This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Lateral collateral ligament sprain or tear
This ligament runs from the bottom outside of your thigh bone and attaches to the small bone called the fibula on the outside of your lower leg. If stress is applied to this ligament then you can sprain the ligament or a tear of some of the ligament fibers can happen. If all the fibers are torn then the ligament has been ruptured. If a severe strain or rupture is suspected then a medical review is recommended by one of the top London knee consultants we work with.
The knee may need to be braced to support full healing of the ligament.
Physiotherapy can help with soft tissue techniques, ultrasound, advice on swelling and controlling inflammation and taking you through a progressive rehabilitation programme. By regaining full movement and strength in the leg then sport specific rehab can take place helping you to safely return to sport.
Lateral collateral ligament Rupture
This is when the ligament described above ruptures completely and a medical referral will be required. We can recommend a top London knee consultant to you in this case.
Lateral meniscus tear
There are 2 meniscus. These are half moon shaped pieces of cartilage that sit between the tibia (shin bone) and femur (thigh bone) within the joint of the knee. The lateral meniscus is the one on the outside of the knee joint. They help to lubricate the knee joint and provide shock absorption on impact. Sometimes if the knee is twisted then they can become inflamed or torn.
Physiotherapy can help by performing tests to determine whether you have injured your meniscus. Treatments offered are advice on relieving any swelling and inflammation and progression through a number of exercises to regain movement of the knee and strength around the knee and return you to sport.
Osteoarthritis
This involves degeneration (wear and tear) of the joint surfaces of the outside of the knee. It is more common in later life and difficult to tell whether osteoarthritis or injury of the lateral meniscus. Often an injury to the meniscus causes more stress on the outside of the knee and therefore makes the process of degeneration faster.
Physiotherapy can help with advice, setting exercises and pain relief using manual treatments or acupuncture. Being overweight contributes to the quickening the process of degeneration therefore weight loss is advised.
Patellofemoral syndrome
Often pain felt on the inside of the knee is connected to Anterior Knee Pain explained in more detail by clicking on 'Pain over front of knee'.
Biceps femoris tendinopathy
The biceps femoris muscle is one of the hamstring muscles that runs down the back of the thigh. The tendon of the muscle joins it to the smaller bone on the outside of the lower leg called the fibula. Pain can arise in this tendon if injured or with overuse particularly activity involving excessive acceleration and deceleration.
Physiotherapy can help by performing manual treatments, release to the hamstring muscle itself, correcting any biomechanical issues in your walking or running style, acupuncture and taking you through an appropriate exercise programme.
Iliotibial band friction syndrome
The iliotibial band is a large piece of connective tissue that attaches to the pelvis and runs down the outside of the thigh to attach to the outside of the knee at the bottom. The bottom end runs over the lateral epicondyle (piece of bone) of the thigh bone. There is a small piece of adipose tissue (fat) which lies between this piece of bone and the iliotibial band and this contains nerve fibers and if becomes inflamed can cause pain. The pain tends to be sharp and burning and usually becomes worse as the activity ie. running continues. Often running downhill is worse.
Physiotherapy can help with reducing the inflammation of the adipose tissue and using manual treatments to work on the soft tissues that are connected to the ilitobial band. Massage and acupuncture to the gluteal muscles and iliotibial band itself can help. Advice on how to avoid pain provoking activites and correction of any problems with your walking or running style will help stop the rubbing on the bursa. It is important to be taken through a specific exercise programme to stretch any tight muscles and strengthen any weak muscles that may be contributing to the problem.
Tibiofibular joint sprain
The top of the main shin bone (tibia) and smaller outside shin bone (fibula) are connected. If certain muscles are weak or tight then this can cause an excessive force to this joint causing pain.
Physiotherapy can help by working directly on the joint with manual treatments and devising an exercise programme to strengthen weak muscles and stretch tight muscles that are causing excessive force to the joint.
Common peroneal nerve pain
This nerve spirals around the top of the fibula bone and if directly injured or over time becomes irritated then can give rise to pain on the outside of the knee.
Physiotherapy can help by determining if this is the source of your pain. Manual treatments on the fibula itself can be used along with releasing any restricting soft tissues around the nerve. Nerve gliding exercises can also be set for the nerve itself to help its mobility.
Synovial plica
A capsule surrounds the knee. There can be 4 parts of this capsule called the medial plica, suprapatella plica, inferior plica and lateral plica. The lateral plica is found on the outside of the knee. Sometimes this plica can rub on the bone. This can give rise to pain on the outside of the knee and clicking. There may be sharp pain felt when squatting.
Physiotherapy can help by performing certain tests to determine if this may be the cause of your symptoms and treat appropriately.
Slipped capital femoral epiphysis
This is a problem with the femur which can cause pain on the inside of the knee. It tends to be more common in boys around the age of 12-15 and being overweight can contribute. The slip of the growth plate over the femur can happen suddenly or more gradually.
Perthes disease
This is a breakdown of bone over the femoral head (top of the thigh bone) which particularly affects males between the age of 4 and 10. Symptoms commonly include a limp and ache in the thigh, groin and knee. Some movement of the hip may be stiff and reduced.
Physiotherapy can help with providing appropriate exercises and advice.
Referral of pain
Pain felt on the outside of the knee may be coming from other parts of the body ie. trigger points in other muscles or from a problem in the pelvis, lower back or hip.
Rheumatoid Arthritis
Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function.
Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
- splinting
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.
Complex Regional Pain Syndrome
This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The knee can be affected by this syndrome and the symptoms can extend up or down the leg. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. 'The sympathetic nervous system' has been shown to be involved which controls blood flow and skin temperature.
Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top London pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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