Knee pain

The knee

The knee joint is a hinge joint, which mainly allows for bending, straightening and a small degree of rotation. The tibiofemoral joint involves the thigh bone (femur) meeting the shin bone (tibia). The patellofemoral joint is where the knee cap (patella) slides on the thigh bone (femur). These joints work together, alongside ligaments, tendons and muscles to provide a stable system to help when standing and walking. 

What are the common causes of knee pain?

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

These pains may be a result of an acute injury or a flare up of a long standing issue. Simple advice is keep active and keep moving, it will often settle with time.

Referred pain

Knee pain may be as a result of referred pain from your hip or from your lower back. If you think that this is the case please discuss this with your health care professional or refer yourself to a physiotherapist for help with management.

Your knee may also cause referred pain into the thigh, hip or lower leg. This referred pain should improve as your knee improves.

Click on the following information to find out about common conditions related with knee pain.

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Early management of sprains and strains

Minor injuries to the knee, such as a mild sprain or strain should settle with time and can be managed at home. 

A sprain or strain to the knee may result in the following: 

  • Pain
  • Swelling
  • Bruising
  • Stiffness and loss of function 

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Go to an urgent treatment centre or the emergency department if you: 

  • have severe pain or feel faint, dizzy or sick from the pain  
  • heard a snap, grinding or popping noise at the time of the injury,  
  • had a large amount of swelling which appeared instantly after the injury (within an hour) 
  • you are unable to weight bear because of the pain 

These might be signs of a more severe injury which may need medical attention. 

Speak to a GP or physiotherapist if: 

  • the pain is severe or stopping you doing normal activities 
  • the pain is getting worse and/or keeps coming back 
  • the pain has not improved in any capacity after treating it at home for 2 weeks 
  • you have ongoing symptoms of giving way or locking 
  • Click here to self-refer to a physiotherapist.

How to manage a sprain or strain

DAY 1 – Early Management

Protect by minimising use of the affected area and initially avoiding stretching the area which could cause further injury. You may require the use of a walking aid to offload pressure on the affected side. You may find it easier to go upstairs leading with good leg first, and downstairs with the affected leg first.   

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to make sure you keep your hip and ankle moving as able, so they do not stiffen up. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the knee can be achieved by using a tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness.   

Elevation. If you have swelling in your knee, try to keep it level or slightly higher than your hip. You can help achieve this with use of pillows. 

Click here for a video of how to manage a sprain or strain at home

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your knee as your pain allows. Start to do normal everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times.

Knee exercises 

 

Lying on your back, bend your knee up towards you, sliding your foot and then let it return.

 

 

 

 

Sitting on a chair bend your knee back as far as it can comfortably go.

 

 

 

 

Sitting on a chair, slowly straighten your knee as high as it can go and slowly lower it down again. 

 

 

 

Hip exercises 

 

Lying on your back, lift your knee towards you and then let it come back down. 

 

 

 

Lying on your back, slide your whole leg out to the side in an arc and return.

 

 

 

WEEK 2 – Strengthening Exercises

You can start these when pain is starting to settle.  

Knee exercises 

 

 

Lying on your back, squeeze your knee in to the bed.  Hold up to 5 seconds and relax.

 

 

 

 

Lying on your back, lift your leg up straight approximately 30 cm off the floor / bed.  Hold up to 10 seconds and slowly lower it down.

 

 

 

  Sitting in a chair.  Stand up and sit down slowly.  Try not to use your hands if possible.  Make this harder by: 

  a) moving the foot of your affected knee closer to you and then progress to 

  b) standing from a lower height.

 

  In standing with feet apart, hold on to something in front to steady yourself.

  Keeping your back upright, slowly let your knees bend and return to upright.

  To begin with you may not do much of a dip and that is ok, the important thing is to be in control.

  Gradually progress to a deeper dip then hold for 5 seconds hold at the deepest part. 

 

 

Hip exercises 

 

 

Standing up and holding on to something if you need to.  Take your leg out to the side and return.

 

 

 

 

 

Standing up and holding on to something if you need to.  Take your leg behind you and return. Remember to keep your back up right and don’t lean forward. 

 

 

 

 

 

  Standing up and holding on to something if you need to. Lift your knee towards your chest and then lower it down.

 

 

 

As you start to do these exercises you may feel there is some discomfort, however, this is okay and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you should reduce the number and gradually build up again. 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the hip or knee.  However, everyone recovers from injuries at different rates. Some may be back in a few days however for some it can take a number of months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies or sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby or sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity in full.  

Osteoarthritis of the knee

What is it?  

Osteoarthritis is a wear and repair process and a commonly affected joint is the knee. It can lead to joint pain with limitation of movement, which can affect daily activities.  Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.

Versus Arthritis have produced a video summary of ‘What is Osteoarthritis?’

In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely. Changes to the cartilage can lead to pain, stiffness, and loss of movement. This can in time lead to weakness around the muscles of the joint.

It most commonly affects people older than 45 and is more common if you are overweight, have a family history of it, or have previously injured the joint in question. Osteoarthritis has varying degrees on functional limitation and effect on quality of life. Contrary to popular belief it does not affect everyone as you get older and does not necessarily get worse with age.

What are the common symptoms of Osteoarthritis of the knee?

With osteoarthritis of the knee you may feel pain on either side of the knee, the front or sometimes around the back of the knee.  Morning stiffness lasting less than 30 minutes is also very common. You may hear noises coming from the knee (crepitus). You may see or feel some swelling around the knee. You may have difficulty fully bending the knee or straightening the leg. Pain may be present if you have been on your feet for a long period. You may have pain when walking or performing the stairs.

How to manage it?

If you think you have, or have been diagnosed with osteoarthritis of the knee by a healthcare professional there are several things you can do to help manage your symptoms and stop it from worsening

Exercise

Exercise has been shown to be beneficial in osteoarthritis. Try to increase your activity levels and consider taking up exercise.  Walking, swimming and cycling are often well tolerated but choose something you enjoy. It is important when starting exercise to start easy and build up slowly. A small increase in your pain when you start is okay.

Strengthening 

Osteoarthritis can lead to weakness.  Strengthening the muscles around your knee will allow you to do things more easily such as standing up, walking and climbing stairs.  You need to focus on getting your thigh muscles (quadriceps) strong.  Again some pain when starting exercise is okay provided it is tolerable.  Start with simple exercises and build up. Please see this link from versus arthritis for a description of some useful exercises to help your knee:

Exercises for the knee from Versus Arthritis

Weight control

If you are overweight, try to lose some weight. Even a modest weight loss can make quite a difference to your symptoms.

Using a walking aid such as a stick or walking pole in the opposite hand to the affected knee can also help to take pressure off the painful joint.

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice or heat therapy 

Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your knee and may allow exercises to be more effective.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

 

Your GP or physiotherapist may refer you to an ESCAPE Pain class.

This is an evidence based programme of 12x one hour sessions over the course of 6 weeks which comprise a 15-20 minute education/discussion element and a 30-45 minute exercise programme.

The aims of the course are to help you better manage your symptoms; carry out normal activities, become more active and to continue to exercise.

The classes are being run in a number of physiotherapy departments. There is also an online programme to follow and escape pain app available to download. Please click here for more information.

Important information to know:

Being overprotective and doing less can mean that you will get weaker and stiffer and eventually have more symptoms.

The stronger the muscles are that surround the knee, the less the arthritic changes will have an impact on your life

It is safe to exercise, and exercise does not speed up the osteoarthritic process.

Many people have signs of osteoarthritis on x–rays but no symptoms. We often find that the changes seen on x-rays do not always correlate to the level of pain a person will report. These changes are best thought of as normal age related changes. The pain is believed to be as a result of a flare up of your osteoarthritis. This often settles as the body repairs itself. This is the wear and repair cycle.

Anterior knee pain (AKP)

What is it? 

Anterior knee pain (AKP) is pain in the front of your knee which is very common.  It is usually not related to any significant injury and can arise at various stages of life.  It is related to various structures around your knee becoming sensitive. 

What are the common symptoms?

Things that may be painful may include deep squatting, walking up or down stairs and slopes, or standing up after a prolonged sitting period.  You may notice clicks within the knee, do not worry about these as they are not necessarily a sign of something being wrong. 

How to manage it?  

Activity modification 

  • If you have significantly increased your activity levels before the onset of the pain try to reduce the activity  
  • Identify any changes in your lifestyle that could have resulted in knee pain, both internally e.g. have you gained weight? or externally e.g. have you started wearing new shoes? If you do, try reversing the changes and see what effect it has on the pain 
  • Limit as much as possible, activities or postures that you know cause your symptoms to worsen. 
  • As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity once the pain has gone 

Weight loss 

Losing weight will reduce the amount of pressure the patella (kneecap) is putting on your knee and even a modest loss in weight will improve your symptoms and reduce the chances of it coming back. 

Exercise

Exercises can be very helpful in this condition but be aware that it may take up to three months before you notice significant improvement. Don’t be disheartened – stick with it! Generally the longer you have had the anterior knee pain, the longer it takes to improve. 

  • Exercises that often help include stretching of the calf muscles and strengthening of the thigh (quadriceps).   
  • The hip and buttock muscles are also key in controlling leg movement while under load (such as going down stairs) and there is evidence to suggest that strengthening of these muscles can also help. 
  • Some pain during exercise is okay but should be tolerable and settle within two hours following exercise 

Try the simple exercises below. If you are having difficulty with them please speak to a physiotherapist for advice.

Strengthening exercises

Isometric knee extension in lying

 

   Lie on your back with one leg bent and the other leg straight. 

   Bend the ankle of the straight leg and press the back of the knee against the floor using your front thigh muscles.
   Hold the tension for a moment and then relax.

   Repeat 10 times. Rest for 1 minute. Repeat 3 times.

 

 

Knee End-range Extension in lying

 

   Lie on your back with one leg bent and the other leg straight. Place a towel roll under the straight knee.

   Bend your ankle and straighten the knee using your front thigh muscles. Keep the back of your knee against the towel roll.
   Keep the tension for a moment and then relax.

   Repeat 10 times. Rest and then repeat 3 times.

 

 

Wall squat

 

  Stand with your back against the wall and your feet slightly away from the wall.

  Slide your bottom down the wall. Slowly straighten your knees and then repeat. Gradually go further down the wall as you get stronger.

  Repeat 10 times. Rest. Repeat 3 times.

 

 

Stretching exercises

Hamstring (back of the thigh) stretches

Stand. Take the leg you want to stretch in front of you, heel on the floor.

Move your pelvis backwards, bend the supporting leg and bend your trunk forward until you can feel a stretch in the back of your thigh.

Hold for 30 seconds. Repeat 3 times.

Quadriceps (front of the thigh) stretches

 

 

 

Lying face down, take hold of your foot and draw towards your buttocks until you feel tension in your thigh muscle.

Hold still for 30 seconds. Repeat 3 times.

Calf (back of the lower leg) stretches

 

In standing, step forwards and bend your front knee, leaning on a chair. Keeping feet facing forwards, straighten the back knee and push the back heel into the floor.

You should feel tension in your calf muscle.

Hold still for 30 seconds. Repeat 3 times.

 

 

 

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

 

Patella tendinopathy

What is it?

Patella tendinopathy is associated with pain at the front of the knee under the knee cap. It is sometime called jumper’s knee.

A tendon is the structure that attaches muscle to bone. The patella tendon (blue arrow on picture) connects the lower end of the knee cap (patella) to your shin bone (tibial tuberosity). It helps the large powerful thigh muscles (1 quadriceps) move the lower leg.

 

  Muscles around the knee

  1 Quadriceps (front of the thigh)

  2 Hamstrings (back of the thigh)

  3 Gastrocnemius (back of the calf)

  Blue arrow Patella tendon

 

It is often caused by an overload to the tendon due to an activity that the knee is unaccustomed to or a sudden increase in activity. There may be structural changes to the tendon over time that may contribute to the ongoing pain.

It most commonly affects people in the age group 15-30. It is more common in men than women and more common in those who play sports involving jumping. Other factors thought to contribute to developing patella tendinopathy include poor fitness levels, being overweight and repetitive heavy load or strain on the tendon.

What are the common symptoms?

Pain is aggravated by activities that increase load going through the quadriceps muscles for example: sitting, squatting, stairs and jumping. Initially it may be a sharp localised pain at the front of the knee, becoming a dull ache around the knee as time goes by.

How to manage it?

Modify your activity

Initial relative rest and modifying activity is recommended. This allows for appropriate tendon healing following a period of overloading or unaccustomed exercise.

This does not mean complete rest from all activity but rest that reduces the load on your tendon.

Examples of ways you can offload your tendon are:

  • Going up the stairs with your unaffected leg first and coming down the stairs with your affective leg fist
  • Putting your affected leg out in front of you when you sit and stand
  • Avoiding hill walking/ hill running/ jumping
  • Rest from sporting activities which involve jumping, squatting etc.

Note these offloading methods should only be used short term as it is important to get back to your usual activates as quickly as possible.

During this stage isometric exercise of your thigh muscles may help your pain; these are exercises in which you tense your muscles without much movement of the knee.

Speak to a physiotherapist for further guidance on relative rest and exercise during this stage.

Isometric knee extension in lying

  Lie on your back with one leg bent and the other leg straight.

  Bend the ankle of the straight leg and press the back of the knee against the floor using your front thigh muscles.
Hold the tension for a moment and then relax.

  Repeat 10 times. Rest for 1 minute. Repeat 3 times.

Heel raise

  Stand tall, with your weight distributed evenly on both feet, and take support if needed.

  Rise up onto your toes and in a controlled manner return to the starting position.

  Repeat 10 times Rest for 1 minute. Repeat 3 times.

Rehabilitation exercises

In order for the tendon to heal and to prevent future problems it is important to strengthen your thigh muscles (quadriceps).  Eccentric exercises (exercises that load the muscle as it lengthens) are recommended for this condition.

A common exercise used is a small squat on two legs, this is gradually progressed to a deep squat on two legs and then single leg squats.

It may also be helpful to strengthen other muscles groups including your calf muscles, hip and buttocks muscles.

In the later stages of rehabilitation if you play a sport involving jumping then jumping and hopping exercises may also be added to your program.

It is important to take a gradual graded approach to your exercises. Doing too much too soon may slow down the recovery. Equally doing too little will not give the tendon the stimulus it needs to heal properly.

 Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

Repeat 10 times rest 1 minute. Repeat 3 times.

 

Deep Squat

Squat down by sitting back and bring your arms upwards. Push back up through the heels, chest up, and straighten your hips.


– keep hips, knees, toes aligned.

– Go only as low as you feel comfortable with.

– Keep weight evenly on whole foot.

Repeat 10  times rest 1 minute. Repeat 3 times.

Single-leg Mini Squat

Stand tall on one leg with the other leg raised behind.

Squat down keeping your knee in line with the toes and your pelvis level. Push back up to the starting position.

As your technique improves and pain reduces, you can progress the exercises to a deeper squat.

Repeat times 10 times rest 1 minute. Repeat 3 times.

Further progression of exercise may include an eccentric strengthening programme and a gradual return to sport or activity. If you need guidance on this please self-refer to a physiotherapist.

Changes to the muscles and tendon takes time, you may need to do the exercises for 3-6 months to aid your recovery.  Be patient and continue to do them regularly.

Mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop and inform your physiotherapist. As a guide your pain should not go above 4/10 (0 being no pain, 10 being the most severe pain).

For guidance on the right exercises for you speak to a physiotherapist.

Weight management

If you are overweight this increases the load and demand being placed on the quadriceps and patella tendon. Therefore reducing you weight to a healthy BMI may help reduce your symptoms.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future symptoms?

Tendons do not respond well to a rapid increase to the load placed upon them.

To avoid excessive load it is best to keep your exercise and activities varied.

Build up your activity and exercise gradually, especially if it is an activity, exercise or sport that you are unaccustomed to.

If you do ‘overdo it’ take some relative rest days to allow the tendon to recover before gradually getting back to your usual activities.

You can also reduce your risk of developing this condition by maintaining a healthy weight.

Hoffa’s fat pad syndrome

What is it?

The infrapatellar (Hoffa’s) fat pad is a structure found within the front of the knee. It can be a common source of anterior knee pain if it becomes irritated or overloaded.

What are the common symptoms?

It is situated deep to the patella tendon below your knee cap area and will often swell with a “horseshoe swelling” under your knee cap area if irritated. This is nothing to worry about and is a normal presentation for this to occur.

You will often feel pain over the site of this swelling, sometimes more to one side of the swelling than the other but it can be both sides equally. The irritation of this structure is often caused by a subtle change in the way we are loading our knee (altered biomechanics). Sometimes this is caused when people over-straighten their knee naturally (hyper-extend).

How to manage it?

Modify your activity

  • If you have significantly increased your activity levels before the onset of the pain try to reduce the activity
  • Limit as much as possible, activities or postures that you know cause your symptoms to worse. In particular, try to avoid hyper-extending your knees or doing activities which would encourage this position.
  • Some taping techniques can be used to offload the Fat Pad.
  • To improve the swelling and pain try simple topical NSAID gels (anti-inflammatory gels) or using ice over the affected area

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

You should be cautious using these treatments if you have altered skin sensation or circulatory problems.

Check the skin regularly during and after the ice pack application

Stop if there is excessive pain, numbness or tingling

Do not put ice directly on to the skin as this may cause a burn.

Exercise

Regular exercise will be helpful but try not to overload the structures at the front of the knee with specific overloading activities such as deep squats or hyper-extending exercises.

Strengthening Exercises

  • Specific strengthening exercises for the quadriceps muscle complex are very helpful for this condition
  • Quadriceps control exercises are very helpful in learning to re-educate the muscle so that it does not over-extend
  • Proprioceptive exercises (positional sense of the joint) in particular re-educating the knee joint to not over-extend are very helpful too
  • Gluteal strengthening and core stabilising exercises will help also reduce the load on the knee and improve the biomechanics
  • As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity as soon as your pain allows

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

Repeat 10 times rest 1 minute. Repeat 3 times.

Deep Squat

Squat down by sitting back and bring your arms upwards. Push back up through the heels, chest up, and straighten your hips.

– keep hips, knees, toes aligned.

– Go only as low as you feel comfortable with

– Keep weight evenly on whole foot.

Repeat 10  times rest 1 minute. Repeat 3 times.

Single-leg Mini Squat

 

Stand tall on one leg with the other leg raised behind.

Squat down keeping your knee in line with the toes and your pelvis level. Push back up to the starting position.

As your technique improves and pain reduces, you can progress the exercises to a deeper squat

Repeat times 10 times rest 1 minute. Repeat 3 times.

 

 

 

Controlled knee extension

 

Stand tall with one knee slightly bent. A loop of an exercise band is placed around your knee and secured low in front of you. Take the slack off the band.

Tighten your front thigh muscles and straighten your knee against the resistance. In a controlled manner, let the band pull your knee back to the starting position

An exercise band can be bought online.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

 

Lateral knee pain

What is it?

Lateral (outer)  knee pain can be caused by several things, but the most common cause is Iliotibial Band Syndrome, an overuse injury due to the Iliotibial band moving across the outside of knee joint.

Muscles and ITB around the knee cap – picture showing the front of the knee

1 Tensor fasciae latae muscle
2 Vastus lateralis muscle
3 Iliotibial band
4 Vastus medialis muscle
5 Rectus femoris muscle
6 Vastus medialis obliquus muscle

 

 

 

This pain on the outside of your knee, is also called Runner’s Knee.

The iliotibial band, a thick band of fibrous tissue (3) that runs down the outside of the leg, works in coordination with several of the thigh muscles to provide stability to the knee and to help in flexion of the knee joint (see picture above). When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

How to manage it? 

This involves relative rest, ice, and anti-inflammatory medications initially. This should improve pain, swelling and tenderness.

Exercises

Stretching the muscles on the outside of your leg will also help to increase mobility of the Iliotibial Band, quadriceps, hamstrings, gluteals and calf muscles.

The final important phase treatment includes a strengthening program and a progressive return to activities, such as running, once pain free.

Knee extensions

 

Sitting on a chair, slowly straighten your knee as high as it can go, hold for 5 seconds and slowly lower it down again.

 

 

 

Hamstring stretches

 

Stand. Take the leg you want to stretch in front of you, heel on the floor.

Move your pelvis backwards, bend the supporting leg and bend your trunk forward until you can feel a stretch in the back of your thigh.

Hold for 30 seconds. Repeat 3 times.

Iliotibial band stretch

Stand close to a wall for support. Cross your legs and lean away from the wall. Move your hip closer to the wall until you feel a stretch down the side of your leg.

Hold for 30 seconds. Repeat 3 times.

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

Repeat 10 times rest 1 minute. Repeat 3 times.

 

 

Deep Squat

Squat down by sitting back and bring your arms upwards. Push back up through the heels, chest up, and straighten your hips.

– keep hips, knees, toes aligned.

– Go only as low as you feel comfortable with

– Keep weight evenly on whole foot.

Repeat 10  times rest 1 minute. Repeat 3 times.

Single-leg Mini Squat

 

Stand tall on one leg with the other leg raised behind.

Squat down keeping your knee in line with the toes and your pelvis level. Push back up to the starting position.

As your technique improves and pain reduces, you can progress the exercises to a deeper squat

Repeat times 10 times rest 1 minute. Repeat 3 times.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling

Do not put ice directly on to the skin as this may cause a burn.

Prepatellar bursitis

What is it?

This is inflammation of the small sac of fluid at the front of the knee (bursa) it is often caused by repetitive or prolong period of kneeling. The bursa is present to prevent friction. If this becomes inflamed it can be painful. It can also be caused by a one off injury or by an infection.

Location of prepatella bursa and muscles of the knee

1 Quadriceps (front of the thigh)

2 Hamstrings (back of the thigh)

3 Gastrocnemius (back of the calf)

Blue arrow – Prepatellar bursa

 

What are the common symptoms?

Pain and swelling usually occurs at the front of the knee, over the knee cap.

There can be a restriction in movement of the knee. You may also have difficulty walking and kneeling.

How to manage it?

The good news is this will usually settle with self-management. If there is an infection causing the bursitis this will need to be treated as soon as possible. If you have any heat or redness around the knee, please speak with your GP immediately.

  • Modification or avoidance of activities which worsen symptoms (such as prolonged kneeling or pressure over the knee)
  • Resting the knee
  • Application of ice (see below)
  • Compression
  • Elevation

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

As the pain and swelling improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity.

Ligament/cartilage injuries

What is it? 

Knee ligament and cartilage (meniscus) injuries are very common and are often sports related, although they can occur from a trauma during everyday activities.

The most common are:

  • a sprain/strain – one or more ligaments is overstretched through twisting or pulling
  • a tear – either a partial tear or complete rupture of the ligament
  • injury or tear to the cartilage in your knee – the cartilage is a crescent-shaped disc called a meniscus, that acts as a ‘shock absorber’ in your knee
  • Cartilage injuries could be caused by an acute injury or trauma or due to a more gradual onset because of age related changes to the cartilage.

  Right knee – picture from the front of the knee
  1 Outer aspect of knee
  2 Lateral collateral ligament
  3 Medial collateral ligament (deep fibers)
  4 Medial collateral ligament (outer fibers)
  5 Medial meniscus
  6 Patellar tendon and patella

 

 

 

Ligaments connect one bone to another. The ligaments outside your knee joint are called the medial collateral ligament (inner knee) and the lateral collateral ligament (outer knee). They provide your knee with stability and limit the amount it can move from side to side.

The medial collateral ligament is strong and can be sprained or completely ruptured (torn) if you twist your straightened leg at the same time as being knocked sideways, for example, when being tackled in rugby.

The ligaments inside your knee joint are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments provide stability to your knee when it is in different positions, particularly in the forward and backward movements of the knee joint. People who sustain an injury to their ACL may complain of symptoms of the knee ‘giving out’.

Acute cartilage injuries may cause the knee to get stuck in one position or ‘lock’. If this is happening to your knee please speak with your GP or a physiotherapist as soon as possible.

Some cartilage injuries may be as a result of a natural ageing process. These might cause pain and swelling without any locking. This may need time to settle and exercises to keep the knee mobile and strong.

How to manage it? 

  • Follow the advice in early management of sprains and strains section
  • Rest the leg and apply ice for 15-20 minutes every few hours for the first 48 hours after the injury.
  • Take some painkillers so you are comfortable.
  • A simple strain of the medial collateral ligament should settle very quickly. If things are not improving please see further advice from your GP or self-refer to physiotherapy.
  • If you have been informed you have an ACL injury or ligament injury and have spoken to a health care professional you may benefit from the following exercises. Please click here for an ACL prehabilitation programme.

On some occasions an acute knee injury needs urgent medical care. Go to an urgent treatment centre or emergency department if you: 

  • have severe pain or feel faint, dizzy or sick from the pain  
  • heard a snap, grinding or popping noise at the time of the injury,  
  • had a large amount of swelling which appeared instantly after the injury (within an hour) 
  • you are unable to weight bear because of the pain

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

How to prevent ligament and cartilage injuries?

There are some precautions you can take to try to reduce the risk of injuring your knee.

  • Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.
  • Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven. 
  • Vary your knee movements: Anterior knee pain (pain in the front of your knee) is generally the result of overusing the joint, so it is important to try and vary the stresses you place on your knee. For example, runners should make sure they mix up the surfaces they run on to include uphill runs and flat ground
  • Stretch regularly: Keep the muscles in your legs as flexible as possible by regular stretching.
  • Strengthen your leg muscles: Perform regular exercises such as squats and lunges to strengthen and keep your leg muscles in good condition.

Footwear: Ensure sports shoes are appropriate for the activity and are replaced regularly to avoid excessive wear. In osteoarthritis of the knee good, cushioned footwear has also been shown to be beneficial.

When to seek medical advice

 

When to seek medical advice

The above advice can help you to manage your condition at home. The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer but this doesn’t mean there is something seriously wrong.

However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek advice. We would advise if you experience any of the following you should seek the advice of your GP.

  • the pain you are experiencing is getting worse rather than better despite following the self-management guidance above for the condition  in the time frame expected
  • symptoms have not been significantly helped by a trial of medication as expected
  • you feel unwell and suffer symptom such as fever, night sweats or weight loss
  • you experience pain at night, possibly worse than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.
  • you experience a change in your ability to walk including balance problems or weakness/heaviness in your legs
  • you develop a hot and swollen joint for no apparent reason
  • early morning stiffness, lasting for longer than 30 minutes

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