The knee is a complex joint that flexes, extends, and twists slightly from side to side. The knee is the meeting point of the thigh bone (femur) and the shin bone in the leg (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint. These bones are connected by ligaments, which are strong bands of tissue that stabilize the joint. The end of the bones in the knee are covered with cartilage, which is a smooth substance that cushions the bones and enables them to move easily with each other. Between the two bones of the leg (tibia and fibula) is a formation called the meniscus, which is comprised of two crescent-shaped discs. The meniscus acts as a cushion, provides stability, weight distribution, and shock absorption for the joint. Shock absorption is increased by synovial fluid, which is a thick liquid that is produced by the lining of the joint. This entire framework is held together by the joint capsule with additional stability coming from the muscles and tendons around the knee.
Understanding Knee Pain
Knee pain can be caused by a number of different factors, some of them are abrupt injury. This type of injury is often the result of an internal derangement such as a torn ligament or a meniscal injury. Abrupt injury may cause severe pain and may be associated with damage to the joint. Most often pain from an injury is self-limited. It can be due to a slipped capital femoral epiphysis and may be associated with a condition known as Legg-Calve-Perthes disease. Another cause of knee pain is Osgood-Schlatter disease which is a condition that is most commonly found in young adolescents and is due to inflammation of the area just below the knee where the tendon from the kneecap is attached to the shin. This information shows that the level the specific pathology of the cause of knee pain can vary, however it is important to identify the cause of one’s pain to treat/manage it effectively.
Impact of Knee Pain on Lifestyle
Osteoarthritis is the most common type of knee pain and it is a degenerative joint disease. It occurs when the cartilage in the knee breaks down, which can cause damage to the underlying bone. In severe cases, the knee can appear misshapen.
A vicious cycle can occur with knee pain. People may reduce their activity because it causes them pain. By moving less, the muscles around the knee can weaken, which then can cause more pain. This may result in more damage or a delay in the healing process.
Patellofemoral pain is a common knee problem in active people, especially athletes and women. It is caused by imbalanced activity around the kneecap, poor alignment of the kneecap with the lower leg, changes in the cartilage on the underside of the kneecap, overuse, muscle tightness or weakness, and foot problems. Patellofemoral pain can be made worse by sitting for long periods of time or by activities that increase the pressure on the kneecap and the bone attached to it, such as climbing stairs, running, and other physical activities.
People with knee pain can have difficulty fully straightening their knee, trouble bending the knee, and a sensation of knee instability or the feeling that the knee will give way. Other symptoms can include weakness or stiffness, and popping or crunching noises.
Knee pain affects people of all ages and is related to a variety of conditions. Acute injuries or overuse conditions are the most common causes of knee pain. In older adults, normal wear and tear can cause pain in the knees. If you are overweight, you put extra stress on your knees, which can cause knee pain.
Tips for Managing Knee Pain
The use of assistive devices has been proven to reduce the load on the knees. For example, using a cane in the hand opposite the affected knee unloads the weight on the knee by 10-15%. This is a simple and effective way to reduce pain and is particularly useful when going up or down stairs or a slope. Other devices include braces and shoe inserts. A variety of over-the-counter braces and inserts are available and can be useful; however, it is best to use these in consultation with a doctor or therapist who can prescribe the correct type and ensure it is properly fitted.
Maintaining a healthy weight is perhaps the best thing you can do for your knees. Every pound you lose takes 4 pounds of pressure off the knees. For even moderate osteoarthritis in the knees, this added pressure means 4 times the stress on the knees. The good news is that just a little weight loss will noticeably improve the symptoms of OA. In some cases, weight loss can actually prevent the disease from occurring. Once the disease is established, weight loss can prevent the disease from progressing.
Regular exercise and stretching can help maintain strength and flexibility in the leg muscles. This is one of the most effective ways to keep knees healthy, as the muscles support the knees. Options include: low-impact strengthening exercises, swimming, aquatic exercise, and tai chi. These types of exercise are easier on the knees than high-impact exercises. Doctors usually recommend avoiding activities that involve repetitive bending and deep knee flexion, such as climbing stairs, squatting, and lunging.
Regular Exercise and Stretching
– Increase flexibility. Joints are meant to move, and many people with osteoarthritis will become less active because of pain, leading to further deterioration of joint function. Inactivity can cause the joint to lose its full range of motion. Exercises to increase range of motion are critical for maintaining joint function.
– Strengthen the leg muscles that support the knee. Research shows that people with stronger leg muscles are less likely to develop knee osteoarthritis, and that among people who have the condition, those with strong leg muscles are less likely to experience pain and stiffness.
Regular exercise and stretching are key factors in maintaining mobility for people who suffer from knee pain. In a study at Wake Forest University in Winston-Salem, N.C., people with osteoarthritis who exercised had less pain and better physical function compared to those who did not exercise. Exercise can help to:
Maintaining a Healthy Weight
A registered dietitian can help determine a balanced meal plan to achieve weight loss while meeting vitamin and nutrient needs. Small changes can lead to big results when reducing calorie intake. Consume lower calorie beverages such as water, diet sodas, and herbal teas. Choose light beer or wine in moderation. Eliminate calorie-dense foods with little nutritional value such as sugary drinks and high-fat foods. Starting with common portion sizes, try leaving 3 bites of food on the plate at each meal. This will decrease calorie intake by 100-200 calories per day. Keep a food diary to track food intake and physical activity, and chart progress towards weight loss over time. Set realistic goals and celebrate weight loss achievements with non-food rewards. Weight Watchers is an effective program for some people due to the amount of peer and professional support available.
A healthy weight is crucial for knee joint pain management. Excess weight causes additional stress on weight-bearing joints such as the spine, hips, and knees. Research has shown that 1 pound of weight loss results in 4 pounds of pressure being removed from the knees. Weight loss can be a satisfying and effective way to decrease knee joint pain. Build healthy eating habits, reduce portion sizes, and lower calorie intake to achieve weight loss. A mental shift is needed to make lifestyle changes, not a short-term diet. The goal is to reduce 1-2 lbs. per week over a 6-month period, resulting in a loss of 25-50 lbs.
Using Assistive Devices
A stick can help reduce the load through the joint and is especially useful when there is a leg length difference. Shock-absorbing canes are best for reducing the load through the knee and other affected joints (and are also more comfortable to use), and are rubber-based with a bigger ferrule or spike to maximize grip on the ground. In cases of severe knee OA, the use of a three-wheeled walker may be necessary. This has the advantage of providing a superior level of stability and can also be used to carry objects around the home.
Using a knee aid will help lower the load on the joint. Many different types of devices, from simple sleeves to more elaborate joint unloading braces, are available. A sleeve provides compression around the knee and can help reduce swelling and control pain. A knee support can help decrease pain by helping to unload the stress from the joint to the healthier compartment. The advantage of a brace over a sleeve is that it has a strap system to help unload the joint. With the more severe cases of knee OA, when the above treatments are no longer effective, a walking aid may be required.
Lifestyle Modifications for Knee Pain
The most logical choice for reducing lower extremity joint stress is to decrease or terminate the activity that is causing the pain. An individual with a job that requires heavy lifting and significant walking/standing may need to consider job modification or changing to a less strenuous job. This is also true for recreational activities. The joint stress from some competitive sports can cause significant knee pain and accelerate joint damage. The ability to perform these activities pain free is likely unattainable and may require changing to other types of activities.
Knee pain can be aggravated by the type of shoes worn and the amount of time spent on one’s feet. Studies have shown that there is a direct link between the type of work an individual does and the risk of developing osteoarthritis. A study of men who had osteoarthritis surgery compared to those who did not proved that those who had sedentary jobs had a lower risk of developing osteoarthritis. These studies imply it is important to take occupational and recreational activities into consideration when trying to reduce knee joint stress. An individual with osteoarthritis may consider alternating heavy activities with light ones. An example would be alternating walking with bicycling. This helps to avoid joint aggravation.
Lifestyle modifications can significantly improve knee pain and function. They can even prevent additional joint damage. The first step toward making positive changes is to increase awareness about how stress on the joints can be related to pain and damage. Begin by examining the activities and footwear that increase mechanical stress on the knees and then make appropriate changes.
Choosing the Right Footwear
On the fashion side of things, it is often known that women have a hard time parting from their heels. Unfortunately, such stylish shoes are often harmful to the knees. An arched posture creates undue stress on knee caps and knee joints, and the narrow heeled shoes require added effort for balance. Instead, it is advised for women to wear supportive, cushioned athletic shoes. Athletic shoes generally offer the most ergonomic support. However, the American Podiatric Medical Association states that the quality of athletic shoes can vary across brands and models. Flexibility may cause added pressure on the knees and arches, thus it is advised to go for a more rigid pair. Potential buyers can check for shoe flexibility by holding the heel and pressing the tip of the shoe into the ground. The shoe should bend with the foot and not in the middle of the shoe.
When choosing your footwear, you want to find something with enough support and cushioning to reduce the impact on your knees. Some studies have examined special shoe inserts for knee OA. In one 12-week study, a flat insole and a cushioned insole produced similar improvements in pain and physical function. Because the cushioned insole appeared to provide added benefits for pain and function in heavier participants, it may be most useful for people with knee OA who are overweight.
Proper Posture and Body Mechanics
Teaching from a qualified Iyengar Yoga instructor on how to perform yoga postures can be quite useful. Iyengar yoga is initially focused on body alignment. This is learned through in-depth instruction in each yoga posture. Beginners may need to start with private lessons or beginners classes so they can receive special instruction. The use of yoga props can be very beneficial to learn postures and to lessen any strain or risk of injury. Qualified instruction is available for those who want to learn how to adapt yoga postures for their special needs.
Learning the principles of the Alexander Technique has been proven an effective way to change body mechanics. It has even been shown to provide significant relief from chronic and recurrent back pain. The Alexander Technique teaches individuals how to stop using unnecessary levels of muscular and mental effort during their activities. It is an educational process rather than a relaxation technique or form of exercise. This technique can be applied to how you perform virtually any activity.
Learning to align your body properly and move in the right way can decrease stress on your knees. Choose your words carefully; avoid saying “should.” Saying “should” can cause an internal negative response which will slow down your progress in changing your body mechanics. Using positive words to yourself will get you further in changing the way you move.
Avoiding High-Impact Activities
Discussing the fact that organized exercise is a new addition to the human lifestyle can enhance the patient’s understanding of an exercise prescription. Endurance exercise is recommended, thus use of a stationary bike or bicycle is a good alternative to running. Swimming is an excellent form of exercise as it involves the whole body and puts little to no stress on the knee. An individual with access to a pool may want to consider aquatics exercise or water walking. This is another excellent form of exercise for those with knee pain.
High-impact activities like running, jumping, and intense sports put unnecessary stress on the joints, which can be detrimental for a person with knee pain. For instance, a force of one and a half times the body’s weight is exerted on the knee while walking, while that force triples while running and jumping. There are alternative ways and means of doing certain activities, and one need not totally avoid an activity if the modified form will not bother the knees. A perfect example, for those who are weekend athletes that play basketball, is to try playing half-court games and to eliminate jumping. There is much available information on ways to modify activities; those that significantly bother the knees should be avoided. An individual with knee pain does have a wide selection of alternative exercise options that are easier on the knees. Some exercise is usually good, as the stronger the muscles and surrounding tissue are, the more stable the knee is. Stretching should also be incorporated in the exercise routine.
Incorporating Low-Impact Exercises
Often when you suffer from knee pain, it is difficult to achieve proper cardiovascular (aerobic) exercise. The following are a few ideas of how to perform aerobic exercise. A general rule is that if an exercise or activity causes pain that lasts for two hours, it was too aggressive and may need to be modified.
Before starting any exercise program, it is best to consult with your doctor or a physical therapist, especially if you have had a recent flare-up of knee pain. They can help you determine which exercises are safe and appropriate for you.
Low-impact exercises reduce the strain on your knees and can improve strength and flexibility. The key to creating a workout is to take selected exercises from many areas and combine them into a routine that you will do at least three times a week. To make an overall impact, the exercise routine needs to be performed consistently throughout your lifetime.
Seeking Professional Help for Knee Pain
In many cases, individuals are able to self-diagnose the cause of their knee pain. However, the severity of the injury or condition can only be determined by a clinical diagnosis offered by a knee pain specialist. If the knee pain is severe or debilitating or if there is persistent swelling that is not related to a specific injury, then it is wise to seek a professional diagnosis. The following are the different types of healthcare professionals that are trained to diagnose and treat knee pain: – Orthopedic Surgeon: a medical doctor who specializes in the diagnosis and corrective treatment of diseases of joints. – Physiatrist: a medical doctor who specializes in rehabilitation and the prevention of disabilities. – Rheumatologist: a medical doctor who specializes in the medical (nonsurgical) treatment of rheumatic diseases, particularly arthritis. – Primary-care physician: a general healthcare provider. Certified athletic trainers and physical therapists are also trained to identify common knee problems. If cost is an issue, then it is probably best to start with an evaluation from a primary-care physician. With managed care, the primary-care physician usually becomes the gatekeeper and is required for referral to other specialists.
Consulting a Knee Pain Specialist
If you have persistent knee pain, you are afraid or unable to participate in preferred activities, and are not responsive to RICE treatments, you should consult a specialist. Knee pain specialists are usually rheumatologists or orthopedic surgeons who have gone through additional training in knee pain. They may help to confirm a diagnosis and rule out other conditions, advise you on treatment options (both those that you can try on your own and those that they may offer), and help you determine the relative risks and benefits of various treatments for your particular situation. Ideally, as medical treatment is redesigning to be a patient-involved process, your provider will help to guide you to a decision that is in line with your preferences and values. Note that there are no definitive answers for many knee conditions, and the “right” treatment for a particular situation is often unclear. In such cases, your provider should be able to give you an estimate of the chance of success of various treatments, but the final decision should be yours. Step-by-step instructions at all times are universally beneficial, as more active involvement by patients in decisions often results in greater satisfaction with treatment.
Treatment Options for Knee Pain
One of the treatments that help reduce pain and swelling is physical therapy. Specialized physical therapy is very important for individuals with arthritis. The therapist will evaluate your needs and lead you through a program of exercises to help restore your knee’s function and strength. Regular exercises give better relief and it is important not to avoid exercises to lighten the knee joints during flare-ups. In addition, some people with arthritis take supplements such as glucosamine and chondroitin, and a few recent research studies suggest they might experience some pain relief from this. Those with weight problems will find relief by losing weight. At worst, the temporary pain relief from taking a painkiller is one solution at times of unbearable flare-ups. However, it is not recommended to rely on drugs to provide comfort and ease as this is not a permanent solution and dependency has its adverse effects. Another way to relieve extensive knee joint damage is knee osteotomy. It is usually reserved for younger patients with limited damage. The procedure involves cutting and reshaping the bone to shift weight from the damaged area to the other side of your knee. This serves to alleviate pain and correct deformities and helps a patient with arthritis whose pain happens only in one section of their knee. While osteotomy can relieve symptoms of arthritis and delay the need for Total Knee Replacement, it doesn’t actually cure the arthritic condition and the patient will have to eventually do Total Knee Replacement if the symptoms arise again.
