Hardy Blogs
knee Pain
Matt Hardy

A pain in the knee…

Hello and thanks for taking time to have a read of this blog about Knee pain. Welcome back to those regular readers!

Knee pain is a very common problem affecting up to 25% of adults and affecting many children during adolescent years. The knee is a relatively complex joint with several large ligaments, a unique cartilage structure (meniscus) and is effected by compensations from foot position and stability of the joints above and below.

What is knee pain?

Good question – well like I discussed – with my back pain blog a lot of knee pain isn’t related to a specific injury to a single structure. There are plenty of ligament and cartilage injuries that can cause knee pain but in the majority of cases it’s a reduction in stability of the joint that can cause pain and also lead to injury of specific structures.

Why does my knee hurt?

Normally with painful knees people people will fall into one of 2 camps. 1) the pain came on out of nowhere, wasn’t too bad but is now getting worse or 2) they’ve had an injury that happened at a very specific point. In both cases the vast majority of people don’t require an MRI or surgery with rehabilitation being the best option.

Should I get a scan?

For nearly everyone as a first port of call I would say no. The first thing I would always recommend is that you have your knee assessed fully by someone who is trained and is able to guide your rehabilitation. If that person feels you need a scan then that’s the time to look into scans. The MRI scanner for example, is a very sophisticated tool that gives us a good picture but it doesn’t tell us the story. It can’t tell us what is normal for you and it doesn’t always see everything. It will also pick up things that are completely irrelevant, as none of us have perfect joint surfaces and minor tears are normal in pain free subjects.

Do I need an operation?

As a last resort… maybe. If you have tried several rounds of rehabilitation and the pain that you’re feeling is significantly impacting your quality of life then an operation may be right for you. The key here is that it is a last resort and all other treatments have been ruled out. Operations aren’t a guarantee to ‘fixing’ a problem. I also see previously common surgeries tested and found to be no more beneficial than a sham surgery. A study was conducted on the age old, knee washout operation (arthroscopy). They took 2 groups, the first they actually performed the operation as normal and the second they performed what is known as sham surgery. This is where they take a person, anaesthetise them, cut holes but then sew them straight back up doing absolutely nothing to the knee. The results show the same rate of improvement from both groups. So we know that some operations are a very expensive and risky placebo.

When should I see someone?

As soon as possible. With muscle weakness being one of the biggest reasons why pain persists in the knee getting seen sooner rather than later is the best course of action to stop the further loss of strength.

But I’ve been told…

I need an injection… injections can be really helpful for some people. There are always risks with injections and they should never be used in isolation and should be part of an overall rehabilitation program. If you require more than 1 injection every 6 months ask to be reviewed by your physio and be referred to a local specialist.

I’ve got a torn ACL and its needs repairing… torn anterior cruciate ligaments are a major injury and cause a lot of pain and disability. But did you know that you can train your hamstrings to do the work of the ACL? Did you know that there’s new evidence coming out from Australia that is suggesting that ACL’s can repair if they are given long enough and rehabbed properly? Did you know that some professional athletes have torn ACL’s and don’t even know about it? With those in mind why wouldn’t you give rehab a chance first?

I’ve got arthritis and my knee is bone on bone… arthritis is very common in knees and when flared can be very, very painful. Now, you cannot stop or get rid of arthritis (unless you have a knee replacement) but you can manage it with the correct muscle power and maintenance program. I’ve heard so many people tell me that they have bone on bone and have been told that there’s nothing that can be done. Now often it’s poor communication and lots of people don’t have bone on bone. For those that do and it’s that, that is causing the problem you can still manage this with the correct program. If it is not manageable it’s at that point I would recommend seeking an orthopaedic surgeon’s opinion for a knee replacement.

I’ve got the knee of a 90 year old… who ever has told you that should hang up their boots and retire as they have no place in the medical professions. What on earth is the knee of a 90 year old? I’ve treated several runners that have no problems with their knees and are in their 90’s. Poor communication blights medical treatment and this is a fine example!

I need my knee washing out… you don’t. As we spoke about further up if you have generalised knee pain an arthroscopy is a very expensive placebo. If you know you have a loose body in there (the knee) and it is likely that, which is causing the problem you have, then go for it, it will probably help.

I’ve tried physio, it didn’t work… first off, not everyone improves with physiotherapy and surgery is indicated for some people. If you have seen a physiotherapist and not been given a comprehensive rehab programme or you’ve seen 1 physiotherapist, give another a chance before going down the surgical or invasive treatment route. Physiotherapy is a profession not a treatment and we all work in slightly different ways, we all have different experiences and skills. Someone else maybe able to help you before you are injected or operated on.

I need to ice my knee to get the swelling down… ice doesn’t reduce swelling! If I said to you the doctor that came up with the theory of Rest Ice Compress and Elevate (RICE) actively tells people he was wrong and you shouldn’t use it to reduce swelling would you listen? (https://www.drmirkin.com/fitness/why-ice-delays-recovery.html) There is also some evidence to suggest it takes longer to recover if you regularly ice your body. Movement is the best way to reduce swelling. Movements helps move fluid into the lymphatic system and pumps it away.

Hopefully we’ve busted some myths there, remember, everybody’s pain journey is unique so I treat everyone uniquely. There are certain cross overs with people but I believe the best way to get you better as an individual, is to treat you as an individual. If you have a bad knee and you need help please give me a call and book a session. I will help to get you back on the right track and hopefully in fairly quick order.

You can arrange an appointment by calling 07891338580 or emailing matt@hardyperformancephysio.co.uk. You can also call me to discuss your problem. I am more than happy to have a chat and answer any questions you may have.

Thank you again for taking the time to read this.

Matt