What is it?
 
Your knee moves freely backwards and forwards; however, the thought of it moving from side to side probably makes you cringe. This is because the knee joint has sturdy ligaments either side of it that prevent sideways movement and we instinctively know that a lot of force would be required to shift it in this direction. 
 
The ligaments on either side of the knee are called the collateral ligaments and they each work to provide stability and restrict the knee’s movement into a sideways direction. The medial collateral ligament (MCL)  is found on the inside of the knee and acts to prevent the knee bending inwards towards your other leg.

How does this injury occur?
 
The typical mechanism for this injury is a force that drives the lower leg inwards. This can occur from an awkward landing from a height, or when twisting with a foot fixed on the ground or from an external force hitting the outside of the knee, such as with a football or rugby tackle.
 
What are the symptoms?
 
MCL tears typically create pain and swelling quite specifically on the inside of the knee. The severity of the pain and swelling will be related to the amount of ligament fibres damaged. Larger tears may also make the knee feel unstable or loose. 
 
A grading system is used to classify the severity of the injury and help to guide treatment. Grade 1 indicates that a few ligament fibres have been torn and grade 3 is used for a complete tear of the ligament with associated joint laxity. Very severe MCL tears may also involve injury to the medial meniscus and anterior cruciate ligament (ACL) and can require surgical repair. However, most MCL sprains can be managed well with physiotherapy. Grade 1 and 2 MCL sprains take between 3-8 weeks to fully heal and a complete rehabilitation program is strongly recommended to prevent future injury.  
 
How can physiotherapy help?

In the early stages of the injury, treatment is focused on pain and swelling management, while allowing the body to start the healing process. This is best managed thought the R.I.C.E. principles (Rest, Ice, Compression and Elevation). 
 
Following any injury, it is natural for muscles to waste a little and the damaged tissues to lose what we call proprioception, the ability to sense their position in space. This loss of muscle strength and proprioception can contribute to future injury if not restored with a proper rehabilitation program. 
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Physiotherapy also aims to restore movement to the joint and support the ligament while healing to ensure that it is strong and healthy, and the scar tissue forms in an organized fashion, which makes the new ligament as strong as it can be and protects against future tears.

A serious injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligament is  important for stability of the knee and may need to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly.
 
Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.

What does the surgery consist of?
 
Each surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.
 
How long does rehabilitation take?
 
Full rehabilitation following surgery can take 9 to 12 months and is divided into different stages. As surgeons can have different protocols for their approaches to surgery, time frames will vary for everyone. 
 
Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence suggests that it may never have the strength of the original ligament.
 
In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the muscles around the knee without putting any undue stress on the graft.
 
As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport.
 
The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however, there are high success rates with this surgery, particularly when followed up with full physiotherapy rehabilitation.

The knees function as hinges, allowing your legs to swing forwards and backwards smoothly as you walk, kick and run. The knee cap (the patella) sits at the front of the knee and has a variety of functions, including guiding the muscles that straighten the knee, protecting the knee joint and absorbing forces when the knee is bent. When something goes wrong and the patella doesn’t glide up and down smoothly, the soft tissue between the kneecap and the knee can become irritated, causing pain. This is called patellofemoral pain syndrome (PFPS), sometimes also referred to as PFJ syndrome, patella maltracking or runner's knee.
 
Pain is usually felt on the inside of the kneecap when running, squatting, jumping, bending, using stairs or hopping. Sitting for long periods of time or keeping your knees bent can also result in pain. 

What Causes It?
 
The patella sits in a shallow groove at the front of the knee and usually moves up and down as the knee bends and straightens without too much trouble. The quadriceps muscles located at the front of the thigh contract and pull on the kneecap, which then attaches to the shin bone and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull more to one side and over time become irritated. 

The cause of muscle imbalance or weakness can be varied. In general, the outer muscles of the thigh tend to be stronger and tighter than the inner muscles. If you have poor posture and hip position, this can cause the outer muscles to work harder and the inside muscles to become weaker. Lack of arch support in your feet or a physical anomaly of the knees can also contribute to this condition.
 
How Can Physiotherapy Help?
 
Diagnosing patellofemoral pain syndrome correctly is important because pain on the inside of the knee can also be caused by other injuries, dislocations, inflammation, arthritis and a variety of other less common conditions. With that in mind, it is helpful to know that your physiotherapist can diagnosis PFPS accurately and identify its likely causes.
 
Whether it is due to poor posture, a lack of arch support in your feet, or poor running technique, your physiotherapist will assess the problem and provide a specific treatment program to best approach your condition. PFPS usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, massage, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.
 
In the rare case that your condition is not helped by physiotherapy, surgery may be considered as a last resort. For more information, please  ask your physiotherapist.

Tendons, the connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles they can have relatively poor blood flow, which is essential for healing. 
 
Tendons and muscles work together to move your joints and together are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful. 

Is my pain related to a tendon injury?
 
For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with a tendon are; 
 
· The pain is quite specific and can be felt over the tendon itself; 
· The pain is worse when under stress and improves when rested; 
· The pain improves after exercise has started, but it might be worse once you cool down; 
· The area around the tendon may feel stiff after periods of rest, particularly in the morning. 
 
How are tendon injuries treated?
 
When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.  
 
Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.
 
Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury. 

What is an ACL tear and how does it occur?
 
The ACL, or anterior cruciate ligament, is a strong piece of connective tissue which helps attach the thigh bone (femur) to your shin bone (tibia). The ACL provides stability to the knee joint as it prevents the tibia from sliding forward relative to the femur.
 
ACL tears are a common sporting injury, however they can also occur from everyday activities. The most typical mechanisms of injury are landing awkwardly from a jump, twisting the knee, or suddenly stopping while running. The ACL may also be injured during knee hyperextension, or getting hit on the outside of the knee. Often, other tissues surrounding the knee are also damaged, including the medial collateral ligament, meniscus, joint cartilage and bone surfaces. The ligament can be stretched, partially damaged or completely torn.

What are the signs and symptoms?
 
Many people report hearing a “pop” in the knee along with immediate pain and swelling. Decreased range of movement of the knee is common and the injured knee is typically unable to take full weight when standing or walking. The knee may also feel unstable, with a sensation of “giving way”. Poor balance and coordination may also be experienced. Smaller tears of the ligament may have only mild symptoms, however, more severe tears will have more significant pain, swelling and instability.
 
 Is surgery necessary?
 
Traditionally, surgery was thought to be necessary for all full-thickness ACL tears. A series of recent studies have shown however, that outcomes are often the same for people who chose surgery and those who didn’t, both in terms of recovery and future risk of osteoarthritis. Individual circumstances will impact this decision. Elite athletes and cases with additional meniscal tears may do better with surgery. Generally speaking however, with time and full rehabilitation, many people can return to their previous levels of activity without surgery. 
 
How can physiotherapy help?
 
For both surgical and non-surgical recovery from ACL tears, physiotherapy rehabilitation is essential for a full recovery. Your physiotherapist will assist you with improving your knee range of movement, lower limb strength, balance, stability and coordination. You will re-learn the tasks of walking, using stairs, and negotiating obstacles with retraining of your balance and control. 

Early in rehabilitation, the RICE protocol (rest, ice, compression, elevation) is used in conjunction with static resistance type exercises to improve muscle contraction in the leg and increase blood flow to the area.
 
Throughout your rehabilitation program, you will progress through a variety of strength and mobility exercises targeted towards your individual needs, with goals of returning to your favourite sport or hobby as soon and as safely as possible.

Osteoarthritis (OA) is a common degenerative joint disease that affects many of the joints of the body. The knees are some of the most commonly affected joints, with many people experiencing at least a small degree of osteoarthritis over the age of 40. The disease is characterized by degradation of the cartilage that lines the surfaces of the joint, growth of osteophytes or bony spurs, pain, stiffness and swelling. 

What are the symptoms?
 
Stiffness in the morning, pain with movement, clicking, crepitus, swelling and a generalized reduction in joint range of motion are all common symptoms of osteoarthritis. As OA is a progressive disease, the condition is categorized into stages to help describe symptoms and guide treatment. Early stages of OA may have only mild symptoms, however as the disease progresses or in more severe case, a joint replacement may be required.
 
What causes it?
 
While ageing is the most significant risk factor for the development of OA, it’s not an inevitable consequence of growing older. Other factors that may predict the development of OA are obesity, family history, previous joint injury, high impact sporting activities and peripheral neuropathy. It is thought that abnormal wear and tear or stress on the joint is the primary cause of OA. It is also important to note that many people will have changes on X-Ray that show OA, but will have no symptoms – which indicates that simply having OA is not a guarantee of persistent pain.
 
What is the treatment?

Your physiotherapist is first able to help diagnosis and differentiate OA from other conditions that may have similar symptoms. An X-Ray can confirm the diagnosis and can be helpful in determining the best course of treatment to follow.

While OA is a progressive disorder, there is often a significant improvement that can be made simply by addressing lifestyle factors and any biomechanical factors that may be contributing to pain.

How can physio help?

Your physiotherapist is able to guide you with strengthening exercises to support the joints, advice for adapting your exercise routine and can even help you to lose weight, all of which have been shown to have a positive impact on the symptoms of OA.
 
If surgery becomes the right course for you, your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best outcome possible. 

1. Choose supportive footwear
 
One of the biggest culprits for ongoing knee pain is wearing unsupportive or high-heeled shoes to work. High heels often lead to tight calves and altered gait patterns, while unsupportive shoes can allow rolling in of the feet, which can then place extra stress on the knee joints. Having an assessment with your physiotherapist to see how your shoes might be affecting your knee pain is a worthwhile investment.
 
2.  Adjust your sleeping position
 
While most of the time, our knees get a well deserved rest during the night-time hours, there are a few sleeping positions that can place additional stress on the knees. Lying on your side with bent knees can place tension on the outer thigh muscles and the knee joint itself. Try to keep your knees straightened to only 30 degrees of bend and if you sleep on your side, place a pillow underneath the top knee to reduce stress on the joint.
 
Alternatively, if you sleep on your back it may be helpful to place a pillow under your knees so that they rest in a slightly bent position, to unload the joint.  Try experimenting with different pillow arrangements to see which combination works best for you.
 
3.  Avoid sitting or resting too much
 
When knee pain strikes, your first instinct is probably to get off your feet and stop exercising. The truth is that our knees, like all our joints, are designed for movement and regular exercise helps to keep them healthy. If you are having pain with high impact activities such as running, try switching to swimming and cycling before stopping exercise altogether. Resting in a sitting position for prolonged periods can also place excess stress over the knee cap and knee joint. When sitting for long periods, try to stretch your legs out ahead of you and avoid crossing your legs.
 
4.  Seek physiotherapy treatment
 
Many of us see putting up with pain as a sign of strength however, a small niggle that is easily treatable can turn into a larger problem if left over time. This may seem like an obvious point, yet the first step to recovery is often just seeking treatment.
 
Our physiotherapists are happy to discuss your condition with you and share their tips to help you stay pain-free.  

What is it?
Our knees are complex hinge joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, if something causes the patella to move in a dysfunctional way, the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ syndrome or patellofemoral pain syndrome (PFPS).

What causes it?
The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull to one side and over time become irritated.

There can be many factors that cause a muscle imbalance or weakness on one side of the quadriceps. In most people, the outer aspect of the quadriceps tends to be stronger and tighter than the inner muscle.

Certain postures and leg positions require the outer muscles to work harder and the inside muscles to become less active. Lack of arch support in your feet or simply a physical abnormality of the knee can also place stress on the movement of the patella.

What are the symptoms?
This condition is characterized by pain felt on the inside or behind the patella with activities that require repetitive bending of the knee. There may be a sensation of crunching, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is generally relieved with rest. The pain may start as a small niggle and gradually become worse over time.

How can physiotherapy help?
The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique.

Once these factors have been identified, you will be provided with a specific treatment program to best approach your condition. PFJ syndrome usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.