Knee swelling, often referred to as “water on the knee,” can be a literal pain to deal with. It’s a condition where excess fluid builds up in or around your knee joint, making it swollen, stiff, and sometimes quite painful. As a physio, I’ve seen my fair share of swollen knees walk (or hobble) through the clinic doors. Let’s dive into what knee swelling is, why it happens, and how physiotherapy can help you get back on your feet.
What Exactly Is Knee Swelling?
Knee swelling occurs when there’s an abnormal accumulation of fluid in the knee joint. This can happen inside the joint capsule (intra-articular) or outside it (extra-articular). The fluid can be synovial fluid—the slippery stuff that lubricates your joint—or, in more severe cases, blood or pus. Swelling is your body’s way of saying, “Something’s not right here,” and it’s often accompanied by stiffness, pain, and a reduced range of motion.
Common Causes of Knee Swelling
1. Injury
Acute injuries like a torn ligament, meniscus tear, or a fracture can cause knee swelling. A direct blow or twist of the knee often triggers an inflammatory response, leading to fluid accumulation.
2. Arthritis
Conditions like osteoarthritis, rheumatoid arthritis, or gout can lead to chronic knee swelling. In osteoarthritis, for instance, the cartilage wears down over time, irritating the joint and causing swelling.
3. Infection
A septic joint, although less common, is a serious cause of knee swelling. This requires urgent medical attention to prevent long-term damage.
4. Overuse or Repetitive Strain
Sometimes, doing too much too soon—whether it’s running, squatting, or even gardening—can irritate the knee joint and lead to fluid build-up.
5. Systemic Conditions
Autoimmune diseases, like lupus, or metabolic conditions, like gout or pseudogout, can also contribute to knee swelling.
Symptoms to Watch For
How do you know if you’re dealing with knee swelling? Here are some tell-tale signs:
- Swelling around or within the knee joint
- When comparing one knee to the other, they don’t look symmetrical
- A feeling of heaviness or tightness
- Pain, especially when bearing weight
- Stiffness and difficulty bending or straightening the knee
- Reduced range of motion
- Warmth or redness (this could signal infection or inflammation)
If the swelling comes on suddenly after an injury or is accompanied by fever, chills, or severe pain, don’t muck around—see a doctor straight away.
How Physiotherapy Can Help
Physiotherapy is a game-changer when it comes to managing knee swelling. Here’s how it works:
1. Reducing Swelling and Pain
First things first: we focus on reducing the swelling and easing your pain. This often involves:
- P.E.A.C.E Protocol: Protect, Elevate, Avoid Anti Inflammatory Medication, Compress, and Education regarding your injury are the best steps initially when you notice swelling.
- Gentle Range of Motion Exercises: Keeping the joint moving—without overdoing it—prevents stiffness and promotes fluid drainage.
2. Identifying the Underlying Cause
A thorough assessment helps us figure out what’s causing your knee swelling. Is it an injury? Arthritis? Something else? Understanding the root cause is crucial for tailoring your treatment plan.
3. Restoring Range of Motion
Once the swelling is under control, we work on getting your knee moving properly again. Techniques might include:
- Manual Therapy: Hands-on techniques to mobilise the joint and surrounding tissues.
- Stretching Exercises: Targeting the muscles around your knee, like your quads, hamstrings, and calves.
4. Strengthening Muscles
A small amount of knee swelling causes the quadriceps muscle to deactivate, making it very hard to contract this muscle. Over time, the muscle can shrink causing imbalances. Weak muscles can put extra stress on your knee joint, so strengthening the surrounding muscles—especially your quads, hamstrings, and glutes—is a must. We’ll start with gentle exercises and progress as your knee improves.
5. Improving Biomechanics
Poor movement patterns can exacerbate knee issues. We’ll assess your gait, posture, and functional movements (like squats or lunges) to identify any problems. Small tweaks can make a big difference.
6. Preventing Recurrence
Finally, we’ll arm you with strategies to prevent future knee swelling. This might involve a mix of strengthening, stretching, and activity modification. If you’re an athlete, we’ll tailor your rehab to get you back to your sport safely.
Treatment Techniques in the Physio Toolkit
1. Taping or Bracing
K-taping or using a brace can provide support, reduce swelling, and improve proprioception (your sense of joint position).
2. Hydrotherapy
Exercising in water is a fantastic way to reduce joint stress while improving strength and range of motion.
3. Dry Needling
These techniques can help relieve pain and promote healing by targeting trigger points or stimulating your body’s natural healing processes.
4. Education and Lifestyle Advice
We’ll guide you on activity modification, weight management (if necessary), and other lifestyle factors that can impact knee health.
When to Seek Further Help
While physio can do wonders, there are times when you might need additional medical input. If your knee swelling is caused by an infection, significant injury, or an underlying medical condition, you may need medications, a corticosteroid injection, or even surgery.
Managing Knee Swelling at Home
While physio is essential, there are things you can do at home to complement your treatment:
Stay Active: Gentle, low-impact activities like walking or cycling can keep your knee moving.
Use Ice for Pain Relief: Apply ice for 15-20 minutes every couple of hours during the acute phase.
Elevate Your Leg: Prop your leg up on a pillow to reduce swelling.
Maintain a Healthy Weight: Carrying less weight reduces stress on your knee joints.
Don’t Overdo It: Listen to your body and avoid activities that worsen your symptoms. This can often be a delayed response, so pay attention for at least 24 hours after activity.
Real-Life Case Study
Let’s take the example of Sarah, a 42-year-old recreational netball player who came to see me with a swollen knee. After a thorough assessment, we identified that she’d strained her medial collateral ligament (MCL) during a game.
We started with P.E.A.C.E protocol and some gentle range of motion exercises. Once the swelling subsided, we worked on strengthening her quads and glutes and improving her movement patterns. Sarah was back on the court within eight weeks, armed with a proper warm-up routine and some K-taping for extra support.
Final Thoughts
Knee swelling can be a frustrating setback, but with the right approach, it doesn’t have to sideline you for long. Physiotherapy offers a holistic, hands-on approach to managing the condition, addressing not just the symptoms but also the underlying causes. Whether it’s a niggling injury, arthritis, or something else, a good physio will guide you through the recovery process and help you get back to doing what you love.
If your knee’s been playing up and you’re not sure where to start, don’t hesitate to book in with one of our physiotherapist’s at XPhysio today. After all, it’s better to tackle the problem head-on than to let it linger—your knees will thank you for it!