To find the cause of symptoms and exactly which structures are affected, we first note all the details about how symptoms came about, what it feels like, timing, daily pattern, aggravating and relieving factors.
We also ask about any issues with your spine and the rest of the lower limb joints, your health in general, and any significant events in the past such as accidents or surgery.
We then observe and assess movement of the knees and related joints in all directions – making note of any restrictions or pain. We will usually also perform some special tests to assess the nerves, joints, muscles and ligaments in the area.
Once we have established our working diagnosis we will always take time to explain to you what we found, and let you know how we can help, and whether we need to make any referrals.
We then use specific massage, mobilisation and stretching techniques to improve the flexibility in joints and muscles, relieve tension, improve freedom of movement and mechanics, and ensure good circulation for effective recovery.
Where appropriate, we also use sports taping to support the injured area as it heals and provide additional stability during the recovery phase.
If we see patients as part of their rehabilitation process after surgery or trauma, our aim is to avoid stiffness developing following a period of immobility, to help with rehabilitation strengthening exercises and ensure good circulation is maintained for optimal recovery.
During the session, we will also provide advice on exercise, posture and other techniques to aid fast recovery and maintain the treatment results.
Exercise and Advice
These are some of the most common techniques and exercises we prescribe for knee injuries or pain:
Medial Quadriceps (VMO) Strength
For patella (knee-cap) maltraction and pain
Sit up with your legs stretched in front of you.
Place a rolled-up towel under the knee you are working on.
Push your knee down into the towel so your knee is fully straightened, checking all the time that your medial (inner) quadriceps muscle is working as you push. Repeat at least 30 times.
How does it work?
Pain behind the kneecap is often caused by uneven pulling of the quadriceps muscle group.
This muscle group keeps the kneecap running smoothly in its groove as the knee is bent and straightened, but if the lateral pull is stronger than the medial (or vice versa), the back of the kneecap may rub against the end of the hip bone.
Most commonly, the medial muscle is the one which needs strengthening to help put the kneecap back on its course, and this muscle is mostly used on its own during the last few degrees of extension – when the knee is fully straightened.
Squats and Half-Squats
All-round lower limb strength
We love squats as they are such all-rounders – adding strength and control throughout the lower limbs and pelvis.
Standing with your feet hip-width apart, bend the knees and hips so your bottom is lowered and ‘sticking out’ backwards (there’s no graceful way of doing a proper squat!)
Come back up to standing, leading the movement with the buttock muscles.
Keep your feet flat on the floor if possible.
There’s no need to squat a long way down in order to feel most of the benefit, so a half-squat or just as far as your knees can bend comfortably, will still be very effective.
Sit up with your legs stretched in front of you, about 90 degrees between them.
Keeping your back straight, lean forward towards each foot.
Why is this stretch important?
As the hamstrings run across the knee joint, chronic tightness in those muscles will lead to compression and pressure on the knee, which can affect its function, circulation and rate of recovery after an injury.
Stand up on a step, holding on to the handrail.
Place one foot firmly on the step, while placing only the ball of the other foot on the step, and extending the heel down.
Maintain a straight body, avoiding twists or bends. Hold this position for a minute or so.
Why is this stretch important?
Several of the calf muscles cross the knee joint, attaching just above it.
As a result, chronic tightness here may lead to compression and pressure through the knee, which can affect normal function, circulation and healing rate.