Relieving knee pain with Peter Growse

I’ve previously seen a different physiotherapist about my ongoing knee problem. They sold me some orthotics and kept telling me I had to keep coming back, but I didn’t ever feel I was getting any better. Why should I see you?

For successful treatment and recovery from your knee pain actually stems from an accurate diagnosis and identification of the contributing factors causing the pain in the first place. By identifying the cause of your pain, rather than just treating the symptoms, we can collaboratively develop a plan to address these issues and work towards your goals.

Broadly speaking, there are three key areas that we assess when looking at contributing factors to knee pain

Local (the knee joint and structures immediately adjacent)

• Effusion or inflammation inside or around the knee joint
• Strength deficits or asymmetry in the thigh muscles
• Patella (knee cap) position

Proximal (structures above the knee)

• Hip strength and control, which directly impacts the position and function of your knee
• Hip joint flexibility, which again is important to lower limb and knee function
• Core strength, which has connections to how we move our whole body and is therefore potentially a key to altered movement patterns at the knee

Distal (structures below the knee)

• Foot posture, which similarly to the proximal issues can affect the way that your knee moves (this is where orthotics may be a useful tool to reduce knee pain for some people)
• Calf and ankle/foot muscle strength deficits

The same physio told me that I could never run again, because running is bad for knees. Do I really have to stop running?

Everyone has different goals when it comes to using their knees. From squatting down in the garden to long walks or playing tennis, they all place varying levels of demand on your knees.

Running is very common activity and has historically divided opinion when it comes to knee joint health. That being said, research has shown us that runners have a lower rate of knee osteoarthritis than sedentary people (Alentorn-Geli et al. 2017). Contrary to popular opinion, some running can actually have a protective effect on the cartilage in your knee.

A return to running, like all activities, would need to be considered by taking into account all of your individual variables such as:
Diagnosis: After some injuries or surgery, it may be necessary to give local tissues time to heal and settle before introducing running.
Activity history: If your knee has had no recent history of tolerating the load requirements of running, it’s then likely to take longer to introduce these loads.
Biomechanics: It may be important to train the way you move with less demanding tasks before introducing running.

Once all factors have been taken into account, we’d be hopeful that most knees (except those who have had a knee replacement) should be able to return to running in some format!

I am losing my patience and I’m frustrated by this injury. How long would it take for you to fix me?

When considering recovery timeframes, we’ll communicate the realistic time that we would expect for you to return to full function given all of the information collected in our assessment.

This timeframe may be shorter, longer or similar to what you may expect, and it’s important for you to understand the reasons behind the recovery time we expect for your injury. Variables such as tissue healing, time for adaption (e.g. strengthening) and your own past history (including past recovery times) all come into play.

Armed with this information we hope that you’ll agree that a thorough recovery is more important than a quick, incomplete, fix.

Another physio has previously given me a whole list of exercises. Is that all physios do?

Physiotherapists are trained to assess your injury and work with you to develop a treatment plan that will set you up for the best chance of recovery.

Exercise is absolutely an integral tool in our toolkit, and especially with knee pain it’s well acknowledged that exercise is a crucial element in any successful treatment plan.

However, there are many other ‘tools’ that we have to help you in addition to exercise, including:

• Taping, which can be effectively used for some knee conditions to reduce pain levels. This may be applied directly over the knee, down at your foot/ankle or even proximal (above) the knee
• Manual therapy, or hands on techniques, which can aid your recovery in conjunction with other treatment modalities. As with the other lines of treatment, this may be used specifically around your knee, or on adjacent areas that will affect it
• Education, which (as is the case with most things is life) is critical. This may refer to your posture or your movement patterns. We often also talk about load management. This basically means that we make sure that you stay in the sweet spot of activity, by NOT doing too little or too much exercise, too soon into your recovery journey

So if I am going to follow a treatment plan you develop for me, what do you think are my long-term possibilities?

Our bodies are amazing, adaptive and resilient. Unfortunately, they occasionally have issues which slow us down. Fortunately when you do hurt this body, specifically your knee, we have the tools that will allow that resilience to come to the fore.

Long-term possibilities will obviously hinge on what your goals and expectations are. Once we establish these goals, most patients are able to successfully return to their activities and reduce the pain that they experience.