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Knee Pain and Injuries

Knee pain can arise from soft tissue injuries eg ligament sprains and muscle strains, bone conditions eg knee arthritis, or poor movement patterns. It may even be referred from another injury or condition like Sciatica!

It’s extremely important to know when to seek a doctor or knee specialist. Here are some signs to look out for that if present, you should go seek medical attention.

  • Obvious deformity

  • Swelling

  • You heard a “pop” or “snap”

  • Less than normal range of motion.

  • Greater than normal range of motion

  • Your knee is “giving way” or “buckling”

  • You cannot weight-bear on that leg.

If you experience any of these please seek medical attention prior to continuation of your fitness schedule!


Anatomy


The knee is a hinge joint that is responsible for weight-bearing and movement. It consists of bones, meniscus, ligaments, and tendons.

The knee is designed to fulfill a number of functions: Supports the body in an upright position without the need for muscles to work, provides stability, acts as a shock absorber, allows twisting of the leg, and helps propel the body forward.


Bones


The femur (thigh bone), tibia (shin bone), and patella (kneecap) make up the bones of the knee. The knee joint keeps these bones in place. The patella is a small, triangle shaped bone that sits at the front of the knee, within the quadriceps muscle. It is lined with the thickest layer of cartilage in the body because it endures a great deal of force.


Cartilage


There are two types of cartilage in the knee:


Meniscus: these are crescent-shaped discs that act as a cushion, or "shock absorber" so that the bones of the knee can move without rubbing directly against each other. The meniscus also contains nerves that help improve balance and stability and ensure the correct weight distribution between the femur and tibia. See Meniscus Tear below for more.


Articular cartilage: found on the femur, the top of the tibia, and the back of the patella; it is a thin, shiny layer of cartilage. It acts as a shock absorber and helps bones move smoothly over one another.


Ligaments


Ligaments are tough and fibrous tissues; they act like cables which connect bones to other bones, preventing too much motion and helping with stability. The knee has four:

ACL (anterior cruciate ligament) - prevents the femur from sliding backward on the tibia, and the tibia from sliding forward on the femur.

PCL (posterior cruciate ligament) - prevents the femur from sliding forward on the tibia, or the tibia from sliding backward on the femur.

MCL (medial collateral ligament) - prevents side to side movement of the femur.

LCL (lateral collateral ligament) - prevents side to side movement of the femur.



Picture credits to www.medicalnewstoday.com


Tendons


These tough bands of soft tissue provide stability to the joint. They connect bone to muscle. The largest tendon in the knee is the patellar tendon, which covers the kneecap, runs up the thigh, and attaches to the quadriceps.


Muscles


Although they are not technically part of the knee joint, the hamstrings and quadriceps are the muscles that strengthen the leg and help flex the knee. The quadriceps are four muscles that straighten the knee and the hamstrings are three muscles at the back of the thigh that bend the knee.


Common injuries

*For Pilate’s sake, I am not going to be going through a few common injuries that I can work with, I am not a surgeon or a physiotherapist. Therefore I will not be going over full ligament tears or any matters that involve surgical repairs. Nor will I be going over muscle injuries that effect the knee, that will be its own post! Pilates is a great continuation of rehabilitation once your doctor and physio have cleared you for further activity!

  • Sprains and Strains

  • Meniscus Tear

  • Arthritis

  • replacements


Sprains and strains.

Sprains and strains are injuries to the ligaments. The ACL and MCL are the ligaments most often injured.


Causes: These injuries usually happen in sports such as soccer, football, and basketball where the knee might experience a sudden twisting motion, a rapid change in direction, or an incorrect landing from a jump. Often a pop or snap is heard followed by swelling. Symptoms also include tenderness along the joint line and pain with walking.


Treatment:

  • Reduce pain and inflammation

  • Normalize your joint range of motion,

  • Strengthen your above your knee, Quadriceps and Hamstrings Hip and Pelvis muscles

  • Strengthen your lower limb: Calves, ankles, and feet

  • Improve kneecap alignment

  • Normalize your muscle lengths

  • Improve your agility, and balance

  • Improve your movement patterns/ correct your form eg walking, running, squatting, hopping and landing

  • Minimize your chance of re-injury.


Meniscus Tear


In the younger population, your knee meniscus is usually torn traumatically, by twisting on a slightly flexed knee. This type of meniscal injuries is most often sports-related.

In the older adult, the tear may be due to a natural age-related degeneration of the meniscus or a rough arthritic femoral bone surface tearing into the softer meniscus. In this case, surgery may be required to fix both the meniscal repair and to repair the damaged joint surface.

Depending on the type of meniscus tear, meniscus repair may be complicated. A large meniscus tear that is inadequately treated may cause premature arthritis.


Treatment: One of the major roles of your meniscus is shock-absorption. Luckily, the other vital shock absorbers around your knee are your muscles. Researchers have discovered that if you strengthening your leg muscles, your bone stresses will reduce as your muscle strength improves and your knee becomes more dynamically stable. Meniscal injuries are commonly associated with other knee injuries, which need to be treated in conjunction with your meniscal tear.

  • Reduce pain and inflammation

  • Normalize your joint range of motion,

  • Strengthen your above your knee, Quadriceps and Hamstrings Hip and Pelvis muscles

  • Strengthen your lower limb: Calves, ankles, and feet

  • Improve kneecap alignment

  • Normalize your muscle lengths

  • Improve your agility, and balance

  • Improve your movement patterns/ correct your form eg walking, running, squatting, hopping and landing

  • Minimize your chance of re-injury.



Arthritis and replacements


The most common cause of Knee Arthritis is Knee Osteoarthritis.

Knee osteoarthritis is a degenerative knee condition where the articular cartilage of your knee joint gradually wears away, exposing the underlying bone. As your knee arthritis progresses, bony spurs also develop in and around your knee joint in response to the change in load distribution and biomechanics.


Within your knee, there are two joints which can be affected by knee arthritis:

the tibiofemoral joint - the joint between your thigh bone (femur) and your lower leg (tibia) and the patellofemoral joint (the joint between the kneecap and the femur itself).


Treatment: Knee arthritis is a degenerative condition. Physiotherapy treatment is aimed at improving the symptoms of the disease (i.e. knee pain, swelling, stiffness), and you should begin to notice a positive difference within one or a few sessions.

The main goals of pilates for your knee arthritis are:

  • Reduce pain and inflammation

  • Normalize your joint range of motion,

  • Strengthen your above your knee, Quadriceps and Hamstrings Hip and Pelvis muscles

  • Strengthen your lower limb: Calves, ankles, and feet

  • Improve kneecap alignment

  • Normalize your muscle lengths

  • Improve your agility, and balance

  • Improve your movement patterns/ correct your form eg walking, running, squatting, hopping and landing

  • Minimize your chance of re-injury.



Knee replacements.


A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced.

There are four basic steps to a knee replacement procedure.

Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

Position the metal implants.

Resurface the patella. The under surface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.

Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.





Pilates is great at rehabilitating, and preventing injuries because we look at the big picture!

With knees for example, not only will the injury be directly addressed, but so will the whole body. One of my goals for all my clients is efficiency. Meaning that the whole body is working together as one to accomplish each and every task. When the whole body is strong, there will be no unnecessary compensations causing injury, no poor movement patterns putting stress on your joints, or underlying weaknesses that are never addressed while rehabilitating just one part of your body.


Remember, everything in the body is connected!

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