Friday, January 19, 2018


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Knee Pain: Signs and Symptoms

Are you suffering from knee pain? Why live with it? Instead let's try and find out the ways and means of relieving the discomfort associated with knee pain

However, the thing that you need to know is to learn more about the main causes. Any problem that you may have in moving your knee has a specific cause behind it. While your knee pain can develop slowly over days, you may often experience an intense shooting pain in your knee when you try to move it or walk on it.

The reasons behind each kind of pain may differ as well. The knee is a joint that is compromised of cartilage, bone, muscle, ligaments and tendons all working together. The knee joint has three parts. The thigh (the femur) meets the large shinbone (tibia) to form the main knee joint. The joint has an inner (medial) and an outer(lateral) compartment. The knee(the patella) joins the femur to form a third joint, called the patellofemoral joint.

Let's now take a look at some of the most common causes of knee pain:

Patellafemoral Pain Syndrome (PFPS): this term usually refers to pain around and under the knee cap. It is often called "Runner's Knee". The pain of PFPS may occur in one or both knees, and tends to worsen with activity, while descending stairs and after long periods of inactivity. It is believed that the cause could be the way the patella tracks along the groove of the femur and lead to irritation of the cartilage on the underside of the patella.

Signs and symptoms

  • Knee pain
  • Pain when the van
  • Pain when squatting
  • Pain when jumping
  • Pain when going downstairs
  • Knee buckling suddenly
  • Knee unexpectedly gives away
  • A catching, popping or grinding sensation when walking

Knee Tendonitis: tendonitis is a condition that occurs when one of the tendons that attaches your muscles to the bones become inflamed. In tendonitis of the knee the superior patellar tendon sometimes referred as "quad tendon", or inferior patella tendon becomes inflamed and irritated.

Signs and symptoms

  • Knee tenderness at superior patellar tendon (SPT) or inferior patella tendon (IPT)
  • Knee pain when running
  • Knee pain or hurried walking
  • Knee pain with jumping activities
  • Knee pain with extending the knee joint
  • Difficulty with lifting leg, straight leg raise

Knee sprain: a sprain is a tear of the knee ligaments, the tough bands of fibrous tissue that can expose the bones. In the knee you have a medial collateral ligament (MCL), a lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). These injuries are very common in sports that require stopping or quickly changing directions. These extreme forces on the knee can result in a torn ligament.

Signs and symptoms

  • Knee pain, knee buckle sideways toward side of sprain
  • Knee pain on palpation MCL or LCL
  • Knee pain with special test for ACL
  • Knee stiffness
  • Knee pain with bearing weights
  • Knee pain on standing up
  • Knee pain with cutting activities
  • Unstable knee with stopping or cutting activities

Meniscus injuries: The meniscuses are two pieces of cartilage that act as a cushion in the knee joint. The Cartilage sits between the tight bone (femur) and the shinbone (tibia). These meniscus are named as to where they sit on the tibia condyle, the one on the outside (lateral meniscus) and the one on the inside aspect of the knee (medial meniscus). A meniscus tear occurs when one of these pieces of cartilage tear in her injured it usually during movement that forcibly rotates the knee while bearing weight. This is usually seen in athletic playing sports in which therefore is firmly planted in cutting is involved.

Signs and symptoms

  • Audible click or popping during injury
  • Knee may become locked
  • Knee will become weak and swell up
  • Tenderness on the side of meniscus injury
  • Pain with any weight bearing on the joint

ACL and PCL injuries: these ligaments were mentioned above in the knee sprain section but are much more common than the MCL or LCL to injury.  The ACL (anterior cruciate ligament) and the PCL (posterior cruciate ligament) are two major ligaments in the knee joint that work together to provide the main stability of this joint.  They cross each other and form and X which allows the need to flex and extend without side to side movement.  The ACL injuries are most common during sports that require a sudden change in direction, sudden or abrupt stops and starts and jumping activities.

The ACL is often stretched, or torn by sudden twisting motion while the bullet remains planted in one direction and the knee is turned in the opposite direction.  This can also happen when landing from a jump.  The PCL injuries are likely with impact to the front of the knee, or from hyper extending the knee.  The PCL can also be injured by a direct impact from the outside of the knee joint, such as those that occurred during soccer or football.

Signs and symptoms

  • Excruciating knee pain at time of injury
  • initially a sharp pain on outside and back at knee
  • throbbing aching pain deep in the knee
  • bending or straightening the knee will increased pain
  • pop sound when injury occurs, audible "pop"
  • swelling immediately
  • loss of stability in knee joint
  • loss of strength
  • feeling of unstable or knee giving out
  • limitation with movement 

Plica Syndrome: Plica syndrome occurs when bands of branded synovial tissues are irritated by overuse or injury.  Synovial plicas are remnants of tissue pouches found in early fetal development.  These pouches normally combined to form one large synovial cavity, but if the process is incomplete, plicae remain as for folds or bands of synovial tissue within the knee.  Injury, chronic overuse, or inflammatory conditions are associated with development of this syndrome.  Usually play has syndrome is characterized by pain near the anteriomedial (in front and toward the midline) cited the patella (kneecap).

Usually the pain is associated with bending of the knee and is irritated after and during exercise.  Usually, no other symptoms other than the pain are present, but it can occasionally be accompanied by swelling of the knee after prolonged physical activity.

Signs and symptoms:

  • Knee pain
  • knee swelling
  • knee clicking
  • knee locking
  • knee weakness

Chondromalacia: Chondromalacia patellar is the most common calls of chronic knee pain.  This condition occurs due to softening of the Cartilage beneath the knee cap.  Chondromalacia patellar results from the generation of Cartilage due to poor alignment of the patella (kneecap) as it slides over the lower end of the thighbone (femur).  This is sometimes referred to as patellofemoral syndrome.

Signs and symptoms:

  • Lateral tracking of the patella
  • rapid growth causing uneven pressures of knee Cartilage
  • discomfort of inner front of knee
  • aggravated by activities, running, jumping, climbing or descending stairs
  • prolonged sitting makes it worse
  • quadriceps weakness
  • mild swelling at the knee joint

Total knee replacements: the severe pain in knee joints can be due to arthritis, injury or other infections which can cause deterioration of the Cartilage in the knee.  The knee is made up of three boats: the end of the femur (thigh bone), the top of the tibia (shin bone), and the patella (kneecap), which are all held together by tendons and ligaments and cushioned by cartilage.  When the musculature of the knee joint declines, then the bones of the knee joint mentioned above begin to grind against each other, wearing away causing moderate to severe pain.  Totally replacements involve removing that portion of the bone which is damaged and resurfacing the knee with metal and plastic implants.

Knee replacements have come a long way over the past 10 years.  Latest being gender specific artificial knee replacements developed especially for women.  This was developed because women skeletal features are different from that of men.  The design of the gender knee is based on computer imaging of a woman, it is more narrow, enter and track set a different angle to better match a woman's knee shape and size.

Its biggest advantage is that it allows for better knee bending "flexion" and there is no kneecap discomfort.

What to consider or discuss with your doctor before getting a total knee replacement, always remember the 4R's:

  1. Remove: this type of procedure is the leastUsing a small camera, the orthopedic surgeon will evaluate the cause of her causes of the patient's knee pain and remove any damaged tissue.  This procedure helps patients with knee pain related to or torn meniscus or cartilage injury may greatly benefit from the removal technique.  Total recovery with physical therapy ranges from 2 to 6 weeks after surgery procedure.
  2. Realign: this type of procedure is for patients experiencing knee pain because their joint is not properlyIn proper alignment may contribute to poor joint function and pain.  To restore proper alignment, a surgeon may manipulate the bone, or may release or tighten soft tissues.  This surgical option may require longer recovery time because it takes time for tissue to heal and physical therapy after this procedure is typically required.  However the benefits may be best of all.  Re-alignment of the knee can decrease pain and prevent further damage to the joint.  Physical therapy will balance soft tissue and musculature to better regain range of motion and stabilize the joint for long-term functional outcome.
  3. Repair: some patients with knee pain may benefit from repair of diseased or damagedCartilage transplant can improve and/or restore normal joint function.  With this procedure, cartilage defects are repaired using tissue borrowed from other areas of the patient's own me or from a donor knee.  This repair procedure may be the best option for younger patients who are not ready for knee replacement.  Once again physical therapy would be very helpful in the recovery of this patient, the recovery time will vary based on what area of the knee and how much the knee has been repaired.
  4. Resurface: the resurface option refers to partial knee replacementThe femur, tibia and the patellar and a total knee replacement are all replaced and knee ligaments are removed.  With a partial knee replacement, only one or two of the parts are resurfaced or replaced and the ligaments are not removed.

When considering any knee surgery it is very important to remember your age, overall health, activity level and the gender into consideration for options.

Therefore some knee considerations may benefit from one, two or even three of the 4R's.  For this reason, it is most important that you pick an orthopedic surgeon wisely, we had many excellent orthopedic surgeons in this world but you need to pick one that will best evaluate and diagnose your knee or knees, but most importantly understand your lifestyle and expectations before determining what option is best for you.  I always recommend you get more than one opinion before making any decisions on surgery.

As the owner of Cross Keys physical therapy I have been trained in the Graston technique.  I personally will do a full evaluation and treatment and one of our locations.  The Graston technique is an innovative, patented form of instrument assisted soft tissue mobilization that enables clinicians to effectively breakdown scar tissue and fascial restrictions.  The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.