KNEE PAIN AND PHYSIOTHERAPY

• Ligament injuries (ACL / PCL / MCL / LCL): these are usually caused by trauma to the knee eg being tackled or a skiing accident. Most ligament injuries can be rehabilitated with physiotherapy, but rarely some people require surgical reconstruction first (if the injury is very severe and depending upon the outcomes required eg the needs of the elite athlete are different to us regular folks!
• Meniscus injuries: your menisci are a pair of crescent moon shaped cushions which absorb impact where your thigh and shin bones meet. Injuries to the meniscus may be traumatic (eg forceful twisting) or degenerative (injury often results from a minor trauma or repetitive load, or you may not even be able to identify the trigger). This can sometimes present as clicking / locking / giving way. The pain may be on the inside or outside of the knee.
• Patella dislocation: the knee cap usually dislocates out to the side, and may spontaneously re-locate when the player straightens their leg. This is always associated with soft tissue injury, sometimes damage to the bone and cartilage may also occur. Dislocations may be caused by a direct force to the knee, or can happen spontansously when your anatomy allows or you have not rehabilitated completely from a previous dislocation.
• Patella Femoral Pain Syndrome ('patella tracking'): pain caused by the way your patella glides through the bony groove in which it sits. This is a highly treatable condition when managed by a physiotherapist and the cause is identified (which is often away from the knee!) eg weak hip muscles, tight quads, poor hip mobility, flat feet, weak quads and many more!
• Tendinopathies (previous known as 'tendinitis') - Recent research has disputed the 'itis' in tendonitis - inflammation is not the key driver, meaning icing and Anti-inflammatory medications are not treatments of choice. Tendinopathies usually require reduced load but increased strength via a highly individualised load managment plan. They also respond very poorly to stretching! Once again correct diagnosis is key.Eg Patella Tendinopathy ('jumper's knee'): overload of the patella tendon (where the bottom of the knee cap joins the shin bone)
• ITB Friction Syndrome ('runner's knee'): pain usually on the outside of the knee
• Baker's cyst: a swelling behind the knee. This results from intra-articular inflammation (inflammation inside the joint capsule). The baker's cyst often feels like 'fullness' behind the knee, it may cause you to have difficulty completely bending and can sometimes be painful here, or elsewhere in the knee. It's important to determine which structure inside the knee is causing the inflammation in order to completely resolve this problem.
  
• Osgood Schlatters: knee pain in teenagers on the front of the shin, just below the knee.
• Bursitis (incl Pes Anserine) inflammation of any one of the many bursa (fluid filled 'cushions') around the knee.
• Arthritis
• Chondromalacia
• Osteochondritis Dissecan

Of course there are also other conditions which may masquerade as one of these musculoskeletal problems. Correct diagnosis not only ensures you're receiving the most effective treatment, but also rules out the rare but sinister conditions, like infection or tumours. Physiotherapists are trained to identify these serious conditions.

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