Knee Pain and Injuries – Treatment and Management
Knee Pain and Injuries – Treatment and Management
Knee pain is very common and can cause huge amounts of disability. Knee pain has a wide variety of specific causes and treatments.
Main function is to facilitate walking. The knee is very complicated joint in that it hinges, twists and rotates. In order to perform all of these actions and to support the entire body while doing so, the knee relies on a number of multiple local structures, including biomechanics.
The complex ligaments within the knee connect the joint together: The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) providing forward/backward and rotational stability to the knee. These are commonly injured with a variety of sports.
Menisci are cartilage structures which are placed in the middle of the joint and provide cushioning for the knee joint along with congruity. Bursae are fluid-filled sacs that help to cushion the knee and help to provide friction between connective tissues.
Initial treatment should consist of rest and protection of painful / injured area. Cease any activity that may increase pain. When resting, place a small pillow under your knee. Ice should be used to reduce pain and swelling. Apply cold immediately to prevent or minimize swelling, for 10 to 20 minutes, 3 or more times a day.
48 hours following an injury, avoid painful movement and heat (inc. hot showers). After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to promote mobility. It is also recommended to alternate between heat and cold treatments. Compression, or wrapping the injured or sore area with an elastic bandage, will also aid to reduce swelling. Loosen the bandage if it gets too tight. Elevate the painful / injured on pillows while applying ice and lying down. It is extremely important that you should however seek advice from an injury specialist ASAP to prevent further injury. Use a crutch in the hand opposite your painful knee where possible.Use two crutches, keeping weight off the leg with the sore knee.Try to gently maintain flexibility and avoid high-impact exercise such as running.
Different types of Knee Pain
Pain from a deeper injury (called referred pain) can be passed along the nerve to be felt on the surface.Generally speaking, knee pain is either acute or long-term (chronic). Acute knee pains can be caused by an acute injury or infection. Chronic knee pain is often from injuries or inflammation (such as arthritis), and ongoing repetitive strain.
Acute Knee Pain
Often caused from sudden ligamentous injury from a fast twisting type motion, this commonly occurring within the ACL. You will also notice your knee can become unstable and high volumes of pain and increased swelling over the next couple of hours because the ACL bleeds briskly when torn. Treatment will often need surgical repair for high-level athletes. Conservative treatment and knee braces may prove sufficient for less severe cases.
The tendons at the front of the knee are vulnerable to tearing. Patellar (knee cap) tendon ruptures typically occur in younger people who have had previous tendonitis or steroid injections to the knee. Symptoms include pain when trying to kick or extend the knee.
Injuries to the meniscus are typically due to trauma but can also be due to overuse injuries. Often, a piece of the meniscus will tear off and float in the knee joint which often causes the knee to lock in a particular position, or either click. Meniscal injuries may also cause the knee to give way. Swelling is common but much less than with an ACL injury.
Treatment of meniscal injuries often need arthroscopic surgical repair.
Chronic Knee Pain
Arthritis is the most common cause of chronic knee pain. This is an inflammatory disorder of the knee joint that is often painful and restrictive in movement.
Types of knee arthritis:
Osteoarthritis (OA) is a degenerative condition of cartilage in the knee. It can range in severity; worse case, the menisci (cartilage) will be completely eroded, and the femur will rub on the tibia, bone on bone. Symptoms include painful knee that is often stiff and painful at extreme ranges of movement. Treatment is aimed at restoring relative mobility, pain control and local strengthening.
Rheumatoid Arthritis of the Knee
Rheumatoid arthritis (RA) is a connective tissue disease that affects multiple joints and often includes the knee.
Symptoms include acute bouts of pain, prolonged morning stiffness and pain in other joints, with increased swelling.
Treatment includes pain medications and graded strengthening.
Crystalline Arthritis (gout and pseudogout)
These acute severely painful forms of arthritis are caused by sharp crystals that form in the knee and other joints. These crystals can form as a result of defects in the absorption or metabolism of various natural substances such as uric acid (which produces gout) and calcium pyrophosphate (pseudogout). Treatment is aimed at controlling inflammation with anti-inflammatory medications, and at aiding the metabolism of the various chemicals that may lead to crystal formation. Food intake is hugely important.
Often as a result of trauma, infection, crystalline deposits, or repetitive strain. These then becoming acutely inflamed. Symptoms include acute or chronic trauma causes a painful and often swollen knee from the inflammation of the bursae. Treatment will usually include home care with rest, ice therapy and NSAIDs. Severe forms, however, can be treated with periodic steroid injections to the
Infection (or infectious arthritis).
Patellofemoral Syndrome and Chondromalacia Patella
Often causes by patellar (knee cap) mistracking. In patellofemoral syndrome, the patella rubs against the inner or outer femur rather than tracking straight down the middle. As a result friction develops and consequently inflammation causing pain that is worse with activity or prolonged sitting. As the condition progresses, softening and roughening of the articular cartilage on the underside of the patella occurs, and the syndrome is referred to as chondromalacia patella. Treatment should consist of home care with rest, ice therapy, NSAIDs, and balancing exercises. Others may benefit from bracing or taping of the patella, arch supports (for the arch of the foot), or orthotic supports that correct foot mechanics and may reduce abnormal forces on the knee.
Tendonitis (inflammation of the tendon), commonly the quadriceps tendon at the upper point of the knee cap. These tendons can often become irritated with prolonged repetitive strain and overuse. Symptoms include localized pain that is worse with activity. Treatment should include home therapy with the rest and ice regimen together with anti-inflammatory drugs is the basis of treatment. After controlling the pain, you should slowly start a strengthening regimen to strengthen the local muscles.
Iliotibial Band Syndrome
This is a fibrous ligament, called the iliotibial band, and extends from the outside of the pelvic bone to the outside of the tibia. When this band is tight it can rub against the bottom outer portion of the femur, and after continuation can cause friction and inflammation. Symptoms include distance runners and cyclists typically suffer from this condition, complaining of outside knee pain. Early on, the pain will typically come on 10 minutes to 15 minutes into a run and improve with rest.
Treatment should include stretching the iliotibial band and strengthening specific muscles of the hip. One way to do this is to place the right leg behind the left while standing with your left side about 2 feet to 3 feet from a wall. Then, lean toward your left for 20 to 30 seconds using the wall to help you support yourself. In addition to stretching the iliotibial band, PRICE therapy and NSAIDs may be of some help.
Prevention of Knee Pain
Knee pain has many different causes, most of which are difficult to prevent, but you can do some general things to help promote prevention of knee injury.
This reduces the forces placed on the knee and can reduce osteoarthritis. Keeping your weight down can also reduce the strain placed on ligaments and tendons.
Many knee problems are caused by tight or imbalanced musculature. Stretching and strengthening, therefore, also help to prevent knee pain. Stretching will promote flexibility and keeps your knee from being too tight and aids in preventing knee injury.
Strengthening and stability exercises are extremely important can help prevent knee injury.
Also consider swimming or water exercises for chronic knee pain. If you are fatigued, consider stopping -- many injuries occur when people are tired.
Any further questions or advise please contact Dynamic Osteopaths on:
T: 07966 317712 (Clinic Mobile)
Knee joint diagnosis
Knee joint treatmnet and management
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Knee injuries and pain.