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The knee joint is a hinge joint created by the femur (thigh bone) and the the tibia and fibula (the two bones that make up the lower leg) This joint's primary function is to bend and straighten the knee. At the joint line, there are two jelly-like discs called the menisci. Two cruciate ligaments attach from the femur to the tibia, and the collateral ligaments run along the outside and inside of the knee. The knee cap's articulation on the femur is also a primary component of knee bending and straightening. Many of the muscles of the hip and ankle begin or end at the knee joint.
Knee pain can originate from any of the muscles and ligaments at the knee. Degeneration at the joint line can also be a source of pain. The anterior or posterior cruciate ligament can tear due to excess stress on the tibia, and sometimes the menisci can develop tears as well. Patellofemoral pain syndrome is the result of stress on the quadriceps tendon that attaches to the knee cap. The iliotibial band that travels from the hip to the knee can become stressed and cause lateral knee pain.
A comprehensive physical therapy exam is critical to determine the cause of knee pain. The hip and ankle must be examined as well due to the many structures these joints share. Once the impairments have been identified, physical therapy interventions include manual therapy, therapeutic exercise, and neuromuscular re-education to strengthen and stabilize the knee.
Physical therapy is an effective way to reduce knee pain, even for those who elect to undergo knee replacement surgery. A study published by the Osteoarthritis and Cartilage Journal found that those who participated in physical therapy within three months before and after total knee replacement surgery had reduced post-operative opioid usage. Another randomized trial from the New England Journal of Medicine found that patients who had knee osteoarthritis and participated in physical therapy had less pain, stiffness, and functional disability than patients who had an intra-articular glucocorticoid injection after one year. One study from the Orthopaedic Journal of Sports Medicine found that knee arthroscopic surgery combined with exercise provided no additional benefit after 5 years compared to patients who performed exercise alone. Physical therapy is a viable treatment option for knee pain.
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