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Knee Calf
Knee pain
If you have chronic knee pain, osteoarthritis, sudden acute knee pain, ligament sprain or tear, or need knee replacement rehabilitation, you can now see a physiotherapist at home or online. Whether you have a sport you want to return to or to get back to everyday activities pain free, we can help. By putting you at the centre of the treatment plan and considering your needs and goals we can help you recover. 

High quality, modern, private physiotherapy gives time to answer all your questions, help you understand the issue and develop a detailed treatment plan that includes so much more than your muscles and joints. Build confidence moving and exercising with friendly, professional guidance. 
Client Stories
I tore the cruciate ligament and cartilage in my knee.....Amanda assessed me and devised a treatment plan with exercise videos - which was very helpful. She helped me understand how to work with my restricted range of movement and advised on knee strengthening exercises. I have received an outstanding, professional service and would not hesitate to recommend Physio in the Sticks. T.J.

Getting a medical assessment from your GP is recommended in the following circumstances:
In the event of any significant injury or trauma to the knee
If your pain levels are severe
If you are unable to put any weight through your knee
If you have developed altered sensation or weakness in your leg
If you have developed swelling in your knee joint - especially if it is hot and red

Knee cap pain (Anterior knee pain)
Pain that is located at the front of your knee around the area of your kneecap (patella) is extremely common. It is also often referred to as anterior knee pain or patellofemoral pain This type of pain is often associated with doing more activity than usual or more than what your knees can tolerate. This type of knee pain is also common in children during growth spurts. Common symptoms are pain behind and around your knee cap, pain worse with activities that place higher loads on the knee joints such as running, stairs, squatting, jumping, and sitting for long periods, pain usually comes on after changing the intensity of an activity -or after doing more activity than you are used to, the pain can start after a trauma like a fall, but more often isn’t associated with any tissue damage.

Knee ligament sprain
Ligaments are strong bands of tissue around joints that connect bones to one another and limit excessive movement. They are not as stretchy as muscles or tendons because they need to be stiff to prevent your bones from moving about too much. A sprain happens when your ligaments have been overstretched or torn, usually as a result of excessive force to a joint. If the ligament is stretched too far or twisted too much, the fibres of the ligament can become damaged and torn. Sprains vary greatly in severity from a few fibres to tearing of the entire ligament and the more of the ligament that is damaged, the more unstable the joint it protects will become. 

The two ligaments outside the knee joint are called the collateral ligaments. They are situated either side of the joint on the outside and the inside (left and right side) of the knee. Their main job is to limit the amount of sideways movement happening between the bones of the knee. An injury to a collateral ligament can occur with a force from either side of the knee causing excessive strain or stretch to the ligament on the opposite side.
The two ligaments inside the knee are the cruciate ligaments. They connect the two large bones together, but deep within the joint, they are known as the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They provide a great deal of stability while allowing the knee to
bend and straighten fully with their main function being to limit the amount of forwards and backward movement of the shin bone on the thigh bone.
The cruciate ligaments are strong and will allow a large amount of force to go through them but if the force is too great an injury can occur when the ligament fibres become overstretched or twisted excessively. ACL injuries are often a result of contact sports that require lots of change of direction and are more common than PCL injuries. The combination of twisting and possibility of sudden force makes the risk of injuring the
ACL higher.
Injury to any of the ligaments can be split into 3 different grades
Grade I - Slight stretching of the ligaments
Grade II - Some ligament fibres are torn
Grade III - Complete tear of the ligament

If you have a grade I or II sprain of your ligament there is a good chance that with some guided rehabilitation from a medical professional you will make a good recovery. For collateral ligament injuries, grade I injuries can recover in a matter of weeks and grade II injuries in a month or so. Time of recovery will be different for everyone depending on the specific injury. Grade III injuries may require an opinion from a surgeon to see if it may be necessary to surgically repair the ligament, which often depends on what level of function you are aiming to get back to. Rehabilitation should
be gradual and incorporate an individualised combination of range of movement, strength, power, speed and balance exercises.

Knee cartilage (meniscus) injury
Inside the knee joint are two pieces of cartilage that sit between the thigh bone and the shin bone, one on the inner half and one on the outer half of the joint. Each cartilage section is called a meniscus, and their function is that of spacer, shock absorber and stabiliser. The inner (medial) meniscus is more prone to injury because it tends to bear more weight and is attached to the ligaments on the inside of the knee. Common symptoms are; pain on deep squat, pain on twisting the knee, not being able to fully straighten the knee or the knee ‘locking’ (getting stuck in one
position), knee giving way when weight is put on the leg.

Damage to the meniscus will often happen through trauma. For example injuries often occur during sports when twisting suddenly on
the knee but can also occur as we get older. It is common to develop a more gradual meniscal injury over a long period of time. It is important to tell the difference between to two types as they might be managed
differently. With tears that happen suddenly whilst playing sports for example it may be that surgery is the best way to manage your symptoms. This is even more likely if you are younger (<30). If your pain has developed over a longer period of time and you are over 45 years old, good
quality evidence tells us that you are just as likely to get better from rehabilitation as you are from going through surgery. So getting in touch with a physiotherapist is a good way to start your recovery. It is essential that whether you have surgery or not you are taken through a full
rehabilitation programme. Recovery following surgery can take 6-12 weeks. Rehabilitation for a meniscus injury that
has developed over time can take longer and it can take up to 12 months of rehabilitation to feel better.

Knee osteoarthritis (OA)

The knee joint can become painful due to changes that happen in the joint as we get older. It can also occur in people who are younger but this may be as the result of a previous injury. When we are young our joints are springy and mobile and there is a thick layer of shiny cartilage which covers the ends of the bones where a joint is formed. There is also fluid between these surfaces to lubricate the shiny cartilage so that friction within the joint is reduced as we move about. Movement helps to lubricate the joint by distributing the fluid all over the joint surfaces, which is why we stiffen up if we keep still for too long. As we age, the tissues in our bodies change, the lubricating fluid naturally becomes thinner and the surfaces of our joints can become less smooth. Bony growths may build up at the margins of the joints, this adaptation happens to help spread load across the joint. The joint surfaces can also become closer together over time. This process is a perfectly normal part of the ageing process and happens in all of our joints but tends to happen earlier in joints that carry a lot of weight through them, which is why you most commonly hear about OA in the knees and at the hip. It is important to note that you can have quite severe OA changes on an X-ray and not be in much pain or sometimes no pain at all. Equally you can have minimal changes on an X-ray but actually experience lots of pain. We are all unique and that can make pain different for all of us. The arthritic changes can cause the joint to become stiff, particularly if it is kept in one position for a length of time. Everyday tasks like bending the knee, walking and taking the stairs can become painful.


Exercise can help you continue to function well with osteoarthritis, as maintaining strength, range of movement and viability of the joint can help you keep using your knee as normally as possible. Exercise and movement will promote strength and health of the joint and there is evidence that exercise can protect the joints from degenerative changes. Weight control is important. OA can be made worse by excess weight because of the obvious increase in load on the joints. However evidence also suggests that body fat stores can also influence OA symptoms due to an increase in inflammatory markers and often managing lifestyle factors around our health can help to minimise symptoms of OA. There will be times where further intervention is needed and you may be referred for X-rays or other scans, orthopaedic opinion or even surgery such as a total knee replacement.


Snap, crack, pop?

Creaky, popping or noisy knees is known as knee crepitus. It usually happens when the knee is bent - going up or down stairs, getting up from a chair or squatting. Generally, on its own crepitus is not a cause for concern. Although this can sound unpleasant, its not harmful and you can continue to do your usual daily activities. 


There are several reasons for crepitus - weak or tight muscles around the knee joint are a common cause. Knee joints are lubricated with synovial fluid, studies suggest that everyday movements may cause pressure and volume changes in the fluid, causing the gases nitrogen, oxygen and carbon dioxide in the fluid to form a gas bubble to form and then pop. After a joint "pop" due to pressure and volume changes it takes about 20 minutes before that joint will "pop" again.


Crepitus is believed to be due to arthritis - but it often isn't. 99% of people without knee problems have noisy knees - there are many reasons joints make a noise but they are mostly non-arthritic. It is important to keep on moving as avoiding physical activity can lead to a loss of muscle strength which is a bigger problem.

Lower leg pain


Getting a medical assessment from your GP is recommended in the following circumstances:

In the event of any significant injury or trauma to the leg, if your pain levels are severe If you are unable to put any weight through your leg, if you have developed any altered sensation, temperature changes or weakness in your leg, if you have developed swelling in your calf or lower leg - especially if it is hot and red. If your pain does not resolve or is worsening, or if you have developed further symptoms such as feeling unwell, fever or unexplained weight loss then please contact your GP for an assessment.


Calf muscle injury

The calf muscles are large powerful muscles on the back of your lower leg that help us to run and accelerate. Injuries to these muscles can happen during activities and sport that involve changes of speed and direction. Common symptoms are sudden pain in the calf muscle at the time of the injury, pain when resuming activity, inability to put weight on your foot, walk or rise-up onto your toes, swelling and bruising, aching and stiffness, abnormal appearance of the calf. Large forces are generated in these muscles during running. Injuries/ tears to these muscles usually occur during acceleration (change in running speed) or during changes in direction. Calf injuries can also occur during different activities that have caused these muscles to be overloaded. The most common part of the calf to be injured is the inside section of the gastrocnemius muscle, however, tears can happen in all areas of your calf muscles and can involve both muscles.


Grade 1: Mild overstretching resulting in some small micro tears in the calf muscle fibres (typically less than 10% of the fibres).

Grade 2: Partial tearing of your muscle fibres (typically between 11-49% of the fibres torn.

Grade 3: Complete tearing or rupture of your calf muscle fibres (typically more than 50% of the fibres torn).

Grade 1 & 2 injuries are most likely to recover within several weeks with the provision of good rehabilitation/ exercises. Grade 3 injuries often require investigations such as ultrasound scans or MRI’s. These may take several months to repair but will also require rehabilitation/ exercises


Shin splints (Medial Tibial Stress Syndrome - MTSS)

Shin splints is a common complaint normally associated with running. You may have developed pain on the inside of your shin bone, normally when increasing the amount or intensity of running you have done.


Sciatica

The sciatic nerve starts in the lower back and runs through the leg into the foot. Pain in the lower leg can occur because of irritation/ injury to this nerve in the lower back. People with Sciatica may also have different sensations in the leg such as pins and needles, numbness and a cold feeling.

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