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Plica syndrome is a painful condition affecting the knee. The plica is a thin membrane inside the knee that can become inflamed, thickened or fibrosed, from trauma caused by injury or surgery. In this inflamed, thickened or fibrosed state it is more likely to catch or be impinged within the joint, when the knee bends or straightens.
As plica syndrome is an inflammatory condition, the treatment is therefore initially rest, to allow the inflammation to settle down. Conservative management can also include natural treatments such as massage to the muscles surrounding the knee, and physical therapy exercises including stretches. Ice is a useful and natural pain reliever.
Physical therapy exercises for plica syndrome focus on strengthening the quadriceps muscles, as well as relaxing and lengthening the hamstrings. There are many different rehab exercises that can be done to strengthen the quadriceps muscles, and it is important to find the exercises that work well for you. The action of the quadriceps is to straighten the knee, but the plica, when inflamed, can be impinged when the knee is bent or straightened. Therefore, depending on what angles and positions you find you get pain will affect your choice of exercise. Below are a few quadriceps strengthening exercises that you can try.
This exercise can be done with a rolled up towel or foam roller under your knee. Push your knee down into the roller and straighten your knee, lifting your foot off the floor. Hold for 10 seconds and repeat 6-10 times, rest for a minute or two, then repeat.
This exercise can be done with a resistance band or using a knee extension machine. Push your ankle into the band to straighten your knee, slowly straighten, hold for 3-5 seconds, then slowly return. Repeat 8-12 times, rest for a minute or two, then repeat.
To relax and lengthen the hamstring you can have massage, used a massage gun or foam roller or do static stretches. Here are two positions that you can use to stretch the hamstring muscle. For both of these versions, keep your knee and back straight, bend from your hips and feel the stretch as the back of your thigh. Hold for 45 seconds and repeat 3 or more times per day.
As the plica is most vulnerable to impingement when the knee bends or straightens through 70-100º, exercises that involve this range of movement should be avoided in the early and more irritable stages. Movements such squats, lunges and high step-ups are likely to irritate. Knee extension can also irritate, but in the early stages it can be done as a static hold in a pain free position or through a small arch of movement that is pain free.
The recovery time from plica syndrome is typically 4-6 weeks. If conservative management is not effective, in this time frame, then steroid injections and or surgery may be offered. Healing time after surgery is typically 4-6 weeks.
Medication can be taken if pain levels are high or if symptoms are not settling as expected. Typically, non-steroidal anti-inflammatories are prescribed for pain relief and to reduce inflammation. If conservative treatment is not effective, then cortisone injections may be recommended. Cortisone is a powerful steroid that can reduce inflammation and help the inflamed plica to settle down. These injections should be done with caution as steroids can do harm to the body and in some tissues can cause breakdown, and weaken their structure.
Plica syndrome surgery recovery is relatively quick, typically 4-6 weeks. It is a simple procedure where the plica is either completely removed or partially excised. The knee can function completely normally without the plica, so there is no adverse effect from surgery, aside from the trauma of getting into the knee.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.