From the Guidelines
Hypermobility affects the knees by causing excessive joint flexibility that can lead to instability, pain, and increased risk of injury, and management should focus on individualized knee-targeted exercise therapy, education, and supporting approaches to improve symptoms and quality of life, as recommended by the most recent study 1.
Key Points
- Hypermobility can cause patellofemoral pain syndrome, meniscus tears, ligament sprains, and patellar subluxation or dislocation due to excessive joint movement.
- Management should include physical therapy to strengthen the muscles around the knee, particularly quadriceps and hamstrings, as well as improving proprioception through balance exercises 1.
- Low-impact exercises like swimming and cycling are recommended over high-impact activities like running to reduce the risk of further injury.
- Education should underpin all interventions, providing a rationale for the delivery of a specific intervention plan, and building confidence and understanding of the diagnosis 1.
- Supporting approaches, such as prefabricated foot orthoses, taping, and manual therapy, should be considered when rehabilitation and/or quality of life is hindered by elevated symptom severity and irritability 1.
Management Recommendations
- Individualized knee-targeted exercise therapy should be delivered following a robust assessment of symptom severity and irritability, with exercise parameters modified accordingly 1.
- Education should be provided to challenge inaccurate beliefs, build confidence and understanding of the diagnosis, and promote autonomy and reduce fear 1.
- Prefabricated foot orthoses should be prescribed when people respond favourably to treatment direction tests, and be customized for comfort by modifying density and geometry 1.
- Taping and manual therapy should be considered when rehabilitation and/or quality of life is hindered by elevated symptom severity and irritability, or high fear of movement 1.
- Movement/running retraining should be considered when symptoms are reasoned to be associated with task-specific biomechanics, such as increasing step rate in a runner with excessive stride length 1.
From the Research
Hypermobility and Knee Problems
- Hypermobility syndrome is a common condition that can affect the knees, causing joint pain and instability 2
- Research has identified that posture, proprioception, strength, and motor control are important components in achieving joint stability and control in individuals with hypermobility syndrome 2
Conservative Treatment of Knee Osteoarthritis
- Osteoarthritis of the knee can cause chronic knee pain, loss of function, and disability, and conservative treatment options such as weight reduction, physical therapy, and rehabilitation can be effective in managing symptoms 3
- A combined conservative therapy approach, including weight loss, aerobic, proprioception, and strengthening training, as well as pharmacological treatment, can achieve the greatest positive clinical and structural outcome 3
Chronic Knee Pain
- Chronic knee pain can be caused by degenerative osteoarthritis, and a standard musculoskeletal and neurological examination is required for diagnosis 4
- Conservative treatment options, such as intra-articular injections of corticosteroids and radiofrequency ablation, can be effective in managing chronic knee pain, and a multidisciplinary approach is recommended when conservative measures fail 4
Treatment of Knee Osteoarthritis
- Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) can reduce synovitis in osteoarthritic knees, and may have a significant anti-inflammatory effect in patients with knee osteoarthritis 5
- Consensus guidelines on interventional therapies for knee pain recommend a standardized approach to treatment, including less invasive options such as physical therapy and pharmacologic agents, before more invasive options such as interventional pain procedures and surgery 6