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Knee

ACL (Anterior Cruciate Ligament)

ds00555_ds00662_im02520_mcdc7_acl_injurythu_jpgDiagnosis: The anterior cruciate ligament (ACL) is a major ligament that connects the thigh bone to the shin bone providing stability. A physical exam can diagnose a possible a tear of the ACL. MRI or ultrasound may confirm this diagnosis as well as show the severity of the tear.

Causes: Most commonly an ACL tear occurs during sports that involve sudden stops or starts or changes in direction. It may be caused by a direct blow to the knee, landing from a jump on an extended knee, or pivoting on a planted foot.

Symptoms: The most common symptoms associated with an ACL tear include knee pain and swelling, inability to place weight through the leg, and a feeling of instability and the knee may buckle. If a complete tear has occurred most people will seek medical attention by an orthopedic surgeon to determine if surgery is necessary. A strained ACL or small tears may heal with correct exercises, bracing and strengthening. Some people may avoid surgery by modifying their activities so there is less stress placed on the knee.

Our Physical Therapy Treatment: Goals of physical therapy will be to reduce pain, restore normal range of motion and allow for safe return to functional and leisurely activities. Treatment will most likely include:

  • Mechanical diagnosis and treatment that focuses on pain management and improving range of motion and strength
  • Balance and stability exercises
  • Sport specific and functional exercises

If surgery is required, treatment will follow a specific protocol. You will likely be placed in a knee brace that will limit your range of motion. During the first 4 weeks, treatment will focus on controlling/reducing swelling, improving range of motion, and increasing tolerance for weight bearing exercise. Weeks 5-12 will focus on normalizing your gait pattern and improving leg strength and balance for return to higher activity levels.

Patellofemoral pain syndrome

PatellofemoralPain_LGDiagnosis: Patellofemoral pain syndrome (PFPS) refers to pain in front of the knee and/or around the knee cap. It is an overuse syndrome resulting from repetitive use of the knee commonly associated with weakness, tightness or stiffness in the muscles around the hip or knee. This may interfere with the ability of the patella (kneecap) to glide properly during movement and thus causing pain.

Causes:  PFPS will often occur in people who have changed their activity level or who are physically active. Their activity involves repeated leg movements such as running, stair climbing, squatting. There may also be muscle imbalances around the hip and knee or malalignment of the lower leg.

Symptoms: The most common symptom associated with patellofemoral pain syndrome is a dull, achy pain in the front of the knee when walking up and down stairs, sitting with the knee bent for long periods, or kneeling/squatting. Some people feel or hear popping or cracking when bending or straightening the knee.

Our Physical Therapy Treatment: Goals of physical therapy will be to reduce pain, restore normal range of motion and strength, and provide a safe return to all functional and leisure activities. Treatment will most commonly include:

  • Mechanical diagnosis/treatment for pain reduction and improved motion and strength
  • Addressing any malalignment issues in the lower leg
  • Knee and hip strengthening and stretching exercises
  • Manual mobilizations of patella
  • Taping and bracing as needed

Treatment will focus on the individual needs of the patient and creating a home exercise program to manage and prevent reoccurrences in the future.

Meniscus Tear

MeniscusDiagnosis: The meniscus is a piece of cartilage that cushions the knee. It lies between the thigh bone (femur) and the shin bone (tibia) and acts as a shock absorber as well as providing stability to the knee.

Causes: A torn meniscus is usually caused by a forceful twisting or pivoting of the knee with the foot planted on the ground. It is common in those who play contact sports, but can also occur with kneeling, deep squatting or heavy lifting.

Symptoms: The most common symptom with a torn meniscus is pain when twisting or turning. Most people will hear or feel a pop at the time of injury. Other symptoms include:

  • Swelling during the first 24 hours after injury
  • Difficulty straightening the knee
  • “Catching” sensation
  • Stiffness or locking of the knee

Our Physical Therapy Treatment: Goals of physical therapy will be to reduce pain and swelling and restore normal motion of the knee. Treatment will focus on:

  • Mechanical diagnosis and treatment for pain reduction
  • Strength and flexibility exercises
  • Balance and stability
  • Return to sport and functional activity training

Treatment will focus on educating the patient on how to manage symptoms independently and establishing a home exercise program to assist in their recovery.

Osteoarthritis of the knee

Diagnosis: Osteoarthritis refers to degenerative changes in a joint from wear and tear that occurs over time. It can affect the entire joint including bone, ligaments, cartilage and muscle. Age, body mass index, activity level, bone structure and strength can influence the progression of osteoarthritis of the knee.

Causes: As degeneration occurs, the space between the joints narrow and causes friction. There is not usually a specific incident that causes symptoms as it is a progressive condition. However, knee OA can occur as a secondary condition following a traumatic knee injury.

Symptoms: Most common symptoms of knee OA are:

  • Pain that worsens with activity such as walking, climbing, or stairs
  • Stiffness and pain after keeping knee bent or straight for a period of time
  • Popping, cracking, or grinding when moving the knee
  • Decreased mobility of the knee
  • Swelling following activity

Our Physical Therapy Treatment: Goals of physical therapy will be to reduce pain and restore range of motion. Treatment will focus on:

  • Mechanical diagnosis and treatment
  • Strengthening muscles around the knee joint
  • Flexibility and range of motion exercises
  • Balance and stability
  • Manual therapy

Treatment will focus on addressing the individualized needs of the patient, education on self-treatment strategies and creating a home exercise program for continued of recovery.

There are many levels of osteoarthritis and most are successfully treated without any surgery needed.