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MANAGING KNEE PAIN


Knee pain is common for all ages and all activity levels.


No matter what the cause of your knee pain, improving strength of the muscles that affect loading on the knee is the gold standard of many rehabilitation programs for knee pain. Lets talk about some of the more common types.


Patellofemoral (kneecap) related pain is often experienced at the front, side or middle of the knee area. This can build up gradually. Pain can be worse walking downhill, up or down stairs, sitting for long periods, upon standing or higher level activity like running. Like many overload injuries, contributing factors can be bubbling away over time even before symptoms come on. Similarly, knee joint related injury such as meniscus and osteoarthritis can build up over time or be "degenerative" in nature. Injuries to the meniscus can also occur from trauma to the knee joint. Pain can also be referred to the knee from the hip of lumbar spine and is more common than probably realised.

Pain can be attributed to many causes and everyone is unique in what factors may lead to pain. This is why getting a comprehensive assessment by a physiotherapist is key to identify and act on the most important risk factors.


MANAGING PAIN

There is however a common deficit - reduced strength of the leg muscles especially at the thigh and hip.


Best evidence suggests strengthening these muscles to reduce the abnormal load on the knee cap and the knee joint. This can be challenging to achieve when you are in pain, so it is important to reduce (but not necessarily eliminate completely) symptoms first.


"PUSHING INTO PAIN?"

As a general rule that I used for my knee pain, not allowing pain to rise more than 2 or 3 out of 10 during activity or rehab was more than appropriate, as is allowed me to challenge the muscles sufficiently to get a change in strength over time without aggravating symptoms too much. Often we shy away from moving into discomfort even when performing good quality exercise but meaningful changed over time will be slow, and may not occur at all.


My suggestion on what boundary to push when it comes to strengthening is to keep either a mental note - or better still a written note - on how your body responds to exercise or activity 2 and 6 hours later, and the next morning. If symptoms do not worsen compared to the previous morning - load is adequate and it is ok to continue to work into mild discomfort when performing targeted strengthening.


WHAT EXERCISES ARE BEST

Any exercise that is completed is the best.

The exercises you enjoy and feel right should be explored and progressed. I have a favourite few that I keep coming back to and have worked well in terms of strengthening and being consistent with. Doing a few sets, over a couple of workouts over the course of a fortnight will not make meaningful change in strength. You need to load the muscle sufficiently - performing 2-4 sets at least with anywhere from 6-15 repetitions is a pretty common prescription for strengthening. This needs to be done 2-4 times a week over a period of 6-12 weeks for a really great change in strength. Thats a decent amount of exercise, and a commitment. So if you do not enjoy your exercises, it might pay to find new ones.


If you have new or recent knee pain, book in to Monty Physio to get a full assessment by the physiotherapist as pain can occur due to many contributing factors, and everyone has a unique presentation.




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