The Knee
The. knee joint is the joint between the femur (thigh bone) and tibia (shin bone), with the fibula bone, which sits on the outside of the tibia, supporting the muscles of the lower leg.
Between the femur and the tibia lie two cartilage 'cushions' known as the 'menisci'. These act as shock-absorbers during weight-bearing activities. Ligaments connect the bones together at the sides of the joint (collateral ligaments), and within the joint (the cruciate ligaments). Ligaments prevent damage to the joint when we twist the knee or experience high forces from one side or the other, such as during rugby, football, or other contact sports.
If a force experienced does cause damage to a ligament, early diagnosis and intervention by a physiotherapist can help to promote the correct healing of the ligament, so that it toughens enough to cope with the stresses it needs to take. If help is not sought early, ligaments can heal in a haphazard manner and become too tight for full successful carefree movements.
The medial collateral ligament is perhaps one of the most frequently strained of the ligaments at the knee joint. It supports the inner side of the knee and prevents damage to the joint when the lower leg has been pushed out to the side. Injury to this ligament can occur in conjunction with a twisting action and damage to the medial meniscus (cartilage) happens at the same time. This can be a problem with footballers who have fallen and twisted the knee, or the foot has become stuck in a divot when they have been tackled; or in skiing when the ski stops the foot moving free as the skier falls.
The lateral collateral ligament is less commonly a problem, but can be damaged in similar circumstances. It protects the outside edge of the knee and can be damaged by a high force from the inside of the knee, or by the foot becoming stuck, turned inwards, and a fall occurring which bends the knee sideways.
The anterior cruciate ligament and the posterior cruciate ligament connect the femur and tibia together within the joint. They work as a team to stop forwards and backwards movement of the tibia on the femur and vice versa. Either of these ligaments (but more commonly the anterior cruciate) can be damaged during sporting injuries. It weakens over time with repeated blows to the knee, and one severe knock forwards or backwards can result in a rupture of the ligament. This kind of damage can usually be diagnosed by our physiotherapists. We will be able to advise you regarding suitable exercises to encourage stability of the joint and a return to sports activity as quickly as practical.
However, in some cases, surgery may be necessary and your physiotherapist can help with the full rehabilitation of your knee after this has been done. Treatment after ligament injuries consists of local hands-on, specific massage techniques. We also check joint position awareness and strengthen weakened muscles around the knee with home exercises and gym or pool rehabilitation programmes to speed a return to sport and normal activity.
The Patellofemoral Joint
Where the knee cap (patella) meets the lower end of the femur (thigh bone), the joint formed is known as the 'patellofemoral joint'. This joint can create problems if the cartilage on the back of the patella becomes rough, causing a 'grating' sensation. This joint can be affected by arthritis or by knock knees or bow legs affecting the alignment of the upper and lower parts of the knee joint.
Sometimes the muscles of the thigh (the quadriceps) can produce problems. One muscle can become stronger relative to the other and pull the patella out of position in its 'groove' of movement at the knee. This can cause pain on movement and discomfort at rest. Sports can sometimes cause this, by over-using certain muscles or starting a new sport without the appropriate strengthening regimes. Our physiotherapists can assess the position of the patella and ascertain whether this might be the cause of pain. Treatment to realign the patella can then involve taping the patella into a good position, while the muscles are strengthened around the joint. The exercises are very specific, in order to target the particular muscles which may not be working at their optimum level.
Osteo-Arthritis of the Knee
Wear and tear of the cartilage between the joint surfaces can occur in the early stage of osteo-arthritis at the knee joint. Deterioration can often be prevented by knowing how to protect the joint. We can advise you which exercises can help with joint maintenance and huge improvements in quality of daily life can occur. We also believe exercises in the local pool are very beneficial in the early stages of strengthening and can create an individual program. Don't leave it undiagnosed because you're afraid of what we might say! We can really help you to make a difference.
Meniscal Tears
Occasionally tears of the cartilage can occur, for example within sports injuries. Spotting the possibility of a tear and advising on the correct course of management can be done if early physiotherapy intervention is sought. Physiotherapy treatment might be the only form of management needed to treat this type of condition and return your knee to normal function.
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