Knees

Please attend your physiotherapy appointment wearing appropriate clothing, ideally supportive shoes that are easy to remove. Consider wearing shorts or loose trousers so your knee can be easily assessed and treated.

Knee pain is a common problem and can have a significant impact on quality of life and function. It can be traumatic (a sudden onset associated with a specific event or events) or atraumatic (typically developing gradually over time). Your physiotherapist will conduct a thorough assessment before developing a treatment plan with your goals in mind.

We work closely with our orthopaedic consultants and their teams to help individuals with knee problems, including through non-operative management pathways and following surgery as part of post-operative management.

Common knee problems

  • Osteoarthritis – for more information, see our section on osteoarthritis.
  • Tendinopathies – refers to problems affecting a tendon, which is connective tissue between a muscle and bone that helps to transfer load. This is typically associated with overloading over a period of time. This usually requires a balance of appropriate exercise to strengthen and restructure the tendon, while being careful not to overdo things and cause flare-ups.
  • Patellofemoral pain – typically affects the front of the knee, where the patella (kneecap) articulates with the femur (thigh bone). This is an umbrella term encompassing several different problems, so it is often important to address several contributing factors to manage symptoms. See our patient information leaflet on patellofemoral pain.
  • Ligament injuries – ligaments connect bone to bone and provide stability to joints. One of the most common ligament injuries affects the anterior cruciate ligament (ACL). Other knee ligaments include the posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). Such injuries are usually caused by trauma, such as a collision, twisting or pivoting during sport. Many of these injuries can be treated non-surgically.
  • Meniscus injuries – the meniscus is crescent-shaped fibrocartilage that rests within the hinge of the knee joint. It provides shock absorption and stability and can be injured suddenly through trauma or become degenerative over a longer period of time.
  • Patellar instability – dislocations or subluxations (a partial dislocation) of the kneecap are typically traumatic. They can become more frequent due to biomechanical predispositions or genetics, weak muscles or a history of injuries.
  • Other knee problems – there are many other problems that can affect your knees or cause pain. These may include Baker's cysts, Osgood-Schlatter disease, referred pain from the lower back or hip, gout or pseudogout and iliotibial band syndrome.

Contributing factors to knee pain

A major part of your physiotherapy management for knee pain will include addressing the modifiable factors associated with your condition. Modifiable means that we can have an impact on these factors through education, exercise or lifestyle changes. There are likely to be several ways we can help improve these and, by optimising as many as possible, we hope to address the whole picture.

Here are several examples of common modifiable contributing factors to knee pain:

  • Muscle strength – improving the strength of the muscles around your knee is a common and important part of managing many conditions. Stronger muscles can support injured structures, improve control to reduce load on joints and improve function in daily tasks such as squatting, walking and climbing stairs.
  • Flexibility – stiff joints at the knee, or nearby joints such as the ankle, hip or back, can contribute to pain in your knee. Your physiotherapist can identify these and provide hands-on treatment as required, as well as recommend joint mobility exercises or muscle stretches to address these problems.
  • Motor control and patterning – training your muscles and nervous system to react and move with good alignment and control helps you to move efficiently. This is especially important for unstable joints, whether caused by ligament injuries or in patients with hypermobility.
  • Weight – increased body weight places additional load on your joints. Forces equivalent to approximately four times your body weight travel through the knee with each step you take. Fatty tissue is also associated with pro-inflammatory chemicals, which can make inflammation worse. Your GP can help signpost you to support with losing weight, or there are several tools available through the NHS Better Health website and app.
  • Loading – some conditions develop or worsen due to an imbalance between capacity (what your tissues can handle) and load (what you are actually doing). We can improve capacity through exercise to improve strength and control, as well as by managing stress and other psychological factors. It is also important to manage your load in both the short and long term to better align with your capacity. We may discuss your weight, how much time you spend on your feet, how often you have breaks or the use of additional treatments such as walking aids or knee braces.
  • Psychosocial factors – stress, poor sleep, fatigue, low mood and fear can all affect your experience of pain, as well as your ability to rehabilitate an injury. It is important to be aware of these effects in order to manage your condition appropriately.

Non-modifiable factors are things that can contribute to your problem but are outside your control. These include age, sex, family history, genetics and previous traumatic injuries or surgery.

Common knee surgeries

Please see the information leaflets below about common knee surgeries performed by our orthopaedic consultants at Chelsea and Westminster Hospital.

Additional resources

Contributors
George Vasilopoulos