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Managing
knee pain carefully in the ADF
Physio facts by Geoffrey
Crowley,
2HSB
If
only I had a dollar for every soldier that I’ve treated for
knee pain – I wouldn’t be sitting here at my desk writing
this, I’d be sipping pina-coladas in the Bahamas right now.
There
are many different causes and types of knee pain. This article will
focus on only one; the most common variety in the military known
as patella (kneecap) mal-tracking or patellofemoral pain.
This
type of knee pain comes on gradually with activity such as running
or squatting.
Often
there is no history of an actual injury such as a twist or football
tackle, but occasionally a minor incident can be described.
Pain
is experienced most commonly at the front of the knee and can be
felt deep under the patella. Sometimes swelling is noticed after
activity.
The
cause of the pain is thought to be incorrect tracking of the patella
within the groove on the thigh bone (femur – thus the name
patellofem-oral pain). This results in excessive pressure on the
smooth cartilage at the back of the patella, which can cause pain
and premature wearing away or roughening of this cartilage.
Referral
to a physiotherapist before the symptoms become long-standing is
vital for optimal treatment.
Physiotherapy
consists of identifying the factors which are causing the disparity
of forces acting on the kneecap.
Most
commonly, muscle imbalance is seen in the form of some muscles being
too weak and other structures too tight.
Correction
of these imbalances is through specific exercises which the physiotherapist
will prescribe.
Taping
of the patella may decrease pain and assist the progress of rehabilitation
and manual therapy to restore optimal joint movement may also be
of benefit.
Modification
of activity is an important part of the management of this condition.
The doctor or physiotherapist will suggest certain restrictions
of activity.
Specific
activities will need to be reduced or temporarily ceased. The member
is best to focus on what they can do to maintain fitness, rather
than focussing on what they can’t do.
Another
contributing factor to the development of patellofemoral pain may
be feet that pronate excessively (flat feet/dropped arches).
This
introduces rotatory forces through the knee which can aggravate
the condition. Treatment may involve the prescription of orthotics
(inserts) for the shoes to reduce inappropriate forces acting on
the knee.
In
more severe cases, when significant roughening of the cartilage
(degeneration) is suspected, surgery may be required.
Arthroscopic
(“keyhole”) surgery can smooth off roughened areas of
cartilage. It is important to note here that surgery does not cure
or heal the worn down cartilage, but can relieve symptoms.
To
conclude, conservative (non-surgical) management of patellofem-oral
pain is successful in most cases.
This
consists of specific exercises, physiotherapy techniques and activity
modification. If this approach fails, surgery may be of benefit.
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