Knee

At Walker and Hall we know through personal experience how any condition affecting the knee can have an enormous effect on every aspect of your life e.g., from standing and walking, to commuting to sports and leisure activities.

The most common types of knee pain we treat are:

Arthritis of the knee
Ligament tear on the inside of the knee (Medial Collateral Ligament tear)
Ligament tear on the outside of the knee (Lateral Collateral Ligament tear)
Anterior Knee Pain
Cartilage tear on the inside of the knee (Medial Meniscus Tear)
Cartilage tear on the outside of the knee (Lateral Meniscus Tear)
Anterior Cruciate Ligament tear – ACL Tear
Posterior Cruciate Ligament tear – PCL Tear
Dislocated knee cap
Osgood Schlatters Disease
Iliotibial Band Syndrome
Referred pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below:

• Arthritis of the knee
• Ligament tear on the inside of the knee (Medial Collateral Ligament tear)
• Ligament tear on the outside of the knee (Lateral Collateral Ligament tear)
• Anterior Knee Pain
• Cartilage tear on the inside of the knee (Medial Meniscus Tear)
• Cartilage tear on the outside of the knee (Lateral Meniscus Tear)
• Anterior Cruciate Ligament tear – ACL Tear
• Posterior Cruciate Ligament tear – PCL Tear
• Dislocated knee cap
• Osgood Schlatters Disease
• Iliotibial Band Syndrome
• Referred pain

MCL Tear – Medial Collateral Ligament (also known as MCL Injury, Medial Collateral Ligament Tear, Torn MCL, MCL Sprain, Sprained MCL, Ruptured MCL)

This is the most common ligament injury of the knee we treat and we know through our experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The medial collateral ligament (MCL) is a strong band of connective tissue which is situated on the inside of the knee and is responsible for joining the inner aspect of the thigh bone (femur) to the inner aspect of the shin bone (tibia). The MCL is one of the most important ligaments of the knee, giving it stability. It achieves this by preventing excessive twisting and side to side movements of the knee. When these movements are excessive and beyond what the ligament can withstand, tearing to the MCL occurs. This condition is known as a MCL tear.

An MCL tear may range from a small partial tear resulting in minimal pain, to a complete rupture of the MCL resulting in significant pain and disability. Like all ligament tears, an MCL tear can be graded as follows:

• Grade 1 tear – a small number of fibres are torn resulting in some pain but allowing full function
• Grade 2 tear – a significant number of fibres are torn with moderate loss of function.
• Grade 3 tear – all fibres are ruptured resulting in knee instability and major loss of function.

Other structures may also be injured such as the cartilage (menisci) and cruciate ligaments.

Causes of an MCL tear

• Excessive strain on the knee – any activity that places excessive strain on the MCL can cause an MCL strain. It often occurs suddenly due to a specific incident, but occasionally it may occur due to repetitive strain.

There are two main movements that place stress on the MCL:

• twisting of the knee
• side to side forces on the knee (valgus force)

When these movements, or a combination of them, are excessive and beyond what the ligament can withstand, an MCL injury may occur. This often occurs in contact sports and sports requiring a rapid change in direction e.g., football, netball and basketball.

The usual mechanism of injury is a twisting movement when weight-bearing e.g., when landing from a jump or due to a collision to the outer knee, forcing the knee to bend in the wrong direction – such as another player falling across the outside of the knee e.g., a tackle in rugby.

Signs and Symptoms of an MCL tear

• Pain – in minor cases of an MCL tear you may be able to continue the aggravating activity only to experience an increase in pain, swelling and stiffness in the knee after the activity with rest, particularly on waking the following morning. Often the pain is situated on the inner aspect of the knee. In cases of a complete rupture of the MCL the pain is usually severe at the time of injury, but it may sometimes quickly subside. You may also experience a feeling of the knee going out and then going back in as well as a rapid onset of swelling (within the first few hours following injury). With a complete MCL tear you will be unable to continue with the aggravating activity due to the pain or a feeling that the knee is unstable. Occasionally you may be unable to weight bear at the time of injury due to the pain and may develop bruising and knee stiffness over the coming days.
• Swelling, bruising and joint stiffness – all these symptoms can be associated with an MCL tear
• An audible “snap” – you might notice an audible “snap” or tearing sound at the time of injury

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the damage to the medial collateral ligament. This is essential if optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a medial collateral ligament strain are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport, usually at the 3 – 6 week mark depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

LCL Tear – Lateral Collateral Ligament (also known as a LCL Tear, LCL Injury, Torn LCL, Lateral Collateral Ligament Tear, LCL Sprain, Sprained LCL, Ruptured LCL)

This is a common ligament injury of the knee we treat at Walker and Hall and we know through our experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The lateral collateral ligament (LCL) is a strong band of connective tissue which is situated at the outer aspect of the knee joint and is responsible for joining the outer aspect of the thigh bone (femur) to the outer aspect of the outer lower leg bone (fibula). The LCL is one of the most important ligaments of the knee, giving it stability. It achieves this by preventing excessive twisting and side to side movements of the knee. When these movements are excessive and beyond what the ligament can withstand, tearing to the LCL occurs. This condition is known as an LCL tear.

An LCL tear may range from a small partial tear resulting in minimal pain, to a complete rupture of the LCL resulting in significant pain and disability. Like all ligament tears, an LCL tear can be graded as follows

• Grade 1 tear – a small number of fibres are torn resulting in some pain but allowing full function
• Grade 2 tear – a significant number of fibres are torn with moderate loss of function.
• Grade 3 tear – all fibres are ruptured resulting in knee instability and significant loss of function.

Other structures may also be injured such as the cartilage (menisci) or cruciate ligaments.

Causes of an LCL tear

• Excessive strain on the knee – any activity that places excessive strain on the LCL can cause an LCL strain. If often occurs suddenly due to a specific incident, but occasionally it may occur due to repetitive strain.

There are two main movements that place stress on the LCL:

• twisting of the knee
• side to side forces on the knee (varus forces)

When these movements, or a combination of them, are excessive and beyond what the LCL can withstand, an LCL tear may occur. This often occurs in contact sports and sports requiring a rapid changes in direction e.g., football, netball and basketball.

The usual mechanism of injury is a twisting movement when weight-bearing e.g., when landing from a jump or due to a collision to the inner knee, forcing the knee to bend in the wrong direction such as another player falling across the inside of the knee e.g., a tackle in rugby

Signs and Symptoms of a LCL tear

• Pain – in minor cases of an LCL tear you may be able to continue activity only to experience an increase in pain, swelling and stiffness in the knee after activity with rest, particularly on waking the following morning. Often the pain is situated on the outer aspect of the knee. In cases of a complete rupture of the LCL the pain is usually severe at the time of injury but it may sometimes quickly subside. You may also experience a feeling of the knee going out and then going back in as well as a rapid onset of swelling (within the first few hours following injury). With a complete rupture of the LCL you will be unable to continue with the aggravating activity due to pain or a feeling of instability in the knee. Occasionally you may be unable to weight bear at the time of injury due to pain and may develop bruising and knee stiffness over the coming days.
• Swelling, bruising and joint stiffness – all these symptoms can be associated with an LCL tear
• An audible “snap” – you might notice an audible “snap” or tearing sound at the time of injury

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the damage to the lateral collateral ligament and this is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a lateral collateral ligament strain are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport, usually at the 3 – 6 week mark depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Anterior Knee Pain (also known as Patellofemoral Pain Syndrome, Patellofemoral Syndrome, Patellofemoral Joint Syndrome, PFJ Syndrome, Chondromalacia Patellae, Patella Pain Syndrome, Runner’s Knee)

Anterior knee pain is a condition we often treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The knee joint is actually comprised of 3 bones i.e., the long bone of the thigh (femur), the shin bone (tibia) and the knee cap (patella). The patella is situated at the front of the knee and lies within the tendon of the quadriceps muscle i.e., the muscle at the front of the thigh. The quadriceps tendon envelops the patella and attaches to the top end of the tibia. As a result the knee cap sits on the front of the femur forming a joint in which the bones are almost in contact with each other. The surface of each bone is lined with cartilage to allow cushioning between the bones when the joint moves and this joint is called the patellofemoral joint.

Normally, the patella “sits” in the middle of the patellofemoral joint so that forces applied to the knee cap during activity are evenly distributed. However in patients with patellofemoral pain syndrome the patella is usually misaligned and as a consequence this may place more stress through the patellofemoral joint during activity. As a result this can cause pain and inflammation of the patellofemoral joint.

Causes of anterior knee pain

This misalignment of the patella may occur for a variety of reasons.

• Muscle imbalance – the quadriceps muscle comprises 4 muscle bellies of which 2 lie in the middle i.e., rectus femoris and vastus intermedius, one lies on the inside of the leg i.e., vastus medialis and the other on the outside of the leg i.e., vastus lateralis. In the majority of patellofemoral pain syndrome cases, the outer quadriceps (vastus lateralis) is stronger than the inner quadriceps (vastus medialis), resulting in the patella (knee cap) being pulled towards the outside of the leg. This may result in abnormal movement of the knee cap when bending and straightening the knee.
• Anterior knee pain often affects young people (adolescents) at a time of increased growth and usually affects girls more than boys.
• In older patients the patellofemoral pain is associated with degenerative joint changes.

Signs and symptoms of anterior knee pain

• Pain – usually felt at the front of the knee and around and or under the knee cap. It can sometimes be felt at the back of the knee or on the inner or outer aspects. It is usually felt as an ache that increases to a sharp pain with activity. It is typically experienced during activities that bend or straighten the knee particularly whilst weight bearing such as going up and down stairs, walking up and down hills, squatting, running and jumping. Occasionally it may be felt whilst sitting with the knee bent for prolonged periods.
• Clicking and grinding sound when bending or straightening the knee
• Giving way or collapsing due to pain
• Quadriceps muscle wasting – in particular over the inner aspect of the thigh (vastus medialis oblique – VMO)

There are a number of factors which can predispose you to anterior knee pain and a few of these are

• muscle strength imbalances
• muscle weakness (especially the VMO and gluteal muscles)
• tightness in specific joints (hip, knee or ankle)
• tightness in specific muscles (especially the ITB or quadriceps)
• poor lower limb biomechanics
• excessive or inappropriate training or activity
• inappropriate footwear or training surfaces
• poor foot posture
• poor training technique

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the anterior knee pain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for anterior knee pain are

• Ice or heat (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint patellofemoral mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Patellofemoral and knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Biomechanical correction
• Home exercise programme – a graduated flexibility, balance and strength (especially the VMO muscle) programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Medial Meniscus Tear (also known as Medial Meniscal Tear, Torn Medial Meniscus, Medial Cartilage Tear, Medial Meniscal Dysfunction, Bucket Handle Tear of the Medial Meniscus, Torn Meniscus)

This is an injury characterized by the tearing of cartilage tissue located at the inner aspect of the knee. It is a condition we treat regularly at Walker and Hall and from our experience it responds well to the appropriate physiotherapy treatment.

Anatomy

The knee joint is the joining of two bones i.e., the long bone of the thigh (femur) and the shin bone (tibia). Between the bone ends within the knee joint are 2 round cartilage discs called the medial (inner) and lateral (outer) meniscii (cartilages).
Each meniscus acts as a shock absorber cushioning the impact of the femur on the tibia during weight-bearing activity. Normally the surface of the meniscus is very smooth allowing easy movement of the femur on the tibia but occasionally, due to excessive weight bearing and or twisting forces, the meniscus can be torn or damaged so that the surface is no longer smooth. When this occurs it is known as a medial meniscus tear.

Injuries to the medial meniscus are more common than lateral meniscus injuries and occasionally they may occur in association with other structures of the knee such as the cruciate ligaments, the collateral ligaments and or the lateral meniscus.

Causes of a medial meniscus tear

• Trauma – due to excessive weight bearing and twisting forces, e.g., during sports that require a sudden change of direction, involve twisting movements and may be performed in combination with excessive straightening or bending of the knee. These may include rugby, football, basketball and netball.

Medial meniscal tears frequently take place when the foot is fixed on the ground and a twisting force is applied to the knee e.g., when another player’s body falls across the leg, or when a player is tackled, or following a forceful jump or landing.

• Wear and tear and overuse – a torn meniscus may occur over time through gradual wear and tear associated with overuse. This typically occurs in association with repetitive or prolonged weight bearing or twisting forces that are beyond what the meniscus can withstand e.g., excessive distance running. Overuse meniscal injuries may also be associated with degenerative changes to the knee joint. In older patients where degenerative changes are present, injury to the medial meniscus may occur with a relatively trivial movement.

There are a number of factors which can predispose you to a medical meniscus tear and a few of these are:

• muscle weakness (particularly of the quadriceps, hamstrings or gluteals)
• muscle tightness (particularly of the quadriceps, hamstrings or calf)
• inappropriate or excessive training
• inadequate warm up
• joint stiffness (especially the knee, hip or ankle)
• poor biomechanics
• inadequate rehabilitation following a previous knee injury
• decreased fitness
• fatigue
• poor pelvic and core stability

Signs and symptoms of a medial meniscus tear

• Pain – a sudden, sharp pain over the inner aspect, front or back of the knee at the time of injury. The pain will be associated with weight bearing activity and twisting movements of the knee. You may also experience pain when climbing stairs, attempting to kneel and when squatting

In minor cases of a medial meniscus tear there may be little or no immediate symptoms. However the symptoms may develop gradually over the following days, typically with an increase in weight bearing or twisting activity. In more severe cases there may be severe pain and significant restriction in knee range of movement

• Swelling – this is often present and may occur a few hours after injury or, more commonly, in the following days
• Tenderness – this may be experienced on firmly touching the knee joint over the inner aspect of the knee
• Intermittent locking, clicking sensations and episodes of giving way or collapsing – these may all be present to a varying degree and may occur during certain movements
• Walking with a limp
• An audible sound or a tearing sensation – at the time of injury

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the torn medial meniscus. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a torn medial meniscus are

• Ice or heat (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated flexibility, balance and strength (especially the VMO muscle) programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment

With a minor medial meniscus tear you can usually expect to return to sport or activity in approximately 2 – 4 weeks. For a moderate tear you would expect a return to sport or activity in approximately 4 – 6 weeks or longer.

• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Despite the appropriate physiotherapy treatment a small percentage of minor meniscal tears fail to improve and may require surgery for an optimal outcome. The majority of large meniscal tears also require surgery. This is particularly true in those cases where the knee is ‘locked’. Surgery for medial meniscus tears is minimally invasive and the procedure is called a knee arthroscopy

Lateral Meniscus Tear (also known as a Lateral Meniscal Tear, Torn Lateral Meniscus, Lateral Cartilage Tear, Lateral Meniscal Dysfunction, Bucket Handle Tear of the Lateral Meniscus, Torn Meniscus, Torn Cartilage)

This is an injury characterized by the tearing of cartilage tissue located at the outer aspect of the knee. It is a condition we treat a lot at Walker and Hall and from our experience it responds well to the appropriate physiotherapy treatment.

Anatomy

The knee joint is the joining of two bones i.e., the long bone of the thigh (femur) and the shin bone (tibia). Between the bone ends within the knee joint are 2 round cartilage discs called the medial (inner) and lateral (outer) meniscii (cartilages).
Each meniscus acts as a shock absorber cushioning the impact of the femur on the tibia during weight-bearing activity. Normally the surface of the meniscus is very smooth allowing easy movement of the femur on the tibia however occasionally, due to excessive weight bearing and or twisting forces, the meniscus can be torn or damaged so that the surface is no longer smooth. When this occurs to the lateral meniscus, it is known as a lateral meniscus tear.

Injuries to the lateral meniscus are less common than medial meniscus injuries and occasionally they may occur in association with other structures of the knee such as the cruciate ligaments, the collateral ligaments and or the lateral meniscus.

Causes of a lateral meniscus tear

• Trauma – due to excessive weight bearing and twisting forces, e.g., during sports that require a sudden change of direction, involve twisting movements and may be performed in combination with excessive straightening or bending of the knee. These may include rugby, football, basketball and netball.

Lateral meniscal tears frequently take place when the foot is fixed on the ground and a twisting force is applied to the knee e.g., when another player’s body falls across the leg, or when a player is tackled, or following a forceful jump or landing

• Wear and tear and overuse – a torn meniscus may occur over time through gradual wear and tear associated with overuse. This typically occurs in association with repetitive or prolonged weight bearing or twisting forces that are beyond what the meniscus can withstand e.g., excessive distance running. Overuse meniscal injuries may also be associated with degenerative changes to the knee joint. In older patients where degenerative changes are present, injury to the lateral meniscus may occur with a relatively trivial movement.

There are a number of factors which can predispose you to a lateral meniscus tear, a few of these are:

• muscle weakness (particularly of the quadriceps, hamstrings or gluteals)
• muscle tightness (particularly of the quadriceps, hamstrings or calf)
• inappropriate or excessive training
• inadequate warm up
• joint stiffness (especially the knee, hip or ankle)
• poor biomechanics
• inadequate rehabilitation following a previous knee injury
• decreased fitness
• fatigue
• poor pelvic and core stability

Signs and symptoms of a lateral meniscus tear

• Pain – a sudden, sharp pain over the outer aspect, front or back of the knee at the time of injury. The pain will be associated with weight bearing activity and twisting movements of the knee. You may also experience pain when climbing stairs, attempting to kneel and when squatting.

In minor cases of a lateral meniscus tear there may be little or no immediate symptoms. In this case the symptoms may develop gradually over the following days, typically with an increase in weight bearing or twisting activity. In more severe cases however there may be severe pain and significant restriction in knee range of movement

• Swelling – this is often present and may occur a few hours after injury or, more commonly, in the following days
• Tenderness – this may be experienced on firmly touching the knee joint over the outer aspect of the knee
• Intermittent locking, clicking sensations and episodes of giving way or collapsing – these may all be present to a varying degree and may occur during certain movements
• Walking with a limp
• An audible sound or a tearing sensation – at the time of injury

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the torn lateral meniscus. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a torn lateral meniscus are

• Ice or heat (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated flexibility, balance and strength (especially the VMO muscle) programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment

With a minor lateral meniscus tear you can usually expect to return to sport or activity in approximately 2 – 4 weeks. For a moderate tear you would expect a return to sport or activity in approximately 4 – 6 weeks or longer.

• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Despite the appropriate physiotherapy treatment a small percentage of minor meniscal tears fail to improve and may require surgery for an optimal outcome. The majority of large meniscal tears also require surgery. This is particularly true in those cases where the knee is ‘locked’. Surgery for lateral meniscus tears is minimally invasive and the procedure is called a knee arthroscopy

ACL Tear – Anterior Cruciate Ligament Tear (also known as Torn ACL, ACL Sprain, Sprained ACL, ACL Injury, Ruptured ACL)

This is a relatively common sporting injury and is characterized by the tearing of the anterior cruciate ligament (ACL) of the knee. It is a condition we often treat at Walker and Hall and from our experience it responds well to the appropriate physiotherapy treatment.

Anatomy

A ligament is a strong band of connective tissue which attaches bone to bone. The ACL is located within the knee joint and is responsible for joining the back of the thigh bone (femur) to the front of the shin bone (tibia).

The ACL is one of the most important ligaments in the knee giving it stability. It achieves this by preventing excessive twisting, straightening of the knee (hyperextension) and forward movement of the tibia on the femur. When these movements are excessive and beyond what the ACL can withstand, tearing to the ACL occurs. This is known as an ACL tear.

Like all ligament strains, an ACL tear may range from a small partial tear resulting in minimal pain, to a complete rupture of the ACL resulting in significant pain and disability, and potentially requiring surgery. An ACL tear can be graded as follows

• Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function
• Grade 2 tear: a significant number of fibres are torn with moderate loss of function.
• Grade 3 tear: all fibres are ruptured resulting in knee instability and major loss of function. Often other structures are also injured such as the menisci or collateral ligaments. Surgery is often required.

Causes of an ACL tear

• Excessive strain on the ACL – this mainly occurs suddenly due to a specific incident, although it may occur as a result of repetitive strain.

There are three main movements that place stress on the ACL. These include

• twisting of the knee
• hyperextension of the knee
• forward movement of the tibia on the femur.

When any of these movements, or a combination of them, are excessive and beyond what the ACL can withstand, tearing of the ACL may occur. Of these movements, twisting is the most common cause of an ACL tear.
ACL tears are frequently seen in contact sports or sports requiring rapid changes in direction. These may include: football, netball and basketball etc. The usual mechanism of injury for an ACL tear is a twisting movement when weight-bearing (especially when landing from a jump) or due to a collision forcing the knee to bend in the wrong direction (such as another player falling across the outside of the knee). Occasionally an ACL injury may occur during a sudden deceleration when running.

Signs and Symptoms of an ACL tear

• Pain – sudden in onset and felt at the time of injury. It often presents as pain that is deep within the knee and poorly localized. In minor cases you may be able to continue with the activity only to experience an increase in pain, swelling and stiffness within the knee after the activity with rest, especially on waking the following morning

In cases of a complete rupture of the ACL, it is usually severe at the time of the injury, but may sometimes quickly subside. Often you cannot continue the aggravating activity as the knee may feel unstable, or may collapse during certain movements especially twisting. Occasionally you may be unable to weight bear at the time of injury due to the pain, may develop bruising and knee stiffness over the next 1 – 3 days and be unable to fully straighten the knee. You may also experience recurrent episodes of the knee giving way following the injury

• Swelling and bruising – rapid onset of extensive swelling within the first few hours following injury
• Loss of movement – see above
• Inability to weight bear – see above
• Audible snap or tearing sound – this may be heard or felt within the knee at the time of injury
• Instability – you may experience a feeling of the knee going out and then going back in again.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the damage to the anterior cruciate ligament and this is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for an anterior cruciate ligament strain are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Muscle strengthening techniques – one of the key components of ACL rehabilitation is pain free strengthening of the quadriceps, hamstring and gluteal muscles to improve the control of the knee joint with weight-bearing activities
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport – grades 1 and 2 ligament tears can usually return to sport within 2 – 8 weeks, depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Complete ruptures of the ACL require surgical reconstruction followed by rehabilitation of 6 – 12 months or longer to gain optimum function. Often when the ACL is damaged other structures within the knee are damaged as well – such as the meniscus and collateral ligaments. If this is the case then the rehabilitation period is likely to be longer than 6 – 12 months

PCL Tear – Posterior Cruciate Ligament (also known as PCL Injury, Posterior Cruciate Ligament Tear, Torn PCL, PCL Sprain, Sprained PCL, Ruptured PCL)

This is a relatively common sporting injury and is characterized by tearing of the posterior cruciate ligament (PCL) of the knee. It is a condition we often treat at Walker and Hall and from our experience it responds well to the appropriate physiotherapy treatment.

Anatomy

A ligament is a strong band of connective tissue which attaches bone to bone. The PCL is located within the knee joint and is responsible for joining the front of the thigh bone (femur) to the back of the shin bone tibia).

The PCL is one of the most important ligaments of the knee giving it stability. The PCL achieves this role by preventing excessive twisting, straightening of the knee (hyperextension) and backward movement of the tibia on the femur. When these movements are excessive and beyond what the PCL can withstand, tearing to the PCL occurs. This condition is known as a PCL tear.

Like all ligament strains, a PCL tear may range from a small partial tear resulting in minimal pain, to a complete rupture of the PCL resulting in significant pain and disability, and potentially requiring surgery. A PCL tear can be graded as follows:

• Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function
• Grade 2 tear: a significant number of fibres are torn with moderate loss of function.
• Grade 3 tear: all fibres are ruptured resulting in knee instability and major loss of function. Often other structures are also injured such as the menisci or collateral ligaments. Surgery may be required.

Causes of a PCL tear

• Excessive strain on the PCL – this mainly occurs suddenly due to a specific incident, but occasionally may occur due to repetitive strain.

There are three main movements that place stress on the PCL, these include

• twisting of the knee
• hyperextension of the knee
• backward movement of the tibia on the femur.

When any of these movements (or combinations of these movements) are excessive and beyond what the PCL can withstand, tearing of the PCL may occur.
PCL tears are often seen in contact sports or sports requiring rapid changes in direction. These may include: football, netball and basketball etc. The usual mechanism of injury for a PCL tear is either a hyperextension force (e.g. where a player falls across the front of the knee causing it to straighten excessively) or due to a direct blow to the front of the shin bone with the knee in a bent position. Occasionally a PCL tear may occur during twisting movements particularly when landing from a jump.

Signs and Symptoms of a PCL tear

• Pain – sudden in onset, felt at the time of injury and poorly localised, frequently being felt deep within the knee or at the back of the knee and sometimes involving the calf. In minor cases you may be able to continue the aggravating activity only to experience an increase in pain, swelling and stiffness after ceasing the activity whilst resting and particularly first thing in the morning. In cases of a complete rupture the pain is usually severe at the time of injury, but sometimes may quickly subside.

With a complete PCL rupture generally you cannot continue activity as the knee may feel unstable or may collapse during certain movements. Swelling may develop immediately or over a number of hours, although this may vary from person to person. Occasionally you may be unable to weight bear at the time of injury due to pain and may develop bruising and knee stiffness over the coming days. You may also experience recurrent episodes of the knee giving way following the injury.

• Swelling and bruising – rapid onset of extensive swelling within the first few hours following injury
• Loss of movement – see above
• Inability to weight bear – see above
• Audible snap or tearing sound – this may be heard or felt within the knee at the time of injury
• Instability – you may experience a feeling of the knee going out and then going back in again

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the damage to the posterior cruciate ligament and this is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a posterior cruciate ligament strain are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Muscle strengthening techniques – one of the key components of PCL rehabilitation is pain-free strengthening of the quadriceps, hamstring, gluteal and calf muscles to improve the control of the knee joint with weight-bearing activities
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport. With grades 1 and 2 ligament tears you can usually return to sport within 2 – 8 weeks, depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Complete ruptures of the PCL require surgical reconstruction followed by rehabilitation of 6 – 12 months or longer to gain optimum function. Often when the PCL is damaged other structures within the knee are damaged as well – such as the meniscus and collateral ligaments – and if this is the case the rehabilitation period is likely to be longer than 6 – 12 months

Dislocated knee cap (also known as Patella Dislocation, Dislocated Patella, Knee Cap Dislocation, Knee Dislocation)

This is a relatively common traumatic sporting injury and is characterized by tearing of the connective tissue surrounding the knee cap (patella) along with dislocation of the patella i.e., it comes completely out of its normal position. It is a condition we have considerable experience treating and it responds well to the appropriate physiotherapy treatment.

Anatomy

The knee joint consists of 3 bones – the long bone of the thigh (femur), the shin bone (tibia) and the knee cap (patella). The patella (knee cap) is situated at the front of the knee and lies in a groove at the front of the thigh bone. The tendon of the quadriceps muscle, the muscle on the front of the thigh, envelops the patella and attaches to the top end of the tibia. Due to this relationship, the knee cap sits on the front of the femur forming a joint in which the bones are almost in contact with each other. The surface of each bone is lined with cartilage to allow cushioning between the bones. The patella also has strong bands of connective tissue known as the patella retinaculum attaching the knee cap on either side of the femur. This joint is called the patellofemoral joint.

Normally, the patella is aligned in the middle of the patellofemoral joint and is held firmly in place by the quadriceps muscle and patella retinaculum. Occasionally, the patella may be pushed completely out of its normal position. This normally occurs due to traumatic forces pushing the patella out of position beyond what the quadriceps and patella retinaculum can withstand. When this occurs the condition is known as patellar dislocation – dislocated knee cap.

Patellar dislocation usually occurs in a direction towards the outside of the knee i.e., away from the other leg. During dislocation, tearing and disruption of the patellar retinaculum usually occurs. The joint surfaces may also be damaged and occasionally there may be an associated fracture. In many cases of patellar dislocation, the patella spontaneously moves back into its original position often with straightening of the knee.

Causes of patellar dislocation

• Trauma – usually due to excessive twisting or jumping forces or due to a direct blow (usually to the inner aspect of the patella)
• Hyper-mobility – occasionally, mainly in young girls, patella dislocation can occur in the absence of trauma, especially if they are hyper-mobile.

Patients with this condition are frequently seen in contact sports or sports requiring rapid changes in direction, such as football or rugby.

There are a number of factors which can predispose you to patellar dislocation and a few of these are

• muscle weakness (especially the quadriceps (VMO), gluteals or hamstrings)
• tight lateral (outer) structures, such as the lateral patella retinaculum or iliotibial band (ITB)
• “loose” medial (inner) patella retinaculum
• general hypermobility (ligament laxity)
• a shallow femoral groove (i.e. the groove that the knee cap sits within)
• genu valgum (‘knock knees’)
• femoral anteversion (where the thigh bones turn inward)
• patella alta (abnormally high patella in relation to the thigh bone)
• poor lower limb biomechanics (flat feet, increased Q angle)
• muscle tightness (e.g. vastus lateralis, ITB, hip internal rotators, calf’s)
• poor balance
• poor pelvic or core stability
• poor landing strategies
• poor coordination
• gender (i.e. greater likelihood in females)
• certain stages of the menstrual cycle (e.g. at mid-cycle (ovulation) when oestrogen peaks and ligament laxity increases)
• fatigue

Signs and symptoms of patellar dislocation

• Pain – a sudden intense pain at the front of the knee during injury, it is usually associated with a feeling of the knee ‘giving way’ or of something ‘popping out’.

Once the patella has returned to its original position following dislocation, you may experience an ache that increases to a sharp pain with activity. The pain is usually experienced during activities that bend or straighten the knee especially whilst weight bearing. Activities that frequently aggravate symptoms include going up and down stairs or hills, squatting, lunging, running, jumping and attempting to kneel. The pain typically increases on firmly touching the edges of the patella i.e., along the patellar retinaculum.

• Rapid onset of knee swelling within the first 1-2 hours following injury
• Deformity – there may be a noticeable visible deformity of the knee owing to the knee cap moving out of position, normally to the outer aspect of the knee, when compared to the unaffected knee. In patients who have experienced recurrent episodes of patellar dislocation, the knee cap may easily move back into its original position with certain knee movements – normally straightening of the knee. In these cases, pain and swelling may also be relatively minimal.
• Clicking and grinding sounds associated with bending and straightening the knee
• Episodes of the knee giving way or collapsing due to pain
• Wasting of the thigh (quadriceps) muscles in long standing cases

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the damage to the patella and the knee joint. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a dislocated patella are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Patella taping or bracing to correct the tracking of the patella
• Home exercise programme – a graduated flexibility, balance and strength (especially the VMO muscle) programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport, usually at the 3 – 6 week mark depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Knee Arthritis – Osteoarthritis (also known as Knee Osteoarthritis, Osteoarthritis of the Knee, Arthritis of the Knee, Degeneration of the Knee)

Arthritis of the knee is a condition characterized by “wear and tear” of the surfaces of the joint associated with inflammation.

At Walker and Hall we know through personal experience how painful and limiting an arthritic knee can be, affecting all aspects of your life, in particular standing, walking and going up and down stairs.

It is a condition that can be extremely frustrating but it does respond well to the appropriate physiotherapy treatment.

Anatomy

The knee joint is the joining of two bones i.e., the long bone of the thigh (femur) and the shin bone (tibia) and they are held in place by the joint capsule and ligaments i.e., anterior and posterior cruciate ligaments and medial and lateral collateral ligaments. The capsule contains fluid (synovial fluid) that lubricates the joint and the bony joint surfaces are coated with cartilage which provides shock absorption and enables friction-free movement.

When the knee is damaged or overloaded, particularly with excessive weight-bearing or twisting forces, degeneration of the cartilage occurs which reduces the knee’s shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth and may have small bony processes called osteophytes. This condition is known as knee arthritis.

Causes of knee arthritis

• This may be caused by a specific injury or due to repetitive forces going through the knee beyond what it can withstand over a period of time. It usually occurs in people over the age of 50 and is more common in people who are overweight or have a past history of injury or trauma to the knee.

Signs and symptoms of knee arthritis

• Pain and stiffness – this usually develops gradually over a period of time. In minor cases of knee arthritis, little or no symptoms may be present but as the condition progresses, there may be an increase in knee pain with weight bearing activity and joint stiffness – particularly after rest and on waking first thing in the morning.
• Swelling and reduced flexibility i.e. an inability to fully straighten or bend the knee
• Severe joint pain, pain at night and grinding sensation during certain movements may also be experienced
• Fluctuating symptoms – symptoms can sometimes fluctuate from month to month with an increase in symptoms with colder weather
• Muscle wasting – often associated with more severe cases of arthritis and may affect both the quadriceps on the front of the thigh and the hamstrings on the back
• Deformity of the knee joint
• Limp – in more severe cases a limp may be present whilst weight bearing

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine the extent of the arthritis in the knee. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for an arthritic knee include:

• advice with regards to remaining as active as possible without aggravating the knee. It can sometimes be difficult to find the right balance between exercise and rest but this is a really important feature of the treatment of knee pain
• advice with regards to the use of crutches and other walking aids
• advice with regards to the use of ice or heat treatment at home
• joint mobilization techniques to improve the range of movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasms
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility and strength
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Osgood Schlatters Disease – OSD (also known as Tibial Apophysitis)

This is a relatively common condition of the knee affecting adolescents between the ages of 10 and 15 years. It refers to an injury to the growth plate at the top of the shin bone (tibia) just below the knee cap.

At Walker and Hall we know through personal experience how painful and limiting Osgood Schaltters Disease can be, affecting all aspects of your life, from school to sports and leisure activities. However it does respond well to the appropriate physiotherapy treatment.

Anatomy

The muscle group at the front of your thigh is called the quadriceps. As it passes down the thigh it attaches to the knee cap (patella) which in turn attaches to the top of the shin bone (tibia) via the patella tendon (figure 1).

In people who have not reached skeletal maturity, a growth plate exists where the patella tendon inserts into the shin bone. This growth plate is primarily comprised of cartilage. Every time the quadriceps contracts, it pulls on the patella tendon which in turn pulls on the tibia’s growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur resulting in pain and sometimes an increased bony prominence at the front of the shin. This condition is called Osgood Schlatters disease.

Cause of Osgood Schlatters disease

• Rapid growth – OSD is frequently seen in children or adolescents during periods of rapid growth. This is because muscles and tendons become tighter as bones grow longer. As a result, more tension is placed on the tibia’s growth plate
• Physical activity – OSD is more commonly seen in active children or adolescents who participate in activities requiring strong or repetitive quadriceps contractions such as running and jumping sports.

There are a number of factors which can predispose you to OSD, a few of which are

• a sudden increase in training or sporting activity
• inappropriate training
• recent growth spurts
• inappropriate footwear
• muscle tightness or weakness (particularly the quadriceps)
• joint stiffness
• poor lower limb biomechanics
• poor foot posture

Signs and symptoms of Osgood Schlatters disease

• Pain – usually experienced at the front of the knee just beneath the knee cap i.e., the tibial tuberosity. It may increase during activities requiring strong quadriceps contractions such as squatting, going up and down stairs, running – especially uphill, jumping and hopping. You may experience pain when kneeling or placing firm pressure to the top of the shin bone just beneath the knee cap
• Swelling – over the tibia tuberosity at the top of the shin bone, this swelling is often in the same area as the pain

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the Osgood Schlatters disease. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a Osgood Schlatters disease strain are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Iliotibial Band Syndrome (also known as ITB Syndrome, Iliotibial Band Friction Syndrome, Iliotibial Syndrome, ITBFS, Runners Knee)

This is a condition that commonly presents in runners and typically causes pain at the outer aspect of the knee where the iliotibial band (ITB) crosses the knee joint. Iliotibial band syndrome describes a condition whereby the iliotibial band rubs against a bony prominence at the outer aspect of the knee and causes inflammation and damage to local tissue.

Anatomy

The iliotibial band is a long band of connective tissue than runs down the outer aspect of the thigh. It attaches to two muscles on the outer aspect of the hip – the tensor fascia latae (TFL) and gluteus maximus, and runs down past the knee to insert into the lower leg bone (tibia). As it crosses the knee, it overlies a bony prominence known as the femoral epicondyle. As the knee bends and straightens the ITB flicks over this bony prominence which places friction on it and local soft tissue. If this friction becomes excessive or too repetitive, such as during excessive running, the ITB or local tissue can become damaged and inflamed resulting in pain. When this occurs the condition is known as Iliotibial band syndrome.

Contributing factors to Iliotibial band syndrome

There are a number of factors which can predispose you to Iliotibial band syndrome and a few of these are

• excessively tight ITB
• muscle tightness (particularly TFL, gluteus maximus, or vastus lateralis)
• excessive or inappropriate training or activity
• abnormal biomechanics
• excessive pronation (i.e. flat feet)
• poor pelvic or core stability
• muscle strength imbalances
• muscle weakness (especially the VMO and gluteal muscles)
• tightness in specific joints (hip, knee or ankle)
• inappropriate footwear or surfaces
• poor running technique

Signs and symptoms of Iliotibial band syndrome

• Pain and stiffness – usually experienced over the outer aspect of the knee and may initially present as a dull ache that increases to a sharper pain with activity. It is typically felt during activities that bend or straighten the knee when weight bearing and may be worse first thing in the morning or following activity once the body has cooled down. It may be associated with knee stiffness and can sometimes cause the patient to limp.

Activities that frequently aggravate symptoms include running – particularly longer runs, downhill running or running on cambered surfaces, walking – particularly up and down stairs or hills, squatting and jumping. You may experience pain when firmly touching the outer aspect of the knee – the femoral epicondyle.

• Swelling and a grinding sound when bending or straightening the knee – this generally occurs in more severe cases
• Giving way or collapsing due to pain.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the Iliotibial band syndrome. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for Iliotibial band syndrome are

• R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping Elevation (providing this is comfortable)
• Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage (especially to the ITB) to reduce pain and muscle spasm
• Knee joint mobilising techniques e.g., gentle stretching and muscle release techniques
• Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
• Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
• Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Referred Pain

Not all knee pain is necessarily coming from the knee. Occasionally, pain felt in the knee can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the knee?

The following structures have the ability to refer pain into the knee

• The lumbar and sacral spines (from the 3rd lumbar spine to the 2nd sacral vertebra – L3 to S2). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a knee problem.
• The hip joint
• The muscles of the hip and pelvis area
• The muscles of the thigh

How can Walker and Hall help you distinguish between a knee problem and referred pain

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the knee symptoms.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.