With the first kick off of football season now behind us and the NBA's opening tip off at the end of October, 'tis the season for knee injuries. Recent headlines reporting NFL's Tom Brady and Nate Burleson out with season ending knee injuries and the Premiere League's Michael Essien on the sidelines recovering from knee surgery, remind us just how fragile and essential our knee health is.
Professional athletes are not the only ones plagued with knee injury and pain. Millions of people experience knee injuries while competing in sports, at work or participating in other daily activities every year. Millions more fall victim to knee diseases and seek relief from chronic joint pain. Although knee pain is common, there are steps you can take to reduce your risk of injury and disease, manage your pain and treat your knee injuries to promote healing.
Preventing Knee Pain
Whether you have never experienced knee pain, you have recovered from an injury or you are dealing with chronic knee disease, there are steps you can take to prevent injury and minimize your pain. Maintaining a healthy weight, performing appropriate stretching and strengthening exercises and using protective and supportive equipment can protect your knees. With your physician's approval, it is important to stay active to keep your knee joints healthy and functioning.
Maintain a Healthy Weight
By maintaining a healthy weight, you are decreasing the burden on your knee joints. Less strain on your knees decreases the risk of injury and degenerative diseases. The Mayo clinic states that if your Body Mass Index (BMI); that is, the ratio between your height and weight, is between 25 and 29.9 you are considered overweight. Calculate your BMI.
If you find that your BMI is above the healthy range there are simple steps you can take to get you to that healthy range. Making nutritional food choices and becoming more active will result in safe weight loss. For more info on how to get started, read the Mayo Clinic's Weight Loss: 6 strategies for success.
When considering how to become more active, remember choosing an activity appropriate for your knee pain is important to ensure you can participate and to prevent further damage. For instance, consider swimming or other low-impact activities over running and volleyball. If your pain allows you to participate in higher-impact activities, do not overdo it. Let your body be your guide and if you experience pain take a break or decrease your level of intensity.
Strengthening and Stretching Exercises
Knee injuries often occur because there is not sufficient muscle support around the joint. By strengthening the quadriceps and hamstrings your balance and stability increases and chance of injury decreases.
Just a few minutes of leg strengthening exercises, 3 times per week will help prevent injury. Ask your physician, the trainer at your gym or your coach for exercises recommended for your specific injury. Don't forget to warm up your muscles before beginning any strengthening exercises with 5 minutes of walking or other low-impact aerobic exercise.
Stretching is often considering an add-on when exercising, however, muscle flexibility also prevents injury. When ligaments and muscles are flexible they are less likely to be twisted, pulled or torn.
Include stretching exercises in your program after your strengthening routine to prevent tightness in your muscles and decrease your risk of damage. Be sure to stretch slowly and do not overstretch the muscle.
Use the Proper Equipment and Protective Gear
Spending some time and money to properly prepare yourself for activities will help to keep you from pain and injury. By using protective gear and equipment appropriate for work or play, you will be able to minimize knee damage.
Knee pads shield you from trauma during sports such as volleyball and in-line skating and provide protection and comfort to those with jobs that require excessive amounts of kneeling like plumbing, tiling and landscaping.
Knee guards and shin guards also provide protection from trauma, especially during sports with frequent blows to the knee such as hockey and basketball.
Wearing a knee brace in situations where jumping, twisting or heavy lifting is required will provide support to the ligaments, muscles and cartilage and help to prevent hyperextension of the knee joint.
Choosing the proper shoe for your activity can ensure you are receiving support and flexibility where you need it. Although athletic shoes may look similar they are designed with the sport in mind. Court shoes are built for quick turns and stops, however, running shoes provide more cushioning and arch support to protect feet and knees from pounding steps.
Treatments for Knee Pain
It is recommended that you see your doctor for an accurate diagnosis of your knee pain before beginning any treatment program. With so many possible sources of knee pain, it is important for you to have an understanding of the cause of your pain to ensure you are treating it appropriately. Below is a list of common knee pain treatments you can discuss with your doctor.
Rest, Ice, Compression, Elevation (RICE)
Symptoms of pain and swelling are shared with both chronic and acute injuries. In either case, RICE is recommended to help control inflammation, swelling and pain. RICE is a treatment process that should be administered immediately following an injury or flare-up and continued for 48-72 hours.
Rest the knee and limit your activity; you may want to use a walking aid to prevent immediate weight bearing on the joint if it is severely damaged or painful.
Ice the knee area 2-3 times per day, for 15 - 20 minutes at a time, to help reduce swelling. Gel packs are a better option than frozen peas or ice as they mold to your knee shape and are reusable. Do not apply ice or gel packs directly on your skin, instead wrap them in a cloth or proper gel packet wrap.
Compress the knee if possible by adding light pressure to minimize swelling. Be sure the compress is snug, but not too tight as it could cause numbness, tingling or more pain.
Elevate the knee above chest level to relieve the pressure and allow any fluid to drain from the injured area. A gentle massage around the knee area or small flexing and extending movements will help by increasing blood flow, oxygen, and nutrients, and will prevent stiffness.
Medication and Supplements
Glucosamine and chondroitin are naturally occurring substances found in cartilage. For injuries and disease causing damage to cartilage, such as osteoarthritis and patellar chondromalacia, supplements help to slow the degenerative process and ease some pain.
Topical pain medications may also help you to relieve pain and stiffness due to cartilage deterioration and improve movement in the joint. The topical cream celadrin is applied on the joint and can improve knee function. For pain relief, ask your pharmacist about capsicum or patches containing lidocaine.
Anti-inflammatory and pain medications are used to manage swelling and tenderness at the onset of an injury or flare up. Unfortunately, taking these medications does not treat the source of your pain. Seek a doctor's opinion for the proper dosage and duration for your condition and to discuss side effects.
Physical therapy is prescribed to patients recovering from surgery or needing to strengthen the muscles around the knee. Physical therapy begins by re-establishing the knee's full range of motion. Next, strength building exercises are incorporated to increase stability and improve balance. Finally, the patient is given ongoing exercises to strengthen muscles and prevent future injury.
Corticosteroid, or cortisone, injections ease the pain of osteoarthritis by lubricating the joints where cartilage has been reduced. Injections can minimize the symptoms of a flare up for a few months at a time, however, they are not effective for everyone. You should see results after the first injection to know whether it is an effective treatment for you. Some risks of cortisone injections include higher blood sugar levels, an increased risk of infection and potential weakening of tissue.
Hyaluronic acid injections have also been known to control inflammation for several months at a time. The hyaluronic acid, naturally found in joints, is injected through a series of shots to provide lubrication and allow movement without pain.
Knee surgery may be inevitable for some conditions, such as locked knee and when the blood supply to the joint is compromised. However, in many cases it is optional and the decision to undergo surgery or use non-surgical methods depends on the injury, desired activity level, risk of future injury and the patient's motivation to work through rehabilitation.
Arthroscopic surgery is used to improve symptoms of a variety of knee injuries and diseases. With small incisions, surgeons are able to reconstruct torn ligaments, remove loose material within the joint, and repair damaged cartilage.
Although arthroscopic surgery has been a popular treatment for osteoarthritis, a recent study completed at the University of Western Ontario and the Lawson Health Research Institute in Canada challenges its effectiveness. In the study, published in the September 11, 2008 issue of The New England Journal of Medicine, researchers treated 2 groups of osteoarthritis patients with medication and physical therapy, but only 1 of the groups with arthroscopic surgery as well. Patients of each group reported comparable improvements in pain, movement and function suggesting surgery had no additional therapeutic value over non-surgical methods. Although arthroscopic surgery may be useful for patients with ACL or meniscal tears, researchers recommend osteoarthritis patients pursue conservative treatment methods before considering surgery.
Knee replacement surgery may be necessary if non-surgical methods fail to improve severe symptoms of arthritis or other degenerative conditions. The surgeon removes any damaged cartilage and bone and replaces it with a metal or plastic prosthesis. Partial replacement is used if some healthy cartilage still remains and only the damaged portion needs to be replaced. A total knee replacement often has better long-term results but does take longer to heal.
Heat Therapy and Cold Therapy
Heat and cold therapies are commonly recommended to manage pain, reduce swelling and heal knee injuries. However, knowing when to use each treatment and for how long can be confusing. Here are a few guidelines to follow when treating your knee pain.
Heat treatment is useful for chronic injuries, prior to activity, to loosen the tissue in the injured area. By relaxing the tissue, the ligament, cartilage or muscle is better prepared for use and further damage is minimized.
Heat therapy is also useful in decreasing recovery time. Moderately heating tissue with a blood flow stimulation therapy device increases blood flow to the injured area. This blood flow transports nutrients to injured cells and flushes out toxins to promote healing. Using heat for healing should be done only when the injured knee has been at rest. Heat should never be used following activity or on an acute injury, icing is the proper choice in these situations.
When an acute injury occurs, icing should be used as a treatment immediately following, and up to 72 hours after, the injury occurs. Cold therapy decreases swelling and relieves pain, enabling mobilization of the joint.
For chronic conditions, cold therapy can be used after activity if pain and swelling recur. Treating the injury with cold therapy helps to alleviate symptoms, allows mobilization and returns the joint to a state where healing can take place.
Combining heat therapy and cold therapy in your treatment program provides you with the ultimate healing package. Click here for knee healing devices.
10 Common Knee Injuries and Diseases
If you suffer from one of the common knee injuries or diseases listed below, click on the links for more information on causes, treatments and prevention.
- Knee Ligament Injuries
- Meniscal Tears
- Patellar Chondromalacia
- Bursitis (Prepatellar Burrsitis and Pes Anserine Bursitis)
- Patellar Fracture
- Patellar Tendonitis
- Osteoarthritis in the Knee
- Osgood-Schlatter Disease (OSD)s
- Patellar Dislocation
- Gout in the Knee
1. Knee Ligament Injuries
Ligament tears, primarily of the anterior cruciate ligament (ACL), are commonly the season ending injuries we hear about in sports. Although male athletes make the headlines, women experience ACL tears 7-8 times more frequently than men due to hormonal and anatomical reasons.
The knee has 2 collateral (parallel) ligaments and 2 cruciate (crossing) ligaments. The medial collateral ligament (MCL) and the lateral collateral ligament (LCL) provide support to the knee by limiting the sideways motion of the joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) stabilize the knee by limiting the rotation and the forward and backward movement of the joint.
The MCL, the most commonly injured collateral ligaments, is often a result of a blow to the outer side of the knee. An ACL injury, the most common cruciate ligament injury, occurs when the knee is locked with the foot planted and the knee is twisted quickly. Athletes required to make sudden directional changes or to slow down quickly and those in contact sports are at high risk for ACL tears.
Minor tears may go unnoticed immediately and will appear a few hours later with pain and swelling. More serious ACL tears are accompanied by severe pain and often a popping sound. The knee may feel as though something has snapped and walking or bending the knee is usually impossible.
Administering ice and compression immediately, reduces pain and swelling. Treatment differs depending on the degree of instability and the patient's activity level. Many ligament injuries heal with conservative treatments such as cold compression therapy and Blood Flow Stimulation Therapy™ (by using the Knee Inferno Wrap®) followed by physical therapy to build muscle strength around the knee. If an injured ligament does not strengthen appropriately or an athlete continues to experience the knee giving way, arthroscopic surgery and ligament reconstruction may be necessary. For more information on knee ligament injuries, read our knee injury articles at mendmeshop.com and follow the links on the left.
2. Meniscal Tears
The meniscus is a C-shaped piece of cartilage that works as a cushion between the femur and the tibia. Tearing of the meniscus occurs when the knee is twisted forcibly while under weight. As the body ages, cartilage deteriorates making knee joints more susceptible to meniscal tears with minor movement. When the meniscus is torn, it starts to move abnormally inside the joint and it may become caught between the tibia and femur.
Those suffering from a meniscal tear commonly experience swelling, pain and difficulty moving the knee.
A minor tear in the meniscus may only require rest, a change in activity, and strengthening exercises to support the joint. Unfortunately, meniscal tears can be difficult to heal because blood supply is often limited to the outside edge of the meniscus cartilage. Blood Flow Stimulation Therapy™ can prevent scar tissue accumulation and speed up healing by increasing the flow of blood and nutrients to the area. In the case of a large or complex tear or if disabling symptoms remain after 2-3 months, arthroscopic surgery may be recommended. For more information on meniscal tears, click here and follow the links on the left.
3. Patellar Chondromalacia
Patellar Chondromalacia occurs when the cartilage enabling the femur and kneecap to glide smoothly over one another becomes damaged. This damage is caused by regular wear and tear or by repetitive trauma due to the knee muscles weakening and the patella (kneecap) becoming misaligned.
Patellar Chondromalacia patients complain of tenderness under or around the kneecap and the pain often increases when using stairs or getting out of a chair. A grinding feeling may also occur when trying to straighten the knee.
When the injury becomes inflamed, icing is recommended and anti-inflammatory drugs may be prescribed. Strengthening the muscles around the knee joint, particularly the inner quadriceps is the best treatment to realign the patella. To prevent further damage to the cartilage, minimize impact exercises until the muscle strength increases. For more information on Patellar Chondromalacia, click here.
4. Bursitis of the Knee (Prepatellar Bursitis and Pes Anserine Bursitis)
Bursitis occurs when the bursae swell from chronic irritation, inflammation and the accumulation of excess fluid within the bursa sacs. This is commonly caused by frequent kneeling and is referred to as "housemaid's knee" as it is often suffered by people whose work requires kneeling for extended periods of time.
Symptoms include knee pain and limited motion, along with swelling and redness over the kneecap. When walking, sufferers experience extreme pain and stiffness that worsens when using stairs. A patient may also experience a fever if the bursae become infected.
When inflammation and pain occur, it is recommended that any aggravating activity be discontinued. However, even daily activities can inflame the tender sacs and cause healing time to be extended. RICE will help to ease the symptoms and promote healing. In severe cases, draining the bursae may be necessary and if fluid accumulation continues, removing the bursa may be the consequence. For more information on bursitis, click here.
5. Patellar Fracture
A fracture of the patella, can occur from an impact on the kneecap; such as in the case of a car accident, a fall or contact while playing a sport.
A fractured patella causes pain and tenderness, swelling, a limited range of motion and the inability to walk. Symptoms may also include muscle spasms and grating of bone if fragments are loose in the joint.
If the fractured bones are lined up, surgery is not necessary and a leg cast is used to immobilize the leg allowing the bones to heal. If the bones are not aligned, surgery is required and the fractured ends are set and held in place with pins and wires. For more information on patellar fractures click here.
6. Patellar Tendonitis
The patellar tendon joins the kneecap to the shin bone and works as part of the extensor mechanism allowing the knee to straighten out. Patellar tendonitis is an injury caused by overuse or recurring trauma to the tendon and is often seen in athletes of jumping sports like basketball or volleyball.
Sufferers experience pain and swelling at the front of the knee along with a limited range of motion. The pain often becomes more severe with jumping or kneeling.
Treatment begins with resting the knee and avoiding the symptom causing activity until symptoms settle. RICE and anti-inflammatory medication will assist in controlling the inflammation, decreasing swelling and managing pain. Once the tendon is no longer inflamed, physical therapy, hamstring stretching and limiting high impact activities is recommended. For more information about patellar tendonitis, click here.
7. Osteoarthritis of the Knee
Osteoarthritis is caused by the cartilage in the knee deteriorating with wear and tear or because of trauma to the joint, ultimately leaving only bare bone. It is the most common type of knee arthritis and is also called degenerative joint disease or wear-and-tear arthritis. The risk of osteoarthritis increases with age and for people who are genetically predisposed to the disease, are overweight or have suffered knee trauma chances are even greater.
Although osteoarthritis worsens with time, sufferers experience periods of flare-ups and remission. Symptoms include increased pain with use throughout the day, joint stiffness, swelling, and tenderness. Patients often experience grinding, clicking, locking or feelings that the knee may give out. Movement of the joint can be limited and deformity may occur over time as bones become damaged.
Pain may be managed and damage minimized by decreasing the burden on the knee joint with weight loss or use of a walking aid. Low-impact and aquatic exercises and physical therapy will strengthen the muscles to support the knee joint. Cold compression wraps, anti-inflammatory medications, and cortisone injections can reduce pain and inflammation. As discussed early, a recent study has called into question the benefit of arthroscopic surgery and you should discuss your options with a physician before making any decisions about surgery. If osteoarthritis pain cannot be managed by these methods, surgical options may be considered; knee arthroscopy, tibial osteotomy or knee replacement surgery, depending on your injury. For more information on knee osteoarthritis, click here and follow the links on the left.
8. Osgood-Schlatter Disease (OSD)
Osgood-Schlatter ("oz-good shlot-ter"") is a disease experience by adolescents, usually athletes, during a period of rapid growth. It occurs when the patellar and/or tendon pulls away from the tibia and becomes inflamed. This inflammation is a result of excess strain on the tendon due to muscles and bones growing at varying rates.
Osgood-Schlatter Disease causes swelling and pain below the knee, just above the tibia. The pain increases with exercise and is relieved when the knee is at rest. It is also common to experience tightening of the muscles and limping after strenuous activity.
As the growth spurt ends, muscles and bones catch up with one another, the patellar tendon strengthens and pain and swelling subsides. In the meantime, resting the tendon is the best way to treat Osgood-Schlatter Disease. If the pain is mild some activity may be continued, but severe pain requires discontinuation of the sport. Pain medication, heating the joint before playing and icing it afterwards can control swelling and pain. It is important to not play through the pain and attend to the injury as needed or recovery time is extended.
For more information on Osgood-Schlatter Disease, click here.
9. Patellar Dislocation
A patellar (kneecap) dislocation occurs when one of the ligaments securing the patella to the knee, usually the medial patellofemoral ligament (MPFL), tears and allows the patella to fall out of its groove.
The most obvious symptom is the kneecap's ability to move freely from side to side. In addition, intense pain, swelling and the inability to walk or straighten the knee will be experienced.
Bracing the knee to allow the MPFL to heal is the first treatment option. However, this can be ineffective as it is difficult for the MPFL to heal without proper tension. If the ligament does not heal correctly, the chance of dislocation recurring is high. Surgery to repair the ligament may be necessary and should be discussed with a physician if proper healing does not occur. For more information on patellar dislocation, click here.
10. Gout of the Knee
Gout is a type of arthritis that is identified by a severe and rapid onset of pain. The pain is a result of an accumulation of uric acid in the knee. It is often an inherited disease but other factors contributing to gout include obesity, excessive alcohol consumption, kidney malfunctions and certain types of cancer.
Gout sufferers will experience sudden and severe pain, warmth, redness, swelling and tenderness of the knee joint. They may also suffer from kidney stones or kidney failure which causes the uric acid to enter the blood stream.
Preventing gout attacks can be achieved with weight reduction, limited alcohol consumption and adequate fluid consumption. Lowering uric-acid levels with medication or dietary modifications (i.e. limiting purine-rich foods and increased consumption of dairy products) can also reduce inflammation. When gout attacks occur, anti-inflammatory medications may be used to control the pain. Other medications available to gout sufferers include colchicines, which is used to reduce gout pain quickly, and allopurinal, used to prevent future attacks. As with any medication, it is important to consult your doctor to see if the medication is right for you. For more information about gout, click here.
Taking measures to protect your knees and maintain healthy joints is something everyone can do to prevent knee pain. Should knee injury or disease become a part of your life, understanding your condition is the first step in determining the appropriate treatment. Get an accurate diagnosis from your physician and discuss your options. Proper treatment will allow you to resume your activities faster and safer.