"Completely recovered, no pain and can stand on my leg normally and naturally. Been for two runs this last week without any problems. The difference is huge!" - Caroline B.

Hip and Knee Pain

Femeroacetabular impingement

The hip is a ball and socket joint. It is made up of the ball on top of the thigh bone called the femur and the socket in the pelvis known as the acetabulum. The socket of the hip is surrounded by a layer of fibrocartilagenous material known as the labrum. You can tear the labrum just like a torn cartilage in the knee. See the Knee cartilage injury section below.

Femeroacetabular impingement is as it suggestes. An impingement between the femur or ball of the hip and Acetabulum or socket of the hip. This can have a number of forms but there are two main types. A picer deformity and a Cam type deformity.

A Pincer deformity is where the ends of the socket are more pointed and pincer like making the sockey more C-Shaped than the subtle U shape it should be. This can then mean that the ball of the hip rubs on one of the pincer ends causing impingement and pain.

A Cam type deformity is where the ball of the hip becomes slightly more square like over time and you now have a square peg trying to fit into a round hole. This again will cause impingement and pain.

As with everything in anatomy, physiology and injury these conditions can be further classified into more specific types and the physiotherapists at Spinal Physio will be able to assess your hip to establish which issue you may have and how best to treat it.

Knee ligament injury

Ligaments connect bone to bone and help control the range of movement in a joint to keep it within a stable range. Ligaments also have numerous sensors called proprioceptors that feed back to the brain to let us know where we are in time and space.

If the force through a ligament is so great that it causes the joint to go beyond its normal range then the ligament will break down, resulting in a sprain. Sprains have three grades.

Grade I - A small number of collagen fibres in the ligament are damaged resulting in an inflammatory response with local tenderness over the ligament. Can often be treated with good advice and self management.

Grade II - A significant number of fibres within the ligament are damaged causing a larger inflammatory response, increased swelling and intense pain. Physiotherapy is required for these injuries.

Grade III - Complete rupture of the ligament. Large amount of swelling, instability of the joint and intense pain. May require surgery to restore the stability to the joint.

The knee joint has a number of ligaments. The cruciate ligaments insifde the knee, which as the name suggests are a cross with one directing forward or Anterior Cruciate Ligament and the other backwards, Posterior Cruciate Ligament. These give the knee it's stability mainly in a backwards and forwards motion and can classically be injured in football with a significant twisting injury of sudden hyperextension injury in skiing.

The collateral ligaments, Medial (inside) and Lateral (outside) protect the knee in a side to side motion and again are vunerable in football, tennis or anything involving a twisting mechanism to the knee.

The lesser known coronary ligaments connect the Tibia or shin bone to the meniscus (disc of cartilage) in your knee. Often an overlooked injury that can easily be misdiagnosed as a cartilage of co-lateral ligament injury.

Knee cartilage injury

A torn cartilage is not an uncommon injury in sport. The knee has 2 discs of fibrocartilage called menisci. They are C-Shaped and slightly thicker at the edge of the joint in order to cushion to opening and closing mechanism of the knee.

The menisci are shock absorbers so will innevitably wear over time and lead to degenerative tears these can lead to pain or discomfort and stiffness in the joint but can usually be managed conservatively with physiotherapy.

More acute tears to the menisci occur in twisting injuries such as football, tennis, skiing and even golf. Imagine your meniscus is like a finger nail that you tear a bit off. You can tear a small piece and you don't either notice or miss it. You can tear a larger piece that can stick up and isn't much of a problem unless you catch it on something and then it will hurt. As the knee is a finite space that piece of cartilage that sticks up, sometimes referred to as a bucket handle tear can get caught in the joint like a biro in the hinge of a door and the knee just won't move. This is called locking of the knee. This requires surgery to remove the piece of cartilage and is normally done with key hole surgery or an arthroscopy. You can also tear off a reasonably large part of the cartilage that floats around the knee, known as a loose body, which can sometimes cause locking or maybe not at all.

If you have locking of the knee, chances are you need surgery. If you have a stiff, painful, swollen or tender joint but no locking or giving way after a twisting injury you will probably require and benefit from physiotherapy.

Patellofemoral dysfunction

The patella is the floating bone over the knee and the femur is the thigh bone. The patello-femoral joint is the joint between these two structures.

The patella is an egg shaped bone sitting on top of the knee joint. It's slightly rounded at the top and pointed at the bottom. The quadriceps muscles are 4 muscles from the hip that all converge on the patella and result in a single tendon, the patellar tendon connecting to the Tibia or shin.

Picture the patella like a wheel in a pulley and the quadriceps are 4 muscles or ropes going into the pulley with one rope, the patellar tendon coming out the other side. If everything is pulling evenly then the wheel of the pulley will operate smoothly and the hinge of the knee works very well. If the ropes pull at different rates or strengths as a result of muscle imbalance, then the patella will tilt and this will cause friction or rubbing of the patella on surrounding structures.

The physiotherapists at spinal physio will be able to assess your knee to establish the dirtection of deviation as this can be medially, laterally, anteriorly, superiorly, inferiorly or any combination of the above. Depending on the mal-tracking will determine which structures are being irritated and what treatment and/or exercise program is required.

It is important with patellofemoal dysfunction to not only treat the structures that have been damaged by the mal-tracking but also the tracking issue itself and this may involve the stability around the hip and pelvis, possibly the back or feet and biomechanics. It's simple really.

Jumpers Knee

Patellar tendonitis is otherwise known as jumpers knee. The term "itis" means inflammation and we now tend to use the word tendonopathy for a problem with a tendon as it isn't always clear if the tendon is actually inflammed or not. Either way what ultimately happens is that the tendon gets over loaded through repitive activity or poor control of that activity. The tendon will get small microdamage or tears as a consequence. If the rate of these microtears is greater than the rate of recovery, this will lead to a prolonged inflammatory phase known as tendonitis. That will give way to the tendon scarring or degenerating and this then becomes a tendonopathy, as the tendon isn't necessarily inflammed anymore but there is pain, stiffness and limited ability to load the tendon to perform tasks.

The physiotherapists at spinal physio will be able to diagnose patellar tendonopahties but more importantly identify the mechanisms as to why it developed and treat accordingly.

Spinal Physiotherapy
& Sports Medicine Clinic
124 Gilbert Rd, Cambridge, CB4 3PD