Knee pain is one of the most common reasons people come to see us. Most of the
time, it’s caused by familiar issues – arthritis, patellofemoral (kneecap) pain, old injuries or
simple overload. But every so often, a case reminds us why it’s important to look
deeper when symptoms don’t behave as expected.
This is the story of a 71 year old patient whose knee pain turned out to be part of a
much bigger picture.
A Sudden Flare-Up After Years of Knee Problems
Our patient had a long history of kneecap instability, including several dislocations in
the past. She stayed active with Pilates twice a week and usually managed her
symptoms well.
Then, without any injury or fall, she developed a sudden increase of right knee pain.
By the time she came to us, she had been struggling for about four weeks.
Her symptoms included:
Pain with stairs, squatting, and bending
Morning stiffness lasting more than 30 minutes
Noticeable swelling
Difficulty sleeping due to discomfort
No locking or giving way
On assessment, we also noted knee valgus (inward collapse), flat foot posture on
the right, a forward flexed posture (indicative of severe pain), and visible effusion (swelling).
Physiotherapy Treatment: Good Effort, Limited Change
Over three sessions, we used a combination of treatments aimed at reducing pain
and improving movement:
Heat and ice
Soft tissue massage
Joint mobilisations and MWM techniques
Electrotherapy
Acupuncture
A personalised home exercise programme
Pilatesbased modifications
Education on pacing and load management
She engaged fully and followed all advice, but her symptoms didn’t settle. The
swelling persisted, her pain remained disproportionate to what we would normally
expect, and her sleep continued to be disturbed.
This was the point where clinical experience mattered. Her knee simply wasn’t
behaving like a typical osteoarthritic flare, and the lack of progress suggested that
something else might be contributing.
Referral Back to the GP: Looking Beyond the Knee
We wrote to her GP requesting further investigation-not to confirm arthritis, but to
rule out other causes.
Her GP arranged:
Xray-This showed lowgrade osteoarthritis, which is very common at her age. However, the
findings didn’t match the severity of her symptoms.
Blood Tests-These revealed significantly raised ferritin levels, which can indicate inflammation or
iron overload. Because of this abnormal result, the GP organised further testing, including genetic
screening.
The Unexpected Diagnosis: Haemochromatosis
The genetic test confirmed haemochromatosis, a hereditary condition where the
body absorbs and stores too much iron. Over time, excess iron can build up in
organs and joints, causing:
Persistent joint pain
Swelling and stiffness
Earlyonset arthritis
Liver problems
Diabetes
Heart complications
Research shows that haemochromatosis can affect large joints such as the knees,
and iron deposits in joint cartilage can lead to chronic inflammation and accelerated
wearandtear. This explained why her knee swelling and pain were so persistent and
why physiotherapy alone wasn’t giving the expected results.
Because haemochromatosis is genetic, her immediate family were advised to
undergo screening as well.
Why This Case Matters
This case highlights an important message:
Not all knee pain comes from the knee itself.
Sometimes, joint symptoms are the first sign of an underlying medical condition. In
this patient’s case, her knee pain was the clue that led to the diagnosis of a systemic
condition that could have caused serious health issues if left untreated.
Physiotherapy played a key role – not just in treating her symptoms, but in
recognising when something didn’t fit the usual pattern and ensuring she received
the right medical investigations.
Moving Forward
With appropriate medical management for haemochromatosis and a tailored
physiotherapy plan focusing on strength, alignment, and joint support, the patient
now has a clear pathway forward. Her knee symptoms make much more sense in
the context of her diagnosis, and she can now manage both her joint health and her
systemic condition more effectively.
References
1. NHS – Haemochromatosis (Iron Overload Disorder)
https://www.nhs.uk/conditions/haemochromatosis/
2. Mayo Clinic – Hemochromatosis: Symptoms and Causes
https://www.mayoclinic.org/diseases-conditions/hemochromatosis/symptoms-
causes/syc-20351443
3. BMJ Best Practice – Haemochromatosis
https://bestpractice.bmj.com/topics/en-gb/3000110
4. European League Against Rheumatism (EULAR) – Haemochromatosis
Arthropathy Review (Example reference) Clinical and imaging features of
haemochromatosis arthropathy: a systematic review.
https://ard.bmj.com/content/early/2018/01/05/annrheumdis-2017-212610
5. Rheumatology (Oxford University Press) – Haemochromatosis Arthropathy
Review This review describes how haemochromatosis can cause joint
degeneration and inflammation, particularly affecting the knees, hips, and
small joints of the hands.
