Knee pain is a common reason people seek physical therapy in Durham, NC. Knee pain can be a very frustrating injury and impact your workouts and daily life. However there is hope! Physical therapy is a great option for those dealing with knee pain and can help you get back to walking upstairs, squatting and running pain free.
In this blog we’ll cover the anatomy of the knee joint, common causes of knee pain, how physical therapy can help and provide you with stretches and exercises you can try to help start relieving your knee pain immediately.
Anatomy of the Knee Joint
The knee, known as a hinge joint, is a relatively stable joint, compared to the shoulder or hip, and its main function is to simply bend and straighten. The knee joint is made up of the thigh bone (called the femur),the shin bone (called the tibia) and the knee cap (the patella). The quad and hamstrings are the main muscles that influence the knee joint. The quad muscle straightens the knee while the hamstring bends it. The quad muscle converges just above the patella and turns into a tendon, which crosses the knee joint and attaches on the tibia. This tendon is called the patellar tendon.
In addition to the muscles, the knee joint is also comprised of the medial and lateral meniscus, which acts as a cushion between the femur and tibia, in addition to multiple ligaments throughout the joint to help hold it together.
Causes of Knee Pain
The most common cause of knee pain is overuse with running or lifting. While sudden injuries such as a fall, trip or car accident can also cause knee pain, we are going to focus on overuse injuries in this blog.
Overuse injuries typically occur as a result of two things – too quick of progression and / or compensation patterns that lead to the knee joint being over stressed.
An example of too quick of a progression would be someone who only runs 2-4 miles per week and suddenly increase their milage to 8-10 miles over a very short period of time. This sudden increase in training load doesn’t allow the body adequate time to recover and adapt to the demands placed on it. This can lead to pain in the knee joint or in the tendons and ligaments that surround the knee.
A common compensation pattern that can lead to knee pain is when the ankle and or hip are lacking adequate mobility. During a deep squat the ankle and the hip need to be able to flex, however if either joint is lacking full range of motion it can cause the knee joint to compensate by bending further than is comfortable or causing slight rotation at the knee joint. When this pattern is repeated it can lead to the knee joint becoming sore and painful.
Types Knee Injuries
Patellar Tendonitis
Patellar tendonitis, or jumpers knee, is an irritation of the patellar tendon. This is characterized by pain just below the knee cap and is typically felt with squatting, stairs, running or jumping. Patellar tendonitis typically occurs with an overuse of the quadriceps muscles, such as when someone has been doing a large volume of running, jumping or squatting above their normal volume. This leads to the quadriceps muscle becoming overwork and tight, which then pulls on the patellar tendon, leading to irritation.
Physical Therapy for patellar tendonitis includes adjusting training loads, stretching the quadriceps muscle and hands on work to the tendon to help decrease irritation.
IT Band Syndrome
IT band syndrome is characterized by pain on the outside, or lateral aspect of the knee. The IT band is a strong, thick band of tissue that originates out of the TFL muscles (which sits on the side of the hip) and attaches to the lateral aspect of the knee joint. The TFL, while not a muscle, helps to aid in stability of the lower leg.
Contrary to popular belief, the IT band itself does not stretch, however the IT band has intimate connections to the quad muscles and when the quad muscle becomes tight it can pull through the IT Band. When this happens, the attachment site of the IT Band gets pulled on and becomes irritated where it attaches to the bone.
Physical Therapy for IT band pain includes improving the stability of the hip joint to decrease the demand on the quad, quad stretching and manual therapy to the quad and IT band attachment to decrease irritation and improve blood flow.
Knee Joint Pain
General pain in the knee joint can be due to a number of factors including arthritis, irritation of the joint from compensation patterns or a wearing away of the meniscus. Many times the quad and hamstring muscles that support the knee joint have become weakened which also leads to increased stress being put on the joint.
Physical Therapy for knee joint pain includes doing joint mobilizations to improve blood flow and the mobility of the joint fluid, quad and hamstring strengthening and activity modification.
Physical Therapy for Knee Pain
Physical Therapy in Durham is a great option for those dealing with knee joint pain. The most important aspect of physical therapy for knee pain is identifying the root cause of the pain. Your physical therapist will take a thorough history, perform a movement evaluation and knee, hip and ankle specific exam to identify any flexibility or strength limitations.
From there, your physical therapist will create an individualized treatment plan. This plan may include hands on work such as cupping, massage or dry needling to help decrease your pain in addition to targeted exercises and stretches.
Typical treatment is going to be seeing your physical therapist about once a week over the course over 8-12 weeks depending on the severity of your pain and your goals. Most patients start to see a decrease in symptoms over the first month of treatment.
At Home Management of Knee Pain
While seeing a physical therapist is recommended for individualized treatment, here are a few great stretches and exercises that you can begin working on at home to decrease your knee pain and improve your strength
Quad Foam Rolling
Foam rolling is a great way to decrease tightness and self-massage tight muscles. Start with 2 minutes of foam rolling to each leg at least once per day.
Quad Stretching
Stretching the quad muscle is a great way to help improve flexibility. Start with at least 30 seconds each leg, once per day.
Glute Bridges
The glute bridge is an excellent way to strengthen the hips and hamstrings, two muscles that play an important role in supporting the knee. Start with 15-20 reps for 2 sets, once per day.
Side Steps
Side steps are another excellent way to strengthen the glutes. Make sure you hinge at the hips (think nose over toes and push your bottom backwards) to ensure better activation of the glutes. Start with 10-15 reps each way, once per day.
If none of the above exercises help resolve your knee pain you may also need to try strengthening your core and stretching your calves and ankles. This is because a weak core can cause compensation patters and tightness in the ankles and calves can also contribute to more stress being put on the knee. Below is an exercise for each.
Calf Stretch
Start with 30 seconds each leg, once per day.
Dead Bug
Start with 10-16 reps, for 2 sets.
If you’re still struggling with knee pain, seek help from a physical therapist. We have helped numerous individuals overcome knee pain and get back to the activities and workouts they love, pain free. Contact us today to get started!
