KNEE PAIN – Physiotherapy Treatment

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KNEE PAIN – Physiotherapy Treatment

Introduction to Knee Joint Pain :

Osteoarthritis of Knee: is degeneration or wear and tear between joint surfaces of the knee. It usually occurs in knees that have experienced trauma, infection or injury or age related changes. Osteoarthritisdevelops as the cartilage that protects the bone ends thins down and the bones will begin to rub against each other when the joint is moved.  With the worn-out cartilage, the joint space between the bones narrows. The surrounding bones react by becoming thicker and grow outward and form bone spurs. All these changes can lead to pain, swelling and discomfort in the knee on movement or rest.

Ligament Sprains or Tear: The knee has four major ligaments. The ligaments inside the knee joint are called ACL and PCL while the ligaments on either side of the knee are called MCL and LCL. These ligaments provide stability to the knee. Knee Ligament Injury can lead to pain and instability with the “giving way” feel. These can be associated with muscle weakness and lack of balance in the long run.

Meniscus Tears: A knee has two menisci. Any activity that causes forcefully twisting or rotating the knee, especially when there is full weight on it, can lead to a torn meniscus. A torn meniscus causes pain, swelling and stiffness of the knee. Torn meniscus might also lead to a block to knee movement and cause trouble while extending the knee fully.

Iliotibial Band Syndrome: Often seen in runners. Iliotibial band is a tight band of muscle and connective tissue on the outer thigh which causes stress on the knee resulting in pain on outer side of knee and typically with running and going downstairs.

Patellofemoral pain syndrome (PFPS)

Pain arises from the patella (kneecap) & excludes other soft tissue. PFPS constitutes 16 to 25 % of all injuries in runners. It can cause pain under the knee cap and swelling around the knee joint. Pain may increase after activities such as jumping, running down slopes, steps, prolonged walking or squatting.

Fractures: Occur in and around the knee joint due to direct or indirect trauma and may involve the patella, femur or tibia.

Dislocation or Shifting of Patella (Knee Cap): When the kneecap is partially or completely displaced out of its normal alignment. The most common direction for a patella to dislocate is outwardly (laterally). When this happens, the muscles and ligaments on the inside of the knee become overstretched and damaged.

Baker’s Cyst: pain at the back of the knee with a round swelling.

Chondromalacia Patella CMP: Happens when the patella glides through the groove with a lateral shift during the knee movement. This causes irritation of the cartilage between the patella and the femur and often results in pain.

Pain is mainly with stair climbing, prolonged sitting and knee bending with weight bearing exercises. Pre-disposing factors may include flat fleet, overuse, tight muscles on the outer side of the knee, injury or weak muscles on the inside of the knee (vastus medialis).

Osgood Schlatter’s Disease: is seen in adolescents who develop pain and a bump just below the knee due to constant overuse and traction on the insertion of the patellar tendon.

Different types of knee pain and what they tell you!

Knee pain can be caused by a variety of conditions depending on what structures are affected. Bonesmuscles, nerves, meniscusand ligaments make up the knee and when any of these structures are injured, it can lead to knee pain. Based on studies, pain in front of the knee is the most common (20-40%) presenting symptom in sports physiotherapy.

Location of pain gives your physiotherapist a general idea on what structures are possibly injured. Other factors to consider include: type of pain (cramping, aching, sharp, tingling), aggravating activities and whether symptom is constant or intermittent.

Common causes of knee pain are :

1.) Patellar Tendinopathy/Jumper`s knee

Clinical Presentation:

            → Pain and swelling just below the knee cap (patella)

            → Tenderness on inferior pole of patella, patellar tendon or on tibial tuberosity

            →  Pain occurs at the start of activity which settles after warm-up and returns after activity

            → Generalized weakness of quadriceps muscle

Aggravating activities:

            → Jumping (volleyball, high jumps, long jumps or triple jumps)

            → Sudden change of direction when running

            → Deceleration

  • Quadriceps Tendinopathy

Clinical Presentation:

            → Pain and swelling just above the knee cap (patella)

            → Tenderness on quadriceps tendon and superior pole of patella

            →  Pain occurs at the start of activity which settles after warm-up and returns after activity

            → Generalized weakness of quadriceps muscle

Aggravating activities:

            → Jumping (volleyball, high jumps, long jumps or triple jumps)

            → Sudden change of direction when running

            → Deceleration

3.) Osgood-Schlatter Lesion

Clinical Presentation:

            → Pain on tibial tuberosity (bony part little below the knee cap)

Aggravating activities:

            → High levels of activity such as running, jumping during a period of rapid growth (adolescents)

4.)Patellofemoral pain syndrome or Pain in front of the knee

Clinical Presentation:

            → Onset of pain is insidious but may occur secondary to an acute traumatic knee injury

            (e.g. falling on the knee, meniscal tear) or following a knee surgery (e.g. ACL reconstruction)

            → Pain located on either front/inner side of the knee, or behind the patella

            → Weakness of Vastus Medialis Obliquus muscle

            → Crepitus (clicking sounds) under patella when bending the knee

Aggravating activities:

            → Ascending/descending stairs

            → Running especially downhill

5.)  Pes anserine Tendinopathy/Bursitis


            →  Localized tenderness and swelling close to the medial joint line

            → Pain when knee is bent against resistance

Aggravating activities:

            → Swimming (breast strokers)

            → Cycling

            → Running

6.) ITB/Iliotibial Band Friction Syndrome

Clinical Presentation:

            → Ache over the outer portion of the knee

            → Tenderness and swelling over the lateral femoral condyle

            → Crepitus (clicking sounds) when bending and extending the knee

Aggravating activities:

            →  Running

            → Cycling

            → Downhill running

Our Singapore physiotherapists and Manila Physiotherapists can help you to manage knee pain and assist you with exercises to take care of your knee pain. Call us for an appointment or send your queries to:

6 Ways to Combat Knee Pain and Stay Active Physio Asia Singapore

Have you ever wanted to start the day with a relaxing morning walk to put yourself in the right frame of mind for the rest of the day? But you remember that your knee hurts during long walks, so you decide to snooze the alarm and sleep in until it’s time to go to work?

Knee pain is a common and debilitating condition which often leads to a sedentary lifestyle. This worsens the severity of the condition and traps people in a vicious cycle of inactivity and knee pain which they find difficult to break out of. However, knee pain should not stop you from living a fun and active life!

Here are 6 simple ways that you can combat knee pain and allow yourself to stay active and pain-free:

1. Stretch Regularly
Flexibility – Use It or Lose it!

Many of us are guilty of sitting for 6-8 hours at school or work only to return home and sit in front of the television or computer for another hour or two. These stationary positions reduce the flexibility of the muscles in the body which result in increased tension at the knee joint and can lead to knee pain. 

A simple solution which most of us know about but rarely do is to stretch!
A regular routine of simple stretches (which can even be done at work or school) can make a significant change to some types of knee pain.

Some simple stretches are:

Hamstring Stretch
1. Sit at the edge of your chair
2. Straighten leg with toe pointing to ceiling
3. Keep your back straight and relaxed
4. Bend forward from your hips
5. Feel a gentle stretch at the back of your thigh.

Quadriceps Stretch
1. Stand behind a chair
2. Hold onto chair for support
3. Bend leg and hold onto ankle
4. Keep your back straight and relaxed
5. Pull your thigh backwards
6. Feel the stretch at the front of your thigh
7. Hold for 15 seconds

Calf Stretch
1. Sit at the edge of your chair
2. Wrap a belt/towel around the ball of your foot
3. Straighten your leg
4. Pull your foot towards you with the belt/towel
5. Feel a stretch at the back of your calf
6. Hold for 15 seconds

These stretches can be done regularly throughout the day.

2. Good Posture
Sitting with your back rounded may feel comfortable but it puts your hips in a rotated position which in turn places the muscles at the back of the thigh in a shortened position. As mentioned above, this puts more stress on the knee joint, which may contribute to the pain felt at the knee.

Some simple tips to ensure good sitting posture are to:
1. Sit back into the chair
2. Ensure lower and middle of the back are in contact with the backrest

3. Do not cross legs
4. Ensure feet are in contact with the groun

3. Change Positions Regularly

Sit, Stand, Sit, Repeat!

Ever gotten so engrossed in your work that you stayed seated at your desk for hours on end? So have I! But ‘Motion is Lotion’ and ‘Rest is Rust’. Staying in one position for a prolonged duration, even with a good posture, results in the stiffening of muscles and joints.

Taking short breaks every half an hour by walking around or even standing up for a minute can make a difference to the body’s flexibility.

4. A Good Pair of Shoes
Find Your Glass Slipper

A well-fitted pair of running shoes with the appropriate arch support for your feet ensures that the forces generated when walking or running are transmitted correctly through the ankles, knees and hips without causing unnecessary stress at the joints. Additionally, ensure that the soles of your shoes are not worn out and if they are, it’s time to get a new pair!

5. Stay Active with Aqua Exercises!
I Like To Move It, Move It!

Knee pain often makes walking an impractical form of exercise due to the pain experienced during weight bearing.

One solution is to try walking in a swimming pool! The buoyancy of the water reduces the weight of the body and decreases the stress placed on the knees. This serves as a good form of low-impact cardiovascular exercise. At the same time, the resistance generated by walking in water strengthens the leg muscles!

Try walking forwards, backwards and side-ways to strengthen different groups of muscles.

6. Moderation is Key

With all things in life, moderation is the key to maintaining consistency. Although we encourage developing a routine of regular stretching and exercising, it is important to start at a low intensity and frequency and gradually progress at your own pace. This reduces the chances of worsening your pre-existing symptoms, which may reduce your motivation to stay active!

*Please ensure that there is no pain when performing any of the exercises listed above. Consult a Physiotherapistbefore trying any of the exercises if you are unsure of how to do them or if you need assistance in developing an exercise plan.

Call us for an appointment or send your queries to:

Patellar Tendinopathy (Front Knee pain) Physiotherapy In Singapore

Description/ Introduction to ITB Syndrome

Patellar tendinopathy (jumper’s knee) is a condition characterized by pain felt at the inferior pole of patella (kneecap). It is a condition which affects individuals who participate in sports; which require repetitive loading of the patellar tendon. The diagnosis is made clinically; thus, please consult a Doctor and then a Physiotherapist if you experience any symptoms around the knee joint.

Causes of Injury

Clinical Signs and Symptoms

  • Pain felt at the inferior pole of knee cap / distal attachment to tibial tuberosity
  • Aggravating activities: climbing stairs, jumping, changing direction, squats, deceleration
  • Increased tendon thickness
  • Quadriceps wasting / weakness
  • Soft tissue tightness

Physiotherapy Treatment

Patients at our clinic leave with reduce pain after treatment with modalities (electrical stimulation, ultrasound and Cold Laser). With activity modification, biomechanical correction, the right stretching and strengthening exercises, they also resume to higher functioning activities pain free. Our 3D Gait analysis also helps to objectively identify errors in walking and running activities and monitor improvements throughout the sessions.

Call us for an appointment or send your queries to:

ITB Syndrome and Pain on Outer Thigh

ITB Syndrome

an overuse injury of the connective tissues located on the outer lateral part of the thigh and knee.


  • pain in the kneewhen running or doing other activities
  • pain after exercise
  • in buttocks
  • and warmth around the knee, especially the outer aspect

Causes :

Poor training habits

  • Spending long periods of time sitting in lotus posture in yoga.
  • Consistently running on a horizontally banked surface on which the downhill leg is bent slightly inward, causing extreme stretching of the band.
  • Inadequate warm-up or cool-down
  • Positioning the feet “toed-in” to an excessive angle when cycling

Abnormalities in lower limb anatomy

  • Highor low arches of the foot
  • Abnormal pelvic tilting
  • Uneven leg length
  • Bowlegsor tightness about the iliotibial band.
  • Muscle imbalance in the lower limb.


  • Initial treatment includes rest, ice, compression, and elevation (RICE).
  • Home treatment includes stretching, massage, and use of foam roller.
  • Physiotherapy to evaluate and treat the underlying cause of the problem.
  • Gait analysis may be used to detect imbalances in muscle strength and balance and/or flexibility.
  • Orthotics may be useful if IT band syndromeis due to a gait problem, pelvic tilt, or leg-length discrepancy.

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Description/ Introduction to ACL Tears

Do you know that most ACL injuries occur in non-contact situations? Commonly occurring in change of direction, landing poorly from a jump or extending the knee with the feet rooted on the floor. According to the American Academy of Orthopedic Surgeons, about 70 percent of ACL injuries in athletes happen through mechanisms such as pivoting, cutting, sidestepping, out of control play or awkward landings, while about 30 percent of ACL injuries occur from contact with other players. Screening of this activities can reduce the likelihood of ACL injuries.

Screening will involve the individual performing some assessment on identifying the sports specific movements. The assessments will assist identify limited mobility, flexibility, weak or poor movement patterns to reduce the risk of ACL injury. With these findings, the physiotherapist can assist in planning a rehabilitation program.

It is vital, for the individual to train on the sports specific exercise programs and re-learn correct movement patterns for the sports. Ultimately, the main aim for both the clinician and client is to reduce the risk of ACL injuries and improve the individual’s sports performance.

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