Common knee conditions

The knee is an area of the body that has so many structures related to it that the source of the pain within the knee can be difficult to isolate. Despite this, there are common findings amongst knee pain presentations that have similarities, presenting themselves more than others.  Here we identify the most common differential diagnoses related to pain in the knee, their characteristics, along with a generalised Osteopathic approach in regards to their treatment and management.

PATELLO-FEMORAL JOINT SYNDROME (PFJS) or “Runner’s Knee”

• Site: 

  • Pain presents at the bottom and inside aspect of the knee cap

• Quality of pain: 

  • Sharp with aggravating movement, achey after aggravation 

• Timing: 

  • The pain will be worse during activity and then may remain sore for a few hours after activity

• Aggravating factors:

  • Going up and down the stairs

  • Kneeling for prolonged periods

  • Squats

  • Lunges

  • Getting up or down off the floor

• Management:

  • Rest can definitely help

  • Icing

  • Offloading the knee through glute activation and strength exercises

  • Ensuring lower limb biomechanics are sound

  • Ensuring lumbo-pelvic girdle biomechanics are functioning optimally as well

PATELLA TENDINOPATHY or “Jumper’s Knee”

• Site:

  • Pain over the patella tendon. This is found under the knee cap - it is actually considered to be a part of the quadriceps. (It is how the quadriceps and knee cap are anchored down to the bone)

• Quality of pain:

  • Sharp with aggravating movements

  • Achey and stiff after aggravation

• Timing:

  • Worse after prolonged periods of immobilisation

  • Usually worse at the beginning of exercise, and then improves / frees up.

• Aggravating factors

  • Jumping

  • Running

  • Any high impact activity (eg Basketball, netball, footy etc)

  • Prolonged periods of sitting

• Management:

  • Usually responds well to manual therapy if treated early in its progression

  • Offloading the quadriceps eg. reducing muscle tension, increasing activation in the glutes 

  • Ensuring foot, ankle and hip mobility and biomechanics are sound.

DISTAL HAMSTRING TENDINOPATHY

The hamstrings are made up from three separate muscles all originating from the same point on the pelvis (at the sit bone), and each attaching to separate points at the back of the knee. 

Although it is common for the common origin of the hamstrings (tendon) - at the pelvis - to become irritated, here we discuss what it looks like when the hamstring tendons become irritated at their insertion points at the knee.

• Site:

  • Pain is at the back of the knee, more commonly on the outer aspect (the biceps femoris tendon) however, the 2 tendons attaching to the inside aspect of the knee can also become irritated.

• Quality of pain:

  • Sharp with aggravating movements

  • Achey and stiff after aggravation

• Timing:

  • Worse at the start of exercise, and can then improve

  • Worse in the morning

• Aggravating factors

  • Running

  • Jumping

  • High impact activity 

  • Stretching

• Management:

  • Avoid stretching

  • Rest can help to reduce inflammation

  • Glute strength exercsies (to assist in offloading the hamstrings)

  • Ensuring foot, ankle and hip mobility & biomechanics are sound

  • In the later stages of rehab, eccentric hamstring exercises to assist in lengthening and strengthening the muscle

MENISCUS TEAR

• Site:

  • Pain is hard to pin-point

  • Generally quite vague. May be found on the inner or outer aspect of the knee joint (depending if one or both menisci are torn / irritated)

• Quality of pain:

  • Deep ache through the knee

  • Patient may report episodes of locking in the knee joint, as well as sensations of instability

• Timing:

  • May be worse with exercise or if the knee has been left in a single position for too long

  • Meniscal tears are erratic in their timing. They can appear problematic and un-problematic for the same task

• Aggravating factors

  • End range knee flexion eg. prolonged sitting

  • End range knee extension eg. prolonged standing

  • Agility exercises eg. lateral movements inc. soccer, netball, footy etc.

• Management:

  • Offloading the knee by ensuring glute activation and strength is sound

  • Depending on the severity of the meniscal tear

    • For a minor tear - Conservative management (ie manual therapy and rehab) may be adequate

    • For a more severe tear - surgical intervention (through a knee arthroscope) may be required to “clean up” the joint itself

  • Manual therapy to help in ensuring lower limb biomechanics are moving efficiently will always be helpful

For all knee complaints, referral to podiatrist may be required if a more thorough and specific assessment of the feet and ankles are required. An orthotic prescription may or may not be indicated however temporary intervention with a similar device may prove itself to be useful in helping to improve alignment and biomechanics at the foot, ankle and knee joints. 

You can tell by reading through these summaries of common knee diagnoses that some can be very similar in presentation, in fact they may overlap. If you knee-d assistance with your knee complaint, don’t hesitate to contact the clinic by calling 9052 4220 or booking an appointment online by clicking BOOK NOW.