What Is Your Knee Plica?
A plica is a fold of synovial membrane most commonly in the anteromedial aspect of the knee. A knee plica is present in about 50% of the population and is the remnants of embryonic connective tissue that failed to resorb during your foetal development fully. Luckily, most plicae are asymptomatic.
While your knee potentially has four plicae, it is the medial plica that is most likely to be symptomatic (Dupont 1997). It runs parallel to your medial patella just below your medial retinaculum and inserts into your fat pad.
What is Plica Syndrome?
Plica syndrome is essentially an inflamed plica. Your plica can catch during:
- repetitive knee straightening and bending,
- blunt trauma or knee twisting,
- fat pad irritation,
- altered knee motion,
- internal knee derangements, e.g. meniscal tears. (Schindler 2004)
Consider plica syndrome if you experience persistent knee pain and weakness in the quadriceps muscles. Plica syndrome often does not always occur in isolation, but concurrently with other knee conditions such as meniscal injuries, patellar tendonitis and Osgood-Schlatter’s Disease.
What are the Symptoms of Plica Syndrome?
Plica syndrome can be suspected when you have:
- Anteromedial knee joint line pain; especially medial femoral condyle.
- Visible and palpably tender plica.
- Audible clicking or snap during knee motion – painful arc 30 to 60 degrees. (Dupont 1997).
- Positive Duvet test: pain eased by using a duvet between your knees to ease the pain in bed.
- Pain with activities: ascending and descending stairs, squatting, rising from a chair or sitting for extended periods. (Shetty et al. 2007).
- Quadriceps atrophy is common in chronic cases.
How is Plica Syndrome Diagnosed?
Your physiotherapist will be able to diagnose plica syndrome clinically. It is more vital that you have your knee thoroughly assessed by a physiotherapist or sports doctor to exclude other knee pathologies, in particular, meniscal injuries.
An x-ray may be useful to rule out other associated pathologies but will not identify a plica. MRIs can detect plica inflammation. However, MRI is more helpful in diagnosing other pathologies that may be related to the plica irritation. A comprehensive examination by your physiotherapist or sports physician is preferable.
Plica Syndrome Treatment
Studies show that about 60% of patients with plica syndrome will settle successfully with conservative physiotherapy treatment within 6 to 8 weeks. (Lu et al. 2010).
Your physiotherapy treatment will aim to:
- Reduce pain and inflammation.
- Improve patellofemoral (knee cap) alignment via taping, bracing and exercises.
- Normalise your muscle lengths.
- Strengthen your knee: esp quadriceps (esp VMO) starting with closed-chain exercises and eventually progressing to open-chain exercises
- Strengthen your hip and lower limb muscles.
- Address foot biomechanics issues.
- Improve your proprioception, agility and balance.
- Improve your lower limb function and quality of movement, e.g. walking, running, squatting, hopping and landing.
- Minimise your chance of re-aggravating your plica syndrome. (Gerbino et al. 2007).
We strongly suggest that you discuss your knee injury after a thorough examination by a knee clinician such as a sports physiotherapist, sports physician or knee surgeon.
Should your symptoms persist beyond 3 to 6 months, consider arthroscopic knee surgery for a plica syndrome. The most successful surgery involves lateral retinaculum release to allow the patella to track more medially and thereby alleviate plica irritation as it rolls over the medial femoral condyle. Success rates exceed 85%. (Gerbino et al. 2007).
How to Prevent Plica Syndrome?
Since plica syndrome usually occurs concomitantly with other knee conditions, it is essential to be proactive in managing your other knee injuries. This proactivity involves maintaining normal knee joint alignment, adequate strength and flexibility in the muscles around the knee joint plus the rest of the lower limb. It is ensuring that you wear appropriate footwear that supports your foot biomechanics. Also, weight-management can play a role in the pressure exerted on lower limb joints, and thus should be something considered as a long-term preventative measure.
Braces for Plica Irritation
Many patients will try a knee brace. A brace that improves patellofemoral joint alignment seems to be the most effective to ease the plica-related pain.
An effective patellofemoral brace can be useful as an alternative to kneecap taping.
Common Causes - Knee Pain
Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.
Knee Ligament Injuries
- Knee Ligament Injuries
- ACL Injury
- PCL Injury
- MCL Sprain
- LCL Sprain
- Posterolateral Corner Injury
- Superior Tibiofibular Joint Sprain
- What Are The Symptoms Of A Torn Ligament In Your Knee?
- Can You Walk With A Torn Ligament In Your Knee?
- ACL Injury
- Is Surgery Needed For My ACL Injury?
- Can You Live Life Without An ACL?
- What Is The Main Function Of The ACL?
- What Happens If You Don’t Get Surgery On Your ACL?
- What Are The Symptoms Of An ACL Tear?
- How Can You Tell If You Have A Torn ACL?
- What Is The Best Surgery For ACL Tear?
- Post-ACL Reconstruction Rehabilitation
Knee Meniscus Injuries
- Chondromalacia Patella
- Fat Pad Syndrome
- Patella Dislocation
- Patellofemoral Pain Syndrome
- Osgood Schlatter’s Disease
- Sinding Larsen Johansson Syndrome
Knee Tendon Injuries
- Corked Thigh
- Thigh Muscle Strain
- Hamstring Strain
- ITB Syndrome
- Popliteus Syndrome
- Muscle Strain (Muscle Pain)
- DOMS – Delayed Onset Muscle Soreness
Children’s Knee Conditions
Other Knee-Related Conditions
- Runner’s Knee
- Plica Syndrome
- Stress Fracture
- Overuse Injuries
- Restless Legs Syndrome
For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee conditions, such as your knee physiotherapist.
Knee Pain FAQs
Knee Ligament Related
Age & Arthritis Related
Knee Treatment & Exercise Related
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
What Does Arthritis In The Knee Feel Like?
Arthritis is an inflammatory disease of the joints. Ankle arthritis typically requires an injury to start the chain of events that lead to ankle arthritis. Knee arthritis can simply develop the disease over time. Given no precipitating event needs to occur, and it usually onsets gradually over time, it’s sometimes difficult to recognise the signs and symptoms of Arthritis. People can suffer from pain that they incorrectly attribute to general old age. If diagnosed and managed correctly, it can drastically improve function and quality of life.
Some signs your knee pain may be Arthritis are:
- Swelling after activity - Your knee may appear puffy or be harder to bend. It may feel ‘full’. The knee swelling is being produced by inflammation. Other classic signs of inflammation to look for are redness, warmth and pain around the joint line.
- Morning stiffness - Your knee doesn’t tolerate periods of inactivity as well as it used to. This is most noticeable in the morning after sleep but improves with movement.
- Achy pain - Arthritic pain is most commonly described as achy. Sometimes it is broad and encompasses the entire knee. Other times it affects only one knee compartment, most commonly the inside compartment and thus produces pain only on the inside.
- Clicking or popping sounds - In the later stages of the disease, Arthritis causes the cartilage surfaces to roughen. This can produce clicking or popping sounds in the knee. It's important to note that some knee sounds are normal. Your physiotherapist can help you decide what knee sounds are of concern.
- Giving away or locking - Your knee may occasionally buckle when you put weight on it, especially when using stairs. It might also become stuck in a bent position for short periods. Bumpy cartilage surfaces may be stopping the joint from gliding smoothly, or pain might be inhibiting your ability to use your muscles efficiently.
Understanding what's going on in your knee will inevitably lead to better management. Much research has focused on improving function and avoiding surgery for knee arthritis, and these protocols have demonstrated excellent results. Whilst a diagnosis of Arthritis may sound daunting, all it means is you now have a ‘why’ for the pain and an opportunity to do something about it.
So please don’t delay in seeing your knee physiotherapist for their opinion on your knee pain.
How Do I Know If I Need An MRI On My Knee?
After having a knee injury, you will often wonder if you should have scans, and often many people ask whether we should have an MRI?
Through a thorough discussion of your knee and the objective testing your physiotherapist performs, a clinical diagnosis will often be sufficient to diagnose your injury and provide your treatment plan. Part of this assessment that your physiotherapist performs will include a discussion of whether you require imaging for your injury. While various imaging tests can be a valuable part of your management plan for your knee injury, the imaging tests should be condition-prioritised. Your skilled healthcare practitioner considers the clinical evaluation to determine that the best imaging modality (e.g. X-Ray, CT, MRI, Ultrasound) is specific to your problem.
A simple rule for choosing whether to have an MRI of the knee is
“imaging should exclude or rule out an injury that would change your management plan or require medical intervention”.
Another reason you may choose to obtain imaging on your knee is that, despite a well-considered management plan, it is failing to respond in the way we would expect based on the diagnosis.
If you have a trauma, and there is a deformity of your knee, or you cannot weight bear on your knee, it may be beneficial to obtain Plain Radiographs, known as X -Rays. A series of Rules, known as the Ottawa Knee Rules, that your physiotherapist will use to help determine if you need a Radiograph.
Suppose you have an injury, and your knee is giving way, collapsing, locking or even stuck and cannot move. In that case, your Physiotherapist or Doctor will often suggest MRI ascertain if your injury requires specialist intervention to assist in your recovery. The most common example of this is when you have a locked knee that is the result of an injury to the meniscus, the MRI will be required urgently to quickly ascertain if you need to proceed to the specialist sooner, as this type of injury is less amenable to non - surgical care.
There are always rare conditions that can present, and the knee is a joint that is known to succumb to conditions such as infections and even gout! In these cases, MRI cannot distinguish between conditions, and it may be more appropriate to have blood tests to confirm the diagnosis and appropriately direct management!
Whilst investigations of knee pain can be required for your injury, it is often best to discuss your injury with your physiotherapist so that they can assess your knee and provide guidance on the best-suited imaging modality to your problem to expedite your recovery!
So please don’t delay in seeing your knee physiotherapist for their opinion on your knee pain.
Article by Shane Armfield
How Much Should I Walk With Knee Pain?
This question depends on how you managed to get knee pain. If you have had a recent significant injury, you should limit how much walking you do until assessed. This is especially true if you are experiencing substantial swelling, any feelings of instability, or getting any painful clicking or locking of the knee.
If your pain is more chronic or intermittent, walking may be precisely the type of exercise you need. We will all avoid what is uncomfortable or painful, but if we avoid using the muscles and joints in our legs, including the knee, we will just decondition. As we lose muscle strength, the pain we have been experiencing may continue or become more apparent with less provocation.
This should be fine if you can walk comfortably and the pain does not worsen as you walk. You may need to limit the distance you walk, the speed you walk, avoid hills and uneven ground. It is also a good idea to walk a loop as it may reduce the distance you have to walk to get back home.
You need to monitor for swelling or increased pain after walking. If you get noticeable, increased swelling, you have overdone it, similarly, with increased pain. If you get increased knee pain into the evening or the next day, you have overdone it again.
Reducing the weight you are carrying is also something to consider, so don't carry bags or groceries when walking. If you are walking for exercise and want to reduce the weight through your knee, you can walk in a pool to reduce your body weight.
As you improve, you can increase your distance and start to incorporate hills and uneven ground. Most rehabilitation programmes for knee pain/injury will include walking at some stage.
If you have any queries regarding walking for your knee problem, speak to your physiotherapist, who will be able to assess the level of walking exercise you can conduct. They will also be able to progress you through a staged programme to your desired activity level.
So please don’t delay in seeing your knee physiotherapist for their opinion on your knee pain.
Can A Torn Meniscus Heal Without Surgery?
The meniscus of the knee is a highly specialised structure to dissipate the forces that go through your knee. However, when we sustain a tear of the meniscus, this ability is impaired, which can have consequences for our knee health. The main reason is limited meniscal blood supply. And blood supply is required for meniscus healing.
When we tear our meniscus, the location and nature of the tear can be crucial. If the site of the meniscal tear is in the outer zone, known as the red zone, there is a greater blood supply to this region. Therefore, it has a greater healing capacity. The inner zone, known as the white zone, has less blood supply, and often healing is sub-optimal. Ironically, this is where most of the tears occur in the meniscus of the knee!
It is important to note that a healed meniscus does not mean that it is pain-free! Many people who have never had knee pain can have tears of their meniscus on MRI.
We need to consider many different factors when trying to determine if we need surgery for a meniscal tear! A thorough assessment of your knee with your PhysioWorks Physiotherapist will help guide your treatment choice! It is essential to recognise that everyone's case is different, and the present symptoms will guide the most effective treatment strategy.
Acute tears, where we often remember a specific mechanism, usually of a rotation nature, may require surgical intervention due to the limited healing capacity of the inner or white zone. These tears are often associated with mechanical symptoms, such as:
If you feel like your knee is stuck in one position and cannot move it, early imaging and referral to an orthopaedic specialist may be recommended.
Clicking or Catching
This may indicate a loose body or piece of the meniscus that is problematic.
However, not all clicks are concerning. Often your Physiotherapist will ask about a change in your clicking and if it is painful or related to your symptoms.
With acute meniscal tears with these mechanical symptoms, you may require surgery to help with your symptoms. The surgical option is highly dependent on the location of the tear. Also, the shape of the tear and your age. Depending on the nature of your injury, they may debride or trim the free edge of the tear or stitch the injured region.
For acute injuries or a knee that is locked, early referral to an Orthopaedic Specialist may be required. Your Physiotherapist can help guide you through this process, advise on activities and exercises that you can do to help expedite your recovery and then follow up on a rehabilitation program at an appropriate time.
As we age, our menisci have less ability to absorb the forces due to the changes in the collagen that forms the meniscus. It's a bit like wrinkles on your face. Our menisci can be slightly easier to injure - often with most of us not knowing that we have done it! Conversely, we can have symptoms that present over time, known as Degenerative Meniscal tears. These types of tears are known as degenerative meniscus tears.
Current evidence demonstrated that surgical intervention is not better for degenerative meniscal injuries than high-quality non-surgical care. Non-surgical treatment includes appropriate exercise and may also have activity modification for a short period and liaison with your GP about the utilisation of medications to manage any flares are of symptoms. Your Physiotherapist is experienced in prescribing these programs to expedite your recovery!
Regardless of your meniscus injury nature, it is crucial to have specific, individualised advice regarding your injury.
In short, the healing capacity of the meniscus is limited. However, not all tears require surgery! More often than not, you can treat your meniscal injury successfully with physiotherapy. Your PhysioWorks physiotherapist will conduct a thorough physical assessment and recommend a treatment plan specific to your meniscal injury and goals.
PhysioWorks offer same-day appointments for prompt diagnosis and rehabilitation plan. Your PhysioWorks Physiotherapist has a particular interest in knee injury and can help guide your rehabilitation to get you back to what you love faster!