There are a number of questions that are important for differentiating the underlying cause of knee pain and these should be considered by all Personal Trainer Sydney CBD. These questions are important for narrowing the differential diagnosis and should be asked of every adult patient presenting with knee pain:
●Did pain begin following an acute traumatic event? Pain immediately following an injury is concerning for possible structural damage to the knee. Delayed pain suggests tendon strains, cartilage contusions, or minor soft tissue tears. The closer the pain onset is to the specific event, the higher the likelihood of significant structural damage.
●Is the pain associated with activity (eg, new exercise regimen, change in previous training habits, day-to-day activity over the preceding few months)? Pain associated with activity should lead to further inquiry about training equipment (eg, shoes, braces), training volume (eg, training days per week, duration of training sessions), intensity, and any recent changes in such parameters. Information about specific activities that trigger pain can be helpful. As an example, anterior knee pain associated with sprinting or jumping is a classic part of the history of patellar tendinopathy.
●In which anatomic quadrant is the pain located (anterior, posterior, lateral, or medial), or is the pain diffuse or vague? Localizing knee pain to an anatomic quadrant or more specific location helps circumscribe the differential diagnosis. Pinpoint localization is generally possible following trauma to a specific ligament, tendon, or other palpable anatomic structure. Pain described as diffuse or vague may be secondary to injury of an intra-articular structure, a rheumatologic or infectious process, or from referred pain.
●Has the painful knee been swollen (ie, joint effusion) or erythematous? Rapid swelling after trauma occurs with bleeding into the knee joint and suggests a significant injury (eg, anterior cruciate ligament tear). Swelling or erythema occurring without trauma may indicate an infectious, rheumatologic, or crystal-induced condition and diagnostic arthrocentesis is often indicated.
●Are constitutional symptoms, such as fevers, chills, night sweats, fatigue, or rash, present? The presence of such symptoms and signs suggests a systemic illness and further investigation of infectious, autoimmune, or neoplastic causes is necessary.
●Is there a history of prior knee injury or surgery? A past history of knee injury is the most accurate predictive risk factor for future knee injury. The clinician should inquire about the type of injury, duration of disability, and the rehabilitation program. Often, a new knee injury is a complication of an old or concurrent injury. As an example, patellofemoral pain can develop in patients who alter their running gait due to discomfort from chronic Achilles tendinopathy. Likewise, prior surgical repairs can "wear out" or fail, leading to recurrence of the initial condition. All patients with prior injury or surgery experience some degree of deconditioning while injured and recovering. This deconditioning, combined with poor or incomplete rehabilitation, predisposes to new injuries.
●Are there symptoms affecting any other joints? Subjective symptoms and/or examination findings that reveal multiple affected joints raise suspicion for a systemic or rheumatologic process.
●Is there a history of systemic or rheumatologic disease? A known history of a systemic or rheumatologic disease can help to guide clinical inquiry, physical examination, and possible laboratory testing.
Consider these questions and discuss the answers with your Personal Trainer Sydney CBD who will be able to help develop a management plan for you.