KNEE PAIN RELIEF IN HILLSBORO & BEAVERTON
If you are looking for knee pain treatment in Hillsboro and Beaverton, the information below will help you make a better decision as well as help you avoid unnecessary and expensive healthcare treatment. Below are the key things you need to recover fully from knee pain.
WHAT EXACTLY CAUSES KNEES TO HURT?
Knee pain is either caused by disease or injury. The resultant pain can restrict range of motion and can quickly degrade strength in the knee and leg by non-use. The most common disease to affect the knee is osteoarthritis - which is a wearing down of cartilage in the knee. Osteoarthritis commonly results in pain and swelling in the joint.
Knee injuries can occur by way of direct or sudden forces at the knee that strains the knee past its usual range of motion; like in an accident, during sports or in a fall. These accidents often cause tears in the knee cartilage or ligaments that support the knee.
There are numerous diagnoses that explain for knee pain (e.g., patella tendonitis, chondromalacia patellae, IT Band syndrome, meniscus tear, ligamentous tears/laxity). Although differing in severity and presentation, they all result in one common thing: faulty biomechanics from weakened hip and quad muscles. All these pain sources can be helped with good knee therapy.
How does faulty biomechanics contribute to knee disease and pain?
Non-traumatic knee pain tends to progress over time, and usually does not prompt the patient to seek immediate medical care for it. As a result of the pain, the body and brain shuts down usage of that limb and starts favoring the other stronger, healthier leg. The quads, glutes and peritibial muscles of the painful leg injury start to atrophy and surely enough, you start to see the biomechanical pattern above. A person with good mechanics and strength would look very neutral - there would be a direct vector line from foot contact on the ground through the hip join. A person with poor mechanics and poor hip and quad strength would demonstrate what us PT's call "knee valgus" - the tendency for the knee to collapse inward because of weak hip abductor muscles, weak quads and excessive foot pronation. Faulty mechanics like these during daily activities will cause the knee pain to get worse regardless of its diagnosis. Knee pain begets more favoring of the leg ... which begets more knee pain ... and the cycle continues.
The same could also be said for "bow-legged" postures - where the knees seem to cave outward. Folks that present like this tend to have a larger probability of having meniscus thinning or tearing, and also higher probabilities of hip joint degeneration because of excessive forces translating up into it.
Those who are all too familiar with this may have tried the following interventions: rest; knee brace/strap; ice; IT Band foam rolling. Though this might help a bit in the short-term, the knee pain would most likely continue because you're not stopping the cycle.
How is Knee Pain Diagnosed?
Your physical therapist will determine the anatomical source for your knee pain and formulate a theory of how the damage occurred. At times you may have already seen a physician and had gotten imaging done such as an X-Ray and an MRI, but imaging is not an absolute need for your PT to evaluate you.
The following information would be useful in helping your PT determine what is wrong with your knee:
- Location of your knee pain
- Whether you twisted your knee recently
- Whether you heard or felt a tearing sensation in the knee
- If you have felt symptoms like locking or catching of the knee joint during movement
- Any difficulty or inability in walking up and down stairs
- Any difficulty with keeping the knee bent for prolonged periods of time, like in sitting
- Pain with sudden movements, bending or straightening
Your physical therapist will perform tests to assess the severity of your knee condition. This may involve measuring range of motion and strength testing, but also should include some provocative manual tests that elicit your pain. This way, your therapist is able to determine the exact anatomical structure that is damaged and may be able to tell whether you would need to be referred out to an orthopedic surgeon.
Another crucial part of the evaluation is to watch your movement in doing daily activities. This may include a gait/walk or run analysis. We may also want to watch how your perform a squat or a hop to see where in the movement chain are you dysfunctional in.
Can Osteoarthritis be helped?
Absolutely. Just because your knee pain has been long-standing (pun intended!), and the cartilage damage may be chronic, it does not mean that you should succumb to a life-long subscription to Ibuprofen to get by, or give in a total knee replacement right away. In fact, there is a recent scientific article published on how exercise and physical therapy and significantly alter your pain:
Exercise rehabilitation plus routine therapy for patients with knee osteoarthritis can effectively improve outcome, promote functional recovery and improve quality of life. Reference: https://www.ncbi.nlm.nih.gov/pubmed/31694122
For severe cases if osteoarthritis, sometimes hylouronic acid injections, also known as synvisc, may help lubricate and cushion the knee joint. It is recommended that the patient goes through adjunct physical therapy along with injections, so they can benefit from biomechanics counseling.
How Can Knee Pain Be Treated?
Here are some common treatments and suggestions we perform at the clinic to help our Stride Strong patients with their knee pain:
- Strengthen your butt muscles
ACL (anterior cruciate ligament) tears typically happen during sports when gluteal muscles are weak. Weakness is usually worsened by inactivity and sedentary lifestyles, which is common in our society. Gluteal muscles provide stability so the knee joint doesn’t get strained during motion. - Stretch the muscles around your knee
Hamstrings and inner thigh muscles, called the hip adductors, tend to overcompensate for weak gluteal muscles. Over time, these muscles can get tight. Typically, hip flexors and quad muscles can also get tight through guarding from knee pain. Stretching these muscles will free up the knee cap better for ease of movement. - Strengthen your core muscles
Much the same as strengthening your gluteal muscles, strengthening your core will also help prevent knee pain because it also provides a stable base for your knee to move from. Strengthening your trunk and core muscles can also affect the posture and movement of the knees. You can experiment this on yourself right now: Arch your back and see how your knees and thighs roll inward. Flatten your low back and watch how your knees turn outward. Strengthening the core will instead keep your back at a neutral spine posture to help minimize knee aberrant motion and helps with maintaining best positions for the thighs and knees. - Maintain a healthy weight
Sedentary behaviors and being overweight increases likelihood of osteoarthritis by up to 5 times. Research shows that reducing your weight by 11lb can result in 50% decrease risk for knee arthritis. Excess body weight adds strain and pressure to knee joints. Change that fat into muscle today! - Change your footwear
Wearing high-heeled shoes increase knee joint compressive forces by 23%. Wearing high-heels also positions your knee and foot in valgus position and places your foot into a pronated position. One wrong move while wearing heels, and you’ve got a recipe for knee pain. Instead, wear lower-heeled shoes and remember to change up workout shoewear every 400-500 miles. This way, you’ll give your knees continued support and cushion, in a much better posture.
For our answers to the Top 10 Questions patients have on Knee Pain, watch our video: https://youtu.be/1ttUNkGtgRc
The following are some of the most common injuries that can benefit from our leg injury therapy here at Stride Strong's Portland physical therapy clinics.
Hamstring Injury Therapy
Hamstring injuries occur usually as a result of sports-related activities, but non-sports-related hamstring injuries can also happen. The hamstring muscle or tendon is usually strained when a load is given to it that cannot yet handle. This overloading can happen either via increased frequency or increased force on the muscle. For example, in the case of weekend warriors who sit for a majority of their week, only to play competitive games of basketball on the weekend, this transition from no-loading to full-loading ignores the body’s need for muscle tissue adaptation to exercise and tears can occur.
The duration of physical therapy after a hamstring tear will largely depend on the severity of the tear, and whether the tendon is involved. Because tendons receive less blood flow than the muscle belly, healing may be slow in a torn hamstring tendon.
Hamstring injuries also tend to re-occur either because of the muscle not completely healing prior to loading it with an activity, or the patient may be continuing to perpetuate bad habits of loading the muscle too hard and too fast without the appropriate muscle conditioning.
Leg physical therapy is very helpful with healing hamstring injuries so that adequate stimulation, progressive loading and tissue healing can occur. This comes by way of soft tissue mobilization, stiff and contracted areas of the muscle, along with progressive therapeutic exercise to strengthen the muscle system. In addition to this, Stride Strong Physical Therapists put our patients through a Video Gait Analysis to watch patients walk and run to detect any walking or running abnormalities that could be straining the hamstring system excessively. Usually, the biggest deficit that we detect in patients with hamstring injuries is glutenal and hip weakness.
IT Band Syndrome
IT Band Syndrome is a common complaint of runners and patients who perform sports with a largely running component to it. The IT Band is a thick band of fascia on the side of our thighs that afford us lateral stability when performing single-leg activities. Running is an activity where we shift body weights from one leg to the other, like a pogo stick. Through this repetitive activity and with longer distance running , the IT Band can be overstrained. The fascia also shares fiber connections with a hamstring muscle and also the lateral knee so pain can felt anywhere from the side of thigh, to the back of the thigh, to the side of the knee.
The typical home remedy for IT Band Syndrome is foam rolling to break up any restrictions, adhesions from inflammation, and to soothe irritation of the IT Band. Although this may temporarily solve the pain and tightness felt, this should be relied upon as the cure-all for IT Band pain. There are other lateral structures at play in running that could present themselves as weak. When these muscles are not able to stabilize the pelvis during single limb stance, the IT Band is recruited to take the load. Therefore, strengthening these structures, namely the gluteus medius muscle, can help tremendously in offloading the pressure on the IT Band.
Additionally, the runner’s gait need to assesses and analyzed to see how other joints are behaving that could provide some information for why the IT Band is getting continually strained. At times, an overly flexed hip while running can predispose the runner to IT Band Syndrome.
When seen by an expert physical therapist, IT Band issues can resolve as quickly as 2 weeks. If the patient waits too long to be treated, the pain and irritation in the tissues may last significantly longer.
Total Knee Replacement Physical Therapy
With the baby boomers entering the age range for osteoarthritis, total knee replacements are on the rise. Total knee replacement surgery is warranted when arthritis and cartilage wear in the knee is so severe that it starts affecting quality of life dramatically. The patient may not be able to ascend or descend stairs at all, and any amount of weight bearing at this stage is intolerable.
Total knee replacements offer the patient the option of increased quality of life with the prosthetic joint. Usually, this involves a prosthetic titanium femur and prosthetic tibia component that smoothes out the articulation between these bones. Total knee replacements allow patients to return to full community ambulation after physical therapy is finished.
However, it must be mentioned that leg therapy and rehabilitation after a total knee replacement can be a long and arduous process because of the amount of scar tissue and trauma that the knee has endured. A total knee replacement is a very involved surgery and patient will need to recover from the pain from surgery trauma. Outcomes fare the best with patients who begin their physical therapy treatments BEFORE their total knee replacement is to happen. This allows the physical therapist to help with swelling control before the surgery. Your PT will also start work on strengthening the essential muscles that help knee rehabilitation: mainly the gluteal muscles, core muscles and balance muscles. There is a lot of planning and preparation for surgery and rehab that would assist in fast healing after surgery so your therapist will go over scar and wound care, exercise frequency, bed mobility and toileting/bathing tips.
After surgery, the focus will be on gaining range of motion, and further working on strength. It is important to not underload or overload the knee after surgery. Too little exercise, and muscle strength would be hard to gain - the result is sometimes prolonged disability and pain. Too much exercise, and that could cause the knee the swell and derail the physical therapy schedule a bit. Close communication with your trusted physical therapist is needed to calibrate exercise dosage so healing is maximized.
Meniscus Tears
Meniscus tears can feel like sharp pain in the knee joint. Loading and weight bearing - especially during squatting and lunging - are typical aggravating factors. Tears can vary from small nicks to severe “bucket-handle tears” (describing crescent-shaped tears that look like bucket handles). Typical causes for meniscus tears tend to be traumatic - sudden pivoting motions of the knee, falling at an awkward angle, etc.
It used to be that the immediate intervention for knee meniscus tears would be orthopedic arthroscopic surgery regardless of the severity of the tear. But recent evidence in the past few years have shown that arthroscopic surgery may not be as effective as physical therapy for knees with minimal to moderate tears. It is therefore suggested that patients try conservative leg treatment with physical therapy first before considering surgery.
Physical Therapy for knee meniscus tears involves swelling control with manual therapy, cold therapy, and kineseotaping. Therapeutic exercise is a must when it comes to normalizing gait and strength. Biomechanics corrections will likely be needed to make sure that the knee joint tracks correctly when performing daily and sports activities. If 6 weeks of therapy does not provide significant gains in function and pain levels, the patient should be referred out to an orthopedist for further imaging and possibly surgery.
WHAT TO DO FIRST – SEE ONE OF OUR KNEE PAIN EXPERTS IN HILLSBORO OR BEAVERTON
Conservative, natural care, which is what we provide here at our practice, is what you should try first. The advantages of seeing one of our physical therapy experts are as follows:
- No waiting - In most cases, you can see us right away,
- No side effects – In most cases, the treatment we provide has little to no side effects and can make you feel much better,
- It’s more affordable – an average course of treatment cost much less than tests, injections, or surgery.
Each patient is different so here’s how our physical therapist will approach your knee pain:
- An in-depth initial evaluation where we ask you about your pain, medical history, and current condition.
- A detailed physical exam looking at movement, strength, and flexibility.
- A personalized plan of care to meet your goals.
- Patient education – details of what we’ve found during the exam and how we will help you address these limitations.
- Manual Therapy – hands-on techniques for pain relief and to restore mobility.
- Neuromuscular Reeducation to address restrictions, weakness, and range of motion
- A Home Program – we teach you what you can do to optimize healing at home as well.
- Modalities – specific treatments to address your pain if needed.
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