NH cares

Knee Pain:

Knee pain and its causes can be broadly classified into the following categories:

• Injury
• Mechanical issues
• Arthritis
• Other causes

Here is a brief elaboration of these etiologies:

Knee pain caused by injuries

• Anterior cruciate ligament tear

Anterior cruciate is one of four ligaments connecting the shin bone (tibia) with the thigh bone (femur). The ACL tear is a common occurrence among sports people, in football, basketball and skating, where a sudden change in the direction of motion is required.

• Fractures

Fracture of the kneecap or patella is uncommon, most often seen as a result of road traffic accidents, or, rarely, as a result of loss of bone density seen in age-related osteoarthritis.

• Meniscal tears

A sudden twist of the knee joint during weight bearing can lead to tearing of the menisci, or the cartilage between the thigh bone (femur) and the shin bone (tibia). The menisci play a role in cushioning the joint, avoiding friction between the two communicating bones.

• Bursitis

Bursae are small sacs of fluid along the sides of the knee joint that allow smooth gliding of the tendons and ligaments against each other. Inflammation of these bursae, or bursitis, is usually a result of injury, and is associated with acute pain.

• Tendinitis

Tendons are the thick fibrous bands that connect the muscles to the bones, enabling movement. The patellar tendon helps attach the quadriceps muscles to the shin bone, the tibia. Injury to this ligament, referred to as patellar tendinitis is often seen in cyclists, runners or those involved in activities that require jumping.

Mechanical problems causing knee pain

Some examples of mechanical causes for knee pain include:

• Loose bodies

Imagine a pen caught in a door hinge making smooth movements difficult. Similarly, sometimes a chipped piece of bone or cartilage formed due to degenerative changes or injury can affect movement along certain angles while floating within the knee joint fluid.

• Dislocation of the patella

The patella or kneecap can get dislocated and move outside the knee joint causing a visual deformity and is usually associated with a lot of pain.

• Illio-tibial band syndrome

The illio-tibial band is a thick fibrous band that arises from beyond the hip joint and terminates outside of the knee joint. This syndrome occurs when this band becomes so tight that it rubs against the thigh bone, the femur. Marathon runners and cyclists are especially susceptible to illio-tibial band syndrome.

• Hip or foot pain

Hip or foot pain can cause a change in your gait in order to put a lesser strain or reduce the pain in these joints. This can in turn put a strain on the knee joint and cause pain. Also, at times pain in the foot or hip joint can cause referred pain at the knee joint.

Types of arthritis

Arthritis, broadly defined as a condition causing inflammation of the joints and stiffness, is of over a hundred types. Arthritis commonly manifests after the age of sixty five years, though it can present in children, teenagers or young adults. Arthritis is more common in women than men, and is more common among obese individuals.
Symptoms of arthritis include pain, restricted range of movement, along with redness or swelling in some cases. The kinds of arthritis most often affecting the knee joint include:

• Osteo-arthritis

Also known as degenerative arthritis, osteo-arthritis is the most common type of arthritis. It mostly affects the knee joint, and is due to wear and tear of the cartilage, causing painful movements and stiffness.

• Rheumatoid arthritis

One of the most debilitating forms of arthritis, rheumatoid arthritis is a result of an auto-immune disorder and runs a chronic course. Commonly affecting women around the age of forty, rheumatoid arthritis requires life-long treatment and shows a waxing and waning pattern.

• Gout

Although gout usually affects the big toe, it is also seen in knee joint. Gout is a metabolic disorder causing accumulation of a metabolic product, uric acid as crystals within the joint fluid.

• Pseudogout

Pseudo-gout mimics gout in its presentation and is due to deposits of calcium crystals within the joint cavity. Pseudogout most often affects the knee joint.

• Septic arthritis

Infection of the knee joint can cause pain, swelling and restricted movement. There is associated fever and usually has a rapid progression causing extensive damage to the cartilage.

Other causes

Patello-femoral syndrome refers to the pain that arises between the thigh bone (femur) and the kneecap (patella). It is seen in athletes, older patients due to arthritis or due slight malalignment.

Having knee pain is not indicative of a serious underlying cause in most cases, and can be alleviated by giving it adequate rest or physiotherapy. However, chronic conditions like osteo-arthritis can cause prolonged or severe pain leading to disability or joint damage.

When you approach a doctor with knee pain, evaluation includes a physical examination, followed by radiological examination and blood tests if needed.

Physical examination

During the physical, the doctor will:

• Inspect your knee for any bruising, swelling, pain or tenderness.
• Check your range of motion
• Assess the strength and integrity of your knee joint.

Radiological evaluation

• X-ray

Usually the first test ordered, an X-ray helps identify fractures or degenerative bone disorders.

• CT scan

A computerized tomography scan, or a CT scan, is the equivalent of hundreds of X-Rays taken at multiple angles and directions to create cross-sectional images of the area of interest. A CTscan can pick up subtle fractures, degenerative changes or even deposits within the joint cavity before manifestation of arthritis.

• Ultrasound

An ultrasound uses sound waves to produce images of the soft tissues in and around the knee joint. This helps pick up signs of inflammation or soft tissue injuries.

• Magnetic Resonance Imaging

MRI uses radio waves and magnetic waves to create 3D images of the knee joint. This helps in revealing injuries of the tendons, ligaments, cartilage or muscles.

Laboratory tests

Blood tests can help diagnose metabolic causes for arthritis such as gout or pseudogout. Another procedure known as arthrocentesis, involves aspirating minute quantities of the fluid within the knee joint for laboratory evaluation.

Here are a few things you can do to relieve your knee pain:

• Rest your knee: Avoid intense activity for a few days. Reducing repetitive strain on the knee, allowing time to heal and helps prevent further damage.
• Ice it: Icing the knee joint reduces the inflammation associated with pain and swelling. Keep ice on the affected joint for fifteen to twenty minutes every three to four hours for a few days or until the pain subsides.
• Compress your knee: Compressing the affected knee with wraps, sleeves, bandages or straps helps keep the swelling down and support the joint.
• Taking anti-inflammatory medication: Non-steroidal anti-inflammatory drugs or NSAIDs are available over the counter and help relieve pain and swelling. However, they should be taken with caution and only if necessary.
• Elevate your knee: Place a pillow below your ankle when you sit or lie down to reduce swelling of the knee joint.
• Practise simple exercises: Stretching and strengthening exercises involving the quadriceps and hamstrings can help reduce strain on the knee joint. Always use caution and do not do more than you are able to comfortably.

Q.  What kind of doctor should I see for my knee pain?

1. Although many patients choose to consult their family physician to investigate knee pain, specialist orthopedic surgeons would be more than happy to see you in consultation for knee pain. They will explain your treatment options, including surgical or non-invasive options, if they are more appropriate.

Q.  What can cause pain in the back of the knee?

1. Pain in the back of the knee can be due to strain in the muscles or inflammation of the tendon, or tendinitis. Unusually meniscal tears, cysts due to degeneration can also cause pain in the back of the knee joint. Injury to the ligaments or clots can cause similar symptoms.

Q.  Is walking good for the knee?

1. Walking is a recommended exercise for knee pain. It should be done as much as possible without aggravating knee pain. It aids in general fitness as well as strengthening the muscles supporting the knee joint.

Q.  How do you reduce fluid in the knee?

1. Fluid accumulation in the knee is usually due to a reaction to some pathology or injury and can cause significant discomfort and pain. In acute conditions, the fluid can be aspirated using a needle inserted in the knee joint. Injecting a corticosteroid also helps reduce recurrent accumulation of fluid.

Q.  Other than knee pain, what are the symptoms of knee injuries?

1. If you have suffered from any injury to the knee, symptoms include stiffness, swelling and instability. At times you can hear popping sounds when you move due to dislocation of the kneecap (patella), or limited mobility. You may not be able to straighten out your knee due to pain.

Q.  What is the best exercise for knee pain?

1. Before starting exercises for knee pain, it is advisable to take your medication forty-five minutes before you begin. Keeping a hot pack for about twenty minutes also helps reduce pain while exercising. After you finish, apply an ice pack to reduce inflammation due to exercise. Here are some simple exercises to do at home, for ten counts each, alternating with each leg:

●   Leg raising (lying down)

1. Lie flat on the floor or on a yoga mat keeping your hands by your side and feet facing upwards.
2. Keeping your leg straight, lift it slowly, as high as you can.
3. Tighten your stomach to push your back flat against the floor.
4. Hold and count to 5, then lower your leg as slow as possible.
5. Repeat with the other leg.

●   Hamstring stretch (lying down)

1. Lie on the floor or mat with both your legs bent
2. Slowly lift one leg, still bent at the knee, and bring your knee back to the chest
3. Hold your hands behind your thigh and straighten your leg.
4. Pull your straight leg towards your head until your feel a stretch.
5. Hold for thirty to sixty seconds and slowly bring your leg back to the ground.
6. Repeat with the other leg.

●   Half squat

1. Stand with your feet shoulder width apart, hands straight in front of you.
2. Slowly bend your knees until your in half sitting position. Use a chair for support if needed.
3. Don’t lean forward, keep your back and chest straight
4. Keeping your feet flat on the ground, hold for five to ten seconds.
5. Repeat

●   Leg stretch

1. Sit on the floor with your legs straight in front of you.
2. Keep your hands by your sides, supporting yourself, keeping your back straight
3. Slowly bend your knee until you feel a stretch.
4. Hold your leg in that position for 5 seconds and slowly stretch out your leg, holding in that position for five seconds.
5. Repeat with the other leg.

Q.  What can I do to relieve knee pain?

1. In case of severe knee pain, do not walk, exercise, or lift a heavyweight. Do a simple trick 'RICE'

   • R - Give your knee some Rest
   • I - Apply Ice
   • C- Wear a Compressive bandage
   • E - Keep your knee Elevated

   This will bring instant relief from the knee pain.

Q.  What is the home remedy for knee pain?

1. Home remedies for knee pain are a bunch of instructions and exercises which are not a treatment for your knee but will help control the condition.

   • Always be aware of your body weight. If you are overweight, then try to reduce it with dieting and mild exercises.
   • Massage your knee loosely. Self-massage is as good as a massage done by others.
   • Lookout for postures and support. Avoid prolonged sitting, low height chairs or cushions, and couches that you sink into. Wear supportive shoes. 
   • Physical Activity to boost the health of cartilage tissue. Practice activities like cycling, walking, swimming, and yoga. 
   • Strengthen your upper leg muscles by working with a physical therapist. These muscles protect the knee joint. Strengthening these quadriceps muscles helps with many of the long-term problems with knee pain.

Q.  How do I know if my knee pain is serious?

1. Knee pain is often accompanied by the following signs and symptoms -

   • Swelling
   • Stiffness
   • Redness
   • Weakness or instability
   • Popping or crunching noises
   • Inability to fully straighten the knee
   • Inability to bear any kind of weight
   • Intense pain
   • A joint that appears deformed

   Visit a doctor and seek immediate medical attention immediately if you are facing any of these signs. 

Q.  What does arthritis in the knee feel like?

1. Arthritis of the knee is inflammation of one or more of your joints. Arthritis in the knee causes pain, swelling, and stiffness. This condition typically occurs in all kinds of body joints, but it is particularly common in the knee. Knee arthritis makes it extremely difficult to perform everyday activities, like walking or climbing stairs. Arthritis in the knee is detected by -

   • A gradual increase in knee pain
   • Swelling
   • Tenderness
   • Buckling & Locking
   • Cracking or popping sounds
   • Poor range of motion
   • Knee deformities
   • Loss of joint space

Q.  What causes a dull ache in the knee?

1. The conditions which cause dull knee pain includes - 

   • Tendinitis - It is the inflammation or irritation of a tendon, a thick cord that attaches bone to muscle.
   • Bursitis - It is a painful condition that affects the small, fluid-filled sacs called bursae, which cushions the tendons, bones, and muscles near the joints. 
   • Chondromalacia Patella - It is a condition where the cartilage on the undersurface of the patella, commonly known as kneecap deteriorates and softens.
   • Gout - It is a painful form of inflammatory arthritis that affects the big toe, and/or the joints, including one or both of the knees.
   • Osteoarthritis - It is the most common chronic joint condition. Osteoarthritis occurs most often in older people, where the cartilage, the protective tissue coving the bones, breaks down and causes the bones to rub together.

   Rheumatoid Arthritis (RA) - RA in joints causes joint pain, swelling, stiffness, and loss of joint function and deformities.

Q.  What vitamins help with knee pain?

1. Supplements and medications that help to prevent and cure knee pain are -

   • Vitamin D
   • Estrogen
   • Glucosamine and Chondroitin Sulfate
   • Methylsulfonylmethane (MSM)
   • Turmeric
   • Omega 3
   • Ginger
   • S-adenosyl-L-methionine (SAMe)