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Knee
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Anterior Cruciate Ligament (ACL) Tear

The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

Medial Collateral Ligament (MCL) Tear

MCL tears are common injuries. A forceful stress on the outside of the knee can cause a stretching and injury of the MCL. Signs and symptoms include knee pain at the inner aspect and swelling. Medial meniscal tears and ACL injury may occur with severe trauma (commonly occurs during football and soccer). Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Severe tears may require surgery.

Anterior Knee Pain

Anterior knee pain is pain that occurs in the front and center of the knee and can be caused by a number of conditions. The patella (kneecap) sits over the front of the knee joint and should glide smoothly as you bend or straighten your knee. Pain often begins when the patella is no longer moving properly due to imbalances caused by tightness or weakness in the muscles surrounding the knee. Overuse or excessive activity may also put too much stress on the kneecap and cause increased pain. Chondromalacia (softening of the cartilage), quadriceps tendinitis/tendinosis, and patellar tendinitis/tendinosis are three common causes of anterior knee pain.

Physical therapy can improve these conditions by addressing strength and flexibility deficits in order to correct muscle imbalances and promote improved functional mobility.

Patello-femoral Pain (Commonly Called Chondromalacia Patella)

Patellofemoral pain (PFP) is diffuse pain in the front of the knee, under, or around the kneecap. It is a prevalent orthopedic condition affecting physically active adolescents, athletes, and people who perform physical labor. Females are at a greater risk of developing PFP. PFP is exacerbated by activities that load the patellofemoral joint such as running, jumping, squatting, and prolonged sitting with flexed knees.

Physical therapists commonly evaluate and provide treatment for patients with PFP, managing pain and restoring patellofemoral function.

Knee Osteoarthritis

Osteoarthritis of the knee occurs when the protective cartilage covering the ends of the femur and tibia wears away over time. There are also two wedge-shaped pieces of cartilage (medial and lateral menisci) which act as “shock absorbers” in the knee. As the cartilage wears away, it becomes rough and frayed, and the space between the two bones decreases. Bone spurs may form causing pain, inflammation, and decreased mobility in the joint.

Osteoarthritis can effectively be managed and it is important to stay active. Physical therapy can help manage pain, increase range of motion, and increase strength in order to promote improved walking, stair climbing, and ability to get in/out of chairs. A good course of Physical Therapy can prevent having surgery as well.

Iliotibial Band Friction Syndrome (ITBS)

The iliotibial band (ITB) is a thick band of fascia that runs along the outside of the thigh. It consists of dense fibrous connective tissue from both the Tensor Fascia Latae and Gluteus Maximus muscle. It inserts into the outer region of the shin bone just below the knee joint.

Iliotibial band friction syndrome (ITBS) is considered a non-traumatic overuse injury that is often seen in runners or cyclists. Repetitive flexion and extension of the knee causes friction of the ITB over the lateral epicondyle of the femur (a region of the outer thigh bone just above the knee joint). This repetitive friction can cause pain and inflammation on the outside of the knee. There can also be an audible snapping sensation as the band slips over the bony tubercle.

Other factors contributing to ITBS can be weakness of the hip muscles, poor flexibility, abnormal body mechanics, improper footwear, or improper bike fit for cyclists. Physical therapy can abolish symptoms of ITBS by addressing strength/flexibility deficits, assessing footwear and body mechanics, and exploring effective pain management techniques.

About Total Knee Replacement

The knee is the most commonly replaced joint in the body. A total knee arthroplasty (knee replacement) is generally indicated when a patient can no longer tolerate the pain of osteoarthritis. In the procedure, arthritic parts of the knee joint are replaced with artificial parts.

Physical therapists help patients with TKA regain movement and function, improve activity, and return to daily activities. Physical therapists can also help the patient prepare for and recover from surgery and will develop an individualized plan for each patient to move again after surgery.

If you have knee pain, you may be able to delay the need for surgery by working with a physical therapist to improve the flexibility and strength of the muscles that support the knee. Physical activity and weight control through proper diet may help reduce the risk of osteoarthritis of the knee from worsening.

Physical Therapy Pre and Post Surgery

There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

  • Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist directed program could help you delay or avoid knee replacement.
  • Seeing a physical therapist before surgery and going through a "prehab" program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.
  • Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.

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