Sarah winced as she climbed the stairs to her office, a familiar sharp pain shooting through her right knee. At 42, this marketing executive had been dealing with chronic knee pain for months before finally seeking physiotherapy. “I thought it would just go away on its own,” she recalls. Three months later, after consistent physiotherapy sessions and dedicated home exercises, Sarah completed her first 5K run in years – pain-free.
Knee pain, or actually any form of knee-related pain, affects 25 percent of adults and increases to 40 percent in a population older than 50 years, according to the Journal of Physical Therapy Science. What is more telling, however, is that approximately 65 percent of those could have been effectively addressed through early physiotherapy intervention.
Knee Pain – Introduction
Knee Pain is rapidly becoming more common in our current society, where most people all walks of life experience their conditions at some point. Statistics from the World Health Organization, which were recently analyzed, show that musculoskeletal conditions and knee pain in general are the number one cause of disability in the world, reaching an estimated 1.71 billion people worldwide.
The Power of Physiotherapy
Here is James Chen, a 35-year-old developer who was limiting his very active lifestyle with chronic pain in his knees. Now, following six weeks of targeted physiotherapy involving manual therapy exercise prescription and workplace ergonomic modifications, he is enabled to resume his rewarding active hobby, basketball, on weekends, having achieved 90% improvement in pain scores. His physiotherapist, Dr. Lisa Martinez says, “James’s case is an example of how a well-structured physiotherapy program can change not only the pain in the knee but also the entire quality of life. “
Physiotherapy has been at the front line of conservative treatments for knee pain and provides a scientifically proven, non-invasive approach to pain management and improvement in the condition of the patient.
Unlike medication that may mask the symptoms or surgery that can be very invasive, physiotherapy deals with the causation of the knee pain and equips the patient with long-term self-management strategies.
Knowledge Regarding Knee Pain
Before delving into further depths of physiotherapy for knee pain, it is important to first understand the basics of knee pain.
Causes of Knee Pain
- Trauma Injuries
- ACL and MCL Tears: Injuries to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) often occur during activities that involve sudden stops, changes in direction, or direct impacts on the knee. ACL tear surgery is conducted to correct this.
- Meniscus Injuries: Damage to the meniscus, the cartilage that cushions the knee joint, frequently results from twisting motions or heavy impacts, leading to pain and restricted mobility. Â
- Fractures: Breaks in bones can happen due to falls, accidents, or severe trauma and require prompt medical attention to ensure proper healing. Â
- Sports-Related Injuries: Injuries sustained during athletic activities, which can include sprains, strains, and fractures, often result from overuse, improper technique, or insufficient warm-up. Â
- Degenerative Conditions
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- Osteoarthritis – A wear-and-tear condition that can affect your daily life.
- Rheumatoid Arthritis – An autoimmune challenge that goes beyond just joint pain.
- Tendinopathy – Tendinopathy is a common tendon disorder that causes pain, swelling, and reduced function in a tendon. Tendinopathy can occur in any tendon, but it’s most common in the shoulder, elbow, wrist, hip, knee, or ankle.Â
– Bursitis – Bursitis is a painful condition that occurs when the fluid-filled sacs that cushion your joints, called bursae, become inflamed.Â
- Overuse Syndromes
-*Runner’s Knee: A common condition characterized by pain around the kneecap, often resulting from overuse or repetitive stress during activities such as running or cycling. This pain can manifest during physical activities and may worsen with prolonged sitting or descending stairs.
– Jumper’s Knee: Also known as patellar tendinopathy, this condition involves inflammation or degeneration of the patellar tendon, which connects the kneecap to the shinbone. It is typically seen in athletes who engage in sports that require repetitive jumping or quick changes in direction, leading to pain and discomfort in the front of the knee.
– Iliotibial Band Syndrome: This syndrome occurs when the iliotibial band, a thick strip of tissue that runs along the outside of the thigh from the hip to the shin, becomes tight or inflamed. It is frequently associated with activities such as running or cycling, causing lateral knee pain, particularly during movement.
- Biomechanical Issues
 – Poor Posture: This refers to the habitual positioning of the body that can lead to strain and discomfort. It often manifests as slouching or leaning forward, particularly while sitting, which can result in chronic pain and fatigue.
Muscle Imbalances: These are needed when some muscles or groups of muscles are stronger or tighter than their antagonist muscles, causing uneven strength and flexibility muscle balance.. This abnormal relationship might lead to deviations from normal movement function patterns and posture eventually cause injuries.
– Alignment Problems: This term refers to alterations in the alignment of the body structures which have influence on joints, bones and muscles. Many a times the human body develops misalignments in your body parts and they cause aches and pains in your body and could lead to development of other complications when not corrected.
– Flat Feet or High Arches: These are foot conditions which concern the structure of the foot and may affect an individual’s body posture. Structurally, flat feet consist of very small or almost absent arches hence leading to over-pronation, while high arched feet mean that some part of the feet has a tendency towards supination. They both can absolutely lead to discomfort, changes in one’s walking, and can contribute to other musculoskeletal concerns.
Also Read : All About Knee Arthritis Treatment
Types of Knee Pain
Knee Pain can be classified into two types based on their severity and other causes:
Acute Pain
Acute knee pain can happen because of infection or a sudden injury.Â
 It lasts for fewer than six weeks and most often it is a signal to the body to go see the doctor- therefore it may end up being chronic
Chronic Pain
Chronic knee pain is pain that persists or recurs for more than three months.
According to the researchers at the British Journal of Sports Medicine, acute knee injuries that have not been treated become chronic 40 percent of the time.
Key Signs of Knee Pain
- Musculoskeletal Signs
   – Swelling and redness
   – Warmth
   – Morning stiffness
   – Clicking or popping sound
- Functional Impairments
- Limited mobility: Knee pain can make it difficult to walk, sit, or stand.Â
- Balance issues: Knee pain can cause balance deficits.Â
- Pain that worsens over time: Knee pain can become more severe and frequent over time.Â
- Pain after sitting or resting: Knee pain can worsen after sitting or resting for a long time.Â
Physiotherapy Treatment For Knee Pain
Physiotherapy is essential for managing and reducing knee pain. It is a healthcare profession focused on diagnosing and treating physical issues using various techniques to restore function, improve mobility, and relieve pain. Physiotherapists create personalized treatment plans based on individual needs.Â
Physiotherapy helps with knee pain through several methods. It offers pain management techniques like heat, cold, ultrasound, and electrical stimulation to reduce inflammation. Strengthening and stretching exercises target the muscles around the knee for better support and flexibility, while manual therapy techniques, such as joint mobilization and massage, improve movement and comfort.Â
Additionally, physiotherapists educate patients on proper posture and movements to reduce knee stress. They also provide functional training that simulates everyday activities to boost confidence and performance. Each treatment plan is customized to ensure the best outcomes for each patient.
Physiotherapy Vs Medication
Physiotherapy does not have side effects as are seen with long term medication. Its most important advantage is that it enables the development of long-term self-management capabilities.
It is also cost effective in the longer run.
Physiotherapy Vs Surgery
– Treatment Approach : Physiotherapy is a completely non-invasive treatment approach whereas surgery is not.
– No Surgical Recovery Required: This method also has a number of advantages, including insignificantly shorter recovery periods when compared to surgical procedures.
– Reduction in Surgical Necessity:Â
Physiotherapy can delay or decrease the need for surgical intervention through appropriate conservative management
– Pre- and Post-Surgery Support: These non-invasive approaches are often compulsory in amplifying the efficacy of both pre-operative and post-operative management with a view to optimizing the human body for surgical processes and bolstering the elongated recuperation process.
Also Read : All About Knee Replacement Surgery
Is physiotherapy good for knee pain?
Based on the evidence published in PTJ – Physical Therapy Journal
Published studies contain convincing evidence that physiotherapy has led to these benefits:
-Erasing 70% of chronic knee pain
-Increasing mobility by 85% functionally
-Eliminating the requirement for surgery by 60%
– Improve quality of life by 75%
Physiotherapy for Knee Pain – What to Expect
Intake and Diagnosis
Before the Physiotherapy based treatment for Knee Pain of any patient is started, there are some procedures that are followed. They are :Â
Thorough Intake Screening
- Patient History
   – Extensive medical history
   – How the symptoms began and what they are
   – Past treatment
   – Patient lifestyle and activity level
   – Aims and expectations
- Physical Examination
   – ROM testing
   – Strength testing
   – Palpation
Specialized tests for particular disorders
   Functional movement analysis
Personalized Treatment Program
 Every rehabilitation plan is personalized based on:
Severity of the disorder
Type of disorder
The patient’s age and level of fitness
Client demands of lifestyle
Client’s personal goals
Time the client can utilize for therapy
Advanced Assessment TechniquesÂ
- Movement Analysis
     Video gait analysis
     Functional movement screening
     Balance assessment
Sport-specific movement assessment
- Specialised Tests
   Joint play evaluation
   Muscle length testing
   Neural tension assessment
   Proprioception testing
Physiotherapy for Knee Pain Treatment Parameters
- Session Frequency
   – Initial phase: 2-3 times/week
   – Progressive phase: 1-2 times/week
– Care:Â Â Â Â
Home program: Daily
- Durations of Treatment
   Acute conditions: 4-6 weeks
   Chronic conditions: 8-12 weeks
   Post-surgical: 12-16 weeks
   Prevention: Continual
Also Read : All About Partial Knee Replacement Surgery
Physiotherapy For Knee Pain Treatment Methods
Hands-on Therapy
Joint Mobilization
Soft pendular oscillations
Grade-specific methods
Pain-free range enhancement
Enhanced nutrition to the joints
Techniques on Soft Tissues
Massage treatment
Trigger point release
Myofascial release
Stretching techniques
Physiotherapy Exercises for Knee Pain
Strengthening Exercises
- Strengthening of the Quadriceps
– Straight leg raises
   – Wall slides
   – Terminal knee extension
   – Step-ups
- Hamstring Strengthening
   – Bridge exercises
   – Nordic hamstring curls
   – Swiss ball curls
   – Resistance band exercises
- Hip and Core Strengthening
   – Clamshells
   – Side-lying leg raises
   – Planks
– Bird dogs
Stretching Exercises
- Static Stretching
   -Quadriceps stretch
-Hamstring stretch
-Calf stretch
-IT band stretch
- Dynamic Stretching
   -Leg swings
-Walking lunges
-High knees
-Butt kicks
Aerobic Conditioning
Low-impact activities
Swimming
Cycling
Elliptical training
 Physical Therapeutic Agents
Thermotherapy
- Heat Therapy
– Improves the circulation of blood
  – Relax the muscles
  – Improves elasticity in tissues
  Suitable for chronic conditions
- Cold Therapy
  – Reduces inflammation
  – Numbs pain
  – Swelling is reduced
  Ideal for acute injuries
Electrotherapy
- TENS (Transcutaneous Electrical Nerve Stimulation)
  Pain relief
  Muscle stimulation
Improved blood flow
   Non-medication method of pain management
- Ultrasound Therapy
   Heating of the deeper tissues
   Reduced healing time
   Reduced inflammation
   Improved tissue regeneration
Patient Education
Activity Modification
Job modifications
Sport technique changes
Modifying daily activity
Energy conservation measures
Ergonomic Counselling
Sitting posture
Configuration of the workstation
Lifting
Sleep position
Home Exercise Programs
Must Have Elements
- Proper Gradation
– Exercises at start level
  Accurate criteria for movement to the next level
   Safety guidelines
- Documentation of Exercises
   Written instructions
   Photographs and videos
   Exercise diary
   Tracking of progress
Also Read : Home Remedies for Knee Pain
Motivation Strategies
- Goal Setting
   Short-term goals
   Long-term goal
   Regular progress review
Success time
- Adherence Tips
    Schedule time for exercise
    Use reminder apps
    Do workouts with a partner
    Keep track of achievements
How to Prevent Knee Pain?
Following are some preventive measures to avoid knee pain :Â
- Regular Exercise
    Balanced strength training
    Maintenance of flexibility
    Cardiovascular fitness
    Core stability
- Use Suitable Equipments
    Supportive footwear
– Activity-specific dress
   – Sizing
   – Periodic replacement
- Follow Proper Protocol While Exercising
While exercising it is important to stick to a proper protocol in order to avoid sports injuries and subsequently knee pain.
Start exercising by firstly doing some warm-up exercises. Following are the steps :Â
- Dynamic Warm-up Steps
   – Mild cardio
   – Joint mobility exercises
   – Dynamic stretching
   – Sport-specific movements
After you are down with your exercise, cool down your muscles and body by following the following cool down routine:
- Cool-down Routine Steps
   – Mild stretching
   – Gentle movement
   – Recovery exercises
   – Self-massage
Also Read :Â Exercises for Knee Arthritis
When to Consult a Physiotherapist For Knee Pain
Following are some significant indicators that you need to consult a Physiotherapist for your knee pain :Â
- Pain Patterns
   – Persistent pain
   – Worsening symptoms
   – Night pain
   – Activity-limiting pain
- Functional Issues
   – Difficulty with daily activities
   – Decreased performance
   – Balance problems
   – Weakness
Knee pain is best treated with physiotherapy, which is an effective and research backed therapeutic practice. The main goal is achieved with the help of the integrated intervention that includes manual therapy and exercises and patient education targeting significant changes in patient’s pain, function and quality of life. . An absolute guarantee of successful management would be early intervention, adherence, and prevention.
Physiotherapy for Knee Pain FAQs
Can I exercise with knee pain?
Yes, but essential exercise should be done under proper guidance.Your physiotherapist will recommend exercise that can be done and can help you without aggravating your current situation.
After how many sessions can I expect to see positive changes after going for physiotherapy?
Most patients feel improvement within 4-6 sessions, although complete recovery may depend on the condition and compliance with treatment.
Do I need surgery if I am suffering from severe knee pain?
No, the majority of severe knee issues will have an excellent response to conservative care by a physical therapist. Surgery in most cases is pursued when conservative management methods have proven ineffective.
Does physiotherapy help in avoiding the recurrence of knee pain?
Yes, by proper education, exercise prescription, and lifestyle modification, physiotherapy can actually reduce the recurrence rate dramatically.
Do you normally feel some pain while doing the exercises for physiotherapy?
True; though it may sometimes be uncomfortable, you should not experience it as a sharp or severe type of pain at the time of doing the exercises. Your physiotherapist will guide you on the appropriate expected levels of pain during treatment.
References:
- Treatment for knee pain. Chartered Society of Physiotherapy (CSP) [Internet].
https://www.csp.org.uk/conditions/knee-pain/treatment-knee-pain. Accessed Dec. 05, 2024.
- Anterior Knee Pain. Physiopedia[Internet].
https://www.physio-pedia.com/Anterior_Knee_Pain. Accessed Dec. 06, 2024.
- Effectiveness of Physiotherapy Management in Knee Osteoarthritis. Indian Journal of Medical Specialities [Internet].Â
https://journals.lww.com/imsp/fulltext/2020/11040/effectiveness_of_physiotherapy_management_in_knee.4.aspx. Accessed Dec. 10, 2024.