Tag Archives: Patella

Knee Care

The knees are one of the larger joints in the body, supporting its entire weight. It is a hinge joint, like that of a door, capable only of moving forwards and backwards. Attempts to force a door to move sideways or push it open in the wrong direction will result in the door “coming off its hinges.” A similar problem occurs when the knee is forced to move in the wrong direction.

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The knee joint is composed of three bones, the lower end of the femur and the upper ends of the tibia and fibula, articulating with one another. The raw bones do not grate against each other. They are separated by a “joint space” filled with synovial fluid, lined with articulating cartilage and separated by little washers called meniscii. There are ligaments inside the joint holding it in place. Considering the size of the knee joint, these ligaments are woefully inadequate. In the front of the knee is the kneecap or patella.

Click & see: Anatomy of knee :

The knee undergoes constant wear and tear. Our daily activities involve walking and climbing stairs as well as exercising. In a lifetime, the knee joint functions over and above its capacity!

The knee undergoes constant wear and tear. Our daily activities involve walking and climbing stairs as well as exercising. In a lifetime, the knee joint functions over and above its capacity!

Pain in the joint can be acute and occurs owing to injury, infection, or age-(or overuse) related degeneration. The cartilage breaks down, exposing parts of the bone underneath. The raw nerves are exposed and this becomes very painful. Bits of broken cartilage can get trapped in the joint. When that occurs, movement can result is sudden pain and the joint can get locked.

Dislocations and injuries are more common in the young — basketball and football are notorious for causing knee injuries. This is because there are sudden abrupt changes in the direction of movement, which may be against the normal anatomical direction of movement. The player may land awkwardly or fall, bruising and injuring the joint.

The two knees support the weight of the entire body between them. The bones are physically capable of supporting only a certain amount of weight. Obesity causes the knees to degenerate rapidly. Depending on gait and posture, one side may wear out faster than the other. This may result in a bow-legged appearance. Walking is extremely painful and the gait may be crab like. The entire joint may be swollen and painful. Or, the pain may be localised on one side. At times, instead of the whole joint, the area under the patella gets worn down and irregular. As that rubs against the bones underneath, there is terrible pain with movement.

Children seldom develop knee pain without injury or a fracture. Boys can develop pain as part of certain inherited congenital syndromes or birth defects in the knee. The patella may also get dislocated. This is more common in teenage girls.

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Infections, acute trauma and fractures result in swollen, warm and tender joints. Arthritis, especially rheumatoid or osteoarthritis, can produce a similar picture. Infection always produces fever. Gout usually affects the big toe but can present itself as a painful knee joint. It may be worth checking uric acid levels.

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Ayurvedic remedies  of knee pain

Ayurvedic Therapy – A Promising Treatment for Knee Osteoarthritis?

Natural Ayurvedic Home Remedies for Knee Pain
Ayurveda for Osteo Arthritis (Knee Joint Pain)

Homeopathy for Knee Pain

Knee Injury Treatment With Six Homeopathic Medicines

Source: The Telegraph (Kolkata, Indi

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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.

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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Bursitis

Definition:
A bursa is a fluid-filled sac that usually overlays a bone or a joint and acts as a shock absorber. There are two types:

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Anatomical bursae normally occur around the body where tendons cross bones or joints. The complex knee joint has 15 bursae, for example.

•Adventitious bursae are not part of the normal body structure but develop when the soft tissue overlying a bone suffers repeated friction or trauma. An example of this type is over the pelvic bone in the buttock muscles because someone has been sitting on a hard chair for several hours a day.

Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Certain occupations predispose people to this. The condition may be acute or chronic.
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Causes:
The most common causes of bursitis are trauma, infection, and crystal deposits.

Trauma
Trauma causes inflammatory bursitis from repetitive injury, which results in widening of the blood vessels. This allows proteins and extracellular fluid into the bursae and the bursae react against these “foreign” substances by becoming swollen.

•Chronic: The most common cause of chronic bursitis is minor trauma that may occur to the shoulder (subdeltoid) bursa from repetitive motion, for example, throwing a baseball. Another example is prepatellar bursitis (in front of the knee) from prolonged or repetitive kneeling on a hard surface to scrub a floor or lay carpet.

Acute brusits: A direct blow (let’s say you accidentally bang your knee into a table) can cause blood to leak into the bursa. This rapid collection usually causes marked pain and swelling, most often in the knee.

Infections:
Bursae close to the surface of the skin are the most likely to get infected with common organisms; this is called septic bursitis. These bursitis-causing bacteria are normally found on the skin: Staphylococcus aureus or Staphylococcus epidermis. People with diabetes or alcoholism and those undergoing steroid treatments or with certain kidney conditions, or who may have experienced trauma may be higher risks for this type of bursitis. About 85% of septic bursitis occurs in men.

Crystal deposits
People with certain diseases such as gout, rheumato:id arthritis, or scleroderma, for example, may develop bursitis from crystal deposits. Little is known about how this process happens. Uric acid is a normal byproduct of daily metabolism. People who have gout are unable to properly break down the uric acid, which crystalizes and deposits in joints-a mechanism for causing bursitis.
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Symptoms:
Bursitis causes pain and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. The most commonly affected joints are the shoulder, elbow, wrist and hand, knee, and foot.

Shoulder…...click & see

The subacromial (subdeltoid bursa) separates the major tendon (known as the supraspinatus tendon) from the overlying bone and deltoid muscle. Inflammation of this bursa is usually a result of injury to surrounding structures-most commonly the rotator cuff. This is often referred to as “impingement syndrome.” It is often difficult to tell the difference between this type of bursitis pain and a rotator cuff injury. Both cause pain in the side or front of the shoulder.

•Overhead lifting or reaching activities are uncomfortable.

•Pain is often worse at night.

•The shoulder will usually have decreased range of active motion and be tender at specific spots.

Elbow. click & see

Olecranon bursitis is the most common form of bursitis. Goose-egg-like, tender red swelling may appears just behind the elbow. This area is at the top of one of the forearm bones called the ulna and is known as the olecranon process.

•The pain may increase if the elbow is bent because tension increases over the bursa.

•This bursa is frequently exposed to direct trauma (bumping your arm) or repeated motions from bending and extending the elbow (while painting, for example).

•Infection is common in this bursa.

Knee....click & see

•Kneecap (prepatellar) bursitis: Swelling on the front of the kneecap is usually associated with either chronic trauma (from kneeling) or an acute blow to the knee. Swelling may occur as late as 7-10 days after a single blow to the area, usually from a fall.

•Anserine bursitis: The anserine bursa is fan shaped and lies among 3 of the major tendons at the knee. The name anserine (gooselike) comes from the shape of the swollen bursa. When restrained by the 3 tendons, the bursa looks like a goose’s foot.

This type of bursitis is most often seen in people with arthritis, especially overweight middle-aged women with osteoarthritis.

*The pain is typically produced when the knee is bent and is particularly troublesome at night. People often seek comfort by sleeping with a pillow between their thighs.

*The pain can radiate to the inner thigh and midcalf and usually increases on climbing stairs and at extremes of bending and extending.

*The area of tenderness is on the middle part of the knee.

*Anserine bursitis also occurs as an overuse or traumatic injury among athletes, particularly long-distance runners.
Ankle.click & see

Retrocalcaneal bursitis occurs when the bursa near the Achilles tendon in the ankle becomes inflamed. This is commonly caused by local trauma associated with wearing a poorly designed shoe (often high heels) or prolonged walking. It can also occur with Achilles tendonitis.

Bursitis in this part of the body often occurs as an overuse injury in young athletes, ice skaters, and female adolescents transitioning to higher heels. The pain is usually on the back of the heel and increases with passive extension or resisted flexion.

Buttocks....click & see

Ischiogluteal bursitis causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying gluteus maximus muscle (one side of the buttocks). Inflammation can come from sitting for a long time on a hard surface or from bicycling.

•The pain occurs when sitting and walking.

•There will be tenderness over the pubic bone, which may be made worse by bending and extending the leg.

•The pain may radiate down the back of the thigh.

•Direct pressure over the area causes sharp pain.

•The person may hold the painful buttock elevated when sitting.

•The pain is worse when person is lying down and the hip is passively bent.

•The person may have difficulty standing on tiptoe on the affected side.

Hip click & see

The iliopsoas bursa is the largest in the body and lies in front of, and deep to, the hip joint. Bursitis here is usually associated with hip problems such as arthritis or injury (especially from running).

•The pain of iliopsoas bursitis radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.

•Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.

•There may be tenderness in the groin area.

•Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.

Thigh click & see

The trochanteric bursa, part of the thigh, can be associated trochanteric bursitis, which occurs most frequently in overweight, middle-aged women.

•It causes deep, aching hip pain along the side of the hip that may extend into the buttocks or to the side of the knee.

•Pain is aggravated by activity, local pressure, or stretching.

•Pain is often worse at night.
Diagnosis:
Exams and Tests:

•History: The doctor will usually take a detailed history about the onset of symptoms and will want to know what movement or activity makes you feel more or less pain. You will need to report other medical problems you may have.

•Fluid removal: The doctor may remove synovial fluid from the joint with a needle (aspiration) and send it to the lab for analysis for possible infection. Bursitis in the knee and elbow are especially prone to infection.

•X-rays: They are usually not helpful, but the doctor may get them if any other disease process is suspected such as a fracture or dislocation. MRI and CT scans are obtained only to exclude other causes.

•Blood testing: The doctor may take blood from your arm for lab testing to rule out infection or other conditions such as rheumatoid arthritis or hyperthyroidism.
Treatment:
The doctor will probably recommend home care with P-R-I-C-E-M: protection, rest, ice, compression, elevation, and medications .

At first  doctor may recommend temporary rest or immobilization of the affected joint.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may relieve pain and inflammation. Formal physical therapy may be helpful as well.

If the inflammation does not respond to the initial treatment, it may be necessary to draw out fluid from the bursa and inject corticosteroids. Surgery is rarely required….

Exercises for the affected area should be started as the pain resolves. If muscle atrophy (weakness or decrease in size) has occurred. Your health care provider may suggest exercises to build strength and increase mobility.

Bursitis caused by infection is treated with antibiotics. Sometimes the infected bursa must be drained surgically.

Prognosis:
The condition may respond well to treatment, or it may develop into a chronic condition if the underlying cause cannot be corrected.

Complications:
Chronic bursitis may occur.
Too many steroid injections over a short period of time can cause injury to the surrounding tendons.

Prevention:
Avoid activities that include repetitive movements of any body parts whenever possible.

You may Click to see :List of Burn Centers in  US

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bursitis.shtml
http://healthtools.aarp.org/adamcontent/bursitis?CMP=KNC-360I-GOOGLE-HEA&HBX_PK=bursitis&utm_source=Google&utm_medium=cpc&utm_term=bursitis&utm_campaign=G_Diseases%2Band%2BConditions&360cid=SI_148893841_6495451981_1
http://www.emedicinehealth.com/bursitis/article_em.htm
http://www.medicalook.com/Joint_pain/Bursitis.html
http://activemotionphysio.ca/article.php?aid=246
http://www.bursitisinshoulder.com/
http://www.bursitis.ws/Knee-Bursitis.html

http://www.aidmybursa.com/foot-ankle-bursitis.php

http://www.sportlink.co.uk/hip_bursitis.php

http://www.bursitistreatment.info/ischial-bursitis_8.html

http://www.steadyhealth.com/articles/Hip_Bursitis___Trochanteric_Bursitis_a246.html

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Hip Exercises Reduces Knee Pain

New research shows that a twice weekly hip strengthening regimen proved effective at reducing or eliminating the kind of knee pain referred to as patellofemoral pain (PFP) in female runners.  Stronger hips may correct running form errors that contribute to PFP.

Click to see video of heap exercises :

The study used a pain scale of 0 to 10, with 3 representing the onset of pain and 7 representing very strong pain. The injured runners began the six-week trial registering pain of 7 when they ran on a treadmill, and finished the study period registering pain levels of 2 or lower.

According to Science Daily:
“PFP, one of the most common running injuries, is caused when the thigh bone rubs against the back of the knee cap. Runners with PFP typically do not feel pain when they begin running, but once the pain begins, it gets increasingly worse … PFP essentially wears away cartilage and can have the same effect as osteoarthritis.”

Vigorous physical activity in young children results in stronger hip bones.

More than 200 six-year olds participated in a study. Researchers measured bone mass and analyzed the structure of the hip and thigh bone. Physical activity was assessed for seven days.

If you find the excerpt from the treatment video helpful you might want to consider the full DVD set that can be very beneficial for a large variety of injuries.

According to Science Daily:

“The results showed that there was a relationship between time spent in vigorous activity and strength of the femoral neck, both in terms of shape and volumetric mineral density. This was independent of other factors such as diet, lifestyle and physical size.”

Sources:
Science Daily June 7, 2010
Science Daily June 6, 2010

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Healthy Knee is Friendly Indeed

Capsule of right knee-joint (distended). Later...

Image via Wikipedia

Whether you are a ballerina, mountaineer, a weekend gladiator or just an office warrior, learn to protect your knees because the knee is a critical link in the kinetic chain that allows you to walk on two feet.
….....CLICK & SEE

Anit Ghosh, a former national footballer, suffered a career-threatening injury to his knee ligament five years ago. Regular and diligent post-injury rehabilitation work under the author’s guidance helped him gradually return to competitive football. Today, he turns out for Mohammedan Sporting and has learned to manage a problematic knee.

In  therapy practice, over half the ladies and about one in 10 men complain of knee pain. After back pain, knee pain is the most common cause of disability and time lost from work or training.

The knee is the largest joint in the human body and is formed by the articulation of three bones, the lower end of the thighbone (femur), the upper end of the shinbone (tibia) and the kneecap (patella). It may appear like a simple hinge, but besides the routine functions of bending and straightening, the knee joint performs a host of complex functions — it slides, glides, pivots, rolls and rotates — sometimes sequentially and at other times simultaneously. All these movements make the knee joint very vulnerable to shearing forces and dependant on good functional stability from the surrounding soft tissue network of ligaments, tendons and the two menisci, tough crescent-shaped cushions within the joint. In addition to the above, the knee joint also includes small, fluid-filled membranous sacs lying between the ligaments or skin, and the bones to provide smooth and frictionless gliding, like ball bearings in a machine. Furthermore, the entire articular surfaces, i.e. those that rub against one another, are covered with a tough, rubbery slippery tissue called cartilage.

Of these parts mentioned above can be a source of joint pain. Sometimes, knee pain can be caused by poor body mechanics and tight muscles elsewhere in the body and can easily be corrected by a slight alteration in gait and mechanics. For example, poor flexibility around the ankle and hip can transfer a lot of shearing forces onto the knee even though pathologically the knee is normal. The knee then is merely the “site” of the pain. The villain or “source” of pain may lie elsewhere.

The most common causes of knee pain  are described below..>..CLICK & SEE

*One of the most crippling forms of knee ailment is arthritis caused by the degeneration of the cartilage coating. The cartilage has very poor blood supply and consequently nutrient supply and therefore once traumatised, has hardly any chance of healing itself. The inherent nature of the cartilage is a huge limiting factor for arthritis rehabilitation.

*Chondromalacia is the softening or the wearing away of the articular cartilage under the kneecap. The articular cartilage on the inside aspect of the kneecap comes in constant contact with the articular surfaces of the femur during normal knee motion. The knee motion can sometimes become abnormal or faulty due to muscle imbalance or biomechanical misalignment and cause the patella to rub against the femoral surfaces. Repetitive ‘rubbing’ of the surfaces causes chronic inflammation sometimes popularly known as “jumpers knee”.

*One of the most common causes of pain inside the joint is a torn meniscus. The crescent-shaped spongy tissues act as shock absorbers within the joint and when torn, either by injury or degeneration, tends to get caught in the joint, causing pain and instability.

*When the articular cartilage begins fragmenting and eroding due to extreme softening, the underlying bone gets exposed. This is a condition called osteoarthritis.

*Often traumatic injuries or contact sports mishaps cause the ligaments within the knee joint to snap. This is a very painful condition and more often than not, needs surgical correction where the surgeon has to reconstruct the ligament necessitating a long healing period.

WHAT YOU CAN DO TO MANAGE, EVEN PREVENT KNEE PAIN?

*Stretch regularly. Regular stretching of the hip flexors, hip extensors and the iliotibial band (a sheath of muscle lying on the outside of your thigh extending from the hip to the lateral aspect of the knee) will ensure good gait and running mechanics and spare the knee of shearing forces.

*Train with weights. Loading the knee and hips early in life with weights will build density in the bones and prevent erosion in later life.

*Work the hamstrings. The average person has stronger quadriceps compared to the hamstrings. Increase hamstring strength for better muscle balance and correct alignment of the kneecap. This will avoid compression forces within the knee.

*Strengthen the vastus medialis muscle — the muscles lying in the inside aspect of your front thigh. This will help to realign and track the kneecap to its normal pathway.

*Exercise discretion while performing repetitive knee motions like running, skipping, jumping etc. If you must run, learn proper running technique. Let’s face it — nine out of 10 people who visit lifestyle and recreation gyms do not have good technique. Running on the treadmill for these people is sheer disaster!

*If you are an active sort of a person, check with your doctor whether you should supplement with Glucosamine sulphate and Chondroitin. They are known to have shown results in preventing degeneration of the knee joint.

*Avoid knee extensions. The leg extension exercise is treated as a panacea for all sorts of knee ailments by trainers and therapists alike. In reality, open-chain movements like the knee extension exercise is potentially more dangerous than closed-chain movements like the lunge and squat.

*The leg extension movement causes compression between the kneecap and the thighbone and I would recommend even healthy knee-owners to stay far away from it. Choose multi-joint exercises that make the quadriceps and hamstrings work together in unison.

The best exercises for the knee are:

*One-legged squats
*Glute ham raises
*Lunges
*Split squats

Sources: The Telegraph (Kolkata, India)

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