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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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Knee Ostearthritis

Osteoarthritis (OA) of the Knee is one the most common knee joint disorder, which is due to aging and wear and tear on the knee joint.

Causes, incidence, and risk factors

Osteoarthritis of the knee is a normal result of aging. It is also caused by constant ‘wear and tear’ on the knee joint.

  • Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
  • If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness around your knee.
  • Bony spurs or extra bone may form around the knee joint. The ligaments and muscles around the knee joint become weaker and stiffer which cause discomfort.

Often, the cause of Osteoarthritis of the knee is unknown. It is mainly related to aging.

The symptoms of Osteoarthritis of the knee usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.

Before age 55, Osteoarthritis of the knee occurs equally in men and women. After age 55, it is more common in women.

Other factors can also lead to Osteoarthritis of the knee

  • Osteoarthritis of the knee tends to run in families.
  • Being overweight increases the risk of Osteoarthritis of the knee joints because extra weight causes more wear and tear.
  • Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and cruciate ligaments in your knee joints.
  • Jobs that involve kneeling or squatting for more than an hour a day put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
  • Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis.

Medical conditions that can lead to Osteoarthritis of the knee include:

  • Bleeding disorders that cause bleeding in the joint, such as hemophilia
  • Disorders that block the blood supply near a joint and lead to avascular necrosis
  • Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

Symptoms

Pain and stiffness in the knee joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint.

If you have Osteoarthritis of the knee, your knee joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the knee joint.

The phrase “morning stiffness” refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that “warms up” the joint.

During the day, the pain may get worse when you’re active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night.

Some people might not have symptoms, even though x-rays show the changes of Osteoarthritis of the knee.

Signs and tests

A physical exam can show:

  • Joint movement may cause a cracking (grating) sound, called crepitation
  • Joint swelling (bones around the joints may feel larger than normal)
  • Limited range of motion
  • Tenderness when the joint is pressed
  • Normal movement is often painful

No blood tests are helpful in diagnosing Osteoarthritis of the knee.

An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.

Treatment

Osteoarthritis of the knee will most likely get worse over time. However, your Osteoarthritis of the knee symptoms can be controlled.

You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.

MEDICATIONS

Over-the-counter pain relievers, which you can buy without a prescription, can help with Osteoarthritis of the knee symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs. If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.

Other medications or supplements that you may use include:

  • Corticosteroids injected right into the joint to reduce swelling and pain
  • Over-the-counter remedies such as glucosamine and chondroitin sulfate
  • Capsaicin (Zostrix) skin cream to relieve pain
  • Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 – 6 months

LIFESTYLE CHANGES

Staying active and getting exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Other lifestyle recommendations include:

  • Applying heat and cold
  • Eating a healthy, balanced diet
  • Getting rest
  • Losing weight if you are overweight
  • Protecting the joints

As the pain from your Osteoarthritis of the knee becomes worse, keeping up with everyday activities may become more difficult or painful.

  • Sometimes making changes around the home will take some stress off your joints, and relieve some of the pain.
  • If your work is causing stress in certain joints, you may need to adjust your work area or change work tasks.

SURGERY

Severe cases of Osteoarthritis of the knee might need surgery to replace or repair damaged joints. Surgical options include:

  • Arthroscopic surgery to trim torn and damaged cartilage
  • Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
  • Surgical fusion of bones, usually in the spine (arthrodesis)
  • Total or partial replacement of the damaged joint with an artificial joint (knee replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)

Expectations (prognosis)

Every person with Osteoarthritis of the knee is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities.

Your movement may become very limited over time. Doing everyday activities, such as personal hygiene, household chores, or cooking may become a challenge. Treatment usually improves function.

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About Knee

How is the knee designed, and what is its function?

The knee is a joint that has three compartments. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third compartment called the patellofemoral joint. The thigh bone (femur) meets the large shinbone (tibia) forming the main knee joint.

The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.

The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for motion and absorbs the load of the body above the knee when standing. The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons. Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone. There are large blood vessels passing through the area behind the knee (referred to as the popliteal space). The large muscles of the thigh move the knee. In the front of the thigh, the quadriceps muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee. The knee also rotates slightly under guidance of specific muscles of the thigh.

The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to a maximum of 135 degrees and extends to 0 degrees. The bursae, or fluid-filled sacs, serve as gliding surfaces for the tendons to reduce the force of friction as these tendons move. The knee is a weight-bearing joint. Each meniscus serves to evenly load the surface during weight-bearing and also aids in disbursing joint fluid for joint lubrication.

What injuries can cause knee pain, and what other symptoms may accompany knee pain? How is knee pain diagnosed?

Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.

Ligament injury

Trauma can cause injury to the ligaments on the inner portion of the knee (medial collateral ligament), the outer portion of the knee (lateral collateral ligament), or within the knee (cruciate ligaments). Injuries to these areas are noticed as immediate pain but are sometimes difficult to localize. Usually, a collateral ligament injury is felt on the inner or outer portions of the knee. A collateral ligament injury is often associated with local tenderness over the area of the ligament involved. A cruciate ligament injury is felt deep within the knee. It is sometimes noticed with a “popping” sensation with the initial trauma. A ligament injury to the knee is usually painful at rest and may be swollen and warm. The pain is usually worsened by bending the knee, putting weight on the knee, or walking. The severity of the injury can vary from mild (minor stretching or tearing of the ligament fibers, such as a low grade sprain) to severe (complete tear of the ligament fibers). Patients can have more than one area injured in a single traumatic event.

Ligament injuries are initially treated with ice packs, immobilization, rest, and elevation. It is generally recommended to avoid bearing weight on the injured joint, and crutches may be required for walking. Some patients are placed in splints or braces to immobilize the joint to decrease pain and promote healing. Arthroscopic or open surgery may be necessary to repair severe injuries.

Surgical repair of ligaments can involve suturing alone, grafting, and synthetic graft repair. These procedures can be done by either open knee surgery or arthroscopic surgery (described in the section below). The decision to perform various types of surgery depends on the level of damage to the ligaments and the activity expectations of the patient. Many repairs can now be done arthroscopically. However, certain severe injuries will require an open surgical repair. Reconstruction procedures for cruciate ligaments are increasingly successful with current surgical techniques.

Meniscus tears

The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or an unstable sensation in the knee joint. The doctor can perform certain maneuvers while examining the knee which might provide further clues to the presence of a meniscal tear.

Routine X-rays, while they do not reveal a meniscal tear, can be used to exclude other problems of the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy, arthrography, or an MRI.

Arthroscopy is a surgical technique by which a small diameter video camera is inserted through tiny incisions on the sides of the knee for the purposes of examining and repairing internal knee joint problems. Tiny instruments can be used during arthroscopy to repair the torn meniscus.

Arthrography is a radiology technique whereby a contrast liquid is directly injected into the knee joint and internal structures of the knee joint thereby become visible on X-ray film.

An MRI scan is another radiology technique whereby magnetic fields and a computer combine to produce two- or three-dimensional images of the internal structures of the body. It does not use X-rays and can give accurate information about the internal structures of the knee when considering a surgical intervention. Meniscal tears are often visible using an MRI scanner. MRI scans have largely replaced arthrography in diagnosing meniscal tears of the knee. Meniscal tears are generally repaired arthroscopically.

Tendinitis

Tendinitis of the knee occurs in the front of the knee below the kneecap at the patellar tendon (patellar tendinitis) or in the back of the knee at the popliteal tendon (popliteal tendinitis). Tendinitis is an inflammation of the tendon, which is often produced by a strain event, such as jumping. Patellar tendinitis, therefore, also has the name “jumper’s knee.” Tendinitis is diagnosed based on the presence of pain and tenderness localized to the tendon. It is treated with a combination of ice packs, immobilization with a knee brace as needed, rest, and anti-inflammatory medications. Gradually, exercise programs can rehabilitate the tissues in and around the involved tendon. Anti-inflammatory injections, which can be given for tendinitis elsewhere, are generally avoided in patellar tendinitis because there are reports of risk of tendon rupture as a result of corticosteroids in this area. In severe cases, surgery can be required. A rupture of the tendon below or above the kneecap can occur. When it does, there may be bleeding within the knee joint and extreme pain with any knee movement. Surgical repair of the ruptured tendon is often necessary.

Fractures

With severe knee trauma, such as motor vehicle accidents and impact traumas, bone breakage (fracture) of any of the three bones of the knee can occur. Bone fractures within the knee joint can be serious and can require surgical repair as well as immobilization with casting or other supports.

What are diseases and conditions that can cause knee pain, and what is the treatment for knee pain?

Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, immune diseases that affect various tissues of the body including the joints to cause arthritis.

Arthritis is inflammation within a joint. The causes of knee joint inflammation range from noninflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis (such as rheumatoid arthritis or gout). Treatment of the arthritis is directed according to the nature of the specific type of arthritis. Many people suffer from arthritis; the pain and discomfort can be so limiting that some patients may require a total knee joint replacement. Knee replacement surgery often allows the patient to regain much of their mobility.

Swelling of the knee joint from arthritis can lead to a localized collection of fluid accumulating in a cyst behind the knee. This is referred to as a Baker cyst and is a common cause of pain at the back of the knee.

Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee. These infections are often diagnosed by aspirating joint fluid accumulations with a needle (joint aspiration) and examining the fluid microscopically and with microbial culture techniques. Treatment is done with antibiotics.

Tumors involving the joint are extremely rare (for example, synovial sarcomas, and giant cell tumors). They can cause ambulatory problems with local pain. Treatment usually involves surgery; a few individuals may require amputation of the knee and lower leg. Treatments and surgery depend on the tumor type.

The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids.

Chondromalacia refers to a softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs or hills. While treatment with anti-inflammatory medications, ice packs, and rest can help, long-term relief is best achieved by strengthening exercises for the quadriceps muscles of the front of the thigh.

Bursitis of the knee commonly occurs on the inside of the knee (anserine bursitis) and the front of the kneecap (patellar bursitis, or “housemaid’s knee”). Bursitis is generally treated with ice packs, immobilization, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or aspirin and may require local injections of corticosteroids (cortisone medication) as well as exercise therapy to develop the musculature of the front of the thigh.

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Pain Free Knee, Is it Possible?

One would have some experiences with knee problems at some point in life regardless of your activity level. Do we really have to live with this pain in the knee? No. Knee pain in a common problem that affects people of all ages. It occurs due to a few different reasons and causes.

Knee Injuries

– Anterior Cruciate Ligament (ACL) tear, Medial & Lateral Collateral Ligament (MCL and LCL) Tear, Meniscal Tear and/or Cartilage Tear are injuries that could result in knee pain. Most of these injuries happen as a result of a shearing or twisting action on tke knee causing laxity and presence of loose bodies or knee movement limitations. People with ACL tears tend to present with higher risk of having knee osteoarthritis where the cartilages are worn off.

– There are two C-shape meniscus in the knee joint that acts as shock absorbers between the thigh and shin bone and as stabilizers of the knee. Meniscus tear comes about when there is sudden twisting and compression of the knee or there is repetitive stress to the knee and this injury can occur together with an ACL tear, and increase the chances of arthritis changes in the knee joint. Medications will be given by your doctor to reduce any inflammatory reactions and physiotherapy is usually the treatment for any such tears. However, is cases where it is imminent to remove or repair the meniscus, surgical interventions such as meniscus repair will be done arthroscopically.

Patellar Tendinitis

A common overuse injury, commonly termed “jumper’s knee” as it occurs mostly in people who don’t jump due to the following reasons:

– Malaligment of knee cap, thigh bone & shin bone

– Rapid weight gain resulting in excessive strain on the tendon.

– Muscle imbalance-tightness of Quadriceps (muscle on front of thigh), tightness of hamstrings (muscle on front of thigh), tightness of hamstring (muscle on back of thigh) and / or weakness of VMO muscle (one of the four muscles of the quadriceps).

In some cases, your doctor may prescribe medications to reduce the inflammation & pain or administer other techniques like ESWT (Extracorporeal Shock Wave Therapy), PRP (Platelet Rich Plasma treatment) to help promote healing in the tendon.

Knee Degeneration

– Osteoarthritis (OA) is one of the most common degenerative problems of the knee and it can affect people of all ages. It occurs due to the wear and tear of the cartilages in the knee joint and is therefore dependent on the amount of impact that the knee takes on with activities, Customised insules can also help elleviate any pain that occurs because of changes in joint allignment thus reduces the impact on the worn our portion of the knee.

– Proper physiotherapy treatments and use of customized insoles greatly reduces the need to have any surgical interventions especially if administered early.

– In certain cases, cartilage degeneration could have occured for a long time, and without proper management this condition canbe debilitating with loss of ROM.

– Rheumatoid arthritis( (RA) is the other type of arthritis that can affect any joint in your body as it is an autoimmune condition. It is a chronic problem that has to be managed by medications, rest and physiotherapy.

Knee Malalignment Problems

– Illiotibial band syndrome occurs when the band on the outer part of your thigh bone becomes too tight and rubs against the outer knee.

– Patellofemoral pain (PFP) syndrome is the pain one experiences in the knee cap due to malaligment of the knee cap and is also experienced in people with OA knee. In most cases, PFP can be resolved with a pair of customized insoles, mobilisation techniques, taping techniques and proper strengthening & stretching exercises.

– Hip & foot allignment problems can also cause knee pain due to changes in loading on the knee. Prople with flat feet or high arch problem may also experience knee pain. In some cases, the lowering of foot arch may be caused by massive weight gain and weight loss programs as precribed. In most cases, a good pair of customized insole and joint mobilisation helps to resolve the whole issue. Stretching & stengthening exercises prescrived by your physiotherapist is beneficial to prevent any recurrence.

As in any other injuries, always consult a doctor or a physiotherapist to find out the root cause of your problem and receive the appropriate treatment forit.

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Common causes of pain at the back of the knee

Common causes of pain at the back of the knee

Baker’s cyst

One of the common causes of popliteal pain is a Baker’s cyst (or popliteal cyst). This is a fluid-filled lump at the back of the knee caused by fluid which has built up under pressure within the knee cavity in response to an inflammatory problem within the knee and not directly related to the lump itself.

The space within the knee joint is lined by cells that secrete lubricating fluid (synovial fluid). If the knee is stressed for any reason excessive fluid can be secreted. In the popliteal region of the knee there is an anatomical connection between the main joint cavity and a lubricating ‘pocket’ at the back of the knee (the gastrocnemio-semimembranous bursa). When the fluid builds up under pressure, synovial fluid can leak into the popliteal bursa to form a cystic swelling known as a Baker’s cyst (or popliteal cyst). The cyst may be obvious to the eye or it may be palpable as a tense ‘balloon-like’ swelling on the inner (medial) aspect of the back of the knee.

Popliteus tendinitis

Another condition that can cause popliteal pain is ‘popliteus tendinitis’. This is an inflammation of the tendon of the popliteal muscle. The popliteus tendon is very unusual. If you look at the second illustration, where the knee capsule has been sketched in, you can see that the popliteus tendon actually passes through the capsule of the knee and into the knee joint itself, where it attaches to the outer side of the femur.In doing so, it runs behind the lateral meniscus and in close proximity to it.

The popliteus tendon is sensitive to overuse activity and may become inflamed (tendinitis) causing pain at the back of the knee, aggravated during deep squats. The patient may also have trouble fully straightening the knee. Popliteus tendinitis pain can often be elicited by bending the knee and resting the ankle onto the shin of the other leg in a figure-of-4 position. Sitting on a table with the lower legs dangling, pain may also be elicited when an examiner rotates the foot and tibia outwards.

Injury to the posterior horn of the meniscus

lateral meniscus

Another cause of popliteal pain is a disruption at the back of the lateral meniscus, in the region known as the ‘posterior horn’. The illustration on the left shows a bird’s-eye view of the menisci sitting on the top of the tibia. You can see that the lateral meniscus is a different shape from the medial meniscus in being more ‘O’-shaped rather than ‘C’-shaped, and in having a recess at the point where the popliteal tendon passes up to the femur bone. The presence of the popliteus means that the lateral meniscus is not tethered at its outer rim as well as the medial meniscus, and it is consequently more mobile.

If we consider just the bit at the back of the knee – the posterior horn – of the lateral meniscus, there may be a tear of the meniscus itself, or there may be a disruption in the fibres that frequently attach the rim of the posterior horn to the popliteus tendon as it sweeps along the back of the meniscus. Either of these possibilities may result in pain at the back of the knee. The pain may be accompanied by feelings of knee instability and giving way.

 

Hamstrings tendinitis (biceps femoris tendinitis)

Inflammation of the biceps femoris tendon as it sweeps along the back of the knee may give rise to pain in this area. The biceps femoris tendon is one of the hamstrings tendons. It may become damaged via overuse during a repetitive activity such as running or cycling, where the tendon abrades over the bone of the femur at the back of the knee. The pain is experienced at the outer side of the knee at the back.

Gastrocnemius tendinitis

The other tendon inflammation that may cause pain at the back of the knee is gastrocnemius tendinitis. Pain may be experienced on the inner or outer aspects of the back of the knee.

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About Knee Pain Overview

If you are suffering from knee pain, see a doctor / orthopedic surgeon who can determine the cause and prescribe an appropriate treatment and pain management plan.

This site covers only the more common types of knee pain. It will familiarize you with various causes, treatments, and prevention of knee pain, but please do not attempt to diagnose yourself.

The knees are the most easily injured part of the body. The largest and most complicated joint, the knee is used for everything from standing up, sitting, to walking, running, etc. It’s a weight-bearing joint that straightens, bends, twists and rotates. All this motion increases your risk of acute or overuse knee injuries.

Acute knee injuries (including torn ligaments and torn cartilage) are often caused by twisting the knee or falling. Sports that involve running and jumping and sudden stopping and turning, such as soccer, basketball, volleyball, tennis, and baseball, as well as contact sports such as football, wrestling, and hockey increase the risk of an acute knee injury.

But more common than sudden knee injuries are injuries caused by overuse

Overuse knee injuries (including muscle strain, tendonitis and bursitis) may develop gradually over days or weeks. Pain is often mild and intermittent in the beginning and worsens over time. When muscles and tendons are stressed even slightly beyond their capabilities, microscopic tears occur. (Inflammation, which is part of the healing process, is what causes the pain). These tears must be given a chance to heal before subjected to the same activity to avoid overuse injury. Treat overuse injuries early to prevent chronic problems.

Knee pain is commonly caused by doing too much too soon when you haven’t exercised for a long period of time – especially high-impact aerobics; walking, running or jumping on hard surfaces or uneven ground; excessive running up and down stairs (When you walk upstairs you are putting pressure on your knees that is equivalent to four times your body weight, when running up the stairs it can be eight times your body weight).

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.

Runners knee (also called patellofemoral pain or anterior knee pain) is a common cause of knee pain in young people (not just in runners). The pain is usually diffuse pain behind the kneecap. Symptoms often worsen after climbing stairs, jumping, running, or after a period of sitting. Caused by poor tracking of the kneecap, appropriate exercises prescribed by a doctor or physical therapist is the main treatment in correcting runners knee. Stay away from high-impact activity if you have this condition.

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 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.

Most knee pain is treated conservatively, but there are situations in which surgery is required. Athletes are at an elevated risk for sudden injuries that may require surgery, such as torn ligaments in the center of the knee or certain types of fractures. People with advanced knee osteoarthritis may need knee replacement surgery if they are severely limited in day-to- day activities because of their condition. This is optional surgery and is a last resort.

Most knee conditions respond to a combination of non-invasive treatments such as applying heat or cold, temporarily restraining from activities that aggravate pain, and medications that target pain and inflammation. Exercises to strengthen the muscles that support the knee help reduce stress on the knee joint and prevent re-injury.

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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.

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
  • “Locking,” or 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
  • Fall because your knee “gives out”

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 or go downhill skiing, because it’s linked to 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 cords that attach muscles to bones. Runners, skiers and cyclists 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

  • 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 — the effect is something like a pencil caught in a door hinge.
  • Knee ‘locking.’ This can occur from a cartilage tear. When a portion of cartilage from the tear flips inside the knee joint, you may not be able to fully straighten your knee.
  • 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. You’ll be able to see the dislocation, and your kneecap is likely to move excessively from side to side.
  • 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 interfere with the alignment of your kneecap and 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

  • 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 pyrophosphate 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

  • 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.
  • Chondromalacia patellae (patellofemoral pain syndrome). This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
  • Osgood-Schlatter disease. This condition affects the softer area of bone near the top of the shinbone, where bone growth occurs. It’s most common in boys who play games or sports that involve running or jumping. The discomfort can last a few months and may continue to recur until the child’s bones stop growing.
  • Osteochondritis dissecans. Caused by reduced blood flow to the end of a bone, osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. It occurs most often in young men, particularly after an injury to the knee.

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

  • Age. Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendinitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.
  • Sex. Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendinitis than girls are.
  • 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.
  • Mechanical 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 sharp twists and turns 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.

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even 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.

Read more about Knee Pain

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