The ultimate guide to knee pain | Types, causes, home remedies, when to see a doctor


Swelling and cracking of the knee could be
related to underlying problems in the knee, such as arthritis, wear and tear, or it could
be related to injuries such as sports injuries sustained while playing football, rugby, tennis, running.
These could all contribute to swelling and cracking. The most important thing is
whether the cracking is painful or painless. Pain and swelling associated with arthritis
are usually of a gradual progression. It happens over time and it gets worse over time and
it’s made worse by activities such as excessive walking, going up and down the stairs or running
for example or sports activities. The other side are the sports injuries such as football,
rugby and tennis. They could lead to injuries to either the ligaments or the cartilage inside
the knee which can be associated with swelling and cracking of the knee. The term “bad knees” is a general term which
could point to the fact that there is a problem with the knees. The way to know if there is
a problem with the knees are the symptoms which include pain, swelling, instability,
difficulty with walking made worse by activities, inability to run, inability or difficulty
going up or down the stairs. These are all symptoms that would signify that there is
a problem with the knee. There’s no medical term that is called bad knees but there is
a problem with the knee which could be either related to wear and tear or could be due related
to an injury sustained in the knee. The most important factor to note is pain: how bad
is it, what brings it on, what makes it worse, are there any aggravating factors, relieving
factors, and if there is any history of trauma associated with this and obviously following
that the examination and the imaging findings such as x-rays or MRI scans of the knee. The common causes of knee pain can be divided
into mainly two groups. The acute injuries: ligament injuries or cartilage injuries, or
arthritis which is wear and tear. The acute injuries or the injuries to the knee could
be divided into two groups either ligament injuries or cartilage injuries like a torn
cartilage. If you look at the knee, there are ligaments that wrap the knee from the
outside, so the collateral ligaments which surround the knee on either side, so the medial
collateral and the lateral collateral ligament, then you have the ligaments on the inside
of the knee which are the cruciate: the anterior cruciate and the posterior cruciate ligament
at the back of the knee itself and they all have to function in synergy to preserve function
of the knee and to allow us to play sports. The other structures that are important on
the knee are the meniscus or the cartilage which act as cushions to the knee when you
run, walk on them and they can be injured and cause mechanical symptoms with the knee.
The second group is the arthritic group or the wear and tear group of the knee. This
is when the knee starts to wear out and the cartilage becomes thinner to the point that
it may reach the point where there is no space at all between the two surfaces and then you
start to erode the bone and that’s sort of an indication to proceed with surgery such
as knee replacement surgery. Other issues associated with a knee and sports for example
are runner’s knee where there is friction as you run between the bones and the soft
tissues and they may lead to painful clicking, Iliotibial band syndrome. Iliotibial band
is a band of tissue that runs across the knee towards the tibia and it can also be injured
or damaged or irritated by certain activities such as squatting or lunges. Other conditions
for example, gout, prepatellar bursitis, or inflammation or swelling of the front of
the knee which is common in carpenters, in gardeners, people who kneel for a living,
and then finally fractures or trauma caused to the knee such as fracture of the femur,
patella, the kneecap or the tibia; which can happen due to traumatic injuries such as falls,
it can happen in car accidents, and it can happen and also simple twisting while you’re
walking down the road, for example. To help relieve knee pain at home, it is important
to start by resting the knee. So, stop activities as much as possible to try and allow the knee
to recover and give it room to breathe. Second thing is if it’s swollen, then you might want
to use ice to reduce the swelling especially after an injury while playing football or
rugby, for example, and using an ice pack at home can help reduce pain and swelling
at the same time. Sometimes we use what we call a compression bandage just to compress
the knee and reduce the swelling as well. Elevating the knee on a stool or a couple
of pillows to relieve swelling as well helps in reducing pain. Taking painkillers, simple
painkillers such as paracetamol or anti-inflammatories such as ibuprofen if you’re allowed to take
it, helps relieve the pain as well and reduce the inflammation. Avoid the activities that
might trigger the onset of pain. For example, if the pain gets worse while squatting or
doing lunges, then you might want to avoid those certain movements. Some people find
that going down the stairs can be a bit tricky. Go one step at a time. Avoid any activities
where you might need to do a sudden change of direction on the knee and try and do linear
exercises. Physiotherapy helps and it helps to strengthen the muscles and the envelope
around the knee to try and provide strength to the knee to be able to cope with stresses.
So, it’s important to start physiotherapy whenever you’re able to do so. Wearing the
right shoe wear is very important especially if you run quite a lot. I would encourage
you to get a fitted running shoe to allow you to run if you do a lot of running. Sometimes
taping, patellar taping can help and also stretching of the tendons using either dynamic
or static taping can help reduce some of the swelling or pain around the knee. You might
have seen this on football players, the blue tape or black tape that’s applied which is also
used on the shoulders as well as the knee. You need to seek medical advice when you have
a problem with your knee that is not getting better or a problem with your knee that’s
associated with instability, knee giving way, problems with going down or up the stairs,
general reduced mobility, pain especially at nighttime, or pain on certain movements.
If you’re getting sharp pain and clicking at the same time, if you’re getting pain and
recurrent episodes of swelling in the knee, then it’s important also to seek help. These
are all symptoms that could delineate that there is a problem which could be either due
to either an injury such as an acute injury or a chronic injury which has become worse
over time. The pain associated with arthritis or wear and tear is usually of a gradual onset
which becomes worse over time and can reach a point where you have pain at rest or pain
at night. If you notice that your walking distance is decreasing, if you have problems
going up inclines or going down hills, if your knee is starting to give way regularly,
if it’s not holding your weight and associated centres of instability, if the patella or
the kneecap is dislocated and moving sideways more than normal and it’s associated with
painful clicking, if there is associated swelling, mechanical symptoms in the knee, then it is
important to seek help. Knee pain is treated by conservative options
and surgical options. The conservative options include the easy options include rest, elevation,
allowing the knee to settle down, compression using a soft bandage and using ice in an acute
injury or what we call the RICE regime: rest, ice, compression, elevation – followed by painkillers
which include paracetamol, anti-inflammatories. These reduce the inflammation and reduce the
swelling and also help to control pain symptoms followed by injections. Injections do help.
Especially if the underlying pathology is wear and tear. There are various types of
injections. The commonest injections that we have are local anaesthetic plus steroid
injections, but there are other forms of injections that are being more commonly used with varying
levels of evidence including platelet-rich plasma or PRP; which is an extract from your
blood that’s injected into the knee to allow to reduce the inflammation and reduce pain.
There is varying evidence. Some people are for it, some people are against it. In certain
pathologies, it does help such as patellar tendinopathy, for example, or the quadriceps
tendinopathy which is where there is inflammation of the tendons around the knee. There is some
evidence that it might help in arthritis as well. Now, if the pain is sharp and intermittent
and it’s associated with mechanical symptoms such as the knee giving way, collapsing on
you, or instability, then it might need further imaging such as X-ray or an MRI scan of the
knee to see if there is any evidence of cartilage damage or ligament damage which might require
surgical intervention. There are other types of injuries such as sports injuries, such
as a runner’s knee, friction syndrome, Iliotibial band. These are repetitive injuries associated
with certain sports which if you rest and avoid certain activities and do some exercises
to help stretch the muscles and tendons do get better. What doesn’t get better obviously
are cartilage tears and the ligament injuries especially ACL injury or a torn medial meniscus
or torn cartilage. These may require surgery in the form of arthroscopic or keyhole minimally
invasive surgery. When you develop arthritis, it can be either mild, moderate or severe.
When it reaches the severe point especially when you have pain at rest or pain at night
or your exercise tolerance decreases to less than 100 or 200 yards, then it becomes important
to treat the problem and if there’s severe arthritis both clinically and on the X-ray
and the symptoms are fairly suggestive of this, then surgery in the form of either a partial
or a total knee replacement is indicated in those cases. According to the latest paper
publication by The Lancet, knee replacements do reasonably well and if you have a knee
replacement in this day and age, your chances of surviving for 20 to 25 years are eight out
of ten which is a good statistic to have.

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