Knees Pain

We often take our knees for granted. They may be hidden under clothing and seem inconspicuous but are, in fact, most important as they balance the entire weight of the body. This makes them prone to injury and malfunction at all ages.

One of the commonest symptoms of any knee problem is pain. This may be acute following a fall. It may occur as a result of an unexpected unbalanced twisting movement in a game of basketball or football. Or the knee may be affected as a result of degenerative osteoarthritis. In autoimmune diseases such as rheumatoid arthritis, generally small joints of the hands and feet are affected. At times, one or both knees may also be swollen. Conditions like gout and pseudogout — which occur when crystals are deposited in the joint space — usually affect the big toe, but again the knee may be affected.

The bones of the knee joint are cushioned by cartilage. Bits of the latter can suddenly break away and form loose bodies inside the joint space. These can get wedged during movement of the knee. There is excruciating pain, and the joint gets “stuck”. It cannot be bent or straightened.

The cartilage may also become worn down and degenerate with constant wear and tear. This exposes the bones. They then tend to grind against each other and produce pain.

Problems in areas like the spine, hip and ankle can produce a change in gait. The person may not balance properly on both feet and may limp. This puts more pressure on one knee. This too can result in pain.

The patella is a triangular bone that sits on top of the knee. Degeneration of the patella or strain of the ligaments that attach it to the bone may cause pain. This is common in children, older people and particularly women athletes.

Bacterial infections which start in other parts of the body can spread via the bloodstream and localise in the knee. This causes an acute infection with redness, pain and fever.

Knee pain can usually be tackled at home. It often disappears with 48 hours of rest. Pain and swelling can be reduced with the application of an ice pack. The pack, however, should not be applied for more than 20 minutes. Ointments containing Capsicain are often effective. They should be applied on the affected joint, followed by an ice pack. Lidnocaine (a local anaesthetic) ointment may also provide relief. Ointments are particularly effective if combined with tablets of paracetamol, ibubrufen or nalidixic acid. Compression of the joint with an “elastocrepe” bandage or a “knee cap” prevents swelling. Elevation of the foot also helps.

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Accupressure and acupuncture have been shown to be effective. The first involves application of pressure to specific points around the knee while in the second, needles are inserted into them.

A doctor needs to be consulted if the joint pain is accompanied by fever, there is obvious swelling, it is impossible to bear weight on that knee, or if it cannot be flexed or extended fully.

By examining the knee thoroughly and performing some diagnostic manoeuvres, it is usually possible for the doctor to arrive at a tentative diagnosis. Blood tests may be done to rule out gout or rheumatoid arthritis. X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans and ultrasound may be needed to clinch the diagnosis.

A combination of physical therapy and medication usually provides great relief. Injections of steroids and other chemicals into the joint space may reduce inflammation and pain. If the problem persists, surgery may be required. Arthroscopy may be done to remove loose bodies and repair tears to the ligaments inside the joint. Surgery for knee replacement — complete or partial — is now common and done in many centres. There are very few contraindications. More and more older people are opting for it and enjoying productive and pain-free lives.

Some knee problems — particularly those resulting from an injury or a systemic disease — may be inevitable and require long-term treatment. The painful arthritis of old age can, however, be prevented with a few lifestyle modifications.

Obesity increases the pressure on the knees. Many years of being overweight take their toll, resulting in degenerative changes. Try to remain as close to your ideal body weight as possible.

Physical activity maintains muscle tone and helps keep the knee joint aligned. Repetitive high impact activity can cause tears in ligaments and cause pain. Runners in particular can develop pain in the ligaments around the joint. This is particularly true if physical activity is not preceded and followed by stretching and strengthening exercises. Cross training helps balance joints and reduce strain and injury. A combination of cycling, swimming, jogging or walking, and yoga is ideal.

Source : The Telegraph ( Kolkata, India)

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