Causes of Knee Pain
Ligament injuries are another problem which can occur from overuse. The anterior cruciate ligament, or ACL, is one of the most commonly injured ligaments and often requires surgery. It is estimated that 100,000 to 200,000 ACL injuries occur in the US per year. An ACL tear occurs from a sudden change in movement or direction. The ACL ligament can be over-stretched or torn partially or completely in more serious cases. This injury is often seen in athletes and sports with a sudden change in movement and direction.
Arthritis is a group of more than 100 different diseases that cause pain, swelling, and limited movement in the joints and connective tissues. The most common type of arthritis is osteoarthritis. It’s a degenerative joint disease in which the cartilage that covers the end of the bone is damaged or worn away. The exact cause of arthritis is still unknown, but the two most common types of arthritis, osteoarthritis and rheumatoid arthritis, damage the joint in different ways.
The knee is a weight-bearing joint, and the impact of walking and running can often cause joints to become inflamed. Some of the more common types of knee problems result from overuse of the joint. Too much weight can damage the intricate structures of the knee. A few examples of overuse problems include:
Arthritis
Arthritis is a chronic disease that a lot of people have difficulty understanding, mainly because it is a very scattered disease. It is a common belief that arthritis is a disease of the elderly. In fact, it is a major cause of long-term disability for people of all ages, and it is a team of over one hundred different diseases. Some forms of arthritis that affect the elderly, such as degenerative joint disease, are relatively mild and are considered more of an inconvenience when compared to some of the more severe forms. Arthritis is not a new word and evidence of the disease has been found in prehistoric times. Today, arthritis is the leading cause of inflammation and destruction of joints. Of the many forms of arthritis, a large number of them can mimic each other or even other types of joint disorders, making it difficult to make a specific diagnosis. Arthritis is the cause of many lost work days because it can affect the individual during their most productive years. It is an immune system disorder where the body begins to attack its own healthy tissues. In the case of rheumatoid arthritis, during the inflammation process, the synovium becomes saturated with inflammatory cells. These cells cause damage to the surrounding areas, such as the cartilage, and the cells eventually cause bone erosion. The result is deformation of the joints. In severe cases, the joint no longer functions and pain is constant. Osteoarthritis is a joint disease of wear and tear on the articular, or hyaline, cartilage. The damage of the cartilage then affects how the joint moves and the surrounding bone. Spurring is the outgrowth of new bone around the joint and the most critical area is where the bone meets the bone, thus, the subchondral bone. Rubbing or grating of the joint is a common symptom and range of motion is impaired. Osteoarthritis usually affects the hands, feet, spine, hips, and knees, and is mostly seen in people over the age of 65. High-impact activities or sports can increase the severity of osteoarthritis. A joint infection caused by bacteria, fungi, or a virus can also cause inflammation of the joints and destruction of the cartilage. This type of arthritis can be, in some cases, cured with the proper antibiotics or antimicrobial drugs. An understanding of how arthritis affects the knee will hopefully lead to more efforts to treat the disease, and with continued medical breakthroughs, an eventual cure for all forms of arthritis.
Ligament Injuries
Unfortunately, these injuries are often something that requires more than just a session of physiotherapy to rectify and may require surgery to reattach the ligament back to the bone. This is because ligaments, unlike muscles, do not have a good blood supply, so they are unable to repair themselves. In less severe cases of partial tears of the ligament, surgery can be avoided, and physiotherapy is sufficient. In very mild cases, rest and decreasing the load on the knee may allow some recovery. Generally, following any form of these injuries, patients are advised to avoid aggravating activities and heavy lifting until they can walk pain-free. Failure to adequately rehabilitate the knee may result in chronic instability and a higher risk of developing degenerative joint disease. ACL tears have a particularly high risk of re-tearing with a reported incidence of 1 in 4 patients.
The human knee has 4 ligaments. These are the Anterior Cruciate Ligament (ACL), the Posterior Cruciate Ligament (PCL), the Medial Collateral Ligament (MCL), and the Lateral Collateral Ligament (LCL). Injuring any of these ligaments is one of the most common sports-related injuries. This is seen particularly in sports that involve changes in direction, e.g. soccer, and from direct impact on the knee, e.g. rugby. People with these injuries often report hearing a popping sound from the knee and feeling the knee give way. Often they experience rapid swelling and discomfort walking, and feel as if the knee is unstable or “won’t hold them”.
Meniscus Tears
Meniscus Tear A relatively uncommon cause of knee pain is a meniscus tear. The meniscus is a rubbery, C-shaped, tough cartilage that acts as a cushion between the shinbone and the thighbone. It can be torn if the knee is suddenly twisted while the leg is bearing some weight. Older people are more likely to have degenerative meniscal tears. These are tears that result from minor or unnoticed injury that weaken tissue over time. A strong force on the knee, especially when the knee is bent or twisted, can cause the meniscus to tear. This injury is common in sports such as football and rugby and can cause swelling and stiffness in the knee. A piece of the torn meniscus can then dislodge and drift into the joint causing the knee to slip, pop, or lock. High chances, this injury is followed by stiffness and limited motion and a sensation of the knee joint “giving way”. This will affect the stability of the knee and if it is not treated properly could lead to further injury of the knee joint.
Overuse and Repetitive Strain
Overuse injuries occur as a result of repetitive strain on the knee. They range from prolonged simple activities, e.g., walking and climbing stairs, to more vigorous activities, e.g., running and jumping. These activities cause the muscles to become fatigued and unable to absorb added force. Eventually, the soft tissues give way. Common examples of this are iliotibial band friction syndrome and runner’s knee. These are seen especially in the running and jumping activities and can often result in a complete tear of the affected soft tissue. Patients often report activity-related pain and stiffness. Treatment involves activity modification, physiotherapy, and addressing any biomechanical flaws that may have caused the overuse. Soft tissue pain can often be very frustrating for patients, and making an accurate diagnosis is important as it often determines the prognosis.
Treatments for Knee Pain
Physical therapy may play a big role in the treatment of a knee problem. This includes exercise programs and manual therapy. If exercises are performed correctly and the right program is followed, the result can be great. It will help in decreasing pain, improving function, and it will also provide education on prevention of future recurrences. There are a few reasons why the exercises would be carried out. These would be to receive the correct balance in the muscles, to improve the range of motion in the knee, and to improve the strength in the muscles. Manual therapy is basically where hands are used to mobilize soft tissues and joints, and it also improves the range of motion of a joint. It’s known to be beneficial as it produces a mechanical pressure which causes a reduction in pain and an increase in the mobility of the knee. In terms of exercises, the main benefit that will be gained is strength. This is of vast importance because the quadriceps are known to help in protection of the knee, and with them being strong, it will make an impact in its prevention from any future injuries. Customized knee exercises can be taught, such as cycling, and it’s an easy, cheap, and effective way to improve the condition of an injured knee. It’s particularly beneficial if the patient is unable to bear weight on the knee. Lying exercises are also incredibly helpful as they put very little stress on the knee, and the same benefits can be gained as those from any exercises that are done in a standing position.
Physical Therapy
Physical therapy is an essential part of pain alleviation and recovery when it comes to knee pain. A therapist will work with you to strengthen the muscles that support the knee, and one of the major causes of knee pain is weakness in these muscles. Different exercises are used to build strength in specific muscles and your therapist will choose the appropriate ones depending on your individual circumstances. For example, if the quadriceps (thigh) muscles are weak, then exercises to target this specific muscle group will be performed. Range of motion exercises are heavily focused on to ensure that there is full movement in the knee joint. If the joint is stiff because of pain or a long-standing condition, then the therapist will use manual techniques to regain movement, then move onto strengthening exercises to ensure there is no future stiffness. Overall, the purpose of the therapy is to correct any faulty biomechanics. It is an often overlooked part of full rehabilitation from knee pain. Another method of therapy is the use of electrical stimulation, which is used to activate muscle groups in cases where the patient is finding exercise difficult. This could be due to pain inhibition or due to after-effects of surgery. A therapist who is experienced in the field of knee rehabilitation will know how to apply this treatment correctly to ensure it is effective.
Medications
Paracetamol is another form of medication which is widely used for knee pain. This drug is an analgesic and does not possess any anti-inflammatory properties. Despite this, it is effective in controlling mild pain and is suitable for patients who are unable to take anti-inflammatory drugs. Patients with more severe pain may take stronger medication such as codeine, which has an effect on the central nervous system and can be used in combination with paracetamol for added pain relief. It should be noted that there are health implications associated with this type of drug and patients should seek advice from a knee pain specialist or pharmacist.
Usually when people talk about medication, they are usually referring to anti-inflammatory drugs. This class of drug can be broken down into two categories, steroidal anti-inflammatory drugs (SAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs). This form of medication is usually given to ease pain and reduce inflammation of an acute injury such as a sprain or strain. Medication usually takes the form of tablets, but the use of SAIDs can sometimes be administered by a doctor in the form of injection for patients with conditions like rheumatoid arthritis.
There are many classes of drugs that are used for the treatment of knee pain. Some are available without a prescription (over the counter), while others are prescribed by a doctor. The type of drug will depend on the underlying cause of the pain. Often, patients will use a combination of drugs to control their symptoms. Below, several classes of drugs are discussed.
Injections
There are a range of different injections that can help to treat knee pain conditions. The most common injections are corticosteroid (also called cortisone) and lubricant. Cortisone is an anti-inflammatory agent which can help reduce the inflammation in your knee that is causing pain. It is not a pain reliever. Pain relief is often experienced when inflammation is reduced. The relief may last days or even years, and if the symptoms return, the injection can be repeated. Cortisone injections are often used for the treatment of various forms of arthritis within the knee. The quantity and results of the relief are unpredictable, and there are a number of possible side effects. Usually, there is a limit of 4-6 cortisone injections into the same spot. Too many injections may contribute to degeneration of the tendons. Cortisone cannot be used if an infection is present, and it is usually held off in the event of bleeding disorders.
Sometimes, your knee pain can be excruciating, and a physician might suggest an injection in your knee that might assist in diagnosing or treating your knee problem. And this is certainly the last option one must consider before going for surgery. If the injecting procedure is meant for diagnosis, the doctor might inject an anesthetic solution in your knee to see if the source of pain is from the knee joint. If the anesthetic is able to relieve the pain, then the pain is arising mainly from the knee joint. Then the knee pain is coming from a different anatomical part in the knee, and the physician will have to follow up with different types of injections to pinpoint the origin of the pain.
Surgical Options
One option is arthroscopy. This is a surgical procedure in which a tube-like instrument called an arthroscope is inserted into the joint space through a small incision. It is often used to confirm a diagnosis made after a physical examination and other imaging tests such as an MRI. Through the arthroscope, a doctor can see the interior of the joint and in many cases can correct the problem with little surgical risk to the patient.
Knee pain is a devastating condition which affects the majority of the world’s population, regardless of race, gender, culture, or any other factor. Knee pain is a common ailment and it affects many of us at some point in our lives. It may be sudden in onset, as seen in an ACL tear, or may be due to a long-term condition such as arthritis. The severity of knee pain can vary widely. Many knee joint injuries can be classified under the term “knee pain.” Knee surgery carries some risk, and it is always an option of last resort. There are several options available depending on the nature and severity of the knee pain.
Knee Pain Specialists in Singapore
For younger patients with torn ligaments or cartilage, arthroscopic ACL reconstruction and meniscus surgery effectively restore stability of the knee and allow a return to previous activities. Total knee replacement is a highly successful surgery for end-stage knee arthritis. A local study by the Singapore General Hospital found an 89.1% patient satisfaction rate for total knee arthroplasty. It is expected that demand for this surgery will increase in the future, and patients should be encouraged to consult their surgeons regarding when is the best time for surgery to maximize their quality of life in the remaining active years. With the rising cost of Singapore’s medical expenditure, patients are encouraged to buy an integrated shield plan to cover any costly knee surgeries.
Orthopedic surgeons are often the first level of physicians consulted for knee problems and offer a range of treatments, from pain relief medications to physiotherapy to surgery. An orthopedist would have an MBBS or comparable medical qualification with a further 5 years of specialist training and would be a member of the Singapore Orthopedic Association. With an aging population of post-menopausal women, knee osteoarthritis will become an increasing problem for which there is no cure. However, orthopedic surgery can often provide lasting pain relief and improved mobility. Joint-preserving surgeries, such as arthroscopic meniscectomy and microfracture, are usually performed by knee arthroscopy and are effective treatments for mild to moderate knee arthritis and sports injuries.
Orthopedic Surgeons
To become an orthopedic surgeon in Singapore, one has to complete a medical degree, a one-year internship, and pass the medical qualifying examination. Following that, they must complete five years of postgraduate training in surgery and orthopedics before being admitted as a Fellow of the Royal College of Surgeons. Only then can they undergo accreditation in orthopedic surgery. This generally takes another five years, including two major sets of examinations after the specialist’s training is completed. With the ever-expanding sub-specialization of orthopedic surgery, it is useful to know an orthopedic surgeon’s specific area of interest. This does not necessarily mean that they are the specific person you want to see. Most orthopedic surgeons are competent in managing the various conditions of the knee, but sub-specialization within the specialty is inevitable.
Orthopedic surgeons specialize in the surgical management of conditions affecting the musculoskeletal system. You may be referred to an orthopedic surgeon if your knee pain is due to a traumatic injury, such as a fracture or an injury to the ligaments. Chronic or acute meniscus tears and ligament injuries are often managed surgically by orthopedic surgeons with good outcomes. Orthopedic surgeons are also involved with joint replacements of the knee in patients with advanced arthritis. They work closely with the rheumatologist and medical team in managing the general problems of arthritis before opting for surgery in cases with advanced joint destruction.
Sports Medicine Doctors
Sports medicine is a specialized area of medical practice focused on maintaining and improving the quality of fitness and health in athletes and active individuals of all ages and abilities. The sports medicine doctor is educated in both the physical fitness and the athletic activity in the context of the patient’s past history and family history. This allows the sports medicine doctor to provide the patient with a comprehensive plan for fitness promotion, injury prevention, and treatment. A sports medicine doctor will use non-operative methods as a primary approach to treating orthopedic and musculoskeletal injuries. These methods can include modification of activity, physical therapy, splinting, bracing, medication, and/or injection therapy. If operative treatment is indicated, the sports medicine doctor can and often will assist the orthopedic surgeon in coordinating pre and post-operative care.
Rheumatologists
Rheumatologists are physicians who are specially trained to diagnose and treat musculoskeletal disease and systemic autoimmune conditions, commonly associated with knee pain. These health problems affect the joints, muscles, bones, and sometimes other internal organs (e.g., kidney, lungs, blood vessels, brain). Because these diseases often change the way a person lives and feels, rheumatologists are particularly adept at treating knee pain symptoms. They develop a course of treatment and management, taking into consideration the lifestyle and activity levels of the patient. With optimal management, there is often a high chance of remission.
Rheumatologists are medical specialists who can help to diagnose, treat and manage back pain, knee pain, rheumatoid arthritis, gout, ankylosing spondylitis, osteoarthritis, and tendinitis. They can make an enormous difference in the lives of people suffering from severe back pain or knee pain.
Physiotherapists
Physiotherapists commonly treat knee pain Singapore, many people are referred to a physiotherapist as their first mode of treatment. Physiotherapy is frequently successful for many patients, and it is a relatively low cost and low risk form of treatment. Physiotherapists have a broad range of specific treatments for knee pain, but they often include application of modalities to reduce pain and swelling, manual therapy to improve the mobility of stiff joints, exercises to improve the strength of weak muscles, and education/advice to improve the patient’s awareness of the problem and ability to manage it. Some physiotherapists have additional training in the area of knee conditions, and may use more specialized treatment techniques. The ones who do not have much experience or success with the patient’s knee problem, and no improvement is seen after 2-6 sessions, will often refer the patient back to a specialist doctor to ensure that further investigation is considered and to potentially change the mode of treatment. StepDown programme provides a simple and effective pathway to safe and efficient recovery, ultimately serving the patient back to the prior level of function. Treatment for knee pain is potentially quite a large and varied topic, and this page is only an insight into the challenges faced by knee pain sufferers and some of the common treatment approaches. The information presented here is based on what is typically seen with these types of conditions, but everyone is different and occasionally conditions can behave in unusual ways.
Recommendations for Managing Knee Pain
An orthopedic surgeon who specializes in knees can diagnose the cause of the pain and provide various treatment options tailored to the severity of the problem and your needs. Treatments provided can range from medication and physiotherapy to keyhole surgery or knee replacement. Keep in mind that the risks of treatments can vary, and it is best to fully understand and consider them carefully. Note that seeking professional advice and treatment is recommended after following the previous 4 recommendations. It is likely that advice and treatment from a healthcare professional may conflict with the ideas given, and it is best to clarify in order to make the best decision for your knee and your health.
Maintain a Healthy Weight
Obese individuals are often lacking physical mobility to exercise, or the knee osteoarthritis may be too painful to endure weight-bearing exercise. Weight loss with these individuals can be achieved through non-weight-bearing exercise programs, and there is moderate evidence that hydrotherapy, water-based exercise programs, are beneficial for overweight individuals with knee osteoarthritis.
The most effective dietary patterns for weight loss in the management of osteoarthritis and knee pain are low-fat, vegetarian, and low-carbohydrate diets. Comparative studies have been conducted to review if there is a difference between a low-fat and low-carbohydrate diet. A 6-month, non-blinded, randomly assigned trial was conducted on 107 overweight adults, all 50-60 years old. The results showed that a low-carbohydrate diet induced greater weight loss, fat loss, and beneficial effects on inflammation compared to a low-fat diet.
Studies have suggested that calorie restriction and weight loss provide preventive benefits and lower the risk of progression for knee osteoarthritis and osteoarthritis in general. Weight loss in obese patients provides great relief and reduces the risk of progression to osteoarthritis in the knees. Both caloric restriction and exercise provide beneficial results, although weight loss is more effective with a combination of the two. Regular exercise combined with a balanced diet is a good way to achieve and maintain optimal weight for osteoarthritis sufferers.
To understand the cause, people need to understand that many dietary patterns lead to weight gain and are associated with chronic inflammation and changes to the metabolism. These dietary patterns and the increased body fat produce systemic metabolic and inflammatory changes that lead to raised systemic levels of insulin and other growth factors. Among dietary patterns, overeating is a major cause of osteoarthritis and weight gain.
Maintain a healthy weight. Obesity and excess weight strain the joints of the knee and can contribute to the progression of knee osteoarthritis. It is estimated that one pound of weight lost equals to 4 pounds of pressure taken off the knee. Weight loss can be an effective way for people with knee osteoarthritis to reduce pain and disability while increasing activity and mobility.
Exercise Regularly
Regular exercise provides a number of benefits for reducing knee pain, in addition to helping you maintain a healthy weight. Strengthening the muscles around the knee protects the joint, while exercising your entire body helps to retain bone density. Strengthening key muscle groups is an important way to manage knee pain. Quadriceps (front thigh muscle) strengthening is an essential part of reducing knee pain. The amount of pressure transmitted across the knee joint is directly related to the force developed in the quadriceps muscles. The stronger the quads, the less pressure on the knee, and the better the knee will feel. Straight leg raises are a good exercise for the novice. There are many great ways to strengthen quads, such as knee extensions using a machine at the gym, wall sits or the leg press. Be careful not to overdo it with the weights, especially leg presses, as this can cause the knee to hurt more. Hamstring (back thigh muscle) strengthening is also important, as it balances the force of the quadriceps, thus reducing the pressure on the knee joint. Hamstring curls on a machine are a great way to strengthen the hamstrings. Repeat each exercise for three sets of ten. If an increase in knee pain is felt, it is best to stop doing the exercise, as some pain is expected, but it should not exacerbate the problem.
Use Proper Techniques and Equipment
There are certain techniques used in various work or sports activities that can help reduce the stress put on the knees. For example, in jobs that require a lot of kneeling, using a knee pad can reduce the force exerted on the patella. In athletics, it would be beneficial to learn the proper techniques of the game to reduce the risk of injury. As for the choice of footwear, recent findings have shown that the use of special shoe insoles can reduce knee pain in those suffering from knee osteoarthritis. Simulation shoes are also available and have been proven to reduce the load on the knee more effectively than standard shoes.
When handling daily activities or tasks, it is crucial to be equipped with sufficient information on how to execute or perform these duties correctly without causing further injury to your knee. One must understand the nature of the task and have knowledge of the proper techniques and tools needed. For example, when lifting heavy objects, it is vital to use your leg muscles instead of the back. Studies have shown that the use of proper body mechanics can prevent the onset of knee pain or the progression of knee osteoarthritis. This can be applied to using a step stool instead of a chair to reach high places or squatting down instead of kneeling.
Avoid High-Impact Activities
The best way to take the stress off the knee joint is to avoid stair climbing and to decrease the number of steps taken, so that you are using the minimum number of steps to reach a destination. At first, it may be difficult, but after some time, your pain should decrease as you are actually reducing the stress and strain on the joint. Always lead up the stairs with the good leg and lead down with the bad leg. Avoid activities that place 2.5 times body weight on the knee joint. This is the amount of force exerted on the joint while walking. As such, jogging puts 7 times body weight on the knee and running puts 5 times. Step aerobics and deep knee bends also exert excessive force on the joint with loads of 7-8 times body weight and should also be avoided. Permanent long-term damage can occur following an injury to the knee and exacerbation of a pre-existing condition. Even with indirect injuries, the knee can swell up with blood. If such a trauma occurs, it may be necessary to remove the fluid and blood from the joint. This treatment is known as arthrocentesis and involves inserting a needle into the joint and removing the excess fluids. If there is too much damage to the joint, there is a potential for surgery. One option is knee replacement surgery, when a physician will replace part or the entire knee with an artificial joint. This is a very serious procedure but may be the only option for those with debilitating knee conditions.
Seek Professional Advice and Treatment
A certain type of knee pain that happens to people who might have been undertaking exercise programs recently is termed Patellofemoral pain syndrome or ‘runner’s knee’. This type of knee pain can improve with advice and education on the effect of activities on your knee, hip, and lower limb control and strengthening, but can sometimes be a long-term program to prevent reoccurrences.
A physiotherapist can help in diagnosing knee pain and offer treatment which can help in improving the quality of life of an individual. Treatment can vary from manual therapy to exercises or advice on load-bearing strategies.
If you have these symptoms, then a doctor or a physiotherapist would be able to help you with further investigations. They might decide on an X-ray or an MRI scan to see the exact cause of your knee pain. This might be followed by treatment in the form of medication, physiotherapy, injections, or in severe cases, surgery.
You should seek medical help if your knee pain is: – Severe or disabling – Chronic (long term) – Associated with swelling, deformity or weakness – Not due to an obvious injury – Not relieved by routine self-help measures
