Sometimes knee pain seems to come out of nowhere. But that doesn’t always mean you need to see a professional pronto. “Knee pain that comes on slowly, is mild in nature, or occurs after strenuous activity may resolve on its own,” says Erica Fritz Eannucci, DPT, OCS, CMP, SFMA, a physical therapist at HSS Paramus. Rest, ice, compression, elevation and nonsteroidal anti-inflammatories such as ibuprofen are often all that you need to manage your knee pain at home, she adds.
Other times, knee pain necessitates a trip to a physical therapist. “Orthopedic physical therapists are highly skilled in the management of knee injuries,” says Fritz Eannucci. “Our schooling trains us to differentiate between a knee injury that can be managed by a physical therapist or one that needs a physician referral. Since access to PT care is often faster and less expensive than a trip to a physician, people should feel confident going to a PT as a first option for the management of knee pain.” If symptoms persist for more than a week, Fritz Eannucci recommends checking in with a physical therapist for an evaluation.
What Knee Conditions Can PT Help With?
Whether your pain is sudden or chronic, some situations where PT can help include:
Meniscus tear. Physical therapy can be highly effective for the management of a meniscal tear, says Fritz Eannucci. “Recent research has shown that physical therapy is not inferior to arthroscopic meniscal surgery for improving self-reported knee function up to 24 months after injury. In fact, depending on the study, the level of pain and function is the same for patients up to 24 months after a meniscal tear, regardless of whether they did surgery or PT.”
PT usually focuses on strengthening and stretching the muscles around the knee so they can better act as shock absorbers during daily activities. A physical therapist may also work to modify activities or improve movement patterns to make them easier and less painful for activities such as walking, climbing stairs, squatting, etc.
Knee ligament sprain. Treatment is similar to that for a meniscus tear, and also may include bracing for protection of the knee or taping for swelling and/or pain. PT will also include strengthening, stretching, balance training, and slowly increasing activity so that the person can return to their previous level of function.
Osteoarthritis (OA). “A structured exercise program is considered a core treatment for knee OA,” says Fritz Eannucci. PT focuses primarily on joint protection strategies, such as bracing, and strengthening the muscles around the knee so they can absorb the impact on the knee better during daily activities. Stretching can also help protect the knee and maintain range of motion, which often diminishes with OA. The physical therapist may also work to modify activities or improve movement patterns to make them easier and less painful, such as getting up and down from a chair. Finally, they will build a home exercise program for long-term management of knee OA.
Patellofemoral pain syndrome. A thorough evaluation is important for this type of pain, says Fritz Eannucci, since many different things may contribute, and treatment must be specific to each person. For example, flat feet may cause the patella (better known as the kneecap) to track improperly. In this case, foot orthotics may help. If weak hips cause the knees to turn in during certain activities, hip strengthening exercises will help. “Strengthening the quadriceps muscle and hips is a hallmark of PT care for patients with patellofemoral pain syndrome,” she adds.
Physical therapists also see people after knee fractures. “Often a knee fracture will cause people to lose strength and flexibility, which PT can help to restore,” she says. The therapist will help people learn to walk, squat, climb stairs, and return to general movements.
When to See a Doctor Right Away
Fritz Eannucci adds that there are some instances in which you should see a health care provider right away. They include:
- You can’t bear weight on your knee or bend it more than 90 degrees, you see an obvious deformity in your leg or knee, or you feel as if your knee is unstable or gives out. “These could be signs of a possible fracture, ligament tear, or large meniscal tear,” she says. “I’d recommended going to an emergency department or urgent care clinic to be evaluated.”
- Pain that’s not alleviated by anything, including rest, elevation, icing, etc.
- Swelling and redness that does not improve when you elevate your leg and/or severe tenderness of your calf. “This can be a sign of a deep vein thrombosis and should be evaluated immediately,” she says.
- Swelling and redness accompanied by general malaise and/or fever can be a sign of an infection and should be evaluated by a physician.
What to Look for When Searching for a Physical Therapist for Knee Pain
While most physical therapists are capable of helping to ease your knee pain, Fritz Eannucci believes you’ll get the best outcome if you work with a therapist who sees a high frequency of patients with knee pain, particularly someone who specializes in orthopedic injuries. “Some therapists are board certified in orthopedics and will have the initials OCS as a credential,” she adds. “Practice makes perfect, so the more you treat and see a certain injury, the better you become at managing it.”
