Treatments for knee pain
Treating knee pain is usually dependent on your diagnosis, but there are a few simple steps you can take to aid your recovery.
Typically, most people will walk many thousands of steps per day and being a key weight-bearing joint, the knee joint is predisposed to suffering with degenerative changes known as osteoarthritis.
The best treatment of most musculoskeletal and orthopaedic knee conditions depends on the nature of the condition and the severity. Many low grade knee instabilities, which are caused by muscular weakness, patellar instability, pain or knee ligament injury, can be effectively treated with knee bracing for a short period of time following injury. Once stabilised, the knee can then improve significantly through a supervised physiotherapy programme of strengthening and balance exercises. Some instabilities caused by knee trauma may require operations to repair or graft a new ligament to stabilise the knee.
If the degenerative knee joint condition is less advanced, a programme of supervised strengthening and flexibility exercises usually results in significant improvement. As degenerative problems become more advanced individuals may require anti-inflammatory injections and eventually a knee replacement.
What can I do myself to get better – now and in the future?
There are some simple strategies you can use to manage your symptoms:
Regular aerobic exercise such as walking or jogging, and muscle-strengthening can help. Click here for exercises which are particularly useful for knee pain. For more information on staying active, click here.
taking regular doses of painkillers like ibuprofen, paracetamol, or a combination, are often helpful. Alternatively, you may prefer to use ‘rub on’ (topical) versions instead. Speak to your pharmacist for further information
This can be very useful to reduce pain and swelling. Take care not to sustain an ice burn by wrapping the ice in a damp cloth and only using for short periods
If you are overweight, aiming to get yourself down to a healthy weight can help your condition.
You can reduce the stress on the affected joint by using a walking stick, wearing supportive footwear or a supportive strapping
When should I see my doctor?
You should see your GP if you have:
- A significant injury causing difficulty with weight bearing on the knee.
- If there is joint swelling, redness or heat or the pain coincides with a fever or rash.
- If the pain is in both knees or affecting other joints as well.
- If your condition flares up or you have any pain or new symptoms that you do not recognise as being “normal” for your condition
- If your pain does not improve with self-management advice above.
How can physiotherapy help knee pain?
Physiotherapy is the first line of treatment for the vast majority of knee pain.
Physiotherapy strengthening exercises will be designed to load specific muscle groups which support the knee joint and control the hip and knee rotation when needed. Common examples of rotational control exercises include side lying clam exercises (which strengthen the gluteal muscles) as well as Pilates based exercises such as side plank torso progressions and single leg squat variations.
In situations where the knee pain may arise from a tendon itself, strengthening exercises will also stimulate the tendon to heal with a stronger structure, thereby reducing pain.
If an individual’s foot posture is thought to contribute significantly to any biomechanical problem then orthotics may be used to correctly support the ankle and foot in a more neutral position and to support the arch of the foot increasing this stability needed for appropriate muscular support.
In cases where an acute knee injury has occurred and significant pain and swelling limit progression, physiotherapy is able to advise on appropriate icing and compression strategies around the knee. Careful range of movement exercises and low-level progressions for the quadriceps muscles which supports the knee we also aid a more rapid recovery.
Significant knee joint stiffness often results as a consequence of an acute injury and following surgery. Physiotherapists are able to use a combination of manual mobilisation techniques towards the knee as well as soft tissue techniques.
Should I consider a knee replacement operation?
Osteoarthritis is the medical term given to describe degenerative changes to joints. This process is characterised by pain, swelling, progressive stiffness and sometimes a feeling of weakness in the joints affected.
A knee replacement operation is the last line of treatment for more advanced, disabling cases of knee osteoarthritis. The operation involves removing the worn joint surfaces and replacing them with metal and polyethylene artificial joint surfaces which are held in place with stems running into the thigh bone and shin bone.
Although knee replacements work very well for reducing significant levels of pain for the vast majority of patients, the new knee components (prosthesis) do not have an unlimited lifespan and loosen after years of use. Therefore, a pragmatic approach to considering knee replacements is taken in which they are considered only when symptoms become severe.
For individuals wondering whether they are nearing the stage to consider a knee replacement a sensible way to evaluate this is whether the pain is disturbing sleep and significantly limiting walking distances in spite of the use of painkillers. If the knee joint is feeling unstable and resulting in falls, or has lost so much range of motion that tasks such as walking and climbing stairs are becoming impossible, an earlier knee replacement should also be considered.
What other forms of surgery are used to treat knee pain?
In rare circumstances, osteoarthritis only affects the patellofemoral joint or one half of the knee joint, the medial or lateral compartment. This opens up the possibility of surgeons performing a unicondylar or oxford knee replacement. These prostheses allow a far better function than a full knee replacement and enable a conversion to a full knee replacement in time if needed.
In younger patients with mild osteoarthritis of only the medial or lateral compartment, surgeons may also offer a high tibial osteotomy. This operation cuts a wedge of bone from the upper shin bone and fixes the bone in a straightened position to reduce the forces on the worn knee compartment.
For ligament injuries other than anterior cruciate ligament reconstructions surgeons are also able to perform a similar reconstruction for injured posterior cruciate ligament injuries, medial collateral and lateral collateral ligament injuries. These operations normally involve a ligament graft taken from the hamstring tendons but if there are multiple ligament injuries to repair then a cadaveric graft may be considered.
I have ruptured my anterior cruciate ligament (ACL). What are the best treatment options?
Unfortunately, knee traumas during sports are common, often involving rapid lateral and rotational movements. Knee injuries can also occur in everyday life, such as by falling awkwardly. Cases which result in significant knee pain and swelling, which continued over several days or weeks, a rupture to the anterior cruciate ligament should be suspected.
There are various treatment options available for ACL injuries. Professional athletes often opt for an immediate anterior cruciate ligament reconstruction operation. However, athletes primarily opt for this operation as it is more likely to guarantee a more rapid return to sport in what is often a very short career. But for some individuals who have ruptured their anterior cruciate ligament, a supervised program of physiotherapy strength, conditioning and balance work for the knee may be appropriate.
Therefore, a period of intense physiotherapy rehabilitation should be considered for recreational athletes and less active individuals before considering surgery. Immediate surgery may be considered instead where there are associated injuries to other ligaments, or other associated injuries to the cartilage of the knee.Knee pain from sport