KNEE PAIN and INJURIES
Patello-femoral Syndrome
 Pain originating from the patello-femoral joint or knee cap (patella) is very common. It can result in diffuse or sharp pains surrounding the knee cap or even behind the knee. It tends to be aggravated by any bent knee activity such as running, kneeling, squatting, sitting for prolonged periods or stairs.
Patello-femoral pain may occur as a result of many factors. In the normal knee, the patella glides up and down through a groove in the bottom end of the femur. When the knee is bent the pressure between the patella and femur is increased. If the patella does not track smoothly through the groove, there is a subsequent increase in pressure and resultant pain and inflammation.
This may result from:
- a muscle imbalance between the inside muscle called the vastas medialis and the outside muscles called the vastas lateralis causing the patella to rub against the femur unevenly
- tight muscles on the outside of the knee (ilio-tibial band)
- a narrow groove in the femur
- pronated or flat feet
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Meniscus Tears
 The meniscus between the two bones that make up the knee joint acts as a shock absorber. If a strong compressive and rotation force is applied to the knee either through a sporting injury or a fall etc, a tear in the meniscus on either the inside or outside of the knee joint may occur. The resultant swelling will cause pain, restricted movements of the joint and even locking of the knee.
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CHONDROMALACIA - RUNNER’S KNEE
 softening or wearing away and cracking of the cartilage under the kneecap, resulting in pain and inflammation. The cartilage becomes like sandpaper because the kneecap is not riding smoothly over the knee.
SYMPTOMS
- Pain usually felt beneath or on the sides of the kneecap
- Crepitus (grinding noise) as the rough cartilage rubs against cartilage when the knee is flexed.
- Pain is most severe after hill running
- Swelling of the knee
CAUSES
- Overpronation (feet rotate too far inward on impact) - can cause the kneecap to twist sideways fatigued or weak quadriceps muscle. The quadriceps muscle assists in the proper tracking of the kneecap.
- Weakness, especially of the inside part of the quadriceps, can prevent the kneecap from tracking smoothly
- Muscle imbalance - between weak quadriceps and tight hamstring and iliotibial band (ITB)
- Muscles can also affect proper tracking hill running (especially down hills) and running on cambered surfaces
- Incorrect or worn shoes
- Overtraining
MANAGEMENT
- Stop running
- Take a course (5 - 7 days) of non-steroidal anti-inflammatory drugs(ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist
- Apply ice to the shin area - for 10 minutes every 2 hours, in order to reduce the inflammation
- Avoid weight-bearing activities and keep foot elevated where possible
- Self-massage - using arnica oil or anti-inflammatory gel, on the sore spots around the knee
- Visit your physiotherapist or orthopaedic surgeon to get an accurate diagnosis of your problem if it has not resolved within 1-2 weeks.
- Your physiotherapist will guide you on the stretching and strengthening exercises appropriate for your problem.
- Return to running gradually
Full recovery is usually between four to six weeks
If pain is not recovering you may need to visit your podiatrist or orthotist for custom-made orthotics or orthopaedic surgeon who is able to, in extreme cases, scrape away rough edges of the cartilage to alleviate some pain.
OTHER FORMS OF EXERCISE THAT IS APPROPRIATE
- Swimming, pool running, cycling (in low gear) "spinning"
- Avoid any exercise that places strain onto the knee
PREVENTION
- Stretching of the quadriceps, hamstring, iliotibial band (ITB) and gluteal muscles - see our page on stretching
- Correct shoes, specifically motion-control shoes and orthotics to correct overpronation if needed
- Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road) .
- Gradual progression of training program
- Incorporate rest into training program
Ligament Tears
Ligaments connect bone to bone and act to provide stability to a joint. If the joint is moved beyond the ligament’s ability to stretch it may tear. The result will be pain, swelling and the joint will lose some degree of stability depending on the severity of the tear.
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Tendon Damage
 Tendons are the end of muscles that connect it to bones. Inflammation of tendons is known as tendonitis and is usually a result of repetitive actions and poor biomechanics of the area affected. It is common for injuries to arise at the front of the knee-known as patella tendonitis and is usually a result of repetitive jumping or running.
Your physiotherapist will assess your knee and determine the cause of your pain. Treatment may consist of:
- rest from aggravating activities
- electrotherapy to reduce inflammation and swelling
- mobilisation of the patella or knee joint
- an exercise program to strengthen weak muscles and stretch tight muscles
- patella or knee taping techniques and correction of biomechanical problems
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