Hip and Knee Pain
Your hips and knees are the largest joints in your body. While many people may experience hip pain or knee pain on their own, it is also common to experience them together as well. You may first notice hip pain on the outside area of the hip, along the outer buttock or upper thigh area. Hip pain can occur whether you are at rest, walking or during any other type of physical activity. Knee pain is another very common reason why people visit our physical therapist each day. In addition to chronic pain, other common symptoms of knee pain include stiffness, swelling popping and general instability. Many physical therapy patients also find that it is difficult or even impossible to fully straighten the knee as well. If you are experiencing hip pain or knee pain, call our offices today to schedule a free physical therapy consultation. Common causes of hip and knee pain are detailed below.
Anterior Cruciate Ligament (ACL) Tear (non-surgical and surgical)
The anterior cruciate ligament (ACL) connects the thigh bone (femur) to the shin bone (tibia) at the knee joint. ACL tears are most common in athletes, but can also affect non-athletes. Most injuries occur due to non-direct trauma where the tibia moves too far ahead of the femur such as stopping suddenly during running or landing on a straight knee after a jump. Females are more prone to ACL injuries due to laxity in muscles and tendons caused by hormonal imbalances. Surgery is not a requirement in most cases, but this option may be preferred to decrease pain and provide more stability for the knee joint.
Symptoms of an ACL tear include sharp pain and a popping sound at the initial injury, swelling around the knee, and feeling like the knee will give way due to joint laxity. A knee brace will typically be used to provide additional stability for the knee joint.
Both in surgical and non-surgical cases, physical therapists will focus on patient education for proper donning (putting on) of the knee brace, strengthening and stretching exercises, manual therapy to increase range of motion, and modalities to decrease pain and swelling and increase the ability for the muscle to contract. If surgery takes place, the patient will be limited in activities for the first 3-4 months with gradual return to sports or prior function after this.
The term fracture refers to a break, crack, or crush to a bone. A hip fracture could be located in the ilium, ischium, or pubis bones. These three bones form the hip complex. A femur (thigh bone) fracture could also occur and affect the mobility of the hip. These injuries may or may not require surgical intervention depending on the type and area of fracture. The most common causes of these fractures includes traumatic events such as falling on the affected side or having a car wreck.
If a fracture occurs, several symptoms may be present: inability to move or stand on the affected side, swelling in the hip area, a change in shape, severe bruising, muscle spasms in the thigh, numbness or tingling, heavy or uncontrolled breathing through an open wound, and confusion or loss of consciousness. With femur fractures, blood clots can be prevalent and life-threatening.
Physical therapy can help restore function and reduce symptoms in both surgical and non-surgical cases. Concentration will be given to reducing pain, building strength and flexibility, improving balance, and training for return to prior level of function.
Greater Trochanteric Bursitis
The greater trochanteric bursa is a fluid-filled sac that sits on top of a bony prominence called the greater trochanter on the outside of the femur (thigh bone). The bursa acts as a cushion preventing friction between the greater trochanter and the muscles that attach to the bone. Bursitis can develop in individuals of all ages and genders, but more commonly affect moderately to highly active people. Common causes include iliotibial band tightness, hip muscle tightness and weakness, abnormal body structures and body mechanics, improper technique with repetitive movements, and a change in exercise routines and sports activities.
Symptoms of bursitis include tenderness over the bursa with palpation, pain when lying on affected side, pain that may start as sharp and decrease to dull with possible radiating symptoms down the leg, tightness in the hip, and pain and stiffness with prolonged sitting, walking, climbing stairs, and squatting.
Physical therapists will address the functional limitations involved with greater trochanteric bursitis through the use of modalities to reduce pain, strengthening and stretching exercises to correct muscle imbalances, manual therapy to improve range of motion and decrease restrictions, education for return to prior function without increased pain, and balance activities to reduce risk of falling.
Knee bursitis refers to an inflamed, irritated sac of fluid that serves as a protective cushion to reduce friction. Most commonly, bursitis occurs between the skin and the patella (knee cap) or between the patellar tendon and tibia (shin bone). However, there are other bursa located in and around the knee joint that can become affected. Common causes of knee bursitis include repetitive motions such as running, prolonged kneeling or crawling, direct trauma to the knee, knee surgery, infection, and autoimmune conditions.
Symptoms of knee bursitis include swelling and redness on the knee, pain with palpation over the affected area, pain with kneeling, and stiffness in the knee joint.
Physical therapy will focus on restoring prior level of function through strengthening and stretching exercises, manual therapy to improve range of motion, modalities to reduce pain, balance training to reduce falls, and education on proper body mechanics to return to sports and activities without injury.
The groin is an area where the abdomen meets the leg and the inner thigh muscles attach to the pubic bone. With a groin strain, the muscles of the inner thigh or the front of the hip are overstretched or torn. Most groin strains happen in athletes such as soccer players who kick forward with force or change directions while running. However, non-athletes are susceptible to this injury as well. There are three grades of groin strains:
Grade 1: mild or partial stretch or tear of the muscle fibers. Use of the leg is not impaired and walking is normal
Grade 2: moderate stretch or tear of a greater number of fibers. Use of leg is notably impaired and limping is common.
Grade 3: severe tear of the muscle fibers. Use of leg is very difficult and walking is very painful.
Symptoms of groin strains include pain and spasms in the groin area, swelling and bruising in the groin area, tightness in the groin area, weakness noted with walking or climbing stairs, limping with walking, and difficulty performing daily activities that require walking or standing.
Physical therapists will aid the healing process by the use of modalities to reduce pain, manual therapy to improve range of motion, strengthening and stretching exercises, and education/training to return to prior function with correct body mechanics and use of the affected extremity.
The hamstrings are a group of 3 muscles called semitendinosus, semimembranosus, and biceps femoris. Their main functions include hip extension and knee flexion. Hamstring injuries occur when excessive force is placed on the muscles such as sudden stops during running or kicking. Therefore, athletes are the most common individuals affected by these injuries. While severe injuries could require surgery, most injuries can be treated with physical therapy.
Symptoms are associated with the intensity of the injury but could include sharp pain in the buttocks or back of thigh, feeling a pop or tearing of the muscle, bruising, swelling, tenderness to palpation, and difficulty walking and sitting without pain.
Physical therapy will address the symptoms by using modalities to decrease pain, manual therapy to increase range of motion, strengthening/stretching exercises, and education to prevent re-injury upon returning to prior level of function.
OA/Degenerative Joint Disease
Osteoarthritis (OA) and degenerative joint disease (DJD) refer to the wearing away of the joint due to repetitive use and breakdown as we age. Injury and inflammation cause the cartilage that lines the joints to deteriorate. Most commonly, OA and DJD affect older adults. These conditions can make walking or climbing stairs difficult due to pain and instability in the joint. In the most severe cases, hip replacements may be required.
With OA and DJD, symptoms include sharp/dull/achy pain surrounding the hip joint, stiffness especially first thing in the morning or after sitting, weakness of the surrounding musculature, crunching sounds during movement, and difficulty walking and performing everyday activities due to pain.
Physical therapy helps to reduce symptoms through the use of modalities to reduce pain, manual therapy to increase range of motion, strengthening/stretching exercises, balance training to reduce falls, and education for proper return to prior function. If a hip replacement is necessary, physical therapists are also trained on post-surgical procedures to rehabilitate the hip joint.
Hip Labral Tears
The labrum is a ring of cartilage that helps hold the femoral head in the acetabulum thus creating the ball-and-socket hip joint. A labral tear results in the labrum separating or pulling away from the socket. If a tear occurs, it will not naturally heal itself. In the most severe cases, surgical intervention may be required to sew the tear. However, most labral tear symptoms can be easily treated with physical therapy.
Symptoms of a labral tear in the hip include a deep ache in the front of the hip or groin, painful clicking or catching in the hip during movement, pain with prolonged sitting or walking, sharp pain in the hip joint with squatting, and weakness and stiffness in the hip joint.
Physical therapy helps treat the symptoms of labral tears through the use of modalities to decrease pain, manual therapy to increase range of motion, strengthening and stretching exercises, and education on safe return to prior function.
Iliotibial Band Syndrome
The iliotibial band (ITB) is a band of soft tissue that runs along the side of the leg from the outside of the hip to the outside of the knee. It also serves as an insertion site for two muscles of the hip, the tensor fascia latae (TFL) and gluteus maximus. In individuals involved in endurance sports, excessive running and cycling can produce pain at the outside of the knee. With these repetitive activities and others, friction is produced between the ITB and the underlying structures resulting in inflammation and irritation.
Symptoms of ITB syndrome include sharp pain at the outside of the knee, a feeling of the ITB snapping over the knee as it bends and straightens, swelling near the outside of the knee, occasional tightness and pain at the outside of the hip, and continuous pain following repetitive activities. Pain is typically worst when the knee is slightly bent due to the ITB rubbing over the femur.
Physical therapy will help reduce symptoms through the use of modalities to reduce pain, manual therapy to increase range of motion, strengthening and stretching exercises, and education for safe return to prior level of function.
The meniscus is a C-shaped piece of cartilage on the inside and outside of each knee that acts as a shock absorber. It also provides stability for the knee joint. A meniscal tear is usually caused by twisting or turning quickly on a bent knee when the foot is planted on the ground. In most cases, symptoms can be managed with physical therapy. However, few cases will require surgical intervention to repair the meniscus.
Symptoms of a meniscal tear include sharp and intense pain in the knee area, a pop or tearing sensation, difficulty walking due to tearing or catching sensation, difficulty straightening the knee, and swelling within the first 24 hours after injury.
Physical therapists help to treat the symptoms of meniscal tears through modalities to reduce pain, manual therapy to improve range of motion, strengthening and stretching exercises, and education for safe return to prior function. In the case of surgical intervention, physical therapists will follow postsurgical protocols to rehabilitate the knee without re-injuring the meniscal repair.
Osgood-Schlatter’s disease is an overuse injury that produces pain and sometimes visible overgrowth of the bone just below the kneecap. It most commonly affects adolescents during the growth stages. As the patellofemoral tendon repetitively pulls on the attachment to the tibia bone (shin bone), overgrowth of the bone can occur and produce pain. Females are typically affected around 11-12 years of age while males develop symptoms around 13-14 years of age.
Symptoms of Osgood-Schlatter’s disease include gradually worsening pain at the top of the shin bone, pain that worsens with exercise, swelling and tenderness at the top of the shin bone, bony overgrowth at the top of the shin bone, loss of strength in the quadriceps muscle, increased tightness in the quadriceps muscle, loss of knee motion, and discomfort with activities of daily living and repetitive activities such as running and climbing stairs.
Physical therapy will reduce the symptoms of Osgood-Schlatter’s disease through the use of modalities to reduce pain, manual therapy to increase range of motion, light strengthening/stretching exercises, and education for safe return to prior level of function.
Osteochondritis Dissecans (OCD) occurs when there is injury to the cartilage within a joint. It is commonly associated with avascular necrosis, a condition where the blood supply to a joint is disrupted resulting in loss of nutrients to the joint capsule and eventually death of the bony structures. As the health of the bone begins to deteriorate, the cartilage loses its support system and becomes more susceptible to injury.
Symptoms of OCD include swelling of the affected area during activity, restricted range of motion, pain when moving the joint, tenderness to palpation along the joint line, a feeling of popping or locking of the joint during movement, and worsening pain during repetitive activities.
Physical therapy helps to reduce the symptoms through the use of modalities to decrease pain, manual therapy to increase range of motion, light strengthening/stretching exercises, education for activity modification and determination of necessary surgical intervention, and bracing if necessary to provide more stability for the joint.
The patella (kneecap) is designed to slide up and down within the trochlear groove of the femur (thigh bone). As the knee bends and straightens, the patella moves in the groove as well. However, when the patella comes out of the trochlear groove, patellar instability is indicated. Most often, this condition is caused by a traumatic injury and typically affects adolescent females more so than males or older individuals. Abnormalities such as a shallow or rotated trochlear groove, muscle weakness surrounding the patella, loose or torn ligaments and tendons around the patella, and poor movement patterns can also contribute to patellar instability in individuals of all ages and genders.
With patellar instability, you may experience knee pain especially with ascending/descending stairs or running, feeling the kneecap shift outside of the trochlear groove, weakness, and swelling in the knee that can lead to stiffness.
Physical therapy will help to reduce the symptoms of patellar instability through strengthening/stretching exercises, modalities to reduce pain and swelling, education for safe return to prior function, and manual therapy to increase range of motion.
Patellofemoral pain refers to inflammation and pain at the front of the knee, in and around the patella (kneecap). Pain typically occurs when friction occurs between the patella and the femur (thigh bone). The most common belief is patellofemoral pain is an overuse syndrome, but other contributing factors include:
Weakness, tightness, and stiffness of the muscles of the hip and knee
An abnormality in the way the hip, knee, and foot line up
Improper tracking of the kneecap
With patellofemoral syndrome, pain is present with all activities but typically reduces with rest, pain after sitting for long periods of time with the knee bent, and a crack or pop felt with bending or straightening the knee.
Physical therapists address the symptoms of patellofemoral pain with modalities to reduce pain and swelling, manual therapy to increase range of motion, strengthening and stretching exercises, specific activity training, taping or bracing, and education for safe return to prior function and activity levels.
Total Hip Arthroplasty (THA)
A total hip arthroplasty (THA) is a surgical procedure that removes the hip joint and replaces it with a prosthetic hip. The ball and socket joint is replaced with a metal ball and a plastic cup. If a total hip arthroplasty is not required, a hemiarthroplasty may be chosen. In this case, only the ball is replaced. THA and hemiarthroplasty surgeries are performed on patients who have traumatic arthritis, avascular necrosis (death of the bone due to loss of blood supply), and traumatic hip fractures.
Prior to surgery, patients may experience severe pain in the hip and groin and occasionally down the thigh. The pain will make walking, ascending/descending stairs, and sleeping on the affected side difficult. Postsurgical symptoms include stiffness and muscle weakness in the hip and leg, pain, and difficulty bearing weight on the surgical limb. As recovery progresses, these symptoms will dissipate.
Physical therapy will aid in recovery through manual therapy to increase range of motion, modalities to reduce pain and swelling, strengthening and stretching exercises, education for hip precautions and safe return to prior level of function, balance training, and gait training. Protocols will be followed to prevent damage of the surgical site. Though patients will recover at different rates, most patients are completely healed one year post-surgery.
Total Knee Arthroplasty (TKA)
Knees are the most commonly replaced joint in the body. Knee replacements are typically performed when the knee joint has been damaged due to arthritis, fractures, and bone diseases or when knee pain and alignment issues affect the ability to walk and perform activities of daily living. During a TKA, the end of the tibia (shin bone) and femur (thigh bone) are removed and replaced with artificial parts. The end of the femur is replaced with a metal part while the end of the tibia is replaced with a plastic part. A plastic insert is also used to replace the patella (knee cap).
Following knee replacements, common symptoms are swelling, pain, numbness around incision, decreased range of motion, and decreased strength. All of these symptoms are related to the surgery and are temporary.
Physical therapy will assist with reducing these symptoms by using modalities to decrease pain and swelling, manual therapy to increase range of motion, strengthening/stretching exercises, balance training, gait training, and education for safe return to activities of daily living and hobbies.