What is Knee Pain? Causes, Symptoms, Diagnosis and Treatments
What is Knee Pain? - Problem :
What is Knee Pain? - Problem:
- Most people have had a minor knee problem at one time or another. Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries most often occur during sports or recreational activities, work-related tasks, or home projects. The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. See an illustration of the structures of the knee. Although a knee problem is often caused by an injury to one or more of these structures, it may have another cause. Some people are more likely to develop knee problems than others. Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase your chances of having problems with your knees.
- Knee pain is a common presenting complaint in primary care – approximately 9.8 million office visits annually. In addition, 1.3 million patients annually present to emergency departments with the problem of acute knee trauma. Patellofemoral syndrome and osteoarthritis cause the majority of knee pain, which respond well to knee strengthening exercises and symptomatic care. Radiographs and MRIs are usually not useful for the evaluation of non-traumatic knee pain unless indicated by history and physical examination.
History and Physical Exam:
The history and physical exam are the most important components of the evaluation and should focus on differentiating the causes of knee pain. If history is suggestive of an inflammatory disorder, a complete physical exam should be obtained, as should appropriate lab testing. Components of a knee exam include:
- Onset, history and location of pain
- Previous history of similar problems in knee or other joints
- Response to activity
- Factors that aggravate pain
- Factors that relieve pain
- Presence and location of swelling
- Grinding, catching, locking or snapping
- Fever or chills
- Change in sensation or muscle strength
How to Resolve Knee Pain
- Visual inspection for dislocations and fractures
- Presence and location of swelling (intra-articular, prepatellar bursa, posterior (Baker’s cyst))
- Presence and location of warmth
- Presence and location of crepitus
- Foot pulses
- Palpate for tenderness (peripatellar, patella, patella tendon, tibial tuberosity, medial and lateral joint lines, medial and lateral collateral ligaments, and pes anserine bursa)
- Apprehension and pain with lateral displacement of patella for indications of patella subluxation or dislocation
- Active range of motion (normal = 0 - 135 )
- Passive range of motion
- Joint line pain or tenderness with extension or flexion is compatible with meniscus tear
- Meniscal compression tests (McMurray’s) to evaluate for torn meniscus
- Varus/valgus instability at 30° of flexion for damage to collateral ligaments
- Evaluate hip range of motion for underlying hip pathology
- Survey other joints for signs of underlying rheumatologic disorder
- Consider indications for fluid analysis (a traumatic effusion and joint redness/warmth)
Sudden Injuries :
Injuries are the most common cause of knee
problems. Sudden (acute) injuries may be caused by a direct blow to the
knee or from abnormal twisting, bending the knee, or falling on the
knee. Pain, bruising, or swelling may be severe and develop within
minutes of the injury. Nerves or blood vessels may be pinched or
damaged during the injury. The knee or lower leg may feel numb, weak,
or cold; tingle; or look pale or blue. Acute injuries include
It is very important to relieve the initial knee pain for comfort and to enable the performance of other rehabilitation exercises. Ice is effective in controlling pain and swelling after sports and after rehabilitation exercises. A bag of ice chips or frozen vegetables can be placed over the knee for 10 to 20 minutes. or water can be frozen in a paper cup and portion of the cup can be torn away to rub the ice over the knee. Ibuprofen can help ease pain and inflammation and can be used in the short term for pain relief activity. Elevation of the knee above the level of the heart can also relieve swelling after activity.
Knee osteoarthritis is a common cause of knee pain. The risk increases with age. Osteoarthritis is a form of arthritis involving degeneration of the cartilage. Exercise is vital to maintain strength and flexibility of muscles supporting the knee, which reduces the stress on the knee joint.
People with knee osteoarthritis may also need to take pain medications and/or other complementary pain treatments.
Knee Pain Treatment:
Your doctor may recommend that you manage your arthritis pain by maintaining a healthy weight. A balanced diet helps manage weight and helps you stay healthy. Additional pressure (weight) on weight bearing joints, such as hips and knees, may aggravate your arthritis. By managing your weight, stress is reduced on weight-bearing joints.
A variety of exercises may also be recommended to help you maintain flexibility and manage weight. According to the Arthritis Foundation, research has shown that exercise is an essential tool in managing your arthritis. Exercises can reduce joint pain and stiffness, build strong muscle around the joints and increase flexibility. Exercise is an important part of arthritis treatment that is most effective when done properly and routinely.
Range of motion (ROM) exercises can help you maintain normal joint movement. They also increase flexibility and relieve stiffness in your hip.
Strengthening exercises will help you increase muscle strength which helps support and protect joints affected by arthritis.
Aerobic exercise improves cardiovascular fitness, can help control weight and may help reduce inflammation in joints.
Your local chapter of the Arthritis Foundation may be able to suggest an exercise program for you.
Rest & Joint Care:
The most important way to improve your condition is rest and rehabilitation.
At home, general care involves "RICE":
- Bracing and Orthotics
- Braces or shoe inserts may be recommended to take pressure off of certain joints
Short-term bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints.
Heat Therapy - increases blood flow, tolerance for pain, flexibility.
Cold Therapy - such as cold packs, ice massage, OTC sprays and ointments - reduces pain by numbing the nerves around the joint.
Your doctor may recommend visiting a
physical therapist. Physical therapy can be helpful in the management
of Osteoarthritis (OA) and Rheumatoid Arthritis (RA). For example, a
physical therapist may recommend:
Isometric ("pushing") exercises to help build muscle strength without subjecting inflamed joints to excessive wear
Isotonic ("pulling") exercises to further increase muscle strength and help preserve function
Daily walking, using a cane or other assistive device as needed
The goal is to get you back to the point where you can perform normal, everyday activities without difficulty. Preserving good range of motion is key to maintaining the ability to perform daily activities. Physical therapists provide exercises designed to preserve the strength and use of your joints. They will show you the best way to move from one position to another and teach you how to use walking aids.
How to fix knee pain with exercise
Symptoms of knee pain:
- Knee joint swelling/ pain on touch along the knee joint line.
- Stiffness of the knee.
- Deformity of the joint like knock-knees and bowlegs.
- Clicking 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.
When to Contact to your Doctor:
- You cannot bear weight on your knee.
- You have severe pain, even when not bearing weight.
- Your knee buckles, clicks, or locks.
- Your knee is deformed or misshapen.
- You have a fever, redness or warmth around the knee, or significant swelling.
- You have pain, swelling, numbness, tingling, or bluish discoloration in the calf below the sore knee.
- You still have pain after 3 days of home treatment
Knee Pain Causes:
In the simplest terms, a joint occurs wherever two bones come together. But that definition doesn't begin to convey the complexity of joints, which provide your body with flexibility, support and a wide range of motion.
You have four types of joints: fixed, pivot, ball-and-socket and hinge. Your knees are hinge joints, which, as the name suggests, work much like the hinge of a door, allowing the joint to move backward and forward. Your knees are the largest and heaviest hinge joints in your body. They're also the most complex. In addition to bending and straightening, they twist and rotate. This makes them especially vulnerable to damage, which is why they sustain more injuries on average than do other joints.
A closer look at your knees:
Your knee joint is essentially four bones held together by ligaments. Your thighbone (femur) makes up the top part of the joint, and two lower leg bones, the tibia and the fibula, comprise the lower part. The fourth bone, the patella, slides in a groove on the end of the femur.
Ligaments are large bands of tissue that connect bones to one another. In the knee joint, four main ligaments link the femur to the tibia and help stabilize your knee as it moves through its arc of motion. These include the collateral ligaments along the inner (medial) and outer (lateral) sides of your knee and the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone.
Other structures in your knee include:
- Tendons. These fibrous bands of tissue connect muscles to bones. Your knee has two important tendons, which make it possible for you to straighten or extend your leg: the quadriceps tendon, which connects the long quadriceps muscle on the front of your thigh to the patella, and the patellar tendon, which connects the patella to the tibia.
- Meniscus. This C-shaped cartilage, which curves around the inside and outside of your knee, cushions your knee joint.
- Bursae. A number of these fluid-filled sacs surround your knee. They help cushion your knee joint so that ligaments and tendons slide across it smoothly.
Normally, all of these structures work together smoothly. But injury and disease can disrupt this balance, resulting in pain, muscle weakness and decreased function.
Some common causes of knee pain and injuries include:
- A blow to the knee, either from contact during sports, a fall or a car accident.
- Repeated stress or overuse, which may occur from playing sports or if your work or hobby requires doing the same activity over and over again.
- Sudden turning, pivoting, stopping, cutting from side to side, which happens frequently during certain sports.
- Awkward landings from a fall or from jumping during sports, such as basketball.
- Rapidly growing bones, which are especially prone to injury during sports.
- Degeneration from aging.
Prevent of Knee Pain:
Prevent knee pain by keeping the muscles that support your knees strong and flexible. Start out slowly. Walk before you run - before you engage in a strenuous high impact activity such as jogging or running, try walking for a week. If walking causes knee pain, you shouldn't be running. Warm up and stretch before working out. Give your body a chance to recover from exercise. If you do high impact activities take every other day off. Avoid running up and down stairs and full squats. Doing knee exercises to strengthen and stretch the muscles that support the knee are vital for knee pain and injury prevention. Proper footwear is also important, especially if walking or running on hard surfaces. Keep your weight under control. Reducing one's weight reduces stress upon the knee.
Knee brace use:
Some people use knee braces to prevent knee injuries or after a knee injury. There are many types of knee braces, from soft fabric sleeves to rigid, metal hinged braces, that support and protect the knee. If your doctor has recommended the use of a knee brace, follow his or her instructions. If you are using a knee brace to help prevent problems, follow the manufacturer's instructions for use.
Understanding What is Knee Pain?
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