Knee Pain

Ryan LaCorte Treatments

The Knee joint consists of the union of the distal femur (thigh bone) with the proximal tibia (shin bone) as well as the patella (knee cap) as it sits in a groove along the distal femur.  The knee joint is the largest joint in the human body.  It is an incredibly strong joint supporting the entire body.  The knee is able to withstand great forces experienced when running and jumping.  The Tibiofemoral joint (where femur meets the tibia) is considered a hinge joint however it does possess slight rotation with end range knee extension (straightening.)  The Tibiofemoral joint consists of the articulation of the convex (rounded) femoral condyles as it contacts the concave tibial plateau.  Both bones are covered by a smooth surface known as hyaline cartilage to allow movement of one bone against the other.  Hyaline cartilage is an extremely strong and flexible material that allows for the bones to glide over each other as the knee bends and straightens.  Additionally, two cartilage rings known as the meniscus, sit atop the tibial plateau and provide cushion as well as stability to the tibiofemoral joint.

Knee joint motion is controlled primarily through two groups of muscles; the Quadriceps and Hamstrings.  The Quadriceps functions to straighten the knee while the hamstrings bend the knee.  As the quadriceps cross the knee, it attaches to the patella through the Quadriceps Tendon.  The patella then attaches to the tibia through the patella tendon.  Finally, the knee has four major ligaments that give it additional stability; the Anterior Cruciate Ligament (ACL,) the Posterior Cruciate Ligament (PCL,) the Medial Collateral Ligament (MCL,) and the Lateral Collateral Ligament (LCL.)  These ligaments are a common site for injury in athletes. There are several bursa around the knee joint that allow for tendons and ligaments to glide over bony prominences.  The entire joint is encapsulated by a joint capsule or synovial membrane that provides a viscous lubricant knows as synovial fluid.  Synovial fluid can be thought of as the oil for the joint.

Knee Arthritis or Degenerative Joint Disease

While there are many different types of arthritis that can affect the knee, the most common is osteoarthritis.  As stated above, Osteoarthritis or Degenerative Arthritis, is the most common form of Arthritis.  Over time, the smooth covering over bones at the joints may begin to wear away.  This is called cartilage and is responsible for secreting synovial fluid, the oil for your joints.  As the cartilage breaks down you will have reduced secretion of synovial fluid.  The knee is one of the most common sites for Osteoarthritic changes to occur due to the tremendous stresses that are placed upon the joint over a lifetime.   Depending upon the severity of the condition, there are several different interventions ranging from non-invasive conservative approaches, to corticosteroid injections, synthetic lubricant injections or surgery.  As arthritis sets in, it is essential to keep the joints moving.  Through physical therapy, we will develop ways to maintain and increase joint motion through PAIN FREE activities.  If the motion or activity is increasing discomfort levels, that is a sign that you are compressing or irritating inflamed tissues which can worsen the condition.  Your physical therapist will work to keep you joints moving as well as increase joint stability and strengthen the muscles supporting your knees.  Additionally, your physical therapist will utilize different modalities and manual interventions to help control inflammation and reduce pain levels.

Through physical therapy, we can greatly reduce your discomfort and restore joint range of motion, returning you to your prior level of function.   Unfortunately, some cases are beyond recovery and will require surgery.  Whether it is simply an arthroscopic procedure, or joint replacement, your physical therapist will be integral part of the recovery process.  Following surgery, intensive physical therapy will help you to regain strength, range of motion and restore your ability to return to prior activities.   Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Meniscus Tear

As described above, the meniscus is two cartilage rings that sit atop the tibia and provide cushion and stability to the knee joint.  Due to stresses placed upon the knee, and limited blood supply, the meniscus is a common site for injury in athletes and non-athletic individuals. Some injuries occur when twisting or pivoting, while others are simply wear and tear over time.  Some cases will require surgical interventions to repair or remove the damaged tissue, while other can be controlled through conservative, non-invasive treatment.  When able to treat the meniscus tear through non-operative interventions, you physical therapist will assess any restrictions, weakness or limitations that you present with through a thorough evaluation.  Your physical therapist will devise an individualized treatment plan appropriate for you injury to help get you back to your prior level of function.

If surgery is required to remove a small portion of the meniscus, recovery is generally quick.  Following surgery, your physical therapist will focus on controlling the inflammatory response while working to restore muscle strength and build stability for the joint.  Some cases will require more involved surgical procedures to repair the meniscal tear.  These cases will have a longer recovery period due to the physiology of the healing process.  Your therapist will work hand in hand with your physician, following post-surgical guidelines, to help return you to your prior level of function.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

***For more information, please see the article on meniscus tears writing by Kim Lotito in our publications.

Anterior Cruciate Ligament Tear (ACL Tear)

The Anterior Cruciate ligament is one of the main stabilizers in the knee.  It prevents anterior translation of the tibia on the fibula (knee hyperextension) as well as provides stability in twisting motions.  ACL tears are common in athletes participating in high demand sports such as football, soccer, lacrosse and basketball.  Most injuries occur with pivoting or twisting motions while some can occur through direct contact or collision.  Intervention following an ACL tear is dependent upon the severity of the injury and the lifestyle of the patient.  An older adult with a less active lifestyle may be able to return to most activity without surgery, while a young athlete will most likely require surgery to repair the ligament to return to play.  Unfortunately, the ACL will not heal without surgery.  In non-operative cases, bracing may be employed as well as physical therapy.  Your physical therapist will devise a treatment plant to fit your goals and lifestyle needs.  The primary focus is restoring stability to the knee through strengthening exercise and balance activities.

If surgery is required, there are several different surgical techniques employed to replace the Anterior Cruciate Ligament (ACL.) The recovery process following an ACL repair is quite extensive.  Initially, it is essential to allow for the ligament to heal and become stable.  During this period, your therapist will focus on restoring your ROM and getting supporting muscles to activate.   Once cleared by the surgeon, your therapists will progress your treatment plan to include more dynamic, sport or activity related exercises to improve joint stability and allow for return to play or prior level of activity.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

***For more information, please see the article “ACL Tears: The Role of Physical Therapy in Rehabilitation and Prevention” written by Erin Sullivan in our publications

Patella Femoral Syndrome (Runner’s Knee)

Patella Femoral Pain Syndrome or Runner’s Knee refers to pain around the patella (knee cap.) As the name implies, Patella Femoral Syndrome is common among active individuals who participate in sports that involve running or jogging.  This does not however rule out the less active individuals.  There are a number of mechanisms behind Patella Femoral Syndrome that must be uncovered to appropriately address the injury.  Most patients with Patella Femoral Syndrome report pain ascending or descending stairs, following prolonged sitting, running or squatting.  Patella Femoral Syndrome is a generally an overuse injury; it occurs due a mal-tracking of the patella within the femoral groove.  Injury occurs through repetitive contact of the underside of the patella (knee cap) with the femoral condyle.  Mal-tracking is frequently a result of an imbalance in the muscles of the thigh and shin.  If weakness presents, it can cause a lateral or outward tracking of the patella.  Over time, this will irritate and inflame the underside of the knee cap and possibly damage the hyaline cartilage.  Other mechanisms include tissue restriction along the outer aspect of the knee or thigh, or poor foot stability (fallen arches) that create an internal (inward) rotation of the lower leg.  In severe cases, excessive mal-tracking can eventually lead to subluxation or dislocation of the patella.  Due to anatomical differences, Patella Femoral Syndrome is twice in women as it is in men.   Most cases of Patella Femoral Syndrome are treated with conservative measure.  Your physical therapist will uncover the underlying cause of the knee pain.  Once identified, the therapist will utilize a wide range of manual techniques as well as possible bracing or taping to realign and stabilize the patella.  Some cases will involve the use more supportive shoes and/or orthotics to improve foot and ankle stability.  Finally, your therapists will design an exercise program to target weak muscle groups or improve tissue mobility through stretching.  All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

***For more information please see the article “What is Patella Femoral Pain Syndrome” written by Maria Kaminski in our Publications for more information.

Iliotibial Band Syndrome (ITB Syndrome)

The Iliotibial Band (ITB) is a thick band of fascia (connective tissue) that runs from the iliac crest (rim of the pelvis) to the outside of the knee.  The ITB serves as a stabilizing structure along the outside of the knee.  The fibers additionally intertwine with that of the gluteal muscles and tensor fasciae latae (muscles that control the hip).  With the knee fully extended the ITB sits anterior to the femoral condyle (large bony prominence along the outside of the knee.)  As the knee is flexed to approximately 30 degrees, the ITB will pass over the lateral femoral condyle to a posterior alignment.  ITB Syndrome is a common injury among runners.  Repetitive knee flexion while weight bearing can cause friction and eventual thickening of the ITB.  As a result, localized inflammation will occur as the ITB crosses the knee.  Symptoms will generally present as a sharp, burning or stinging pain just above the outside of the knee.  Pain will most commonly occur with stair climbing, running or even walking.  The key to treating ITB Syndrome is uncovering the underlying mechanism.  Whether the mechanism is muscle weakness or imbalance, limited flexibility or joint motion, running form or even improper footwear, it is essential to recognize the cause in order to effectively treat the injury.  Your physical therapist will perform a thorough evaluation to assess you flexibility, strength, foot posture and joint motion to uncover the underlying mechanism.  Following the evaluation, your therapist will create a treatment plan to best address your needs, reduce pain, and return you to your prior activity levels.    All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

**For more information, please see the article “Understanding Iliotibial Band Syndrome” written by Eric Ivancich in our publications.

Post-Surgical Care

Whether your surgery is due to a traumatic injury or structural abnormality, your physical therapist will help to restore your prior level of activity.  Based upon your physician’s orders, your physical therapist with expedite your recovery through state of the art modalities, advanced manual techniques, as well as strengthening and stretching exercises.  Many knee injuries will require surgical intervention to correct.  Whether it is a meniscus repair, Patella-Femoral Syndrome Correction, a tendon or ligamentous repair such as ACL, or Patella Tendon Rupture, a Partial or Total Knee Replacement or simple Arthroscopy, your physical therapist will work hand in hand with your surgeon to ensure maximal recovery and return you to your prior level of activity.  Your therapist will design a treatment plan, following post-surgical guidelines, to address your needs and help you meet your goal.  Every individual is different, and therefore all cases will be evaluated and assessed based on the patient’s needs and goals. All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

**For more information, please see the article “What to Expect After a Total Knee Replacement” written by Joel Maietta in our publications.

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