Physiotherapy solutions for knee pain

Physiotherapy solutions for knee pain ================================== Physiotherapy provides a specific program consisting of manual therapy, strengthening and stretching exercises, and patient education by carefully evaluating knee biomechanics and identifying movement disorders. The main goal of physiotherapy treatment for knee pain is to reduce pain, improve range of motion, increase muscle strength and improve joint balance. Studies show that resistance and balance exercises reduce the pain caused by knee arthritis by 30% and improve the overall function of the joint. Knee pain is one of the most common musculoskeletal problems that affects people of all age groups and is usually caused by a combination of different factors. Its causes include knee arthritis, sports injuries, joint overuse and patellar instability. Chronic knee pain can reduce the quality of life and cause significant limitations in daily activities such as walking and going up and down stairs. In addition, complementary treatments such as electrical muscle stimulation and ultrasound can accelerate the healing process and reduce inflammation. Proper training on how to perform daily activities and correct movement patterns plays an important role in preventing recurrence and creating healthy movement habits. Early intervention by a physiotherapist can prevent the transformation of acute pain into chronic pain and help to recover faster. In general, physiotherapy for knee pain is a non-surgical and low-risk method that plays a key role in the management and relief of knee pain based on strong clinical evidence. 10 important knee injuries In this section, we will comprehensively review 10 important knee injuries. Each injury is described with the mechanism of formation, main symptoms, diagnosis and principles of physical therapy treatment for knee pain. 1. **Anterior Cruciate Ligament (ACL) Rupture**: Provides anterior-medial stability and is torn during a sudden stop or rapid rotation in sports. 2. **Posterior Cruciate Ligament (PCL) Rupture**: Prevents the posterior movement of the tibia and is often injured in a direct impact to the knee (such as an accident). 3. **Middle lateral ligament (MCL) tear**: resistance to valgus (inside) forces and is torn by impact on the outside of the knee. 4. Rupture of the lateral collateral ligament (LCL): maintains external lateral stability and is damaged in impact from the inside of the knee. 5. Meniscus tear: C-shaped cartilage, which acts as a shock absorber, is torn in a sudden twist or rotation under the weight of the body. 6. **Dislocation of the patella**: The patella is out of the groove of the femur and causes sudden pain and swelling. 7. **Patellar tendinopathy (Jumper's Knee)**: Inflammation of the patellar tendon causes pain in front of the knee during jumping activities. 8. Iliotibial Band Syndrome (ITBS): Friction of the external fibrous band on the side of the femur is common in runners and cyclists. 9. **knee bursitis**: inflammation of fluid-filled bags (bursa) occurs as a result of repeated trauma or pressure. 10. **Ogood-Schlatter's disease**: Tibial apophysitis in teenagers with a painful bump under the patella that improves with growth. ### Anterior Cruciate Ligament Rupture (ACL Injury) Anterior Cruciate Ligament is one of the four main ligaments of the knee, which prevents the tibia (tibia) from moving forward with respect to the femur (thigh). This ligament is mainly injured in sports with a sudden stop and change of direction, such as football, basketball and volleyball, and the patient often feels a "crack" or "pop" sound at the time of rupture. After the injury, rapid swelling, loss of range of motion and feeling of instability in the knee are common. Diagnosis is often based on history (sudden pop, swelling) and clinical examination (Lachie test, drawer test); MRI imaging is necessary to accurately assess the location and degree of the tear. Non-surgical treatment includes a period of rest, ice, compression and elevation (RICE), using a knee brace and a rehabilitation program with strengthening exercises to compensate for the dynamic stability of the ligament. In complete rupture and in active people, ligament reconstruction surgery with autologous graft (usually from hamstring or patellar tendon) and follow-up of 6-9 months physiotherapy program is recommended. ### Rupture of posterior cruciate ligament (PCL Injury) Posterior Cruciate Ligament (in English: Posterior Cruciate Ligament) is located in the center of the knee in a crosswise manner with the ACL and is responsible for preventing the posterior displacement of the tibia. The usual mechanism of injury is a direct blow to the front of the knee in a bent position (eg hitting the dashboard in a car accident). Symptoms include deep pain in the back of the knee, mild swelling, and in severe cases, a feeling of "posterior sag" of the tibia relative to the femur. Clinical diagnosis is done with Posterior Drawer and Posterior Sag test; MRI imaging helps to confirm a ligament tear and check for accompanying injuries (meniscus, cartilage, collateral ligaments). In most cases of grade I and II tears (partial tears), conservative treatment with physical therapy and strengthening of the hamstrings and quadriceps muscles is sufficient. In complete tear (Grade III) or multi-ligament involvement, PCL reconstruction surgery may be required with hamstring or axillary grafts. Physiotherapy for knee pain provides exercises including increasing the range of motion, strengthening surrounding muscles and improving dynamic balance so that the patient can return to daily activities. ### Rupture of the medial collateral ligament (MCL Injury) The medial collateral ligament (in English: Medial Collateral Ligament) is located on the inside of the knee and resists valgus (inward) forces. The injury usually occurs as a result of an impact from the outside of the knee or a sudden twist. Patients have local pain and tenderness along the ligament, swelling and sometimes a feeling of instability. In the clinical examination, the Valgus Stress test determines the degree of injury in the open knee position and bent 20-30 degrees; MRI imaging is recommended for complete evaluation of the ligament and adjacent structures. In grades 1 and 2 (minor to moderate tears), conservative treatment with RICE, stabilizing braces, and local strengthening physical therapy (especially of the hamstrings and quadriceps) is usually sufficient, and recovery occurs in 2–8 weeks. In a complete tear (Grade 3) or in combination with other injuries (eg ACL), ligament reconstruction surgery may be required. Physiotherapy exercises for knee pain include balance exercises on an oscillating treadmill, gentle stretching of the ligament and gradual progression of loading so that the person can return to sports activities smoothly. ### LCL Injury The lateral collateral ligament (in English: Lateral Collateral Ligament) is located in the outer part of the knee and prevents displacement and lateral deviation (varus). Usually, a blow to the inside of the knee or a twist with a fixed leg causes a complete or partial tear. The classic symptom is pain and swelling on the outer side of the knee along with a feeling of instability in bearing weight. The examination is performed with the Varus Stress test in the open/bent knee position and MRI imaging shows the severity of the injury and the presence of simultaneous lesions such as the lateral meniscus. In minor tears (Grade 1-2), non-surgical treatment with protection, bracing, ice and physical therapy combined with semi-load strengthening and balance exercises is effective. A complete tear with damage to other ligaments sometimes requires surgical repair. Physiotherapy for knee pain includes special exercises to strengthen the outer thigh muscles and balance exercises on the unstable board to restore the lateral stability of the knee and reduce the risk of recurrence. Meniscus tear Menisci are two pieces of C-shaped cartilage between the tibia and femur that play the role of shock absorbers and load distributors. Sudden twisting of the knee while bearing weight can cause medial or lateral meniscal tears. Patients usually have localized pain, swelling, locking, or "stiffness" of the knee and may not be able to fully extend or bend the knee. Diagnosis is made by clinical examination (McMurray test) and MRI confirmation to determine the type of tear (longitudinal, bucket-handle, flap) and blood supply area. In small and peripheral fragments with blood supply, conservative treatment with physical therapy (range of motion exercises, quadriceps and hamstring strengthening) and NSAIDs is sufficient. Large or locking tears require arthroscopy to cut or repair the meniscus. Physiotherapy after surgery with an emphasis on restoring the range of motion, strengthening muscles and balance exercises helps to quickly return to activity and prevents muscle atrophy. Patellar Dislocation Patella dislocation occurs when the patella is out of the lateral femoral groove and often occurs in young people and knees prone to instability during sudden twisting. The main symptom is sudden pain and swelling in front of the knee, and the patella may be visible in a prolapsed position. Clinical diagnosis is done with preliminary examination and radiography to rule out fracture; MRI is necessary to evaluate concomitant injuries such as MPFL (Medial Patellofemoral Ligament) tears. For simple sprains without severe cartilage or ligament damage, conservative treatment with immobilization vests, low-lock braces, and strengthening physical therapy for collateral ligaments and quadriceps strengthening is recommended. In cases of frequent recurrence or MPFL damage, ligament reconstruction surgery is necessary. Physiotherapy for knee pain focuses on VMO (Vastus Medialis Oblique) strengthening exercises, improving patellar motor mechanics and balance exercises to prevent instability. ### Patella tendinopathy (Jumper's Knee) Patellar tendinopathy or "jumper's knee" (Patellar Tendinitis) is an injury caused by frequent and excessive use of the patellar tendon that connects the patella to the tibia. Jumping sports such as volleyball, basketball and track and field increase the risk. The patient has pain in front of the knee, sensitivity to touch, and it often worsens with increased activity. Diagnosis is usually clinical, and MRI or ultrasound can show thickening of the tendon and signs of inflammation. Conservative treatment includes reduction of jumping-oriented activities, use of Patellar Strap brace and eccentric quadriceps strengthening exercises. Physical therapy for knee pain focuses on slow, controlled exercises for tendon strengthening, hamstring stretching, and core strengthening. Electrical stimulation and ultrasound may reduce pain and speed up the healing process. ### Iliotibial Band Syndrome (IT Band Syndrome) Iliotibial band syndrome occurs when the fibrous band from the hip to the outside of the knee causes friction, especially in runners and cyclists. The classic symptom is a sharp or burning pain on the outer side of the knee and sometimes mild swelling. Examination is done with Ober's test to detect band stiffness and MRI to rule out deeper injuries. Treatment includes relative rest, ice, NSAIDs, and physical therapy to stretch the IT band and strengthen the gluteal muscles. Foam rolling exercises, static stretching for the band, and hip stabilization strengthening exercises have a special place in the rehabilitation program to re-establish proper running mechanics. ### Knee Bursitis Bursae are fluid-filled sacs that reduce friction between tendons and bones. Knee bursitis (eg, precapillary bursitis, suprapatellar bursitis) can be caused by repetitive stress, trauma, or infection. Symptoms include local pain, swelling, and tenderness. Primary treatment is RICE and NSAIDs. In infectious bursitis, there is a need for aspiration and antibiotics. Physiotherapy for knee pain with range of motion exercises and strengthening the muscles around the knee helps improve performance and reduce pressure on the bursa. ### Osgood-Schlatter disease Tibial apophysitis (Osgood–Schlatter) occurs in adolescents during the growth spurt. Repeated stretching of the patellar tendon on the tibia causes inflammation and painful swelling under the knee. It mainly affects boys aged 10-15 years and girls aged 8-14 years, and the pain is worse with activity and improves with rest. The diagnosis is clinical and sometimes X‑ray shows separated bone fragments or swelling. Conservative treatment includes relative rest, ice, NSAID, quadriceps and hamstring stretching and low-stress activities such as exercise. Usually, with the end of the growth spurt, the pain stops and the bump remains, but it has no symptoms. By understanding the mechanism and symptoms of each of these injuries, a targeted and effective physiotherapy program can be designed so that the patient can quickly return to daily activities and sports and prevent recurrence. Principles of physiotherapy for knee pain 1. Detailed evaluation: Before any intervention, a complete evaluation including clinical examination, examination of range of motion, muscle strength and walking pattern is necessary to identify movement and structural disorders. 2. Muscle strengthening exercises: strengthening the quadriceps and hamstring muscles is the main goal; Studies have shown that increasing the strength of these muscles reduces joint load and pain by 30%. Resistance programs are designed with the principles of progressive overload (Progressive Overload) to gradually increase muscle power. 3. Improving Range of Motion: active and passive stretching exercises are performed to remove movement restrictions and reduce soft tissue stiffness; Maintaining or restoring full knee range is essential to prevent compensatory movements and secondary injuries. 4. Balance and proprioceptive exercises: exercises on unstable boards, Bush pillows, static and dynamic balance are designed to improve neuromuscular control and reduce the risk of falling and re-injury. 5. Manual therapy: mobilization and hand manipulation techniques are used to improve the quality and range of motion of the joint and reduce muscle spasms. 6. Patient education and self-management: Teaching how to perform daily activities, lifting techniques, and home exercises is essential to maintain treatment progress and prevent relapse. 7. Functional rehabilitation and targeted activities: The patient's daily and sports movements are identified and modified with specific exercises to ensure a safe return to normal activities. Physiotherapy modalities for knee pain - Cold and heat: Cryotherapy reduces pain and inflammation by reducing local blood flow. Thermotherapy reduces stiffness and improves range of motion by increasing blood flow and tissue elasticity. Therapeutic Ultrasound: It has been proven to produce deep heat, increase metabolism and accelerate the healing process of soft tissues. Meta-analysis studies show that ultrasound improves pain and function in the short term. - Neuromuscular electrical stimulation (TENS/NMES): TENS reduces pain with the control gate mechanism. NMES is used to improve muscle response and prevent atrophy after injury or surgery. - Low-Level Laser Therapy: By stimulating cellular processes, it reduces inflammation and accelerates tissue repair. - Iontophoresis: distribution of anti-inflammatory drugs through electric current without injection, is a non-invasive method to reduce pain and inflammation. - Kinesiotaping: By improving proprioception and reducing pressure on tissues, it relieves pain and improves performance. - Aquatic Therapy: The relative weightlessness and gentle resistance of water makes strengthening and stretching exercises possible without putting too much pressure on the joint. - Shockwave Therapy: high-energy sound waves are used to stimulate tissue repair and reduce chronic pain in some cases (initial evidence is promising). ### How to design a treatment plan for knee pain - The intensity and repetition of the exercises are adjusted according to the pain level and strength of the patient and are gradually increased. - Combining active and passive exercises with physical modalities makes the treatment more effective. - The regular use of modalities is planned separately in the acute phase (pain and inflammation reduction) and chronic phase (strengthening and rehabilitation). To relieve knee pain at home, focus on strengthening and stretching the muscles that support the knee—including the quadriceps, hamstrings, glutes, and calves. Key movements are clamshells, straight leg raises, sit-ups (chair squats), step-ups, glute bridges, seated knee extensions, and simple stretches for calves, hamstrings, and quadriceps. Performing 2-3 sets of each exercise with 10-20 repetitions (or holding the stretch for 30 seconds), 3-5 times per week, can improve stability, range of motion, and overall health of the knee joint. ### Suggested exercises to do at home for knee pain #### 1. Clamshell Lie on your side, thighs together and knees bent at about 90 degrees; Press the soles of the feet together and slowly lift the top knee towards the ceiling, hold for 2-3 seconds and then slowly lower. Do 15-20 repetitions on each side. This exercise strengthens the hip abductor and gluteus medius muscles, which play a role in knee stability in daily activities. #### 2. Straight‑Leg Raise Lie on your back, one knee bent and the sole of the foot on the floor, and the other leg completely straight. Engage the hamstrings and raise the straight leg about 30cm (1ft) off the floor, hold for 2-3 seconds and lower with control. Do 10-15 repetitions for each leg. This exercise strengthens the quadriceps without putting extra pressure on the knee joint. #### 3. Sit-to-Stand or Chair Squat Place a sturdy chair next to the wall, sit slightly forward and spread your legs shoulder-width apart. Stand up from the chair without using your hands and then sit down slowly. Do 3 sets of 10 repetitions. This movement is similar to everyday activities and strengthens the quadriceps and glutes while working normally. #### 4. Step-Up Have a step or platform 15–20 cm (6–8 in) high available. Place one foot on the step, push up with the heel, then slowly lower the back foot. Do 10-15 repetitions for each side, in 2-3 sets. This exercise improves lower body strength and balance with minimal pressure. #### 5. Glute Bridge Lie on your back, knees bent and feet hip-width apart on the floor. Push through the heels until the hips lift and the body is in a straight line from shoulder to knee, hold for 2-3 seconds, then lower. Do 10-12 repetitions. This movement engages the gluteal and hamstring muscles and takes the pressure off the knee. #### 6. Seated Knee Extensions Sit in a straight chair and place your feet flat on the floor. Slowly raise one knee without locking the joint until it reaches the hip level, hold for 3 seconds and then lower. Do 2 sets of 10 repetitions for each leg. These gentle movements strengthen the quadriceps and improve knee range of motion. #### 7. Calf Stretch Stand facing the wall and place your hands against the wall. Step one leg back, keeping the heel on the floor and keeping the knees straight until a stretch is felt in the calf. Hold for 30 seconds and then repeat on the other side. Stretching the leg will reduce the stiffness that may affect the knee. #### 8. Hamstring Stretch Lie on your back and straighten one leg as much as possible. Grasp the back of the thigh with your hands and slowly pull the straight leg towards you to create a stretch in the back of the thigh. Hold for 30 seconds and then repeat on the other side. A flexible hamstring reduces compensatory pressure on the knee. #### 9. Quadriceps Stretch Place both feet together and lean on a chair or wall with your hands for balance. Bend one knee and bring the heel to the hip, grab the ankle with the hand. Keep the knees close and push the hips forward slightly to feel a stretch in the front of the thigh. Hold for 30 seconds for each leg. Quadriceps flexibility helps track the patella better and reduce pain in the front of the knee. **Safety tips and recommendations** - Number of sessions: Do these exercises 3-5 times a week and gradually increase the number of sets or repetitions. - Progression: When exercises become easy, use resistance bands or light weights or increase the number of repetitions. - Pain control: You may feel some mild discomfort, but if you have sharp or worsening pain, stop the movement. - Warm-up/Cool-down: Warm up for 5 minutes before starting (such as slow jogging or walking) followed by gentle stretching to prevent stiffness. - Professional consultation: If the knee pain is new, severe or accompanied by swelling and locking, consult a specialist before starting an exercise program. **key points** - Before starting, consult with a physiotherapist to get a suitable program for your condition. - Gradual progress in the intensity and number of repetitions prevents pain from worsening. - If you experience severe pain or more swelling, stop the exercise and use the RICE (rest, ice, compression and elevation) method to reduce inflammation. Physiotherapist role and referral time By carefully evaluating your condition, the physiotherapist designs a specific program including strengthening, stretching and balance exercises. If there is no significant improvement after 4-6 weeks or the symptoms worsen (persistent swelling, locking of the knee), be sure to see a specialist. If you suffer from knee pain, Mana Physiotherapy is ready to serve you.