Knee

The knee is an important weight bearing joint that is to acute injuries as well as wear and tear. Pain in the knee could be due:

Osteoarthritis of knee OA : is degeneration or wear and tear between joint surfaces of the knee. It usually occurs in knees that have experienced trauma, infection or injury or age related changes. Osteoarthritis develops as the cartilage that protects the bone ends thins down and the bones will begin to rub against each other when the joint is moved.  With the worn-out cartilage, the joint space between the bones narrows. The surrounding bones react by becoming thicker and grow outward and form bone spurs. All these changes can lead to pain, swelling and discomfort in the knee on movement or rest.

SYMPTOMS

⦁ Extra fluid, often known as “water in the knee”, that causes swelling.
⦁ Normal activity becomes painful and difficult
⦁ Pain usually progresses as the day goes, in damp weather or after long periods of inactivity. An example is when sitting for too long.
⦁ Deformities in the affected joint like knock-knees and bow legs.

CAUSES

⦁ Heredity: There is some evidence it can be linked to heredity.
⦁ Weight: Weight increases pressure on joints such as the knee.
⦁ Age: As one ages, there is increased wear and tear and also a decrease in the ability of cartilage to heal itself.
⦁ Gender: Women who are older than 50 years of age are more likely to develop OA Knee than men.
⦁ Trauma: Previous injury to the knee, including injuries during high impact sports like soccer, long-distance running and tennis.
⦁ Repetitive Stress Injuries: In occupations involving kneeling or squatting, prolonged standing every day, excessive stair-climbing or lifting heavy weights regularly.
⦁ Other Ilnesses: Repeated episodes of gout, metabolic disorders and some congenital conditions.
⦁ Bone Alignment or Poor Standing Posture: Poor general fitness and muscle weakness.

PHYSIOTHERAPY

Physiotherapy is aimed at relieving pain; improving joint function with exercise joint mobility and helping you live a normal life.
⦁ Interferential Therapy or Transcutaneous Electrical Nerve Stimulation (TENS): mild electric pulses to nerve endings that lie beneath the skin in the painful area.
⦁ Shortwave Diathermy: High frequency heat energy to reduce swelling and increase circulation
⦁ Laser: Low level lasers to increase deep circulation and reduce localized pain.
⦁ Ultrasound: For localised pain/swelling
⦁ Exercises

Moderate Stretching Exercises will help relieve the pain and keep the muscles and tendons around the affected joint more flexible.

Strengthening Exercises for muscles that support joints affected by arthritis.  They can be performed with weights or with exercise bands.

Low Impact Activities such as swimming, walking, water aerobics and stationery bicycling that get your heart pumping and can keep your lungs and circulatory system in shape.
Weight Control: can reduce stress on weight-bearing joints, limit further injury, and increase mobility.  A healthy diet and regular exercise helps reduce weight.

Ligament Sprains or Tear: The knee has four major ligaments. The ligaments inside the knee joint are called ACL and PCL while the ligaments on either side of the knee are called MCL and LCL. These ligaments provide stability to the knee. Knee Ligament Injury can lead to pain and instability with the “giving way” feel. These can be associated with muscle weakness and lack of balance in the long run.

Meniscus Tears:  A knee has two menisci. Any activity that causes forcefully twisting or rotating the knee, especially when there is full weight on it, can lead to a torn meniscus. A torn meniscus causes pain, swelling and stiffness of the knee. Torn meniscus might also lead to a block to knee movement and cause trouble while extending the knee fully. There are two menisci or cushions in your knee; each rests between the thigh bone (femur) the shin bone (tibia). Their function is to:
⦁ Assist in distributing your body weight across the knee joint
⦁ Increase joint stability
⦁ Shock absorption

Acute injury involves twisting injury with foot anchored on the ground.
Medial Meniscus Injuries (inner) happen more frequently than the Lateral Meniscus Injury (outer). Players usually experience mechanical problems with the knee, often with the “locking or giving way”.
There may also be degeneration of the medial or lateral menisci with sports like runing.

Iliotibial Band Syndrome: Often seen in runners. Iliotibial band is a tight band of muscle and connective tissue on the outer thigh which causes stress on the knee resulting in pain on outer side of knee and typically with running and going downstairs.

Patellofemoral pain syndrome (PFPS)
Pain arises from the patella (kneecap) & excludes other soft tissue. PFPS constitutes 16 to 25 % of all injuries in runners. It can cause pain under the knee cap and swelling around the knee joint. Pain may increase after activities such as jumping, running down slopes, steps, prolonged walking or squatting.

Fractures: Occur in and around the knee joint due to direct or indirect trauma and may involve the patella, femur or tibia.

Dislocation or Shifting of Patella (Knee Cap): When the kneecap is partially or completely displaced out of its normal alignment. The most common direction for a patella to dislocate is outwardly (laterally). When this happens, the muscles and ligaments on the inside of the knee become overstretched and damaged.

Baker’s Cyst: pain at the back of the knee with a round swelling.
Chondromalacia Patella CMP: Happens when the patella glides through the groove with a lateral shift during the knee movement. This causes irritation of the cartilage between the patella and the femur and often results in pain.Pain is mainly with stair climbing, prolonged sitting and knee bending with weight bearing exercises. Pre-disposing factors may include flat fleet, overuse, tight muscles on the outer side of the knee, injury or weak muscles on the inside of the knee (vastus medialis).

Osgood Schlatter’s Disease: is seen in adolescents who develop pain and a bump just below the knee due to constant overuse and traction on the insertion of the patellar tendon.
The knee is an important weight bearing joint that is to acute injuries as well as wear and tear. Pain in the knee could be due:

Osteoarthritis of knee OA : is degeneration or wear and tear between joint surfaces of the knee. It usually occurs in knees that have experienced trauma, infection or injury or age related changes. Osteoarthritis develops as the cartilage that protects the bone ends thins down and the bones will begin to rub against each other when the joint is moved.  With the worn-out cartilage, the joint space between the bones narrows. The surrounding bones react by becoming thicker and grow outward and form bone spurs. All these changes can lead to pain, swelling and discomfort in the knee on movement or rest.

Ligament Sprains or Tear: The knee has four major ligaments. The ligaments inside the knee joint are called ACL and PCL while the ligaments on either side of the knee are called MCL and LCL. These ligaments provide stability to the knee. Knee Ligament Injury can lead to pain and instability with the “giving way” feel. These can be associated with muscle
weakness and lack of balance in the long run.
ACL or Anterior Cruciate Ligament   is a major stabilizer of the knee. Tears occur when twisting forcefully on a planted foot and this leads to instability and pain.
⦁ PCL or Posteriour Cruciate Ligament gets injured by direct impact on front of the knee, usually when it is slightly bent. This results in instability with the “giving way” feel.
The ligaments on either side of the knee are called MCL and LCL. They provide sideways stability to the knee.
⦁ MCL or Medial Collateral Ligament is on the inner side of the knee. It can be sprained when the knee is twisted in the straight position as being knocked sideways, like when being tackled in football.
⦁ LCL or Lateral Collateral Ligament is on the outer side of the knee. It may get injured with sideward pressure on a straight knee.

KNEE INJURY

Knee injuries are common whether they happen due to sports or even in regular activities. Some injuries are due to overuse and some as a result of Acute Trauma.
Most injuries would heal with rest, ice and time, but some may be difficult to resolve.
For those involved in active sports, a strong knee is very important for a good performance and to prevent injuries. Prevention is better than cure, thus having good strength and conditioning program before you increase your activities is always helpful as it reduces the risk of injuries.
Good quadriceps and hamstring strengths helps the knee function better and makes it less likely to get ligament or cartilage injuries during sports.

TREATMENT

Immediate treatment should include: R.I.C.E.S. – Rest, Ice, Compression, Elevation and Support
Medical Treatment
The doctor may prescribe:
⦁ Anti-inflammatories for pain and swelling
⦁ X-rays or MRI depending on the injury
⦁ Surgery if required
⦁ Splinting or support for the knee
⦁ Physiotherapy

PHYSIOTHERAPY

In non-operated as well as operated knee injuries, this is useful in regaining the pain relief as well as function. Early exercise with controlled movements prevents muscle atrophy.
Mobilization & Manual Therapy: Significant effect to restore restricted mobility of the knee joint and kneecap. This aids to reduce pain, muscle spasm and stiffness.
Interferential Therapy: The application of a medium-frequency electrical current stimulates the peripheral sensory and muscle nerve fibers and reduces pain and inflammation.
Electrical Stimulation: Re-establish/re-educate muscle activation and strength of the thigh (quadriceps muscle) through electrical stimulation. This reinforces stability and strength of the knee.
Ultrasound: The application of ultrasonic waves causing improved cell metabolism and cell membrane permeability, thereby enhancing tissue healing.
Exercise Therapy: Depending on the different phases of rehabilitation program, exercises may include stretches, gait re-education and muscle strength, stability and stamina.
A personalized exercise programme to be done at home and in clinic will include appropriate education and exercise progression to enable you to return to your highest functional level.

OUR TIPS

⦁ Get a well planned exercise program for your knee muscles for preventing undue stress on the knee during sports.
⦁ Use proper foot wear.
⦁ Good practice and training for your sport will make accidents less common.
⦁ Previous injuries that haven’t healed or been rehabilitated can increase risk of further injury – so get them checked.