Quadriceps muscle strains are usually the result of quick sprints or stops during running. A “bulge” or an area of localized tenderness may be present with a muscle strain of the thigh area. Raising the thigh, ascending/descending stairs, and rising from a seated position are a few activities that will exacerbate a muscle strain. Physical therapy treatments focus on proper stretching and re-strengthening of the hip and leg.
A meniscal tear occurs when there is tearing of the cartilage pads (or cushions) when the knee is forcefully bent and twisted. The meniscus (menisci for plural) functions to reduce the compressive loads through the knee. Signs and symptoms will include pain at the joint line with locking and/or swelling of the knee. Physical therapy treatment is beneficial for proper healing and return to function. Surgery is indicated for large tears that aren’t healing with conservative measures.
The ACL (anterior cruciate ligament) crosses the front on the knee joint and stabilizes the knee. The ACL can tear when the knee is hyperextended or twisted beyond its normal range. A person who sustains an ACL tear will oftentimes hear a “pop” followed by significant swelling and pain and a feeling of instability. Surgery is indicated to repair large tears followed by physical therapy for progressive functional return to activities. ACL tears are very common is teenage female athletes.
The PCL (posterior cruciate ligament) crosses the knee joint behind the ACL and is less often injured because it is stronger. It is also called a “dashboard injury” because it happens when the knee hits the dashboard in an MVA and with similar mechanisms of injury. Surgery is not typically required, but physical therapy is helpful for strengthening and stabilization for proper return to normal activities.
MCL (medial collateral ligament) tears are also very common injuries to the inner part of the knee that occur from a forceful stress to the outside of the knee. MCL and ACL tears can occur together with severe trauma, such as during football or soccer. Severe tears may require surgery followed by physical therapy.
LCL (lateral collateral ligament) tears, like PCL tears, are less common and hardly ever require surgery. They can occur during sports where there is an external force to the inner knee.
Anterior knee pain is often the result of a patellofemoral issue, where the knee cap meets the leg. Reasons for anterior knee pain include excessive force to the cartilage on the underside of the kneecap, quadriceps tendonitis, patellar tendonitis, and chondromalacia (softening of the cartilage). Overuse and poor hip strength can also be associated with anterior knee pain which can be managed with physical therapy for appropriate bracing/taping, exercises, and stretches for healing.
Chondromalacia means softening of the cartilage under the patella and is often misdiagnosed for anterior knee pain since the only way to diagnose chondromalacia is to actually see the cartilage during a surgical procedure. Physical therapy is needed for swelling control as well as bracing and progressing strengthening of the quadriceps muscle.
Patellar tendonitis occurs with jumping sports such as basketball and volleyball from the resulting stress on the kneecap and attaching tendons. Signs and symptoms include painful touching of the patellar tendon as well as swelling. There are two specific disorders of the patellar tendon in maturing teens – Sinding-Larsen-Johansson is a disorder where the tendon attaches to the base of the kneecap, and Osgood-Schlatter is a disorder where the tendon attaches to the tibial tuberosity. Treatment includes activity modification and physical therapy for proper strengthening and stabilization for return to sports and activities.
Iliotibial Band Syndrome (ITBS) is inflammation/irritation of the iliotibial band where it passes over the lateral aspect of the lower thigh just above the outside of the knee joint. ITBS is commonly the result of repetitive bending and extending the knee as with long-distance runners or with fast-growing teens. Common causes include abnormal hip/knee/foot mechanics during running, repetitive overuse, poor muscle strength, poor flexibility, poor shoewear, training on uneven surfaces, improper bike fit, and running on the same side of the road. Conservative treatment such as physical therapy is recommended. A physical therapist will evaluate running and walking patterns as well as test flexibility, range of motion, and strength for imbalances.
Knee osteoarthritis occurs when the cartilage covering the ends of the bones that comprise the joint wear thin. This cushion is also referred to the as the menisci. As the cushion flattens, bone spurs can form and the joint can become inflamed, which can lead to decreased range of motion, strength, and function. Physical therapy can certainly help manage pain from osteoarthritis as well as regain lost range of motion and strength as well as improve walking with a customized exercise program. If the pain becomes unbearable or unmanageable, a total joint replacement may be indicated.
A total knee replacement may be suggested if knee pain due to osteoarthritis becomes too severe and conservative approaches have failed. Hips and knees are the most commonly replaced joints. The new joint is called a prosthesis, which can be made out of metal and/or plastic. It can also be cemented or uncemented (where the bone is designed to grow into the prosthesis). Physical therapy certainly needs to be performed after having a knee replacement to help regain range of motion and strength, but it can also be performed having surgery to assist patients in a quicker post-op recovery.