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Knee & Heel Pain

GENERAL INFORMATION
BASIC FIRST AID
WHEN to BEGIN BASIC STRETCHES
SIGNS & SYMPTOMS
WHEN TO CALL MD
WHEN TO SEE A PHYSICAL THERAPIST
CAUSES /RISK FACTORS /PREVENTION

Your knees and feet
are complicated joints.  When they work normally we take them for granted.  When problems occur, your ability to walk comfortably becomes limited. Since walking is how we get around, problems with walking have a major impact on our daily lives.

Tips:
 knee pain   Heel pain

 Most minor problems occur as a result of tight muscles.  These problems generally do not involve trauma
(ie: twisting or spraining the joint, tripping or falling)

Sharp knee or ankle pain after a fall or significant swelling after a sprain needs to be evaluated by an MD to rule out a fracture or ligament tear.  Persistent pain due to a minor sprain which lasts more than 2 weeks and does not respond to basic stretches should be evaluated by a MD or physical therapist.  

Below you will find advise for treating knee or heel pain that has occurred without any history of a recent trauma/fall.

It is common to notice knee or heel pain with out any obvious cause.  These types of aches and pains are often due to tight muscles.  They may follow periods of increased walking, as when sightseeing while on vacation.  Often there is some change such as the addition of hills to your normal walking routine.  In other cases there may be no apparent cause. 

 When we exercise muscles get stronger but they also get shorter.  Without an equal amount of stretching we end up with tight muscles.  Walking exercises the major muscles of the leg.  Since it is a mild exercise, it may take years to develop enough stiffness in the muscles to cause knee or heel pain.  Someone with tight muscle is at risk to develop knee and heel pain.

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Knee and Heel Pain Overuse Injuries
(example: Tendonitis / plantar fasciitis)

SIGNS & SYMPTOMS-OVERUSE INJURIES           
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Knee Pain

  • pain or deep ache of the knee usually in the front under, just above or below the knee cap (patella)

  • Stiffness and cracking/clicking of the knee joint.  

  • Locking or buckling of the knee. (this usually indicates a more serious problem and requires medical attention.)
Heel Pain
  • Pain or deep ache of the heel or back of calf or sole of the foot.  
  • Pain is worse in AM with first few steps out of bed.

Causes               Top of page

  • sudden increase in the amount of walking, such as sightseeing while on vacation or addition of hills/ stairs to daily routine.  
  • Slow onset without any clear cause.  May be due to muscles tightening slowly over many years.

Risk Increases With

  • age
  • deep squats (knee pain)
  • change of walking routine
  • change of footwear (heel pain click for details)

How to Prevent

  • Stretch the basic muscle groups involved in walking on a regular basis and especially at the first signs of knee or heel pain.
  • Increase frequency of stretches if you increase your daily walking or when you include more walking on hills or stairs.  
  • Use first aid at the first sign of injury.

Click here for prevention /first aid for Knee pain.

Click here for prevention /first aid for Ankle pain.


WHAT TO EXPECT WITH IF YOU SEE AN MD:

Diagnostic Measures for knee or ankle pain

  • Observe your symptoms. (What makes the pain worse/better)
  • Medical history and exam by a doctor & referral to a physical therapist for persistent symptoms.
  • Range of motion testing to check how far your knee or ankle bends. 
  • Testing to determine if there has been tearing of the ligaments of knee/ankle or the meniscus in the knee.  
  • The doctor will bend and push on the joint looking for abnormal motion.  
  • If abnormal motion is found or in the case of severe of persistent swelling of pain the doctor may order an 
    • MRI (check for ligament tears)   
    • x-ray (rule out a fracture or heel spurs)
  • If the symptoms are not severe the MD may recommend a trial of conservative treatment including rest, medications and physical therapy.

Note: A physical therapy evaluation will be similar.  Since the therapist can not order tests, they will refer you to an MD if they determine testing is required.

Treatments

  • Physical therapy should be prescribed if pain persists and the doctor does not feels additional tests are needed or if testing is negative.  If testing shows a torn ligament or other structural damage your doctor will discuss your options including rest, physical therapy bracing and surgery.
  • In most states you can go directly to a physical therapist. 
  • If the condition is severe or requires evaluation by an MD the therapist will refer you to a physician.  
  • The physician can prescribe medications, order tests and check to be sure you do not have a more serious medical condition that may be causing your symptoms.
  • Physical therapy treatments should address risk factors, prevention & set up a home exercise program.  Hands on pain reduction treatments are used as needed.
    click here for first aid tips.

A physical therapy evaluation should include:

  1. History (The therapist will ask: How did you hurt yourself, When did the pain first appear? What makes the pain worse/better? Have you had this type of pain before?  What were you doing just before you felt pain?  What does your daily routine involve? etc.)
  2. Physical exam: ( You will be asked to do certain movements to determine what movements increase your pain.  Your ability to walk with or without a limp will be evaluated.  The mobility and quality of the motion of your joints, and the flexibility of the muscles will be checked.  
  • Physical therapy treatments will vary depending on the condition.  A through treatment will include a few basic elements:
    1. Pain reduction may include use of ice, massage, stretches, joint mobilization and other modalities including ultrasound & electric stimulation.
    2. A home program may start out as simple as a list of things to avoid, ie: long walks and hills.  The home program should include exercises, stretches and some type of simple first aid.  The goal is for you to gain control over the symptoms and gradually eliminate the cause of the problem. 
    3. Prevention includes:
      • discussing risk factors for your specific condition.
      • exercises to increase strength and flexibility.
      • training in how to return to sports, etc. without re-injuring yourself.
      • Suggestions for bracing or orthopedic devices including orthotics and heel cups if indicated.  

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HOME TREATMENT-FIRST AID
(relieve pain, promote healing, avoid re-injury)
 Immediately after an injury and for the next few days, 

First Aid #1  - to remember the basics think  R.I.C.E.

R - Rest the injured joint - 

  • Stay off the leg as much as possible for the first few days.  You may use a cane or crutches to relieve weight when walking. 
  • Tips: If you are limping then you should use a cane or one or two crutches.  When you use a cane or one crutch the cane is held in the hand opposite the injury.  (ie sprained right knee - hold cane in left hand)  If you have trouble using a cane a physical therapist can instruct you in proper technique.

I. - Ice - 

  • As soon as possible, apply an ice pack to the injured area. (10-15 minutes every hour). Cold limits swelling, reduces pain and speeds healing.

  • Soft gel packs work well.  Apply cold packs or ice for 5-10 minutes three or four times a day.  You can apply ice as much as once an hour.  Continue ice for the first three days.  You can continue beyond three days if the cold continues to provide relief.

C. Compression - 

  • Ace wrapping or use of a soft compression wrap.  

  • If ace wrapping avoid circular turn as this may block circulation.  The wrap should be on a diagonal across the joint.  With both ace wrapping and soft compression wraps, check to be sure it is not too tight.  

  • You should be able to slip a finger of two between the wrap and the skin.  

  • When wrapping the ankle if the toes get cold or change color the wrap is too tight.

E. Elevation - Elevate the leg on a pillow when in bed or on a foot stool when sitting. 

First Aid #2  MEDICATION  

Try over the counter medications.  
If the non-prescription dose does not relieve your pain 
CALL YOUR DOCTOR. 

  • There are a variety of over the counter medications.  The two classes of medication are pain medications and anti-inflammatory medications.  Take as directed on the bottle Take these medications sensibly.  Never exceed the dosage suggested on the bottle.  
  • Masking the pain completely might allow movement that could lead to re-injury.

First aid # 3 STRETCHES
The goal is gentle stretches to provide
PAIN RELIEF.

STOP ANY EXERCISE THAT INCREASES PAIN.  
 

  • Do stretches three to four times a day .
     
  • When your pain is gone slowly resume normal activities.  Start with short walks.  Gradually introduce hills and stairs.  Remember you may not feel sore until the next day so start slow.  
  • Continue using basic stretches before after and during long walks or sports.  

    Click here for basic stretch details. 

Exercises to Avoid 

  • Deep knee bends put a lot of compressing on the underside of your knee cap (patella).  This leads to wear and tear type of arthritis (osteoarthritis).   Partial squats (bend knees to 45 degrees or less and hold) are a good alternative.  They provide good quad strength gain without the wear and tear on the patella. 
  • Avoid or use caution with exercise machines that provide resistance while you straighten your knee.  (Think sitting and kicking forward against resistance)
  • Stationary bikes / elliptical trainers are a good alternative.  
    • The best exercises for your knee are closed chain (ie your foot is connected to something - the floor, a bike pedal, a platform) 
  • There are not any specific ankle exercises to avoid.  Don't over do it with toe raises with resistance remember to stretch before and after.

Possible Complications

Chronic ankle or knee pain.

DON'T LIVE WITH PAIN - SIMPLE TREATMENTS CAN HELP.   A PHYSICAL THERAPIST CAN ASSIST WITH REDUCING PAIN AND SETTING UP A HOME PROGRAM.

CALL YOUR DOCTOR IF you have sharp knee or ankle pain after a fall or significant swelling after a sprain or if you are not able to bear weight on your leg.   This needs to be evaluated by an MD to rule out a fracture or ligament tear. 

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