Knee

knee

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

  • Osteoarthritis: Wear and tear of the cartilage between joint surfaces
  • Ligament Sprains or Tear: (four major ligaments –  ACL, PCL, MCL and LCL) leading to instability.
  • Meniscus Tears: (Quadriceps, the front thigh muscle and Hamstrings; the posterior thigh muscle)
  • Fractures: of the knee bones
  • Dislocation or Shifting of Patella i.e. the Knee Cap
  • Baker’s Cyst: a swelling at the back of the 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.

 

 

COMMON KNEE INJURIES

Meniscus Injuries:

There are two menisci or cushions in your knee; each rests between the thigh bone (femur) the shin bone (tibia). Their function is to:

  1. Assist in distributing your body weight across the knee joint
  2. Increase joint stability
  3. 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.

Ligament Injuries:

Ligaments connect one bone to the other and the knee has four major ligaments:

The ligaments inside your knee joint are called ACL and PCL which cross in the center of the knee like a Cruicifix. These two provide stability to the knee especially in forward and backward movements in sports that involve pivoting and quick turning and twisiting on the knees

  • 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.

Fractures:

A fracture may happen as a result of direct or indirect trauma and may involve the patella, femur or tibia.

 

 

OTHER COMMON KNEE PROBLEMS

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).

Iliotibial Band Syndrome: is often seen in runners. It is a tight band of muscle and connective tissue on the outer thigh which causes stress on the knee resulting in pain with movements.

 

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.

 

 

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.

 

Call us for an appointment or send your queries to: info@physioasia.com

KNEE PAIN

INTRODUCTION

The knee is an important weight bearing joint that is most prone to acute injuries as well as wear and tear related osteo–arthritis. Pain in the knee could be due to any of the following components:

  • Osteoarthritis: Wear and tear of the cartilage between joint surfaces
  • Ligament Sprains or Tear: (four major ligaments –  ACL, PCL, MCL and LCL) leading to instability.
  • Meniscus Tears: (Quadriceps, the front thigh muscle and Hamstrings; the posterior thigh muscle)
  • Fractures: of the knee bones
  • Dislocation or Shifting of Patella i.e. the Knee Cap
  • Baker’s Cyst is a swelling at the back of the knee


 

SYMPTOMS

  • Knee joint swelling/pain on touch along the knee joint line
  • Stiffness of the knee
  • Deformity of the joint like knock-knees and bow legs
  • Clicking, locking and pain with certain twisting activities like getting out of car or rolling over in bed
  • Increase of pain in damp weather or after periods of inactivity, for example sitting in the cinema
  • Instability of the knee, where the knee feels wobbly on weight bearing
  • Difficulty in going up and down the stairs


CAUSES OF KNEE PAIN

  • Trauma: to the ligaments or meniscus of the knee during high impact sports like soccer, long-distance running and tennis.
  • Repetitive Stress Injuries: like inflammation of the tendon of the knee cap, etc. are usually common with certain occupations involving kneeling or squatting, prolonged standing everyday, excessive stair-climbing or lifting heavy weights regularly.
  • Inflammation of the cartilage of the kneecap: common in youngsters
  • Heredity: There is some evidence it can be linked to heredity.
  • Weight: Weight increases pressure on joints such as the knee.
  • Age: The ability of cartilage to heal itself decreases as people age
  • Arthritis: When the joint cartilage is gone, the bone ends up rubbing against each other and wears away. This results in an arthritic knee.
  • Other illnesses: Repeated episodes of gout, metabolic disorders and some congenital conditions.
  • Poor posture or bone alignment: Poor general fitness and muscle weakness.


 

TREATMENT OF PAINFUL KNEE

  • Medical Help – Your doctor may prescribe some anti-inflammatories and pain-killers.


PHYSIOTHERAPY

A physiotherapist will make a detailed assessment of your condition and put together a treatment programme for your specific problems.

This may include:

  • Mobilization & Manual Therapy: This aids to reduce pain, muscle spasm and stiffness of the knee joint.
  • Shortwave Diathermy: High frequency heat energy to reduce swelling and increase circulation
  • Radial Shockwave Therapy: Used for chronic Jumper’s knee or Ilio-tibial band pain. This therapy makes use of high energy acoustic waves travelling faster than the speed of sound which initiate a healing response in the deep inflamed tissue.
  • Interferential Therapy: Mild electric pulses to nerve endings that lie beneath the skin to reduce pain and inflammation.
  • Electrical Stimulation: Re-educate and strengthen the thigh muscle (quadriceps) through electrical stimulation. This reinforces stability.
  • Ultrasound: For localised pain/swelling.
  • Exercise Therapy: Exercises emphasizing on various therapy goals will be taught. This may include stretches, gait re-education, exercises to improve knee movement, strength, stability and stamina. Also Omnibands are used for strength training besides ankle weights.
  • Win Plate Vibration Unit: Used for  improving strength on specific muscles groups of the knee and balance training.


 

TIPS TO PROTECT YOUR JOINTS

  • Warm-up/cool down before and after exercising
  • Pace yourself by alternating heavy or repeated tasks with easier tasks or breaks
  • Wearing proper shoes and using aids such as canes or walkers can also take off some of the strain.
  • Weight control can reduce stress on weight-bearing joints.

 

Call us for an appointment or send your queries to: info@physioasia.com

KNEE PAIN FROM OSTEOARTHRITIS

OSTEOARTHRITIS OR OA

OA Knee which used to be called “wear and tear” arthritis usually occurs in knees that have experienced trauma, infection or injury.  A smooth, rubbery material called cartilage works like a protective cushion between bones and protects bones from rubbing against each other.

ARTHRITIS develops as the cartilage thins and becomes weak 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 spurs.

 

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.

  

TIPS TO PROTECT YOUR JOINTS

  • Warm-up/cool down before and after exercising
  • Apply ice after injuries
  • Pace yourself by alternating heavy or repeated tasks with easier tasks or breaks
  • Wearing proper shoes and using aids such as canes or walkers can also take off some of the strain.

Call us for an appointment or send your queries to: info@physioasia.com