At Pilates 4 Physio we treat all types of knee pain, from sports injuries to more generalized knee pain without a specific cause. In your initial assessment there are a number of clinal tests that we perform on you that help determine what type of knee pain you have. If this is a sports related injury, then the mechanism of the injury is important, as this will tell us what structures in your knee could be damaged. For those non-specific types of knee pain, we are going to assess your hip, knee and foot mechanics, as well as strength and flexibility. Some sports related knee injuries will need referral to a Sports Doctor if we think an MRI is needed. You can still work on the rehabilitation to reduce pain and mobility while waiting for an MRI. For most soft tissue injuries it is essential to start this process in the early stages.
Sports related knee pain:
A common injury is an Anterior Cruciate Ligament (ACL) tear. In your assessment we can determine if there is a possible injury to this ligament. There are specific clinical tests that can determine if you have a torn ligament. This should also be confirmed on an MRI. If so, you should be referred to a Sports Medicine Doctor to decide if you are a candidate for surgery. They will also arrange for you to have an MRI. We can recommend some doctors for you, depending on where you live in Toronto. You can still start to work on regaining your movement and strength before your surgery, as this will speed up your recovery post-surgery. There are specific rehabilitation protocols that we follow to progress your joint mobility, strength and return to sport. Typical ACL rehabilitation is 6 months.
Meniscus injuries are also common in sports. A twisting injury under load may cause the fibrocartilage to tear. In the clinic we can determine how serious this is and if you need to be referred to a Sports Doctor. If your range of motion is not severely restricted then conservative exercise-based physiotherapy is the normal course of action. As the tear heels, the knee will become less painful and your strength will improve. It is a gradual process of re-loading the knee, while respecting pain. The research shows that exercise is just as effective as arthroscopic surgery for minor meniscus tears. Strengthening the knee and hip will help to prevent further wear and tear to the meniscus. It will also protect against it progressing into arthritis. For mild tears, your rehabilitation time is about 3 months.
Muscles and tendon injuries: There are a number of different injures that can occur to the muscles that control the knee. Hamstring and quadricep strains are common. Depending on the severity, your physiotherapist will determine if you need to be sent for imaging, or to see a Sports Doctor. For lower grade injuries a gradual rehabilitation program will strengthen the damaged tissues. A common condition we see is hamstring tendon strain. These may be caused by over-stretching the muscle or a sudden pull on the tendon. Tendons take longer to heal than muscle strains but they still need strengthening. Most of the research for muscle and tendon strains show that tissue loading, using progressive strengthening, is most effective treatment. Unfortunately there are many passive treatments being recommended, such as shockwave and PRP injections, that do not have the science to back them up. Typical rehabilitation times are 3-5 months.
Patello-Femoral pain is one of the most common types of knee pain seen in the physiotherapy clinic. This can be caused by sports activities as well as from non-specific causes. We have a blog on this injury for more detailed information on how we assess and treat it: Patella-Femoral (Knee Cap) Pain.
Patella-Femoral knee pain is very common. Non-specific causes are related to hip and knee muscle imbalances. There can be imbalances in the quadricep muscle at the front of the thigh. The gluteal muscles, hamstrings and adductors can also be weak. The research points to strengthening the hip and knee and not relying on passive treatments. Each patient will have a different pattern of muscle imbalances and there is no recipe approach.
Non-Specific Types of Knee Pain:
Some knee pain can be described as ‘non-specific’ where there is no direct injury or cause. The pain may have been insidious and may not be related to a specific event. Some of the injuries in the sports section may also arise without a specific event. Meniscus tears can be caused by degeneration as we get older. Knee arthritis can also arise from general wear and tear on your knee joint. Patella-Femoral (Knee Cap) Pain can occur from just normal activities.
With these types of knee pain, we look at your biomechanics and strength. You may have muscles that are too short and weak. Your hip and foot muscles may not be strong enough and so your knee joint is taking all the strain. You may also be performing some exercises incorrectly with improper technique. A simple correction can make a huge difference in how you load your knee. The Pilates equipment is ideal for gradual hip and knee strengthening as it allows numerous adaptation to avoid flaring the injury. Hip and foot strengthening, as well as trunk muscles, are essential to prevent over-loading the knee. Weakness in the hip and knee muscles can cause torque and hyper-extension at the knee joint.
Your assessment will show is what the underlying cause of your condition is. Observing how you perform clinical tests and exercises provides valuable information on strength and flexibility of key muscle groups. The Pilates Reformer, which looks like a leg press, is ideal for foot, hip and knee rehabilitation. Exercises can be performed lying on your back, side-lying and standing. You can also do supported lunges to build-up the strength and technique without pain. The overall goal is to program the exercises into functional movements that you do in normal activities. Squat, lunges, stepping-up and down can all be adapted on the Pilates equipment. We also have mini-trampolines to get you back to jumping activities.
At Pilates 4 Physio we have a full complement of equipment for effective knee rehabilitation. The design of the Pilates equipment allows us to work with the most acute injury, through the full rehabilitation process and return you back to your regular activities.