Knee & Kneecaps
The knee can be described as a hinge joint, its main movements being flexion and extension (i.e bending and straightening). It is vulnerable to torsion which can damage a) the ligaments (running from bone to bone) either on the inner or outer aspect of the knee b) the cartilages (washer type structures inside the knee) c) the cruciate ligaments inside the knee - these are designed to hold the knee steady from front to back - so they are more likely to become injured when the knee is “sheared”.
Some sports are particularly tough on knees, football for instance. Knees that have taken a lot of trauma over the years will tend to get arthritic. This means that the actual cartilage surface on the femur and the tibia gets ragged and irregular. Normal cartilage surfaces slide on each other incredibly smoothly, like ice on ice. When this surface deteriorates, movement of the knees can be more restricted, certainly more noisy, but not necessarily painful. The mechanism of injury often suggests the structures most likely to be damaged. The physiotherapist can then confirm the problem by careful (and gentle) testing in the clinic. It is common practice to use expensive scanning procedures for many injuries these days, but a good physiotherapist can often identify the injury in the clinic by examination.
Kneecaps
A common cause of pain around the knee, not only for sporty types, is retro patellar pain, (pain behind the kneecap). The kneecap is actually enclosed within the tendon of the quadriceps muscle (four muscles on the front of the thigh) The balance between the muscles needs to be just right so that the knee cap sits centrally over the knee. If the balance goes off then the muscles tend to pull the kneecap sideways (usually towards the outer aspect) on the knee. This causes friction between the back of the kneecap and the front of the femur, leading to inflammation.
Alternatively the knee can hyper extend (when standing with the knees locked straight, they don’t just straighten, they go past straight and bow backwards) this can cause the kneecap to rub excessively against the knee joint, setting up a low grade inflammation which will become painful.
Typically the pain is more noticeable when sitting for a long time, (for instance, in the car or at the cinema), or when the knee works under load - e.g down or upstairs. For some, kneeling is impossible. Physiotherapy assessment will include muscle testing, measuring the “lie” of the patella, working out how to correct the position and retrain the muscles to restore balance.
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