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.
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.
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.
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.
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.
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.”
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.”
Most people have had a minor knee problem at one time or another. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries most often occur during sports or recreational activities, work-related tasks, or home projects..
The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. See an illustration of the structures of the knee .
Although a knee problem is often caused by an injury to one or more of these structures, it may have another cause. Some people are more likely to develop knee problems than others. Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase your chances of having problems with your knees.
Sudden (acute) injuries
Injuries are the most common cause of knee problems. Sudden (acute) injuries may be caused by a direct blow to the knee or from abnormal twisting, bending the knee, or falling on the knee. Pain, bruising, or swelling may be severe and develop within minutes of the injury. Nerves or blood vessels may be pinched or damaged during the injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look pale or blue. Acute injuries include:
•Sprains, strains, or other injuries to the ligaments and tendons that connect and support the kneecap.
•A tear in the rubbery cushions of the knee joint (meniscus).
•Ligament tears. The medial collateral ligament (MCL) is the most commonly injured ligament of the knee.
•Breaks (fracture) of the kneecap, lower portion of the femur, or upper part of the tibia or fibula. Knee fractures are most commonly caused by abnormal force, such as a falling on the knee, a severe twisting motion, severe force that bends the knee, or when the knee forcefully hits an object.
•Kneecap dislocation. This type of dislocation occurs more frequently in 13- to 18-year-old girls. Pieces of bone or tissue (loose bodies) from a fracture or dislocation may get caught in the joint and interfere with movement.
•Knee joint dislocation. This is a rare injury that requires great force. It is a serious injury and requires immediate medical care.
Overuse injuries occur with repetitive activities or repeated or prolonged pressure on the knee. Activities such as stair climbing, bicycle riding, jogging, or jumping stress joints and other tissues and can lead to irritation and inflammation. Overuse injuries include:
•Inflammation of the small sacs of fluid that cushion and lubricate the knee (bursitis).
•Inflammation of the tendons (tendinitis) or small tears in the tendons (tendinosis).
•Thickening or folding of the knee ligaments (Plica syndrome).
•Pain in the front of the knee from overuse, injury, excess weight, or problems in the kneecap (patellofemoral pain syndrome).
•Irritation and inflammation of the band of fibrous tissue that runs down the outside of the thigh (iliotibial band syndrome).
Conditions that may cause knee problems
Problems not directly related to an injury or overuse may occur in or around the knee.
•Osteoarthritis (degenerative joint disease) may cause knee pain that is worse in the morning and improves during the day. It often develops at the site of a previous injury. Other types of arthritis, such as rheumatoid arthritis, gout, and lupus, also can cause knee pain, swelling, and stiffness.
•Osgood-Schlatter disease causes pain, swelling, and tenderness in the front of the knee below the kneecap. It is especially common in boys ages 11 to 15.
•A popliteal (or Baker’s) cyst causes swelling in the back of the knee.
•Infection in the skin (cellulitis), joint (infectious arthritis), bone (osteomyelitis), or bursa (septic bursitis) can cause pain and decreased knee movement.
•A problem elsewhere in the body, such as a pinched nerve or a problem in the hip, can sometimes cause knee pain.
•Osteochondritis dissecans causes pain and decreased movement when a piece of bone or cartilage or both inside the knee joint loses blood supply and dies.
Treatment for a knee problem or injury may include first aid measures, rest, bracing, physical therapy, medicine, and in some cases surgery. Treatment depends on the location, type, and severity of the injury as well as your age, health condition, and activity level (such as work, sports, or hobbies).
Home Treatment Home treatment may help relieve pain, swelling, and stiffness.
•Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness. When resting, place a small pillow under your knee.
•Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
*For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
*After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments.
•Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling.
*Don’t wrap it too tightly, since this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.
*Don’t expect the bandage to protect or stabilize a knee injury.
*Talk to your doctor if you think you need to use a wrap for longer than 48 to 72 hours; a more serious problem may be present.
•Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
. •Reduce stress on your sore knee (until you can get advice from your doctor):
*Use a cane or crutch in the hand opposite your painful knee.
*Use two crutches, keeping weight off the leg with the sore knee. You can get canes or crutches from most pharmacies. Crutches are recommended if a cane causes you to walk with a limp.
•Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
. •Try the following exercises to maintain flexibility: *Hamstring stretch *Knee-to-chest exercise •Avoid high-impact exercise, such as running, skiing, snowboarding, or playing tennis, until your knee is no longer painful or swollen.
Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.
Medicine you can buy without a prescription Try a nonprescription medicine to help treat your fever or pain: –
.•Acetaminophen, such as Tylenol or Panadol
Note: Do not use a nonsteroidal anti-inflammatory medicine, such as ibuprofen or aspirin, for the first 24 hours after an injury. Using these medicines may increase the time it takes your blood to clot and cause more severe bruising from bleeding under the skin.
. •Nonsteroidal anti-inflammatory drugs (NSAIDs):
*Ibuprofen, such as Advil or Motrin
*Naproxen, such as Aleve or Naprosyn
•Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin
Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Safety tips Be sure to follow these safety tips when you use a nonprescription medicine: –
•Carefully read and follow all directions on the medicine bottle and box.
•Do not take more than the recommended dose.
•Do not take a medicine if you have had an allergic reaction to it in the past.
•If you have been told to avoid a medicine, call your doctor before you take it.
•If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
•Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:
•Signs of infection develop.
•Numbness, tingling, or weakness develops.
•Your knee, lower leg, or foot becomes pale or cool or looks blue.
•Symptoms do not improve with home treatment.
•Symptoms become more severe or frequent.
The following tips may prevent knee problems.
General prevention tips
•Wear your seat belt in a motor vehicle.
•Don’t carry objects that are too heavy. Use a step stool. Do not stand on chairs or other unsteady objects.
•Wear knee guards during sports or recreational activities, such as roller-skating or soccer.
•Stretch before and after physical exercise, sports, or recreational activities to warm up your muscles.
•Use the correct techniques or positions during activities so that you do not strain your muscles.
•Use equipment appropriate to your size, strength, and ability. Avoid repeated movements that can cause injury. In daily routines or hobbies, look at activities in which you make repeated knee movements.
•Consider taking lessons to learn the proper technique for sports. Have a trainer or person who is familiar with sports equipment check your equipment to see if it is well suited for your level of ability, body size, and body strength.
•If you feel that certain activities at your workplace are causing pain or soreness from overuse, call your human resources department for information on other ways of doing your job or to talk about using different equipment.
. Tips specific to the knee
•Keep your knees and the muscles that support them strong and flexible. Warm up before activities. Try the following stretches:
?Hamstring stretch ?Knee-to-chest exercise ?Calf stretch ?Straight-leg raises •Avoid activities that stress your knees, such as deep knee bends or downhill running.
•Wear shoes with good arch supports.
•Do not wear high-heeled shoes.
•When playing contact sports, wear the right shoes that are made for the surface you are playing or running on, such as a track or tennis court.
•Replace running shoes every 300 to 500 miles (480 to 800 kilometers).
Tips specific to female athletes
Sports trainers recommend training programs that help women learn to run, jump, and pivot with knees bent to avoid knee injuries. In sports such as soccer, basketball, and volleyball, women who bend their knees and play low to the ground have fewer knee injuries than women who run and pivot with stiff legs.
Knee brace use
Some people use knee braces to prevent knee injuries or after a knee injury. There are many types of knee braces, from soft fabric sleeves to rigid, metal hinged braces, that support and protect the knee. If your doctor has recommended the use of a knee brace, follow his or her instructions. If you are using a knee brace to help prevent problems, follow the manufacturer’s instructions for use.
Keep bones strong
•Eat a nutritious diet with enough calcium and vitamin D, which helps your body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods. For more information, see the topic Healthy Eating.
•Exercise and stay active. It is best to do weight-bearing exercise, such as walking, jogging, stair climbing, dancing, or lifting weights, for 45 to 60 minutes at least 4 days a week. Weight-bearing exercises stimulate new bone growth by working the muscles and bones against gravity. Exercises that are not weight-bearing, such as swimming, are good for your general health but do not stimulate new bone growth. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness.
•Avoid drinking more than one alcoholic drink per day. People who drink more than this may be at higher risk for weakening bones (osteoporosis). Alcohol use also increases your risk of falling and breaking a bone.
•Stop or do not begin smoking. Smoking puts you at a much higher risk for developing osteoporosis. It also interferes with blood supply and healing. For more information, see the topic Quitting Tobacco Use.
Bruises are often the first sign of abuse. Seek help if:
•You suspect abuse. Call your local child or adult protective agency, police, or a doctor, nurse, or counselor.
•You or someone you know is a victim of violence.
•You have trouble controlling your anger with a child or other person in your care. Resources are available for help.
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.
A synthetic skin as good as the natural one is likely to be mass produced, thanks to a new technique pioneered by German scientists. The good news is that it will be a boon for burn victims, who require extensive skin grafting to cover damaged parts — a very painful process. The availability of this “artificial skin” opens up almost unlimited new possibilities for medical scientists. One of their upcoming projects is to produce intestinal tissue for resorption tests.
Tissue engineering has been at the focus of research for many years, and tissues such as cartilage or skin are already being cultured in numerous biotechnology labs.
But researchers at the Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB in Stuttgart plan to go a step further. They are aiming to enable fully automated tissue production.
First of all, a biopsy is checked for sterility. A gripper arm then transports the biopsy into the automated device where the individual steps are performed, said an IGB release. The machine cuts the biopsy into small pieces, isolates the different cell types, stimulates their growth, and mixes the skin cells with collagen.
A 3-D reconstruction of different skin layers is produced with the aid of a special gel matrix – and the skin is ready. In the final step, the machine packages the cells for shipment. Alternatively, the tissue can be deep-frozen and stored for later use.