Is there really a "best way" to resolve my knee pain?

I have blogged about this in the past, and it is a subject I feel strongly on. I have been asked so many times by friends via social media that my knee hurts, what is it and what do I need to do to get it better? There are so many diagnoses and therefore treatment pathways for the knee that the question alone is one that any good clinician should struggle to answer without a full, accurate assessment. However, this has not stopped a group of researchers trying to put together a best practice guide for such! Barton et al. (2015) undertook a systematic review of all current evidence, in addition to interviewing a group of what was considered excellent, experienced specialist to gauge their subjective viewpoint on what has worked for them anecdotally.

Their research identified through both systematic reviews and interviewing the experts, the following should be considered

Muscle length surrounding the knee

Particularly apparent from the interviews, they experienced muscle tightness in the quadriceps, calves and hamstrings. If you have tightness in these muscles, then this could lead to your knee pain. Anecdotally, I have found significant gains when I give stretches to my clients with knee pain.

Muscle strength surrounding the knee

Not only is this regarding the quadriceps and hamstrings, those who know me or who have been treated by me, know how much emphasis I put on the gluteals. The researchers have identified that this is a key component for knee pain too. The researchers did not conclude there. They suggested there is increased evidence in looking at the core stability namely trunk strengthening exercises.

Yet, worryingly, there are still experts in the field who still believe you can isolate the quadriceps individually with exercise and target those. This has been an ongoing argument in the physiotherapy world for years and still continues. Neurologically, it has been proven on numerous occasions that there is no activation deficit between any of the quadriceps. I stopped trying to isolate the quadriceps when I was still a student. Use of adjuncts

Joint mobilisations, massage, acupuncture, taping and knee braces provided mixed results from the research. Knee braces tend to be advocated from orthopedic surgeons, particularly post surgery. Acupuncture is becoming less and less endorsed, particularly by NICE guidelines for the management of other knee conditions, such as osteoarthritis. Anyone who has been treated by me knows I have never taped a knee and have never performed acupuncture.

Increasing research and evidence does not support the long term benefits from taping. The research suggests there is a distinct lack of evidence to support massage and joint mobilisations for the management of knee pain. However, I would argue if some muscles are tight and over working, I have demonstrated benefits from soft tissue release of tight muscle in the management of knee pain.

Movement retraining

Functional exercises, for example: Sit - stand and step ups should be considered. As anyone who has been treated by me will testify, I am a huge advocate in functional rehabilitation and prescribe step ups with high control in the management of knee pain. These types of exercise retrain the gluteals and help you break down poor inadvertent bad habits you may have developed. Exercise prescription

Reassuring, the researchers were unable to conclude a definitive exercise regime for the treatment and rehabilitation of knee pain. Why? Because they all concluded that treatment needs to be individualised and specific to the person's needs! Which leads me to my summary perfectly. When I saw this paper, my heart sank. I was worried that someone had tried to write a bible if you like for a one treatment suits all approach to the management of knee pain. Thankfully, they haven't. Because you can't. It is impossible to answer that social media message with I suggest you perform some step ups without assessing your patient. assessing their current ability, ascertaining their understanding of the exercises, knowing they can perform the exercises well and not make themselves worse. After all, would you expect a GP to give you a prescription without taking a proper look at you? It is reassuring to my clients that I can say with my hand on my heart that I already follow all of these best practice principles. If you suffer with knee pain, please contact your local, friendly, knowledgeable physiotherapist.