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Patient Education about Knee Pain

The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:

  • The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
  • The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
  • The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.
Numerous bursae, or fluid-filled sacs, help the knee move smoothly.

Your knee joints serve a vital role holding up your bodyweight and are put through even more pressure when you walk, run or jump. Knee pain is very common, both from sport injuries and the wear and tear of day-to-day life.

Knee pain can come from injuries including sprains, swollen or torn ligaments (anterior cruciate ligament or ACL), meniscus or cartilage tears and runner’s knee.

Sports injuries tend to affect one knee at a time. Pain in both knees is more common with arthritis, osteoarthritis, gout or pseudogout, usually later in life.

Conditions that cause knee pain

  • Tendonitis. This is an overuse injury causing swelling of the tendons, the bands of tissue that connect your bones and muscles. This is sometimes called ‘jumper’s knee’ as it is common in sports involving jumping, such as basketball.
  • Bone chips. Sometimes, a knee injury can break off fragments from the bone or cartilage. These pieces can get stuck in the joint, causing it to freeze up. You may also have pain and swelling.
  • Housemaid’s knee or bursitis is caused by kneeling for long periods of time or repetitive knee movements. Fluid builds up in the bursa, the sac of fluid that cushions the knee joints. Swelling behind the knee is called a ‘Baker’s cyst’ and may be caused by injuries or arthritis.
  • Bleeding in the knee joint. This injury is also called haemarthrosis and affectsblood vessels around the knee ligaments causing the knee to feel warm, stiff, bruised and swollen. This may require hospital treatment in serious cases.
  • Iliotibial band syndrome. This is an overuse injury to the iliotibial band of tissue that runs from the hip to the shin past the knee.
  • Medial plica syndrome. This overuse injury affects the plica, a fold of tissue in the knee joint.
  • Osgood- Schlatter Disease. This overuse condition is common in teenagers playing sport and causes swelling and tenderness over the bony bump just below the knee.
  • Partially dislocated kneecap (or patellar subluxation). This is usually due to a physical condition with the legs rather than a sports injury. The kneecap slides out of position and causes pain and swelling.

Treatment for knee pain

Treatment will depend on the type and severity of the injury. Many knee injuries will get better on their own, or can be treated at home. Avoid putting weight on the injured knee as much as possible. Raise the leg with cushions and use an ice pack or bag of frozen veg wrapped in a towel held to the knee. Painkillers such asibuprofen can help with pain and swelling.

You may need to see your GP or seek medical advice if:

  • No weight can be put on the injured knee
  • There’s severe pain when no weight is put on the knee
  • The knee locks, clicks painfully or gives way
  • The knee looks deformed
  • There’s fever, redness or a feeling of heat around the knee, or there’s extensive swelling
  • The calf beneath the injured knee is painful, swollen, numb or tingling
  • Pain is still there after three days of home care treatment

A doctor will carry out a physical examination of the injured knee and may arrange some extra tests, including blood tests, an X-ray or MRI scan.

Treatment may involve physiotherapy, painkillers and sometimes an arthroscopy – a form of keyhole surgery that is used to look inside a joint and repair any damage that has occurred.

When will my knee pain feel better?

Recovery from knee pain will depend on the type and severity of the injury.

If recovery prevents you doing high impact sport such as running, try a low impact one like swimming.

Preventing knee pain

Knee pain cannot always be avoided, but good precautions include stretching, warming up and cooling down around a workout or playing sport. Having the right equipment, such as trainers designed for running and kneepads for jobs involving kneeling can help.

Stop exercising if you feel pain in your knee.

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Pain Behind Knee

Pain Behind knee is a major problem for a lot of people and many of them have been suffering from it for years now. In most cases, the patients that get pain behind the knee are older in age. Usually, the case of the pain is either an older knee injury, or a problem of an orthopedic nature. One of the possible causes for pain behind the knee is the excess weight. The problem can either be the fact that you carry heavy objects around, or it can be excessive body weight. The possibility that an injury will appear increases considerably in this case and the bone degeneration is much faster as well. The result is the appearance of pain behind knee.

Causes of Pain Behind the Knee

Back of Knee pain causes can be many, so it’s not always easy to figure out which one is the problem in your case. This type of pain can be caused by arthritis, cartilage injury, baker’s cyst, ligament injury, patellar tendonitis or a meniscal tear. This type of problem can appear in patients of all ages.

 

  • Arthritis is one of the possible explanations for knee pain, a condition which appears when the joint gets inflamed. You will find that there is medication available which can be used to treat it, medication which can be obtained by visiting a doctor, which can confirm the problem.
  • Injuries in the ligament area can appear because of a few different problems, including injuries to the MCL (medical collateral ligament),PCL (Posterior Cruciate Ligament) and ACL (Anterior Cruciate Ligament). Treating this type of injury is sometimes a matter of a surgical procedure, but that’s a call that the doctor has to make, based on what he finds and on the symptoms. This type of injury is usually experienced by athletes.
  • Meniscal tear is another type of cause for knee pain and it’s a type of cartilage injury. It doesn’t matter if you’re old or young, you can still get this type of injury. The cause is sometimes traumatic injury, which is something that athletes experience. In other cases, when the patient is older, the cause is usually a degenerative process, caused by brittle bones. The tests which tell doctors if a meniscal tear is the cause of the pain include MRIs and x-rays.
  • Another potential cause for pain behind knee is the condition known as Patellar Tendonitis, which appears because of the knee’s extreme usage. The knee is surrounded by tissue and tendon, which can become irritated and swollen. Another name that is used for this condition is Jumper’s knee, since it often appears during jumping, when the knee is used excessively. Athletes which practice sports which require lots of jumping will often have this problem, especially if they’re not reducing the amount of physical activity they do.
  • The baker’s cyst is another major knee pain cause.It is also known as popliteal cyst.In this type of condition, fluid accumulates in the area behind the joint of the knee.This is not something that can spread behind the area where it appears though, so it is not considered a tumor. This condition is something that older people get and young individuals don’t usually have a problem with it.

Back of Knee Pain Symptoms

Feeling pain in back of knee usually happens because of an inflammation of the knee joints, making it difficult to move it backward or forward, either when climbing or walking stairs. If you’re having this type of problem, it’s a good idea to talk with a physiotherapist, so he can give you advice on the right posture to keep when you’re carrying or lifting heavy objects. One other possible reason why you would feel pain in that area is because of a weaker hamstring. These muscles are important when you want to bend the knee, together with the quadriceps muscles.

Treatment options for Pain Behind the Knee

If you want to reduce the chance that you will get an injury to the knee and if you want to keep them as supple as possible, you should try to make sure that the joints remain flexible and strong. When you do feel pain behind your knee, you should try resting it, while applying a cold compress on it. At the same time, try to make sure that the symptoms don’t get any worse.

When it’s a chronic case, you should discuss the problem with a doctor, in order to get a course of treatments which will improve your situation. Once the doctor examines you and figures out what causes the knee pain, he will be able to give you some recommendations. One example would be to wear some knee braces, which would help the ligaments act naturally, while easing your knee soreness feeling. There are a number of different types of equipments available for gyms which can help with the pain you feel behind your knee. They work by making weak muscles stronger, muscles which give support to the joint of the knee. It is advisable that you discuss it with a physiotherapist though, as he knows best what you need and he can give you advice on the sets of exercises which will not force the joints.

These days, there are improved surgical procedures and better drugs that are anti inflammatory, so if you have damaged tissue area and knee joints chances are better than ever that the doctors will be able to fix the problem. The patients that suffer from these problems today are much more likely to recover faster and to get back a good function level of the joint, while getting rid of pain at the same time.

Know your limits

People don’t know the limits of what their body can do, or they don’t realize that as they grow older, they can’t do as much as before. Repeated stress put on the knees can result in injuries and pain. The best course of treatment for pain behind  knee is preventing it in the first place, something that is true for many medical issues.

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Patient Guide to Knee Pain

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.

Symptoms

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee

When to see a doctor
Call your doctor if you:

  • Can’t bear weight on your knee
  • Have marked knee swelling
  • Are unable to fully extend or flex your knee
  • See an obvious deformity in your leg or knee
  • Have a fever, in addition to redness, pain and swelling in your knee
  • Feel as if your knee is unstable or your knee “gives out”

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

  • ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball, soccer or other sports that require sudden changes in direction.
  • Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
  • Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
  • Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists, and those involved in jumping sports and activities are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems
Some examples of mechanical problems that can cause knee pain include:

  • Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
  • Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.
  • Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you’ll be able to see the dislocation.
  • Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:

  • Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
  • Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
  • Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
  • Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
  • Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems
Chondromalacia patellae (patellofemoral pain syndrome) is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in athletes; in young adults, especially those who have a slight misalignment of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

Risk factors

A number of factors can increase your risk of having knee problems, including:

  • Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
  • Biomechanical problems. Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make you more prone to knee problems.
  • Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don’t absorb enough of the stress exerted on the joint.
  • Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
  • Previous injury. Having a previous knee injury makes it more likely that you’ll injure your knee again.

Complications

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.

Preparing for your appointment

You’re likely to start by seeing your family doctor. Depending upon the cause of your problem, he or she may refer you to a doctor specializing in joint diseases (rheumatologist), joint surgery (orthopedic surgeon) or sports medicine.

What you can do
Before your appointment, you may want to write a list of answers to the following questions:

  • When did you begin experiencing symptoms?
  • Did a specific injury make your knee start to hurt?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications and supplements do you take regularly?

What to expect from your doctor
Your doctor may ask some of the following questions:

  • Do you exercise or play sports?
  • Do you experience any swelling, instability or locking of the knee?
  • Are you experiencing symptoms in other areas, or just in your knee?
  • Have you ever had knee pain before? If so, do you know what the cause was?

Tests and diagnosis

During the physical exam, your doctor is likely to:

  • Inspect your knee for swelling, pain, tenderness, warmth and visible bruising
  • Check to see how far you can move your lower leg in different directions
  • Push on or pull the joint to evaluate the integrity of the structures in your knee

Imaging tests
In some cases, your doctor might suggest tests such as:

  • X-ray. Your doctor may first recommend having an X-ray, which can help detect bone fractures and degenerative joint disease.
  • Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles, to create cross-sectional images of the inside of your body. CT scans can help diagnose bone problems and detect loose bodies.
  • Ultrasound. This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee, and how they are working. Your doctor may want to maneuver your knee into different positions during the ultrasound, to check for specific problems.
  • Magnetic resonance imaging. MRI uses radio waves and a powerful magnet to create 3-D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

Lab tests
If your doctor suspects an infection, gout or pseudogout, you’re likely to have blood tests and sometimes arthrocentesis, a procedure in which a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.

Treatments and drugs

Treatments will vary, depending upon what exactly is causing your knee pain.

Medications
Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.

Therapy
Strengthening the muscles around your knee will make it more stable. Training is likely to focus on the muscles on the front of your thigh (quadriceps) and the muscles in the back of your thigh (hamstrings). Exercises to improve your balance are also important.

Arch supports, sometimes with wedges on one side of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. In certain conditions, different types of braces may be used to help protect and support the knee joint.

Injections
In some cases, your doctor may suggest injecting medications directly into your joint. Examples include:

  • Corticosteroids. Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.
  • Supplemental lubrication. A thick fluid, similar to the fluid that naturally lubricates joints, can be injected into your knee to improve mobility and ease pain. Relief from one or a series of shots may last as long as six months to a year.

Surgery
If you have an injury that may require surgery, it’s usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what’s most important to you. If you choose to have surgery, your options may include:

  • Arthroscopic surgery. Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage, and reconstruct torn ligaments.
  • Partial knee replacement surgery. In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You’re also likely to heal more quickly than you are with surgery to replace your entire knee.
  • Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Lifestyle and home remedies

Over-the-counter medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) — may help ease knee pain. Some people find relief by rubbing their knees with creams containing a numbing agent, such as lidocaine or capsaicin, the substance that makes chili peppers hot.

Self-care measures for an injured knee include:

  • Rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time.
  • Ice. Ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You can also use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.
  • Compression. This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation.
  • Elevation. To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner.

Alternative medicine

  • Glucosamine and chondroitin. Study results have been mixed about the effectiveness of these supplements for relieving osteoarthritis pain. People who have moderate to severe arthritis pain appear to get the most benefit from these supplements.
  • Acupuncture. Research suggests that acupuncture may help relieve knee pain caused by osteoarthritis. Acupuncture involves the placement of hair-thin needles into your skin at specific places on your body.

Prevention

Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:

  • Keep extra pounds off. Maintain a healthy weight; it’s one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
  • Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning. Work with a coach or trainer to ensure that your technique and movement are the best they can be.
  • Get strong, stay limber. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.
  • Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

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