of the knee is one of the strongest yet vulnerable joints in the body. Jaguar specializes in knee rehab with extensive and personalized programs ranging from a simple knee sprain to a complete ACL surgery or knee replacement.
The complex joint
ACL (Anterior Cruciate Ligament) Tear
The anterior cruciate ligament (ACL) crosses inside the knee joint and runs from the tibia (lower leg bone) to the femur (thigh bone). This ligament provides stability against excessive anterior movement of the tibia on the femur. Injury commonly occurs during “deleceration” activities, hyperextension of the knee, or planting and cutting in sports. Signs and symptoms include a “pop” heard during injury, significant swelling, pain, decreased motion, and feelings of instability. Surgery is often, but not always, indicated and consists of reconstruction of the torn ligament. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to re-introduce strengthening and mobility activities as appropriate.
IT (Iliotibial) Band Friction Syndrome
The Iliotibial (IT) band runs from the iliac crest (top of the hip) to the lateral tibia (lower leg bone). As knee flexion/extension occurs, the IT band rubs over the lateral femoral epicondyle (lower portion of thigh bone), creating friction and causing inflammation. Injury most often occurs during repetitive walking, running or cycling. Signs and symptoms include pain over the lateral femoral epicondyle which worsens with activity and abates with rest. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to strengthen and stretch lower extremity muscles and maximize function through lifestyle modifications.
Knee Osteoarthritis/Knee Replacement
Osteoarthritis is a degenerative process in which joints wear down over time, causing inflammation and a change in the shape of the joint surfaces. Signs and symptoms include morning stiffness, clicking/grinding (crepitus), pain, swelling, and loss of motion. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to strengthen and stretch lower extremity muscles and maximize function through lifestyle modifications. Because osteoarthritis causes irreversible changes to occur in the joint surfaces, knee replacement surgery may be indicated in patients who don’t respond to conservative therapy. Both the ends of the femur (thigh bone) and tibia (lower leg bone) are replaced, creating correctly shaped surfaces for proper articulation of the joint. In addition to rest, ice, and medications to reduce pain and inflammation, post-surgical physical therapy is indicated to regain strength and mobility in the knee.
LCL (Lateral Collateral Ligament) Tear
The lateral collateral ligament (LCL) runs down the lateral side of the knee joint and provides stability against lateral movement of the knee. Injury to this ligament is less common, but occurs when a varus (lateral) stress forces the knee laterally. Ligament tears are graded I-III based on severity of the tear and degree of involvement of additional structures (surrounding ligaments or hamstring tendon). Signs and symptoms include pain and increased laxity (joint movement), however swelling is usual minimal. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to re-introduce strengthening and mobility activities as appropriate.
MCL (Medial Collateral Ligament) Tear
The medial collateral ligament (MCL) runs down the medial side of the knee joint and provides stability against medial movement of the knee. Injury commonly occurs as a result of a valgus (medial) stress applied directly to the lateral side of the knee joint, or with weight-bearing rotational activity. Ligament tears are graded I-III based on severity of the tear and degree of involvement of additional structures (surrounding ligaments or tendons). Signs and symptoms include pain, increased laxity (joint movement), mild to severe swelling, and bruising. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to re-introduce strengthening and mobility activities as appropriate. Surgery may be indicated for a severe tear (grade III).
Meniscal Tear
The menisci are cartilaginous discs that sit on top of the tibia (lower leg bone) and serve to absorb shock and assist in fluidity of knee joint movement. A meniscal tear can be caused by a variety of mechanisms, including trapping between bony surfaces, rotation during pivoting activities, and compression during weight bearing activities. Signs and symptoms include “locking” of the knee, pain during activity, and possible swelling. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to re-introduce strengthening and mobility activities as appropriate. Surgery to remove torn portion of meniscus may be indicated in patients who are non-responsive to conservative treatment.
Patellar Tendonitis (Jumper’s Knee)
The patellar tendon crosses the front of the knee and is the attachment of the quadriceps muscle to the tibia (lower leg bone). The patella (kneecap) is embedded within this tendon. Sports requiring repetitive jumping movements (“jumper’s knee”) place recurring stress on this tendon, which can lead to inflammation (tendonitis). Injury usually results from overuse in combination with lower extremity muscle imbalances in strength and flexibility. Signs and symptoms include pain and tenderness on the patellar tendon, as well as mild swelling. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to strengthen and stretch affected muscles, as well as to correct improper movement patterns and educate against overtraining.
Patellofemoral Pain (Chondromalacia Patella)
The patellofemoral joint is composed of the patella (kneecap) and its articulation with the femur (thigh bone). Pain caused by improper alignment or inflammation in this area is known as patellofemoral pain. The underside of the patella is covered by cartilage that can wear down with improper movement, thus giving this condition its previous name of chondromalacia patella. Injury usually results from a combination of faulty movement patterns, tightness and weakness of muscles, and overuse due to overtraining. Signs and symptoms include clicking/popping during movement (crepitus), pain, swelling, locking, and instability. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to strengthen and stretch affected muscles, as well as to correct improper movement patterns and educate against overtraining.
PCL (Posterior Cruciate Ligament) Tear
The posterior cruciate ligament crosses inside the knee joint and runs from the femur (thigh bone) to the tibia (lower leg bone). This ligament provides stability against excessive posterior movement of the tibia on the femur. Injury commonly occurs during extremes of rotation, hyperextension, or a “dashboard” injury, in which the tibia is forced backward by contact with the dashboard in a car accident. Signs and symptoms include pain and tenderness behind the knee, swelling, and feelings of instability. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to re-introduce strengthening and mobility activities as appropriate. Surgery is not usually indicated, but ligament reconstruction may be performed in patients with severe injury involving other structures.