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Knee Pain - Causes, Treatment, and Rehabilitation

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The knee joint is one of the synovial joints prone to wear and tear depending upon its use or abuse. Read on to know more.

Medically reviewed by

Dr. Atul Prakash

Published At October 20, 2022
Reviewed AtMay 24, 2023

Introduction

The knee joint is one of the synovial joints present in the body. A pair of long bones are articulated against one another, separated by a capsular ligament and articular cartilage. Like any mechanical component, the joint is prone to wear and tear depending on its use or abuse, especially in sports, athletics, old age, and arthritis.

What Are the Principal Contents of the Knee Joint?

The knee consists of three main bony components and an array of ligaments, cartilage, blood, nerve, and muscle supply. The components can be sub-classified as follows;

Bony Components.

  • The thigh bone or femur.

  • The shin bone or tibia.

  • The kneecap or patella.

Ligaments.

  • Anterior cruciate ligament.

  • Posterior cruciate ligament.

  • Medial collateral ligament.

  • Lateral collateral ligament.

Cartilage.

  • Medial meniscus.

  • Lateral meniscus.

The joint is outlined by a layer of a fluid-filled membrane known as the synovial membrane.

  1. Muscles.

  2. Blood vessels.

  3. Nerves.

When Does Knee Pain Occur?

The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The nature of the stress and the quality of the underlying bone determines the intensity of the pain. The common causes behind this are;

  1. Tear in the ligaments.

  2. Arthritis or inflammation of the joints.

  3. Tear of cartilage meniscus.

  4. Loss of blood supply to the bone.

  5. Trauma or injury to the joint.

  6. Increased body weight.

  7. Fracture of the joint.

  8. Repetitive strain or common overuse.

When to Consult a Specialist?

Knee pain is the principal cause for patients turning up to consult specialists in the field. Other symptoms may include;

  1. Crackling sounds.

  2. Discomfort while performing menial tasks like walking, climbing stairs, or getting up from a chair.

  3. Swelling of the joints, which is not relieved by medication.

  4. Locking of the joints.

  5. Instability of the joint.

  6. Loss of range of motion.

  7. Stiffness.

  8. Bow-legged knee deformity.

What Are the Diseases that May Necessitate a Surgical Procedure?

  • Osteoarthritis is an age-related "wear and tear" type of arthritis seen in people around 50 years of age and older but may occur in younger people. The articular cartilage that acts as cushions between the bones soften and wear away with time. The friction between the bones leads to knee pain and stiffness.

  • Rheumatoid arthritis is a disease where the synovial membrane surrounding the joint becomes inflamed, which can damage the cartilage and eventually cause cartilage loss, pain, and stiffness and is termed "inflammatory arthritis."

  • Post-traumatic arthritis following a severe knee injury due to fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

What Are the Treatment Modalities to Treat Knee Pain?

Knee pain can be treated with the help of the following modalities;

  1. Nonsurgical pain management.

  2. RICE protocol.

  3. Knee reconstruction.

  4. Knee replacement surgeries.

What Is the RICE protocol?

The RICE protocol is an effective treatment method for most sports-related injuries.

The term RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest: This requires taking a break from the activity responsible for the injury. Use of crutches or other orthopedic aids may be used to avoid putting weight on the knee joint.

  • Ice: This requires using cold packs for about 20 minutes at a time, several times a day. Ice must not be directly applied to the bare skin.

  • Compression: Additional swelling and blood loss can be prevented by wearing an elastic compression bandage over the affected area.

  • Elevation: Reclining the patient when at rest and putting the leg up higher than the heart level.

What Are the Procedures for Knee Surgeries?

Knee surgeries are typically performed either under general or spinal anesthesia. First, an incision is made on the affected joint's surface skin. The damaged portion of the bone or cartilage is then removed, and suitable grooves are created to house the implants necessary. Following this, the implants are stabilized using either screw plates or cement. A plastic liner insert is placed between the two articulating bone surfaces to act as the cartilage.

In the case of ligament reconstruction surgeries, the hamstring tendon is used as a graft, coupled with drilling holes in appropriate places of the knee joint surfaces, then pulled through it. This is followed by stabilization, using screws or plates, and suturing to allow healing of the cartilage into the bone.

How Is Rehabilitation Done Postoperatively?

Rehabilitation postoperatively follows almost immediately. A physical therapist is appointed to train the patient with suitable exercises to help strengthen the joint to somewhat original capacity and restore adequate knee movements. Prosthetic devices such as a walker, crutches, or cane may be prescribed for a while until the joint regains its functionality. A continuous passive motion (CPM) machine may passively move the joint while the patient relaxes. An exercise program at home will also be prescribed to keep joint functionality intact.

What Are the Postoperative Complications?

  1. Infection of the operative site.

  2. Knee stiffness.

  3. Blood clots or deep vein thrombosis.

  4. Damage to nerve and blood vessels.

  5. Implant loosening.

  6. Wearing out of plastic liners.

  7. Kneecap dislocation.

  8. Injury to ligaments.

  9. Addiction to Narcotic pain relief medication is usually provided short term.

What to Do at Home?

Surgical efficiency, however perfect, must be complemented with adequate home care for the patient during and after the recovery phase. The safeguards and measures taken at home can be as follows;

  • Create a living space restricted to one floor at home.

  • Install guard rails and handles wherever needed, such as in showers and stairways.

  • Stable chair with cushion and footstool to elevate the joint.

  • Arrange for a toilet seat riser with handles if the toilet height is short.

  • Remove loose rugs and cords.

Conclusion

The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The quality of the bone and the nature of the exertions subjected to it cause significant stress to its components, resulting in a wide array of problems leading to knee pain. However, in most cases, patients experience a dramatic knee pain reduction and significant improvement in performing everyday activities of daily living.

Frequently Asked Questions

1.

What Is Knee Rehabilitation?

Knee rehabilitation aims to increase muscle strength, flexibility, and control. In addition, these exercises reduce problems like knee pain, stiffness, swelling, and instability. Along with that, it can also help with long-term knee problems and post-surgery complications.

2.

What Are the Latest Treatments for Knee Pain?

In some cases for knee or joint pain, doctors prescribe painkillers, and in other cases, steroids may also be prescribed. Nowadays, various new treatments have been introduced, such as -
- Hyaluronate Injections.
- Platelet-Rich Plasma (PRP) Injections.
- Bone Marrow Aspirate Concentrate.
- Botox Injections.
- Cooled radiofrequency treatment.

3.

Does Walking Help With Knee Pain?

Walking is considered excellent aid for patients with joint pain or stiffness. Walking helps build muscles that take off the pressure from the joints and provide more strength in handling the weight. Walking at least 30 minutes daily can improve overall health and reduce pain.

4.

How to Treat Knee Pain at Home?

Mild to moderate pain can be treated at home by using various home remedies such as -
- Heat and cold therapy.
- Daily exercising.
- Weight management.
- Try RICE - rest, ice, compression, and elevation.

5.

What Exercise Is the Best Knee Rehab Exercise?

The exercises that are considered best for rehabilitation of the knee include -
- Knee Extension.
- Knee Flexion.
- Heel and Calf Raise.
- Wall Squats.

6.

Which Medicine Can Be Taken for Knee Pain?

Painkillers are the most prescribed drugs in case of knee pain. Some of the over-the-counter drugs are Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (or NSAIDs), including Aspirin, Ibuprofen, and Naproxen (Aleve). These drugs can help provide fast relief in case of simple sprains and even to the pain of arthritis.

7.

For How Long Should the Knee Be Rested for Pain Relief?

The duration usually depends on the type of injury. Resting for one to two days is sufficient to provide time for healing. However resting phase depends upon the severity of the injury. In serious injuries, the patient might keep off their feet for longer compared to minor soft tissue injuries.

8.

What Are the Initial Signs of Knee Pain?

The initial signs of knee pain include -
- Swelling and stiffness.
- Redness around the knee area.
- Skin feels warm to the touch.
- Instability.
- Crunching noises.
- Unable to straighten the knee.

9.

Should Knee Rehab Be Done Daily?

Doctors usually recommend exercising daily for at least 20 to 30 minutes. This can be done even two to three times daily. Walking is best for older adults, which can help in early recovery.

10.

Can Knee Injury Be Treated Without Surgery?

This usually depends upon the amount of damage to the knees. If the knees are badly damaged, knee surgery is the only way to treat them. However, in the case of moderately damaged knees with various conservative treatments, the damage can be reversed, and surgery is rarely needed in that case.
Dr. Atul Prakash
Dr. Atul Prakash

Orthopedician and Traumatology

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knee joint tearknee pain
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