A word about chronic
pain
Pain is broken down into two categories: acute or chronic. If you fall
down and hurt or twist your knee, that is called "acute" knee
pain. Chronic pain is something that occurs more gradually over time,
often worsening as weeks and months go by. Unlike acute pain, which
can be linked to a specific event or time, such as when you fall or
twist your knee, chronic pain is more like an ache that isn't linked
to any event. Your doctor will find out when and how your pain started
to learn more about the potential cause of the pain.
Ligament
injury
The knee is the largest joint in the body. Two ligaments in the front
and back, the anterior cruciate ligament (ACL) and the posterior cruciate
ligament (PCL), give the knee its stability. According to the American
Academy of Orthopaedic Surgeons, over six million people and other
athletes visit orthopedic physicians for knee problems each year. Gymnasts,
dancers and athletes are all at risk for knee ligament injury. The
AAOS indicates that sports and activities that involve changing directions
quickly, jumping, or slowing down while running or going downhill increases
the risk of straining the ACL. You may not experience pain immediately,
but a popping noise preceding swelling may indicate an injury to the
ACL. A complete tear may require reconstruction. Treatment may include
operative and non-operative choices, based on activity levels and type
of injury.
The PCL is injured less often than the
ACL. However, common injuries to the PCL ligament include a blow to
the knee or hyperextension (e.g. missing a step while walking downstairs).
In most cases, surgery is not necessary unless a piece of the shinbone
is pulled away with the ligament.
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Strains
& sprains
These two terms are sometimes used together. However, technically they
differ. A strain occurs when a muscle is overworked or overstretched.
Sprain relates to ligaments or tendons. For instance, a strain can
occur at the start-up of a new exercise regime. If the body isn't properly
stretched, sudden impact can tear muscles, ligaments, tendons and soft
tissues. As our body becomes accustomed to a specific type of exercise,
like running, it compensates for potential injuries by strengthening
muscles and ligaments. If we start a running program after living a
relatively sedentary lifestyle, our body has not yet had a chance to
compensate, and we are more prone to a strain.
If you are about to start up an exercise
program, remember to stretch before embarking on the new activity.
That is crucial. Also try to ease into the program, allowing your body
to strengthen before pushing it to the limit.
Sprains, in particular, relate to an
over-stretched or torn ligament. Usually, the sprain is tender, or
swelling occurs, and it can look black and blue like a bruise. This
is a little more serious because it indicates a torn ligament. Tears
are more severe than strains or sprains. When muscles, ligaments or
tendons are torn, they are actually disrupted. The torn ends grossly
disrupt the continuity of their structure.
The location of the injury should clarify
any confusion over whether it's a sprain or strain. Strains occur in
the muscles of the neck, back, thighs and calves. Sprains are found
around joints—knees, ankles or wrists.
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ligament problems
An increased interest in sports seems to have been the catalyst for
more and more ligament problems each year. In fact, there are more
than 50,000 hospital admissions for ligament repair. Interestingly,
women are eight times more likely to have an ACL tear than men. Some
experts theorize it may relate to high heels or a difference in anatomy.
The ACL (anterior cruciate ligament) and the MCL tend to be particularly
susceptible to injury during sports. Common causes of these tears is
when someone turns quickly and twists the knee, slows down when running,
and lands from a jump. High-risk sports include soccer, skiing, basketball
and tennis.
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Pain
from meniscal tears Meniscal tears stem from sports-related injuries or even from seemingly
innocuous activities such as squatting. Athletes who play football,
basketball and tennis, as well as adults over the age of 40, are
especially prone to meniscus tears. The type of movement that most
often causes meniscal injury is one in which the foot is firmly
planted on the ground while the knee is twisted. Shoes with cleats
often contribute to this type of injury by anchoring the lower
leg into the ground and preventing it from moving with the knee.
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fractures
A bone can break for a number of reasons. A traumatic injury, such
as a car accident, can cause a bone to break. Other causes for broken
bones can be "stress" fractures in which a bone is used repetitively,
and because of compression, it breaks.
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Dislocation
Sometimes, especially when doing something physically strenuous, we
can throw a joint out of alignment with the bone. Although nothing
breaks, the alignment is off. This is called dislocation.
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Chondromalacia
Chondromalacia indicates a degenerative condition that results from
chronic wear on the kneecap. Over time, this cartilage may fray and
soften. It is a degenerative condition, which occurs as the result
of chronic wear of the kneecap against the femur. The articular cartilage
gradually softens and then frays. In other circumstances, it can
stem from one particular, traumatic incident. Symptoms for this condition
could be pain at the front of the knee, especially when walking up
and downhill, stiffness after prolonged sitting and a grinding or
clicking sensation as the knee is flexed and extended. This condition
is more common in middle age. It happens mostly to women and can
begin as early as the teenage years.
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Arthritis Arthritis: osteoarthritis
This is a degenerative joint disease stemming from wear and tear on
the knee, usually affecting those in middle age and older. Osteoarthritis
causes the cartilage to erode away. Symptoms include pain, stiffness
and swelling that at first happens once in a while but can progress
to chronic pain.
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Arthritis: rheumatoid
arthritis
Unlike osteoarthritis, this type of arthritis does not erode the cartilage
slowly, rather it inflames the joint (usually many joints at one time)
until the joints are ruined. Rheumatoid arthritis is most common in
middle aged women but can affect people of all ages.
Arthritis: crystalline
arthritis
Inflammation of the joints can occur when a small granule of sodium
urate (related to gout) or calcium phosphorate (related to chondrocalsinosis)
gets lodged in the joint. The effect is similar to getting a piece
of sand trapped in your eye. It irritates the surrounding inflammation.
Middle-aged men are most prone to this sort of arthritis.
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Pre-patellar
bursitis
Between the tendon and the skin are small sacs called bursae, which
allow the skin to smoothly and painlessly slide over bones. When the
bursae become inflamed, any knee movement can cause pain. In the knees,
one function of the bursae is to allow the knee cap to move around
freely without pain. Repetitive kneeling and/or direct impact on the
knee can cause the bursae to swell and cause pain.
Those in professions where the knees are often bent such as masonry,
house cleaning, carpet layers and electricians are more likely to experience
post-patellar bursitis. At other times, the condition can occur when
the sacs become infected. Usually, surgery for this ailment is not
necessary (although may be called upon in extreme cases), and treatment
includes avoiding bending of the knees and relieving pressure to the
knee cap.
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The Four Most Common
Knee Problems
Knee cap pain: The pain usually become most noticeable
when walking upstairs, going downstairs, running or sitting.
Pain from a torn meniscus: The meniscus is the cartilage
that keeps the femur (the thigh bone) and the tibia (the shin bone)
from hurting or grinding when they rub against each other. If the
meniscus is torn, stretched, or out of place, pain may occur when
the joint is moved.
Pain from ligament problems: There are four ligaments
in the knee: the anterior cruciate ligament, the posterior cruciate
ligament, the medial collateral ligament and the lateral collateral
ligament. When the ACL is torn, it is often because the leg rotates
while the foot stays planted on the ground. Often times, an ACL tear
is accompanied by a loud popping sound from the knee, and the support
of the knee gives way. A posterior cruciate injury happens when the
knee is forced backwards, or when it receives a hard impact. A medial
collateral ligament injury most commonly occurs when the knee is
hit from the outside, while a lateral collateral ligament injury
occurs when the knee is impacted from the inside.
Pain from tendon problems: Inflamed tendons that connect
the knee cap to the shin bone can cause pain.
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