this I will then give you my provisional diagnosis with appropriate exercises. I may need a couple follow-up questions before I arrive at my diagnosis. I'm sure I don't need to tell you, that my advice should not substitute seeing a REAL LIFE health care professional.

Feel free to also ask questions about physiotherapy/PT in general. Other PT's or doctors feel free to contribute.
Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia

Offline The KNEEguru

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Re: Physiotherapy/PT thread for knee pain
« Reply #1 on: January 23, 2014, 10:42:54 AM »
Thank you, Prophylaxis. Under the terms of our HONcode registration, any clinical professional declaring themselves as such and participating on the bulletin board must give their full name, qualifications and country of practice. You can pop this into the 'Signature' line of your Profile.

I have marked this thread to 'Notify' me as I will be interested in any dialogue.
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KNEEguru

Offline Prophylaxis

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Re: Physiotherapy/PT thread for knee pain
« Reply #2 on: January 23, 2014, 11:45:34 AM »
Thank you, Prophylaxis. Under the terms of our HONcode registration, any clinical professional declaring themselves as such and participating on the bulletin board must give their full name, qualifications and country of practice. You can pop this into the 'Signature' line of your Profile.

I have marked this thread to 'Notify' me as I will be interested in any dialogue.

Apologies Kneeguru, I was not aware of those specific terms!

My qualifications and details have been added to my signature. Please let me know if you require any further information.

I am looking forward to assisting any members of this forum.
Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia

Offline The KNEEguru

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Re: Physiotherapy/PT thread for knee pain
« Reply #3 on: January 23, 2014, 01:25:34 PM »
Thank you. That is grand.
Sheila
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KNEEguru

Offline Snowy

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Re: Physiotherapy/PT thread for knee pain
« Reply #4 on: January 23, 2014, 09:23:04 PM »
What a great offer! Thanks for doing this.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Skibum680

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Re: Physiotherapy/PT thread for knee pain
« Reply #5 on: January 24, 2014, 03:37:34 AM »
A week and a half ago I landed on my right knee pretty hard playing a pickup game of football (I am from the States). It hurt a bit at the time but I was able to continue playing without any issues. I was Running and cutting without any problem. Then last week I went to do my regular lower body routine at the gym and found that when I went to do squats it was very painful to bend down and put pressure on the effected area. Particularly when I got to the bottom of my squat and needed to "push" to get to a standing position. Because of this I took the week off for my lower body to let it rest.

It felt much better by the weekend and had no issue running. I decided it would be fine to toss the football around with my buddies again and, of course, ended up landing awkwardly on the same knee again. Hurt much more than the first time and had to sit out the rest of the game. The pain has subsided significantly from when I initially re-injured it but it can still be pretty painful when put it under any kind of load or when touching the area. The effected area is right bellow the right knee on the very top of the Tibia, where I would describe there is a tinny bump (This bump is on both knees, not caused by the injury, just trying to be specific as possible describing the location) right in the middle of my leg.

It doesn't particularly bother me when I am walking around but it is extremely painful to touch the effected area which is slightly smaller then a fingernail. I should note that it doesn't really hurt when I touch around the effected area, only when I apply pressure to the relatively small and specific location. It is also pretty painful to bend the knee when under any weight or preform activities such as going up stairs or putting on socks that put added pressure on the area. It is also painful to jog, or preform anything other then a walking pace. I can bend my knee without pain when there is no weight on it, for example when I sit in a chair I can bend it freely while elevated it the air.

Is resting my best course of action or should I be more concerned?

Thanks in advance for any advice you can offer!
« Last Edit: January 24, 2014, 03:41:01 AM by Skibum680 »

Offline Prophylaxis

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Re: Physiotherapy/PT thread for knee pain
« Reply #6 on: January 24, 2014, 04:49:45 AM »
Is resting my best course of action or should I be more concerned?

Thanks in advance for any advice you can offer!

Hey Skibum,

Sounds like you were pretty unlucky to land on that same knee twice!

I am going to assume that you could put weight through your right leg after the second time you landed on it, and that there are no nasty fractures in the area (which doesn't sound like the case if you can bend it back all the way!)

Landing on the knee can certainly cause a lot of irritation to some of the tendons, joints and ligaments around the knee.

A few follow-up questions:

How old are you?
Did you hear a pop or a snap at the time?
Is there considerable swelling around the knee?
Is there any recent clicking/clunking, locking or giving way/buckling of the knee?
Did it feel like the kneecap moved out of place or does your knee feel unstable?
Did you get any pain at the back of the knee?


Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia

Offline Skibum680

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Re: Physiotherapy/PT thread for knee pain
« Reply #7 on: January 24, 2014, 05:39:02 AM »
I am 24 years old, and would like to think I am in pretty good shape!

No pop or snap

No noticeable swelling, it looks practically identical to the other knee, and it has been almost one week since the second incident. I don't think there was much swelling earlier in the week either.

The knee hasn't buckled but I haven't tried much more then walking. I can preform an unweighted squat, with discomfort in the described area, but I certainly wouldn't want to preform one with weight. I can barley bend down while standing on only my right leg, which I usually could with ease.

The knee cap is fine, and feels stable. It is the area about one inch or 2.5 cm bellow the knee cap causing the discomfort, right bellow the skin. It feels like it is pretty much all bone in the area I am talking about.

The back of the knee feels fine as well

I am going to assume that you could put weight through your right leg after the second time you landed on it,

Not entirely sure by what you mean by this.

Anyways, Thanks for the help
« Last Edit: January 24, 2014, 05:42:02 AM by Skibum680 »

Offline Prophylaxis

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Re: Physiotherapy/PT thread for knee pain
« Reply #8 on: January 24, 2014, 07:06:52 AM »
I am 24 years old, and would like to think I am in pretty good shape!

No pop or snap

No noticeable swelling, it looks practically identical to the other knee, and it has been almost one week since the second incident. I don't think there was much swelling earlier in the week either.

The knee hasn't buckled but I haven't tried much more then walking. I can preform an unweighted squat, with discomfort in the described area, but I certainly wouldn't want to preform one with weight. I can barley bend down while standing on only my right leg, which I usually could with ease.

The knee cap is fine, and feels stable. It is the area about one inch or 2.5 cm bellow the knee cap causing the discomfort, right bellow the skin. It feels like it is pretty much all bone in the area I am talking about.

The back of the knee feels fine as well

I am going to assume that you could put weight through your right leg after the second time you landed on it,

Not entirely sure by what you mean by this.

Anyways, Thanks for the help

Great news. Just 2 more tests

Does it hurt if you straighten your leg out fully, especially any pain at the end?

If you pinch under your kneecap (like below), is there any pain?
Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia

Offline Skibum680

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Re: Physiotherapy/PT thread for knee pain
« Reply #9 on: January 24, 2014, 05:29:14 PM »
Passed both test without any issues

After looking at some pictures on the internet it would appear that the "small bump" on the top of my tibia is the tibial tuberosity. I have these small bumps in the same location on both legs but this is where the pain is  specifically localized on my right leg.

It almost seems like I am experiencing symptoms of Osgood Schaltter's disease but from what I understand that is for teenagers going through growth spurts. 

Offline Prophylaxis

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Re: Physiotherapy/PT thread for knee pain
« Reply #10 on: January 24, 2014, 11:32:34 PM »
Passed both test without any issues

After looking at some pictures on the internet it would appear that the "small bump" on the top of my tibia is the tibial tuberosity. I have these small bumps in the same location on both legs but this is where the pain is  specifically localized on my right leg.

It almost seems like I am experiencing symptoms of Osgood Schaltter's disease but from what I understand that is for teenagers going through growth spurts.

Hey skibum,

Thanks for your patience - falling on the knee can cause a few problems, so I wanted to make sure I could be as accurate as possible. You are correct, Osgood Schlatter Disease most often affects adolescents, and is usually not associated with a particular incident (i.e. falling onto knees).

I would say your pain is caused by some slight periosteal (bone) and soft-tissue bruising over the tibial tuberosity. As the tibia is quite superficial to the skin, it is often susceptible to be knocked, especially during contact sports such as football.

The tibial tuberosity is also the attachment of the patellar tendon, so landing on it can cause some slight irritation whenever you recruit your quadricep muscle. This, along with the heavy weight-bearing forces the tibia must transfer, may explain the pain you were experiencing while squatting.

Essentially rest is the best treatment for this (nothing revolutionary unfortunately!), so it sounds like what you've been doing, (avoiding any activities that aggravate the knee) is the best route. It can take weeks for this to resolve, so don't be too worried if there is still a bit of pain with certain activities.

When returning to football, I would apply some cushioning around the protected area - cutting a hole around the tibial tuberosity (like a doughnut). It's similar padding you see when athletes hurt their AC joint in the shoulder, you just want to minimise any irritation that would be occur if you were to fall onto the tibial tuberosity again.

Let me know if you have any further questions!
Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia

Offline Skibum680

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Re: Physiotherapy/PT thread for knee pain
« Reply #11 on: January 25, 2014, 06:38:24 AM »
Thanks for the advice, it is encouraging to hear that it should be okay with rest. I will post back after a few weeks and let you know how everything feels.

Offline kaelyn

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Re: Physiotherapy/PT thread for knee pain
« Reply #12 on: January 25, 2014, 10:34:03 AM »
Approximately 3 years ago I had an accident falling off a pushbike onto a hard graveled surface landing on both knees in a kneeling position. I got up fine and thought I was ok apart from a few bruises. The next day I had visible swelling in my left knee and felt a gap running all the way across my kneecap. Dutifully went to A & E and was put in an immobiliser and sent for an MRI. Results for Mri were a just a bone bruise in my medial femoral condyle and was sent for physiotherapy. Had physio for 10 months with no relief, Athroscopy performed and they removed my medial plica and I had chrondroplasty on my medial femoral condyle. had relief for approximately 2 months before pain returned. returned to physio and had a repeat Mri with no diagnosis, had ultrasound to check for tendonitis but none found. Discharged from physio summer last year after receiving no relief. Doctors appointment next month to ask for a referral to a new hospital.

Body Chart: (Where exactly does it hurt?) in regards to the attached image - is pain above/below/outside/inside or over the kneecap.

Currently my knee is constantly swollen to the lower lateral side of knee as well as constant swelling directly below which feels as though it is constantly pushing my patella tendon. I also have distortion over my kneecap that almost feels like a valley over the entire width which has small movable lumps asnd I can't stand any pressure on it so this excludes things like kneeling and tight clothing. I also have pain within the joint under the kneecap and a dull ache on the joint line on the medial side.

How long have you had the pain for?

For the 3 years since the accident.

Age: (How old are you?) 28

Mechanism of injury: Did the pain occur during ONE particular event? Or can you think of nothing that
brought it on?


Described above

Aggravating factors: What makes the pain worse?

Crouching, kneeling impossible, going down stairs, twisting movements. I can only swim slowly and gently as the resistance of the water also hurts if I try to push it. Uneven ground. I could not perform any straight leg exercises during physio more than once or twice without horrible pain across my kneecap which was slightly alleviated by turning my knee inwards slightly before bending my leg and bringing my foot back down, was simply told to avoid this type of exercise.


Easing factors: What relieves the pain?


Avoiding activities, my knee doesn't hurt whilst on holiday unless I swim too much or do stairs, unfortunately I can't be on holiday all the time.

Any painful clicking/locking/giving way of the knee?

My knee clicks constantly, sometimes if I twist it feels like the knee is going to give way.


I got diagnosed as having hypermobile joints from the physio and my own doctor, I also walk with my feet turned inwards and have done since being a child if it has any relevance. I also believe my kneecap sits quite high in the joint from my own research but have never been told such.

Thank you for any advice you can offer.

Offline Prophylaxis

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Re: Physiotherapy/PT thread for knee pain
« Reply #13 on: January 26, 2014, 01:29:24 AM »
My knee clicks constantly, sometimes if I twist it feels like the knee is going to give way.


I got diagnosed as having hypermobile joints from the physio and my own doctor, I also walk with my feet turned inwards and have done since being a child if it has any relevance. I also believe my kneecap sits quite high in the joint from my own research but have never been told such.

Thank you for any advice you can offer.

Hey kaelyn,

I'm sorry to hear you've been through such an ordeal. It must be frustrating to put up with this pain for 3 years.

Just a few followup questions:

What did the doctor or physio tell you was causing the pain?
What exercises were you doing with the physio?
Did the MRI state the meniscus or PCL were damaged?
Has your kneecap ever been popped out or was out of place when you fell? (Also have you had any previous episodes of your kneecap popping out?)
Does it hurt when you pinch under the kneecap? (the image above I posted to skibum)
Any pain when you fully bend or straighten your knee?
Allan Manuel
B App Sci (Physiotherapy) Usyd
Australia















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