Do you KNEEd help?

England football captain Rio Ferdinand may have missed the whole Fifa 2010 Football World Cup because of his knee injury, but you don’t have to be an international footballer to have trouble with your knees.  In this blog I take a look at the range of knee problems affecting different age groups.

Osteoarthritis (“wear and tear”) of the knee affects 1/3 of people aged 63 and over, often causing knee pain, difficulty rising from a chair and climbing stairs.  But knee pain is also not unique to older people- in fact there are many knee problems that are common in adolescents and teenagers, not to mention the knee problems that beset the athlete and sportsperson.  Knee problems are one of the most common conditions that we treat at BOOST PHYSIO, let’s take a look at the type of knee problems that affect different age groups and how we treat them.

Active adolescent children (aged 10-14) complaining of knee pain at the front of the knee below the knee cap are often affected by Osgood Schlatters Disease.  X-rays will confirm the diagnosis for this condition, but are often not

Diagram of Osgood Schlatters Disease

needed as the clinical examination can be enough to make the diagnosis.   There will usually be a tender, enlarged area at the tibial tuberosity (this is the bump between the knee cap and the top of the shin bone), where the quadriceps muscle tendon attaches to the shin bone and pulls on the not yet fused tibial tuberosity.  The ratio of boys to girls affected by this condition is 7:1.  A Finnish study showed a frequency of 13% of adolescent athletes had Osgood Schlatters.

At BOOST PHYSIO our treatment programme for Osgood Schlatters involves decreasing of physical activity to allow the inflammatory reaction to subside, a programme of stretches to the knee muscles to assist in the muscle length and ensure that range of movement of the knee is maintained.  Most importantly carefully guiding the adolescent back to sport with a graded programme.

Teenagers with knee pain are often affected by anterior knee pain.  Anterior knee pain is often also called Chondromalacia Patella or Pattela femoral pain syndrome.  Anterior knee pain by contrast to Osgood Schlatters is much more common amongst girls than boys.  This prevalence amongst girls is partly due to the wider female pelvis which leads to an increased likelihood of knock knees (technically called genu valgus).  Pain is usually at the front of the knee underneath the kneecap (patella) and is worse climbing stairs.  Anterior knee pain is caused by poor alignment of the patella largely due the mechanics of the patient’s knees (often knock kneed and flat footed) which leads to maltracking of the patella causing excessive pressure under the patella.  In severe cases this will roughen the cartilage surfaces under the knee cap.

Example of severe maltracking of the patella

We treat anterior knee pain by always tackling the root of the problem first which is normally the biomechanics of the legs.  BOOST PHYSIO often recommends orthotics (inner-soles) to correct foot and knee position and always gives corrective exercises to deal with muscle-imbalances at the knees focussing on strengthening the vastus medialis portion of the quadriceps thigh muscle which helps to re-align the patella. We often also use special strapping techniques to off-load the patella and re-educate the muscles around the patella.  Often “hands on” work is also needed to loosen tight structures around the patella.

Knee problems in people in their 20s-50s are often related to an injury or trauma and are often sports related. Whether it is the Sunday footballer with a torn meniscus (cartilage of the knee) or a runner with a tendonitis problem we assess all these patients very carefully with specific tests to accurately identify the nature of the injury.   These knee problems can be challenging to deal with as tissue healing is slower in people over 20 and indeed sometimes the damaged tissue cannot repair itself at all.  While the majority of our patients with sports injuries to the knee are treated successfully with physiotherapy a small number need the help of a knee surgeon and we make sure that our patients receive the appropriate advice and care in this regard.  For those who do require surgery we work very hard on their rehab programme aiming to regain full strength and flexibility as soon as possible.

Over 60s suffering with knee pain can often be due to osteoarthritis of the knee which can also cause stiffness and often swelling of the knee.  While surgery can be a very effective solution for many of these patients, most will respond very well to a programme of physiotherapy focusing on strengthening the leg muscles to off-load the knee joint and work to improve the flexibility of the knee.  Both these elements lead to decreases in pain levels and improvements in functional ability.

If you would like to discuss your knee problem and have a thorough physiotherapy assessment and examination please do call us on 020 82017788 to arrange an appointment or visit our website www.boostphysio.com for more information.

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