Understanding Knee Pain: Insights from Singaporean Specialists
Pain in the knee can be due to a serious injury, such as a torn ligament or torn cartilage. It may be associated with other symptoms such as swelling or inability to fully straighten the knee. Some people may also experience instability or weakness, and this can be caused by a problem with one of the structures inside the knee. The menisci are the most commonly injured structure. The injury can be a result of trauma or it can be due to degeneration. As the person gets older, the menisci get weaker and are more easily damaged. The function of the menisci is to evenly load the surface of the knee joint. It also serves to increase the stability of the joint. Similar to the menisci, articular cartilage can be torn or damaged due to trauma or degeneration. The result is often painful clicking or catching in the knee. Over time, a piece of the cartilage or menisci can come free, and this can cause the knee to ‘lock’. An injury to the ligaments of the knee often occurs during sports or a fall. This can result in a feeling of instability in the knee and the sensation that the knee may ‘give way’. It can also be associated with swelling and pain.
Causes of Knee Pain
Anterior knee pain is a common problem. The pain can be the result of a number of different problems but is often related to the patella and patellar tendon. Patellar tendonitis (jumper’s knee) and fat pad irritation can cause pain of varying degrees. If the articular cartilage on the back of the patella is damaged, it can cause a dull, aching pain that is difficult to localize. This problem is common in women and often referred to as chondromalacia, but this term is outdated. A more accurate description would be patellofemoral joint pain or patellofemoral arthritis. This can also be caused by maltracking of the patella.
The knee joint is a common site of overuse or acute injuries from physical activity. A sprained ligament or torn cartilage is often the result of a sudden twist or a misstep. In some people, the knee joint may be affected by the onset of arthritis, a general term for inflammation of the joint. Various types of arthritis can affect the knee joint. Although there is no cure for arthritis, there are a number of treatment options available to help manage the pain.
Common Knee Pain Symptoms
Pain is the most common reason for a person to consult a healthcare provider. It is also the most common reason for the consumption of over-the-counter medication. It is estimated that up to 80% of the population will experience back pain at some time in their lives. Knee pain has a prevalence of 19% with osteoarthritis being the commonest cause. The increasing prevalence of overweight and obesity in both the developed and developing world is having an effect in increasing the burden of knee pain. The burden of knee pain is also increasing in the young athlete. Knee injuries account for a large proportion of the orthopedic caseload. A number of factors will predispose to painful knee conditions, e.g. people of certain occupations with knee-straining postures, those doing heavy manual work, people taking part in certain sports. One of the strongest risk factors for knee pain is previous injury. Pain has a number of consequences. It will result in functional deficit, e.g. an inability to stoop or squat, to use stairs, and to rise from a chair, resulting in so-called mechanical symptoms. Pain also has psychological consequences such as anxiety and depression. It has been shown that in the elderly population, chronic knee pain is a strong predictor for premature mortality.
Diagnosing Knee Pain
– X-rays are often requested if the doctor suspects a problem with the bone. This may include a fracture, stress fracture, or damage to the smooth joint surface.
– A magnetic resonance imaging (MRI) scan will provide better images of both bones and soft tissues. This is often requested if the doctor suspects a problem with the ligaments, menisci, or articular cartilage.
Testing: Tests may be requested depending on what the doctor suspects is causing the pain. Here are some of the more commonly requested tests:
Physical examination: During the physical examination, the doctor will look for any swelling and determine where the pain is located. He or she may also assess any pain or instability of the knee when walking, squatting, pivoting, or attempting to stand on one leg. This information will help the doctor determine which structure in the knee may be causing the pain.
Medical history: The doctor will ask about all of the patient’s symptoms and any other medical problems. He or she will also want to know about any previous injuries to the knee and any history of knee problems, including any surgeries. It may be useful to take a diary of knee pain to the consultation to accurately convey how frequent the pain is and what causes the pain to start or stop.
When diagnosing knee pain, a knee pain specialist will take a medical history and do a thorough physical examination.
Treatment Options
With more than 100 different types of arthritis, it is likely that a primary care doctor won’t be able to definitively diagnose the type of arthritis you have. You may be referred to a rheumatologist for further blood tests and x-rays to pinpoint the problem. A rheumatologist can be beneficial in developing a treatment plan and monitoring the progress of the disease.
The simple rule is: the greater the damage to the joint, the more likely a surgeon would be to recommend surgery. If you are considering surgery, it is always a good idea to get a second opinion. There is no harm or commitment involved in seeing another doctor, and it can be very reassuring to know that surgery is the best option.
This is considered by some to be one of the most vexing questions for many patients suffering from knee problems. The good news is that many types of knee pain can be successfully treated without resorting to surgery. The bad news is that there isn’t one treatment that works for everyone, and the success of a given treatment can be very difficult for a doctor to predict. The best approach for you depends on the type and severity of your knee pain and the damage to your knee.
Non-Surgical Approaches
Keyhole surgery is often the last solution for patients with the advanced stage of osteoarthritis. Anti-inflammatory medication is effective for relieving pain. Weight loss and exercise are advisable for overweight patients. It has been shown in clinical studies that strengthening the quadriceps muscles can reduce pain and improve function in the knee. High tibial osteotomy is a procedure that shifts the weight-bearing load to the undamaged part of the knee. This is often a procedure for younger patients with early-stage osteoarthritis. The most common and effective treatment is knee replacement. This can relieve most pain and disability affecting the knee in this stage of arthritis.
Osteoarthritis Wear and tear with age may cause the softening of the articular cartilage, which is known as osteoarthritis. It is more common in women than men, and there is often a family history of the disease. Symptoms include aching and burning pain, especially with activity, and stiffness after periods of inactivity. Sometimes the knee gives out during daily activities. An examination is usually conclusive with the creaking of the knee.
In the last section, the authors have stated where the symptoms occur and for what knee pain is most common for. Diagnostic history and physical examination are very important to determine the cause of knee pain. X-rays, MRI, or CT scans may be required to further discover the cause of knee pain. The key to proper treatment is to know what is causing the knee pain. Incorrect diagnosis can only lead to more problems in the future. Common things bring about knee pain without involving the need for surgery. Our chapter explains the non-surgical treatments for knee pain. Information is broken into different areas and causes for knee pain, then explaining the treatment and advice for it. Those causes include:
Surgical Interventions
According to the article, various surgical interventions are available for the treatment of knee pain. Surgical intervention is considered when the pain and stiffness in the knee joint are severe. The initial type of surgery is usually an arthroscopy. This is a form of keyhole surgery which is generally carried out under local anaesthetic. It is a minimally invasive surgical procedure where an arthroscope is inserted into the knee joint via a small incision. The camera attached to the arthroscope allows the surgeon to see within the knee joint and investigate the cause of the knee pain. The article suggests that this is useful for diagnosing problems within the knee such as damage to the cartilage or ligament. Arthroscopy can also be used to remove loose debris or fragments of bone and cartilage. This is known as a debridement and steaming which essentially cleans the knee joint. According to the article, this surgery is good for older people with osteoarthritis and can help to reduce inflammation and pain. The article reports that the benefits of arthroscopy are that it is minimally invasive and can often be performed as a day case surgery. It is also relatively low risk and has a good success rate. However, it is not always suitable as a treatment for all forms of knee pain and the long-term benefits are still controversial with some patients not finding any improvement in symptoms.
Rehabilitation and Physical Therapy
What follows is the guide to help patients understand the nature of their injury and its treatment, ideally allowing them to be more involved in their rehabilitation. This understanding of their injury, its severity, and the treatment is beneficial, if not crucial in guiding their compliance and determining their expectations and goals towards recovery. This is instrumental to a satisfactory outcome, ensuring patients do not feel like their treatment is hit and miss and are clear on what is required from them for a successful rehabilitation.
Outlining the following stages of treatment necessary for an individual’s successful return to full fitness, minimizing the risk of re-injury. These should only be used as a guideline, as specific progression is based on the nature and degree of the injury, the age of the patient, and the specific demands of their chosen activity or sport. But overall, the treatment stages are: Reducing pain and inflammation Regaining range of motion and strength Restoring normal function
Prevention and Self-Care
There are certain measures for a person with healthy knees to prevent knees from degeneration. They include: – Weight control: maintaining the ideal body weight helps to prevent occurrence of osteoarthritis in the knees and reduces severity of the disease. This is because every pound of body weight adds up to four pounds of pressure on the knee. Hence, being overweight or obese is a modifiable risk factor for osteoarthritis in the knees and weight reduction helps to reduce the pressure on the knees. – Avoiding or modifying activities with high stress on the knees: These activities include excessive stair climbing, running, and high impact sports. They increase the risk of osteoarthritis degeneration in the knees. It is advisable to replace these activities with exercises such as swimming and cycling which are less detrimental for the knees.
Lifestyle Modifications
Footwear can have a real impact on knee pain. For example, a number of studies have shown that when shoe insoles are used to decrease the overpronation of the foot, knee pain is measurably reduced. In essence, footwear should give your knees as much support as possible to reduce the pressure on them. When the knee pain has decreased, it is still important to continue with the use of good footwear to prevent the return of the knee pain.
Keep your weight down. One of the most effective methods for reducing knee pain and preventing further damage is to lose weight. Excess weight increases the stress placed on the knee during ordinary activities such as walking and standing. It also increases the risk of degenerative changes in the kneecap as well as osteoarthritis of the knee. There is now compelling evidence that weight reduction alone can significantly decrease pain and improve function of knee.
Lifestyle modifications are an essential part of a self-care program for someone with knee pain. By changing factors in your environment and behavior that increase the likelihood of developing knee pain, and those that aggravate the condition, you can prevent the onset of knee pain or further damage to your knees, and relieve current symptoms.
Exercise and Strengthening
Step exercises are a good way to build strength in the quadriceps and hamstring muscles. Step up on a step or stair with one leg, letting the other leg hang free. Then lower the hanging leg to touch the step, but do not shift weight onto it. Use the thigh muscles of the stepping leg to rise back up. Knee conditioning programs guided by a physical therapist are designed to get the healing process underway and continue the progression until the patient achieves their highest potential. This can also be done after surgical treatment to help speed recovery. High-speed strengthening to increase muscle power and functioning is helpful for people with knee pain but should not be taken on without the advisement of a doctor.
Muscle conditioning is key to supporting the knee joint. People with any knee condition can benefit from isometric exercises. An isometric quad set is a simple but effective exercise that can be done anywhere and anytime. Simply sit with the legs straight and the back of the knee pressed against the floor. Then tighten the muscle on the top of the thigh while pushing the knee down. Hold for five to ten seconds and release. Hamstring sets work the muscle on the back of the thigh. Simply sit on a sturdy table or bench with knees bent at a 90-degree angle with feet flat on the surface. Then slide the heels while straightening the knees and contracting the hamstring. Hold for five to ten seconds and release. These exercises can be done in repetitions of five to ten, around two to three times a day.
Exercise helps to build strength in the muscles that support the knee and increase flexibility. Good choices include walking, swimming, low-impact aerobics, and range of motion exercises. It is best to balance exercise with rest. Rest too much, and the muscles will weaken, which will slow recovery and increase the risk of further injury. But taking it easy for too long can decondition the muscles and lead to weight gain, which puts extra stress on the knee. It is important to check with a doctor to see which exercises are appropriate for the specific condition and to discuss what is the right balance between exercise and rest.
Proper Knee Care
When you think about knee health, the first step is to try and avoid putting them in compromising situations. A good example is when carrying multiple items; if you’re like most people, you’ll try and get it done in one trip, which may involve carrying a heavy load. What then happens is that you’ll open the car door with an awkward maneuver and at the same time try to prevent it from hitting your leg. This is a setup for knee pain, potentially serious. The heavy load will put more pressure on the knee joint, and the twisted, unbalanced body position will put excess stress on the ligaments and possibly cause internal damage to the cartilage. The correct here would be to make two trips and prevent potential knee stress from occurring.
Treating your knees with care and respect is an effective way to prevent knee problems from developing and causing you further pain and discomfort. Most of the self-care principles are mere applications of common sense. The extent to which you incorporate these ideas into your daily routine will depend a lot on how much you value your knee health and how much you wish to be proactive in the prevention of problems.
If your knee pain is getting in the way of doing the things you love, or if it gets worse over time, the last thing you want to do is make it worse. Preventing problems at this point and learning the right way to take care of your knees is an essential step to recovery.
