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Structural and functional
causes of patella malalignment
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Ilotibial friction syndrome
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Anterior Knee
Pain | Lateral
Knee Pain | Medial Knee Pain | Posterior
Knee pain
Anterior Knee Pain:Possible
Diagnoses:
Patellofemoral Syndrome
Patella Tendinitis
Patellofemoral Syndrome
|
Mechanism
of injury
|
Symptoms
|
Management
|
| This
is usually an overuse injury caused by excessive friction of the kneecap
on the femur. Can also be caused by an acute traumatic episode e.g.
falling on the knee. Often seen in long-distance runners. Most common
in people with abnormal kneecap alignment and movement. |
Pain behind or around
the kneecap, which is aggravated by exercise. Pain increases with
an increase in pressure on the kneecap, e.g. squatting and on stairs.
Pain is aggravated
by holding the knee in a bent position for long periods of time,
called “moviegoers knee”. Clicking or grating may occur.
|
Correct
the biomechanical abnormality (stretch shortened muscles especially.
on the outside of the leg, and get an expert to assess your running
shoes). Treat the symptoms with ice, anti-inflammatory drugs and
physiotherapy. |
Patella Tendinitis
|
Mechanism
of injury
|
Symptoms
|
Management
|
| Caused
most commonly by overloading of the quadriceps muscles by jumping
and landing. Is less commonly caused by running sports. The incidence
is increased when the sport is done on a hard surface. |
Usually
a gradual onset of pain. Pain at the start of activity, which settles
down during activity and returns after the activity. There may be
a small area of localized swelling over the tendon. |
Prevent
the problem by gradually increasing your training load. One should
rest from the activity which caused the pain, use ice to decrease
the swelling and speed up the healing process, seek physiotherapy
and take anti-inflammatory drugs. |
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Lateral Knee Pain:Possible
diagnoses:
Ilio-tibial Band Friction Syndrome (ITB)
Patellofemoral Syndrome (Pain
may be present on the outside of the knee as well.)
Lateral Collateral Ligament Tear
Ilo-tibial band friction
syndrome (ITB)
|
Mechanism
of injury
|
Symptoms
|
Management
|
| It
is an overuse injury caused by friction between the ilio-tibial band
(see diagram),and the outside of the femur. This results in inflammation
of the tissues on the outside of the knee. It can be caused by abnormal
biomechanics, excessive pronation of the feet and an imbalance in
the pelvis. It occurs commonly with a sudden increase in long-distance
running. |
Pain
on the outside of the knee, normally during activity. The pain usually
starts while running especially downhill running. Pain may be very
sharp and may stop you running altogether. Pain can persist for a
period after exercise has ceased. There is also tenderness over the
outside of the knee. |
Rest
or relative rest from running. Ice and physiotherapy. Full assessment
of your running shoes by an expert. Once back on the road, one should
always start off slowly, running only until pain starts,running on
level ground and trying to avoid downhills. |
Lateral Collateral Ligament
Tear
|
Mechanism
of injury
|
Symptoms
|
Management
|
| Always
due to an external force, usually to the inside of the knee. Most
common in contact sports. |
Pain
on the outside of the knee. May be intense, or mild depending on the
severity of the injury. The knee may have a degree of instability.
Localized swelling and tenderness as well as possible bruising. Movement
may be limited in accordance with the pain. |
Ice,
compression, elevation, anti-inflammatory drugs and physiotherapy.
It may be necessary to wear a knee brace depending on the stability
of the knee joint. Severe injuries will require surgical repair. |
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Medial Knee Pain:
Possible Diagnoses:
Patellofemoral
Syndrome.( Pain can also be present on the inside of the knee)
Anserine Bursitis/Tendinitis
Medial Collateral Ligament Tear
Medial Meniscus (cartilage) Tear
Anserine Bursitis/Tendinitis
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Mechanism
of injury
|
Symptoms
|
Management
|
| Overuse
injury, or overstrain of the hamstring(muscle of the back of the thigh),
or adductor (muscle of the inner thigh) tendons. |
Pain
and swelling on inside of the top of the shin bone. Pain on static
contraction of one of these muscles. |
Physiotherapy,
ice, acupuncture rest, and stretching, anti-inflammatories. |
Medial Collateral Ligament
Tear
|
Mechanism
of injury
|
Symptoms
|
Management
|
| Excessive
force to the outside of the knee joint forcing the knee to collapse
inwards. Commonly occurs in contact sports but doesn’t always require
an external force. The injury can also be due to a twisting injury.
|
Pain
on the inner side of the knee. There may be some degree of instability.There
may be a small amount of local swelling or the knee may be generally
swollen indicating further damage within the knee joint. The inside
of the knee is generally tender to the touch. Muscle spasm and pain
may cause a limitation in knee movement. Ice, compression(a firm bandage),
elevation, anti-inflammatory drugs and physiotherapy. |
It
may be necessary to wear a knee brace depending on the stability of
the knee joint. Strengthening exercises are essential. Severe injuries
will require surgical repair. |
Medial Meniscus (cartilage)
Tear
|
Mechanism
of injury
|
Symptoms
|
Management
|
| Most
commonly caused by a forceful bending and twisting motion. (Uncommon
in cycling and running). This injury is very often associated with
other injuries of the knee. |
Symptoms
vary according to the size and position of the tear within the knee
joint. Pain is usually localized over the joint line. Larger tears
also show some swelling within the knee joint and around the joint.
The knee may lock in certain positions and you may experience some
kind of clicking in the joint. Pain is experienced mostly with bending
the knee. |
The
most common route of treatment is surgery of one kind or another.
Alternatively physiotherapy may be effective with smaller tears. Strengthening
essential. Some patients choose to alter their sporting activities
rather than to have surgery. |
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Posterior Knee Pain: Possible
Diagnoses:
Referred Pain from the
Lower Back (see articles on the spine)
Popliteus Tendinitis
Biceps Femoris Tendinitis
Gastrocnemius Tendinitis
Popliteus Tendinitis
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Mechanism
of injury
|
Symptoms
|
Management
|
| This
is an overload injury usually caused by hard running (esp. downhill).
This muscle works hard to slow you down and to prevent the knee from
bending the wrong way. |
Pain
is felt on the posterior-lateral side of the knee when running downhill.(it
should not be confused with Ilio-tibial band syndrome). Pain is also
present after running. |
Reduction
of activity especially downhill and speed running. Ice, anti-inflammatory
drugs and physiotherapy. Surgery is seldom necessary. Ensure biomechanics
are not the cause. |
Biceps Femoris or Gastrocnemius
Tendinitis
|
Mechanism
of injury
|
Symptoms
|
Management
|
| Most
common in endurance sports such as running and cycling. Overloading
causes micro-tearing of the tendon close to its attachment to the
bone. |
With
biceps femoris tendinitis, pain is felt at the back, outside of the
knee. With gastrocnemius tendinitis, pain can be felt behind the knee
either on the inside or outside. In both cases the area is tender
to touch and it may be painful to stretch the respective muscle. |
Reduce
the activity or change to another activity that doesn’t affect the
injury. Ice, anti-inflammatory drugs, physiotherapy and gentle stretching.
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