Pain Column: Knee Pain

Author: Raphael Fung Registered Physiotherapist | Sports Injury

Knee pain is a common ailment among Hongkongers. This edition of Aloha Wellness & Physiotherapy's pain column will address the causes, symptoms, daily impact of knee pain, precautions for those suffering from it, and proposed treatment plans from Aloha. Remember to read to the end!

Causes of knee pain:

1. Patellar Tendinitis Patellar Tendinitis
Also known as jumper's knee. The main cause is insufficient strength or improper activation of the quadriceps and gluteal muscles. Repetitive jumping can increase the load on the patellar tendon, leading to long-term overuse and inflammation, ultimately causing pain below the knee.

2. Ligament injury （MCL, LCL, ACL, PCL）
The main function of ligaments is to maintain knee stability and prevent knee dislocation during exercise. However, sudden external impacts or improper landing posture during jumps can lead to knee ligament injuries or tears. The location of the pain varies depending on which ligament is injured.

3. Referred pain from muscle trigger points
A trigger point refers to a small knot of muscle fibers that remain contracted and tight, making the area sensitive and causing intense pain when pressure is applied. When trigger points occur in muscles near the knee, such as the sartorius, vastus medialis, and popliteus, they can lead to problems with muscle activation and cause referred pain on the inner side of the knee.

4. Iliotibial Band Syndrome Iliotibial Band Syndrome
The iliotibial band primarily connects the tensor fasciae latae, gluteus maximus, and the lateral side of the knee. When there is a sudden and significant increase in the volume or intensity of lower limb exercises, it can cause excessive tension in the iliotibial band, leading to a loss of elasticity. During activity, the iliotibial band repeatedly rubs against the lateral side of the knee, ultimately causing pain on the outer knee.

Symptoms of pain (daily impact):

1. Sharp pain below the knee with each step when descending a slope

• Stabbing pain intensifies when landing from a jump
• A lump can be felt between the patella and tibia

2. Redness and swelling around the knee ligaments after exercise

• Persistent dull pain even after resting
• Increased pain in the knee ligament area when turning or moving quickly during exercise

3. A particularly hard nodule can be felt along the muscle fibers

• Adductor muscle group clearly weaker
• Light touch reveals a particularly sharp pain at a certain point on the thigh, which may even radiate to the knee area.

4. Pain on the outer side of the knee is particularly noticeable when going up or down stairs (when the knee is bent at 45 degrees)

• In the early stages of pain, there may be a sharp, stabbing sensation on the outer thigh during exercise.

Who is prone to knee pain?

1. Athletes

• Athletes who frequently perform repetitive jumping (volleyball, basketball)
• Athletes in high-impact collision sports (rugby, soccer)
• Long-distance runners

2. Hikers

3. Individuals who consistently engage in long-term fitness training

4. Overweight individuals

5. Individuals with prolonged sedentary jobs

• Poor posture (crossed legs, pelvic tilt)

6. Women

• Because women have wider pelvises, the iliotibial band experiences greater force during exercise.

Aloha's suitable treatments/methods:

• Manual Therapy: The therapist will identify the muscles related to the pain and perform manual massage and vacuum cupping for fascial release.
• Acupuncture: Needling at trigger points will elicit a twitch response in the muscle, immediately releasing the trigger point.
• Rehabilitation Exercises: Tailored exercise plans for weakened or dormant muscles to improve muscle strength, enhance knee joint stability, and address the root cause of the pain.
• Anti-inflammatory and pain relief: The therapist will use appropriate equipment to alleviate knee joint pain and reduce inflammation in the affected area, depending on the specific knee pain issue. (ultrasound therapy, interferential current therapy, shockwave therapy)

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