Knee

Knee

If you suffer from knee pain, there is no reason why you have to stay in pain. In fact, we have designed this portion of our site with you in mind.

On this page you will find information on how to manage old conditions, with our Feeling Fab exercises, manage pain with recent conditions and to learn more about the anatomy and more complex information in our know your body section. 

Knee problems account for around 13% of the patients accessing Physio Med services from our clients.

Of the knee patients seen:
Domestic 63%
Work aggravated 26%
Accidents at work 10%

Managing Conditions

Are you currently suffering from knee pain?

Our Managing Musculoskeletal Complaints knee guide and video has been developed by our chartered physiotherapists to help those suffering from pain and limited mobility suffered from a recent musculoskeletal accident, injury or trauma.

Designed to reduce pain, improve range of movement, and to recover from injury quickly and safely.

Feeling Fab

Occupational physiotherapy exercises for your knee

Our Feeling Fab programme is a set of stretching and strengthening exercises. They have been designed to manage and prevent an onset of a range of musculoskeletal conditions.

There are certain activities in the work place that may contribute to developing a sore knee. The nature of these activities can, if not addressed lead to the gradual build-up of tension and stiffness in the knee.

 

Guides

Maintaining a fit and healthy workforce

Full Body Stretching and Strengthening Exercises: Occupational Physiotherapy - Getting You Back To Work

How to choose an office chair

There are many types of office chairs and many factors that influence the choice of which chair to use. Ergonomic chairs that offer better leg, pelvic and lumbar positioning have become popular, but they still have their own drawbacks.

Common Condition

A common condition that Physio's treat in the hip is an Anterior Cruciate Ligament injury.

Common Condition

The anterior cruciate ligament (ACL) is probably the most commonly injured ligament of the knee. In most cases, the ligament is injured by people participating in athletic activity. As sports have become an increasingly important part of day-to-day life over the past few decades, the number of ACL injuries has steadily increased. This injury has received a great deal of attention from orthopedic surgeons over the past 15 years, and very successful operations to reconstruct the torn ACL have been invented.

This article will help you understand:

  • where in the knee the ACL is located
  • how an ACL injury causes problems
  • how doctors treat the condition

Portions of this document copyright MMG, LLC.

Anatomy

Where is the ACL, and what does it do?

Anatomy

Ligaments are tough bands of tissue that connect the ends of bones together. The ACL is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to connect to the front of the tibia (shinbone).

The ACL runs through a special notch in the femur called the intercondylar notch and attaches to a special area of the tibia called the tibial spine.

Tibial Spine

Knee 2

The ACL is the main controller of how far forward the tibia moves under the femur. This is called anterior translation of the tibia. If the tibia moves too far, the ACL can rupture. The ACL is also the first ligament that becomes tight when the knee is straightened. If the knee is forced past this point, or hyperextended, the ACL can also be torn.

knee 3

Other parts of the knee may be injured when the knee is twisted violently, as in a clipping injury in football. It is not uncommon to also see a tear of the medial collateral ligament (MCL) on the inside edge of the knee, and the lateral meniscus, which is the U-shaped cushion between the outer half of the tibia and femur bones.

Portions of this document copyright MMG, LLC.

Causes

How do ACL injuries occur?

The mechanism of injury for many ACL ruptures is a sudden deceleration (slowing down or stop), hyperextension, or pivoting in place. Sports-related injuries are the most common.

The types of sports that have been associated with ACL tears are numerous. Those sports requiring the foot to be planted and the body to change direction rapidly (such as basketball) carry a high incidence of injury. In this way, most ACL injuries are considered noncontact. However, contact related injuries can result in ACL tears. For example, a blow to the outside of the knee when the foot is planted is the most likely contact related injury.

Football is also frequently the source of an ACL tear. Football combines the activity of planting the foot and rapidly changing direction and the threat of bodily contact. Downhill skiing is another frequent source of injury, especially since the introduction of ski boots that come higher up the calf. These boots move the impact of a fall to the knee rather than the ankle or lower leg. An ACL injury usually occurs when the knee is forcefully twisted or hyperextended while the foot remains in contact with the ground. Many patients recall hearing a loud pop when the ligament is torn, and they feel the knee give way.

The number of women suffering ACL tears has dramatically increased. This is due in part to the rise in women's athletics. But studies have shown that female athletes are two to four times more likely to suffer ACL tears than male athletes in the same sports.

Recent research has shown several factors that contribute to women's higher risk of ACL tears. Women athletes seem less able to tighten their thigh muscles to the same degree as men. This means women don't get their knees to hold as steady, which may give them less knee protection during heavy physical activity. Also, tests show that women's quadriceps and hamstring muscles work differently than men's. Women's quadriceps muscles (on the front of the thigh) work extra hard during knee bending activities. This pulls the tibia forward, placing the ACL at risk for a tear.

Meanwhile, women's hamstring muscles (on the back of the thigh) respond more slowly than in men. The hamstring muscles normally protect the tibia from sliding too far forward. Women's sluggish hamstring response may allow the tibia to slip forward, straining the ACL. Other studies suggest that women's ACLs may be weakened by the effects of the female hormone estrogen. Taken together, these factors may explain why female athletes have a higher risk of ACL tears.

Portions of this document copyright MMG, LLC.

Symptoms

What does a torn ACL feel like?

The symptoms following a tear of the ACL can vary. Some patients report hearing and/or feeling a pop. Usually, the knee joint swells within a short time following the injury. This is due to bleeding into the knee joint from torn blood vessels in the damaged ligament. The instability caused by the torn ligament leads to a feeling of insecurity and giving way of the knee, especially when trying to change direction on the knee. The knee may feel like it wants to slip backwards. There may be activity related pain and/or swelling. Walking downhill or on ice is especially difficult and you may have trouble coming to a quick stop.

The pain and swelling from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable. The symptom of instability and the inability to trust the knee for support are what require treatment. Also important in the decision about treatment is the growing realisation by orthopedic surgeons that long term instability leads to early arthritis of the knee.

Portions of this document copyright MMG, LLC.

Diagnosis

When you visit Physio Med, our Physiotherapist will first take a history and do a physical examination.

Diagnosis

The history and physical examination are probably the most important ways to diagnose a ruptured or deficient ACL.

In the acute (sudden) injury, the swelling is a good indicator. A good rule of thumb that orthopedic surgeons use is that any tense swelling that occurs within two hours of a knee injury usually represents blood in the joint, or a hemarthrosis. If the swelling occurs the next day, the fluid is probably from the inflammatory response.

During the physical examination, special stress tests are performed on the knee. Three of the most commonly used tests are the Lachman test, the pivot-shift test, and the anterior drawer test. Our Physiotherapist will place your knee and leg in various positions and then apply a load or force to the joint. Any excess motion or unexpected movement of the tibia relative to the femur may be a sign of ligament damage and insufficiency.

Another way to check for anterior tibial translation is with the KT-1000 and KT-2000 arthrometers. The patient's leg is bent and supported on a wedge with the knee in 30 degrees of flexion. The arthrometer is placed against the knee to be tested and strapped to the lower leg. Usually, the normal knee is tested first. The arthrometer applies an anterior force of 15 pounds against the tibia. The amount of anterior tibial translation is measured. The test is repeated with a force of 20 pounds. A third test applies a manual maximal force to the posterior (back) of the tibia. This is similar to the Lachman test.

The results of these tests will help our Physiotherapist determine how badly the ACL was injured. We may also combine other tests with tests of ACL integrity to determine whether other knee ligaments, joint capsule, or joint cartilage have also been injured.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physiotherapists at Physio Med have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Portions of this document copyright MMG, LLC.

Our Treatment

Non-surgical Rehabilitation

When you begin your Physio Med program, our initial treatments for an ACL injury will focus on decreasing pain and swelling in the knee. We may recommend rest and mild pain medications to help decrease your symptoms.

You may need to use crutches until you can walk without a limp. Most of our ACL reconstruction patients are instructed to put a normal amount of weight down while walking. Our Physiotherapist will treat swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation.

Our Physiotherapist may apply treatments such as electrical stimulation and ice to reduce pain and swelling. We then gradually add exercises to improve knee range of motion and strength to help you regain normal movement of joints and muscles.

Our Physiotherapist will have you begin range of motion exercises right away, with the goal of helping you swiftly regain full movement in your knee. This may include the use of a stationary bike, gentle stretching, and careful pressure applied to the knee by the Physiotherapist. We will also give you exercises to improve the strength of your hamstring and quadriceps muscles. As your symptoms ease and strength improves, we will guide you in specialised exercises to improve knee stability.

Our Physiotherapist may suggest use of an ACL brace. This type of brace is usually custom made and is designed to improve knee stability when the ACL doesn't function properly.

We often recommend an ACL brace when the knee is unstable and surgery is not planned. As mentioned, a torn ACL that isn't corrected often leads to early knee arthritis. There is no evidence that an ACL brace will prevent further damage to the knee due to wear and tear arthritis. The ACL brace may help keep your knee from giving way during moderate activity. However, it can give a false sense of security and won't always protect the knee during sports that require heavy cutting, jumping, or pivoting.

Although the time required for recovery varies, nonsurgical rehabilitation for a torn ACL typically lasts three to six months. You can return to your sporting activities when your quadriceps and hamstring muscles are back to nearly their full strength and control, you are not having swelling that comes and goes, and you aren't having problems with the knee giving way.

Post-surgical Rehabilitation

If you undergo surgery, you will probably be involved in a Physio Med progressive rehabilitation program for about four to six to twelve months after surgery to ensure the best result from your ACL reconstruction. If your surgery and rehabilitation go as planned during the first twelve weeks, you may only need to do a home program and see our Physiotherapist every week. If there are any complications expect to see our Physiotherapist about two to three times per week for the first 12 weeks. Dependent on the level of activity you are returning to expect the rehabilitation to return you to sporting activities in 6 to 12 months.

At Physio Med, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our clinic will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home programme.

Portions of this document copyright MMG, LLC.

Physician Review

Physician Review

Aspiration

If there is fluid associated with your ACL injury, your doctor may need to place a needle in the swollen joint and aspirate (drain as much fluid as possible) to give relief from the swelling.

Your Doctor may order X-rays of the knee to rule out a fracture. Ligaments and tendons do not show up on X-rays, but bleeding into the joint can result from a fracture of the knee joint, or when portions of the joint surface are chipped off.

Magnetic Resonance Imaging is probably the most accurate test for diagnosing a torn ACL without actually looking into the knee. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the knee. The pictures show the anatomy, and any injuries, very clearly. This test does not require any needles or special dye and is painless.

Magnetic Resonance Imaging (MRI)

Knee 7

In some cases, arthroscopy may be used to make the definitive diagnosis if there is a question about what is causing your knee problem.

Knee 8

Arthroscopy is an operation that involves inserting a small fiber-optic TV camera into the knee joint, allowing the orthopedic surgeon to look at the structures inside the joint directly. The vast majority of ACL tears are diagnosed without resorting to this type of surgery, though arthroscopy is often used to repair a torn ACL.

Portions of this document copyright MMG, LLC.

Surgery

If the symptoms of instability are not controlled by a brace and rehabilitation programme, then surgery may be suggested.

The main goal of surgery is to keep the tibia from moving too far forward under the femur bone and to get the knee functioning normally again.

Even when surgery is needed, most surgeons will have their patients attend Physiotherapy for several visits before the surgery. This is done to reduce swelling and to make sure you can straighten your knee completely. This practice also reduces the chances of scarring inside the joint and can speed recovery after surgery.

Arthroscopic Method

Most surgeons now favor reconstruction of the ACL using a piece of tendon or ligament to replace the torn ACL. This surgery is most often done with the aid of the arthroscope. Incisions are usually still required around the knee, but the surgery doesn't require the surgeon to open the joint. The arthroscope is used to view the inside of the knee joint as the surgeon performs the work. Most ACL surgeries are now done on an outpatient basis, and many patients go home the same day as the surgery. Some patients stay one or two nights in the hospital if necessary.

Patellar Tendon Graft

One type of graft used to replace the torn ACL is the patellar tendon. This tendon connects the kneecap (patella) to the tibia. The surgeon removes a strip from the center of the ligament to use as a replacement for the torn ACL.

Knee 9

Hamstring Tendon Graft

Surgeons also commonly use a hamstring graft to reconstruct a torn ACL. This graft is taken from one of the hamstring tendons that attaches to the tibia just below the knee joint. The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the tibia. The graft used in ACL reconstruction is taken from the hamstring tendon, called the semitendinosus. This tendon runs along the inside part of the thigh and knee. Surgeons also commonly include as part of the hamstring graft a tendon just next to the semitendinosus, called the gracilis.

Hamstring Graft

Knee 10

When arranged into three or four strips, the hamstring graft has nearly the same strength as a patellar tendon graft.

Knee 11

Allograft Reconstruction

Other materials are also used to replace the torn ACL. In some cases, an allograft is used. An allograft is tissue that comes from someone else. This tissue is harvested from tissue and organ donors at the time of death and sent to a tissue bank. The tissue is checked for any type of infection, sterilised, and stored in a freezer. When needed, the tissue is ordered by the surgeon and used to replace the torn ACL. The allograft (your surgeon's choice of graft) can be from the tibialis tendon, patellar tendon, hamstring tendon, or Achilles tendon (the tendon that connects the calf muscles to the heel).

Many surgeons use patellar tendon allograft tissue because the tendon comes with the original bone still attached on each end of the graft (from the patella and from the tibia). This makes it easier to fix the allograft in place.

The advantage of using an allograft is that the surgeon does not have to disturb or remove any of the normal tissue from your knee to use as a graft. The operation also usually takes less time because the graft does not need to be harvested from your knee.

Portions of this document copyright MMG, LLC.

Knee Problems Solved

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What we do

Our blended approach to workplace physiotherapy

We provide occupational physiotherapy services to small or large workplaces nationally, aiming to get their employees back to work as quick as possible. Our average ROI is 10:1. Watch our video to find out how your staff benefit from physiotherapy access.

Case Studies

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Access to physiotherapy speeds up return to work.

In 2011, North East Ambulance Service reported a 60% reduction in musculoskeletal disorder cases as a direct result of Physio Med's treatment.

North East Ambulance Service

I have just read the latest scores from the survey of users of the physio service you provide to DWP and felt I had to write to congratulate you on the 96% approval rating.

Department for Work & Pensions

As an international power-lifter I was impressed that not only did your staff know what that was but named a few. I imagine they have used this service. My knee started to feel better straight away partly due to the massage and the harder of the step exercises - I now no longer even noticed it an I am back to squatting the weight I normally do. I returned to get my shoulder treated and the isometric exercises are brilliant. It no longer hurts when I drive and I moved up 4 weights jumps in bench press.

Michale M

Frequently Asked Questions

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If you suffer from pain and mobility issues it is quite common for us to get by, using over the counter pain killers and ointments. Often we don't seek the support of a Physio until we have been referred via a GP or until the pain is so bad.

Physiotherapists are trained professionals that help injured patients get back to the highest range of movements. If left untreated injuries often don't heal as well as if you were on a treatment plan. Injuries, if left for 12 weeks can become chronic and chronic injuries are a lot harder to treat. Injuries also heal a lot quicker if you work with a physiotherapist, with the added benefit of often having less pain and more range of movement than before you had your injury.   

If you feel it is only a minor injury and you are still in pain 48 hours after the injury, make an appointment with a physiotherapist. If you feel the injury is more serious make an appointment immediatley. If for an extended perioid, you have been living with chronic pain and or limited mobility and range of movement make an appointment with a physiotherapist.  

 

Our Physiotherapists use different treatment methods in order to deal with a wide range of injuries. Depending on the nature and severity of your injury, you may require:

Manipulation or mobilisation of joints

Electrotherapy (Laser, Ultrasound, Interferential, Short Wave Diathermy)

Acupuncture

Exercise therapy

Stretching and strengthening

Core stability training

Soft tissue massage

Heat or cold therapy

Patient education, home exercises

Biomechanical analysis

Wear something comfortable. Bring a pair of shorts if it is a lower back, hip, knee, ankle, or a foot problem. Bring a tank top / vest if it is a neck, upper back, shoulder, elbow, or hand problem.

Physiotherapy can be helpful for people of all ages with a wide range of health conditions, including problems affecting the: 

bones, joints and soft tissue – such as back pain, neck pain, shoulder pain and sports injuries

brain or nervous system – such as movement problems resulting from a stroke, multiple sclerosis (MS) or Parkinson's disease

heart and circulation – such as rehabilitation after a heart attack

lungs and breathing – such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis

Physiotherapy can improve your physical activity while helping you to prevent further injuries.

Yes. These can be arranged for patients who are disabled or are too ill to attend the practice.

Yes, Physio Med is a registered provider for most medical insurance companies.

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