“Be kind to your knees. You’ll miss them when they’re gone.”
Everybody’s Free [to Wear Sunscreen], Baz Luhrmann.
More young people are suffering ACL injuries in Australia because they are pushing their bodies harder and reducing the time spent moving in lots of different ways (they don’t “free play” including climbing outdoors and trying lots of different things as much). Kids are specialising in a particular sport earlier, playing longer seasons, training harder and playing to a higher level. And their knees are paying the price. (Sidetrack: Parents – I recommend you read The Dying Art of Tree Climbing).
The knee is actually made up of three joints – the main tibiofemoral (between your shin and thigh) is what we think of as the knee. But the other parts of the complex include the patellofemoral joint (between your kneecap and lower end of the thigh bone) and your superior tibia-fibula joint (the joint between the two bones of your shin).
Myths about Knees
- My knees hurt so I can’t run. Besides, I don’t want to wear my knees out by running.
Despite common misconceptions, runners do not have higher rates of arthritis than non runners (Miller et al 2014). We are designed to run.
If your knees hurt, then there are likely imbalances around your hips, knees or ankles (weakness, stiffness etc) that can be tested and measured and quantified relative to the other muscles. There might be something with your technique that we can fix up – from stride length, the number of steps you take or your overall posture. Finally, the training load or intensity might need adjusting. There’s lots of ways physiotherapy can help.
2. I hurt my knee and the scan shows a tear – I need surgery.
Australia has the highest rate of ACL repair surgery in the world, and this rate just keeps on increasing. It’s not to say we have the highest rate of injury – just that we are opting to go under the knife more often, and more of these surgeries are repeat ACL repairs.
Nowadays we are becoming much more selective with who needs to undergo surgery for knee injuries like ACLs (thank goodness!). It is now accepted that people who suffer knee strains and sprains can be classified as “copers” and “non-copers”. In a nutshell, given the same level of damage picked up on an MRI, some people will function perfectly well and return to sport (copers) while others will not (non-copers). We don’t know exactly why.
- Copers need rehab to build and balance the muscles supporting the knee
- Non-copers need surgery
Of course, if you’re a non-coper you can totally decide not to have surgery at all if your can do everything you want to.
3. I’m booked for surgery; I’ll start my rehab after.
Return to sport after an ACL injury is a good 12 – 18 months. If you start your rehab now, you’ll speed up your recovery. Plus, if it turns out along the way that you’re a “coper”, you could even choose to delay or not have the surgery at all and still return to full sport and function without getting cut up. Why not start now?
4. I just have to cross my fingers and hope I don’t injure my knee at netball/footy/soccer/(insert other sport here).
Specific balance and control exercises can more than halve your chance of getting an ACL injury (50-80% reduction) (Zbrojkiewicz et al 2018). If there was a pill with these results, then all sports people would be taking it! You don’t have to cross your fingers – we can reduce your likelihood of injury (whether or not you’ve had one before) by testing and designing the right program for you based on our knee rehab protocol.
5. It’s been x weeks since my injury/surgery. I think that’s long enough to just go out and give it a go?
Research tells us that your injured side needs to perform within 10% of your good side in power and control tests to significantly reduce your risk of injury. We also know that the muscles around the knee must be balanced (equal in strength and able to lengthen enough for good flexibility) for safe return to sport. These are both things we test for at PhysiYoga with our signature knee testing protocols. No matter whether you’re injured or just have a feeling one side isn’t as good as the other, we can help quantify and answer this question for you and give you concrete things to work on to minimise your injury risk.
Common Knee Problems We Treat
- Anterior cruciate Ligament (ACL) strains
- Posterior cruciate ligament (PCL) strains
- Medial collateral ligament strains
- Lateral collateral ligament strains
- Meniscal tears
- Patellofemoral pain
- Patella dislocations
- Iliotibial band friction syndrome
- Bakers cysts
- Knee replacement rehabilitation
Common Causes of Knee Pain
- An increase in training intensity, type of exercise and amount may cause an overuse injury to the knee. For example, running, squats etc (a common cause of patellofemoral pain).
- Lots of kneeling on hard surfaces
- Almost three quarters of ACL reconstructions in Australia (72%) are sport-related – so if you play sport, you’re likely at increased risk of knee injuries.
- The sports most frequently involved in ACL injuries are Australian rules football, rugby union, rugby league, netball, basketball, soccer, and skiing.
- ACL injuries are associated with a higher likelihood of having a knee replacement down the track
Stand with your feet facing comfortably forward. Do a squat, keeping your heels down (tip: poke your bottom out). Make sure your knees track straight forward over the middle of your foot.
Now stand on one leg, and try the same action (a single leg squat). Watch where and how your knee moves over your foot – does it move straight or does it roll in? Are you steady or wobbly? How many can you do?
Compare the quality and quantity of single leg squat side to side. If there is a difference side to side in ease, quality and number you can do, then it’s worth getting further assessment with our physiotherapy team. Especially if you’ve had knee pain or injuries in the past.
How We Help
- Clinical testing of the structures of your knee
- Reading and review of any scans (MRIs and XR) in conjunction with the clinical tests to determine what this means for you
- Functional testing to determine strength and control deficits
- Muscle strength and length testing to find your weak spots
- Design of specific, individualised exercise protocols
- Return to sport testing
- Rehabilitation design and monitoring – we keep you on track
Miller RH, Edwards WB, Brandon SC, Morton AM, Deluzio KJ. (2014). Why don’t most runners get knee osteoarthritis? A case for per-unit-distance loads. Medicine and Science in Sports and Exercise. Mar;46(3):572-9. doi: 10.1249/MSS.0000000000000135. PMID: 24042311. Accessed 9th October 2021 from https://pubmed.ncbi.nlm.nih.gov/24042311/
Zbrojkiewicz, D., Vertullo, C. and Frason, J (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Medical Journal of Australia; 208 (8): 354-358. || doi: 10.5694/mja17.00974. Accessed 9th October 2021 from https://www.mja.com.au/journal/2018/208/8/increasing-rates-anterior-cruciate-ligament-reconstruction-young-australians