Knee Pain - What your symptom is telling you

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What Your Symptom Is Telling You
When To See Your Doctor
Symptom Relief

What Your Symptom Is Telling You
Those #*&!%@ knees! You push them just a little too far and the next thing you know, you feel like you've double-crossed the Godfather!

As one of about 50 million Americans with knee problems, you've just joined the Painful Knee Club. Our knees have always been vulnerable to an assortment of bumps, bangs and bruises. But as we have become an older and more active society, our hapless knees now bear more burdens and face more wear and tear than ever before. Hence the club's ever increasing membership.

A fall, twist or bang on the knee can obviously qualify you for membership. So can an old injury that never healed properly and now acts up in response to changes in the barometer. But most recurrent or unexplained knee pain comes from overuse.

The knee is held together by tough ligaments that connect, protect and stabilize the joint; cartilage that cushions the bones; and tendons that join muscles to bone. But even these resilient tissues have their limits. Too much bending and twisting, too much running or too much jumping can cause them to rupture or become inflamed.

WHEN TO SEE YOUR DOCTOR

Your pain makes it hard for you to walk.

The knee feels loose or unable to support your weight.

You also have severe swelling, redness or discoloration that doesn't diminish after 24 hours.

Unexplained pain lasts for more than three days.

Pain following an injury doesn't diminish within five days.

Damage to these tissues also takes its toll on the sensitive surfaces of the knees' bones. "The tissues in the knees work like the shock absorbers in a car," says M. Solomonow, Ph.D., director of the bioengineering section at the Louisiana State Medical Center in New Orleans. "If you make a lot of sudden stops or subject these components to stresses they weren't designed to handle, they wear out. In a car you'll hear the sound of metal on metal; in a knee you'll feel the pain of bone rubbing on bone."

Many overuse pains are lumped under the umbrella term chondromalacia patellae—a fancy way of saying pain in, around and under the kneecap.

But not all overuse pains belong in this category. Suppose you have an active teen in your house complaining of pain just south of the kneecap. It could be Osgood-Schlatter disease, commonly called growing pains—a condition arising from excess stress on the tendons of the lower leg bone. Combine lots of physical activity with the rapid muscle and bone growth of puberty, and you get one miserable kid with a painful, bony enlargement or bump on the upper part of his lower leg, just in front of and below the kneecap.

When the knee is subjected to misuse as well as overuse, it can develop a condition called synovitis. Your mother may have called it water on the knee, because the achy joint now bears a striking re-semblance to a water balloon. Synovitis is from a bang or twist that causes certain tissues in the knee to fill with blood or other fluids.

Another knee condition related to overuse is sometimes called housemaid's knee. It's really a form of bursitis—irritation to the front of the knee causes a bursal sac in front of the kneecap to fill up with fluid. Its most common cause: prolonged kneeling on hard surfaces.

The knee is also a potential site for a painful condition called osteochondritis dissecans—a necrosis, or death, of a segment of bone or cartilage. Its cause is unknown. Eventually, the dead cartilage or bone chip can break off and produce even more pain as well as a locked knee.

In some instances, nasty knee pain can actually originate elsewhere in the body, such as the toe, foot, spine or hip. Fallen arches or weak ankles can cause your foot to overpronate (rotate too far inward), putting too much force on the knee. And if you have poor posture or an improper gait, it can focus pain directly to your knees.

The knee is also a favorite target for arthritis in its many forms. Osteoarthritis results from the breakdown of cartilage and other joint tissues after years of wear and tear. Rheumatoid arthritis is characterized by a progressive development of pain and swelling in joints and their connecting tissues, which can be coupled with other symptoms like fatigue, weight loss and low-grade fever. And gout is a metabolic condition in which severe arthritis develops when uric acid is deposited in joints and other tissues.


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In addition, the knee is also a potential site for tumors and cysts as well as painful bacterial infections.

Symptom Relief

The key to silencing most angry knees is not to subject them to the kind of activities that ticked them off in the first place. Repeated abuse is a sure-fire means of provoking a ferocious response.
Treat painful knees with kindness and they'll behave. Let these tips show you how.

Use RICE on injuries. Whether from an acute trauma like a sprain or simple overuse, injuries respond best to RICE: an acronym for rest, ice, compression and elevation. "Rest is the key component," says Edward J. Resnick, M.D., professor of orthopedic surgery at Temple University Hospital in Philadelphia. "Then after a period of limited activity, doctors like to see a gradual resumption of activity and exercise." Supplement several days of rest with applications of ice: 15 minutes at a time, several times a day to reduce swelling. Compress the knee by wrapping it snugly, but not too tightly, in an elastic bandage to limit movement. And elevate the knee with pillows to drain fluids from the joint.

Take an analgesic. Aspirin,ibuprofen and MSM are powerful pain and inflammation fighters that will help sore, swollen knees. Acetaminophen will help pain, but won't do anything for swelling.

Warm your wobbly knees. Cold is fine for injuries after they first occur, but most lingering pain responds best to moist warmth, says Dr. Resnick. He recommends a warm, moist towel, a hot-water bottle, a moist heating pad, a warm bath or a whirlpool.

Drop a few pounds. "If you're overweight, losing weight is a good way to reduce some of the painful forces acting on your knees with each step," says David W. Lhowe, M.D., orthopedic surgeon at Massachusetts General Hospital in Boston and professor of orthopedic surgery at Harvard Medical School. "Contact forces on joint surfaces in the knee can range up to eight times body weight. Lose 10 pounds, and you'll reduce those forces by 80 pounds, which is a lot."

Support your arches. A simple over-the-counter arch support in your shoe can prevent overpronation, says Peter Francis, Ph.D., professor of physical education at San Diego State University. People who pronate severely may require a professionally fitted arch device.

Cushion your knees. If you must spend periods of time on your knees, take some of the stress off your kneecaps by wearing cushioned knee pads or knee wraps. And take frequent rest breaks so that the stress isn't applied constantly.

Avoid squatting. Squatting and deep knee bends put enormous stress on the knee and can cause cartilage tears or possible rupture of the quadriceps tendon. Repetitive squatting can also produce prolonged episodes of knee pain in certain individuals, says Dr. Lhowe.

Find alternatives to running. Nonpounding activities like biking, walking and swimming can provide the same benefits as running, but are much kinder to your knees, says Dr. Francis. If you must run, increase your warm-up time, cut back your mileage, run on softer surfaces and always wear quality running shoes.

Send your knees to the gym. "Poor muscle tone is often the real culprit underlying most chronic knee problems," says Phillip J. Marone, M.D., director of the Jefferson Sports Medicine Center at Thomas Jefferson University Hospital in Philadelphia. "That's why in 80 percent of all cases, painful knees will respond to a sensible exercise program focusing on building flexibility and strength, particularly in the quadriceps and hamstrings [the large muscles at the front and backs of the thighs]."

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