Preventing Knee Pain: Advice from Singaporean Specialists

Understanding Knee Pain


– Acute injury: such as a broken bone, torn ligament, or a meniscal tear. This could be as a result of impact or trauma, such as a sports injury.

– Overuse: Relying too much on a certain joint or muscle to perform a task can cause it to become fatigued, leading to an overload on the knee joint resulting in pain. This is a common cause of knee pain and is chronic in nature, often developing into a more serious overuse injury.

– Medial knee pain in the lower back and knee drives around to the inside of the knee.

– Osgood Schlatter’s disease: A condition common in adolescents that causes pain at the front of the knee around the patellar tendon. Often caused by a growth spurt, it is due to inflammation of the area where the tendon attaches to the shin bone.

– Incorrect movement: Poor mechanics or an abnormality in gait can cause an overload on the knee joint due to certain parts of the joint taking more load than they should. This damages the joint over time, eventually leading to pain and a feeling of instability in the joint.

– Arthritis: In particular, osteoarthritis, is a common cause of knee pain, especially in the older population. It is characterized by joint degeneration often due to wear and tear, causing pain, swelling, and sometimes a feeling of clicking or cracking in the knee joint.

– Prepatellar bursitis: This causes pain at the front of the knee due to pressure on the front of the knee, usually from activity involving a lot of kneeling. A direct blow to the front of the knee, an increase in pressure on the knee from excessive standing, or tight leg muscles cause the bursa to become irritated and inflamed, leading to pain and swelling at the front of the knee.

Causes of Knee Pain

This is an age-related ‘wear and tear’ of the knee that is very common. It can occur in adults of any age, but it is more common in the older population. Osteoarthritis is a gradual breakdown of the cartilage in the joints. The cartilage is there to provide a smooth surface over which the bones can glide easily on; it also acts as a shock absorber. When this cartilage breaks down, bone is exposed underneath, which can be very painful. The bone may also become thicker and start to grow out sideways, forming bony spurs. The synovial membrane can start to produce more fluid, which can cause the knee to swell. Finally, the cartilage may break off and become lodged in the joint, and this can cause it to lock. This can all cause pain and it can also affect the movement of the knee. Usually, the pain is most severe after activity or towards the end of the day.

The knee is the largest joint in the body and, as such, is subjected to huge forces during physical activities such as running and jumping. The knee is a hinge joint that also has the ability to rotate so that it can cope with the various forces that are applied to it. These forces can lead to many wear and tear problems and also traumatic injuries. During the aging process, the ability of the knee to cope with these forces is reduced, which is why knee pain is very common in the older population.

Symptoms of Knee Pain

Swelling is a common symptom of an injury to the knee, and the swelling can be acute or chronic. Acute swelling occurs quickly and is typically the result of a traumatic incident such as a blow to the knee or an injury while twisting the knee. This can cause pain and difficulty bending the knee, and the knee may feel unstable. Chronic swelling, on the other hand, can result from a meniscus tear or a predisposing arthritic condition. This can cause minimal to mild pain and recurrent effusions. Depending on the cause of the swelling, recurrent swelling can lead to further injury of the knee structures because of the resultant instability.

When knee pain occurs, it generally causes different symptoms between individuals. This varies based on the differences in individuals’ anatomies and causes of the knee pain. Below are some symptoms that occur when an individual is suffering from knee pain. The location of the pain in the knee can vary depending on which structure is involved. With an injury or inflammation to any of the structures of the knee, pain can be experienced at the specific location of the injury or structural damage. For example, if the injury to the meniscus is in the back of the knee, there will be posterior knee pain. Pain can also be referred from one area. An example of this is an individual with a lateral meniscus tear presenting with medial side knee pain because they are also suffering from an MCL injury. This pain can change in severity, from a mild ache to a severe and disabling pain. The onset of the pain can also vary. Some injuries will cause pain and swelling immediately, while for others the pain is more gradual in onset. Meniscus injuries and cartilage tears, for example, can cause slight pain which worsens over a period of days.

Preventing Knee Pain

Maintaining a healthy weight Weight control is a key factor in preventing knee pain. It is well known that pressure on the knee is 3-4 times one’s body weight when walking on level ground. This means that up and down a flight of stairs, the pressure on each knee can be 7-8 times one’s body weight. If you have knee pain or have had knee surgery, it is wise to minimize the amount of weight that your knees have to support. This can be achieved by consuming a healthy diet and/or increasing exercise intensity and frequency. In the long run, exercise is preferable as it has the added benefit of strengthening the muscles around the knee and thus improving knee stability. Remember though, you should avoid increasing exercise intensity too quickly as this may aggravate your knee.

If you are susceptible to knee pain, the following are some specific advice that you can incorporate into your daily routine. By heeding this advice, hopefully you can prevent the occurrence or slow the progression of knee pain and thus keep your knees functioning well for years to come.

Maintaining a Healthy Weight

Being overweight is a major risk factor for developing osteoarthritis of the knee. Weight loss can decrease pressure on the knee, lower the chance of acquiring an injury, and slow the progression of arthritis. Our knees support our entire body weight – the force on the knees is two to three times our body weight when we go up and down stairs, and four to six times our body weight when we squat. For example, they would be getting a force of 60-90 kg with each step if a person weighed 30 kg. If this person went up 10 stairs, the force on their knees would be 600-900 kg. High forces increase the wear and tear on our knees and the rate of progression of arthritis. Even a small amount of weight loss can make a big difference – decreasing one’s body weight by 5% can decrease pain. Weight loss is a particularly important factor for people with knee osteoarthritis. In addition, eating a healthy diet will provide the required nutrients for damaged tissues to repair. People who have knee pain may avoid exercise, however weight loss can be achieved through a combination of a healthy diet and increasing daily activity. Future articles will touch on more specific advice about diet and weight loss.

Strengthening the Muscles around the Knee

When you have strong, flexible muscles, your knee is better protected from injury. For people with arthritis, exercising the knee is important because it increases muscle strength to help support the joint. Strong muscles help the knee absorb shock more effectively. This can help prevent stress-related injuries such as a broken bone, torn ligament, or cartilage. Start with a warm-up and end with a cool down. Your warm-up should include 5 to 10 minutes of low-impact activity, like walking or riding a stationary bicycle. This helps to warm the muscle that will be used during exercise. A warm-up increases your blood flow, making muscles more pliable and less prone to injury. A good cool down involves the same low-impact activity as your warm-up. The activity is important in aiding the dissipation of waste productions in your muscles, like lactic acid, which can cause stiffness and muscle soreness. Stretching during the cool down is important for maintaining and even increasing muscle flexibility. Gentle stretching should be held for 10-15 seconds for each muscle group and is most effective when the muscle is warm and pliable. Any pain felt should be only mild. If it is more than mild, you may be pushing the stretch too hard. Stretching is important, especially for the knee joint. It maintains and increases the movement in surrounding muscles and tendons and prevents the shortening and tightening of these tissues. Static quadriceps contractions and straight leg raises are good exercises to initiate muscle strengthening, with a low risk of increased pain and are suitable for most people. Static quadriceps contractions can be performed anywhere, anytime and are a good way to maintain muscle strength. Simply tighten the muscle on the front of your thigh and try to straighten your leg, holding it tight for 5-10 seconds. Do this about 10-15 times. Straight leg raises also strengthen the quadriceps on the front of the thigh. Lie on your back, with one knee bent and the other straight. Raise the straight leg to the height of the opposite knee and slowly lower it to the ground. Do this 10-15 times with each leg. This exercise can be made more difficult by placing weights around the ankle you are lifting. This group of exercises can be increased as pain allows to include more difficult exercises and resistance training. The strength and flexibility of the muscles around the knee can make the difference between moving easily and moving with pain and difficulty. This makes the effort to exercise these muscles and the maintenance of a healthy weight truly worthwhile.

Using Proper Techniques during Physical Activities

Finally, remember that the goal of good knee care is not just the prevention of knee pain and injury, but also the avoidance of future knee problems as knee pain increases the risk of developing osteoarthritis in later life. By employing good knee care strategies now, you can be assured of healthier knees in the future.

For example, instead of running, you may want to consider a form of exercise that is less jarring on your knee such as swimming or cycling. Instead of playing singles tennis, you may want to consider doubles tennis which entails less running. For those who are keen to continue their current activities, it is important to understand methods of knee protection such as using the right footwear and knee guards. All the above comes to naught if you are unsure what good knee care involves. Always consult your physiotherapist or knee pain specialist if you are in doubt.

Physical activities are a common component of our lifestyle, and it is important to use the right techniques when engaging in these activities. Some common pointers include pacing yourself, avoiding sudden increases in activity level, and ensuring that you warm up and cool down when exercising. Another important aspect is to avoid activities that place excessive stress on your knees.

Wearing Appropriate Footwear

It is very important to also use good judgment in the purchase of everyday shoes. Many women’s shoes, high heel shoes, and boots can put an increased load and force on the knee and should be avoided by those with knee pain or knee osteoarthritis. A semi-rigid orthotic with a varus wedge that inserts under the heel may be helpful in reducing knee pain by reducing force across the knee joint. A shorter and wider heel will also be less stressful to the knee. In those with knee osteoarthritis who have severe deformity of the knee joint, custom-made shoes may be necessary to reduce pressure on affected areas of cartilage.

Footwear is the only contact between the body and the ground during weight-bearing activities. Shoes that provide good shock absorption and stability help to reduce harmful forces on the knee. Newer athletic shoe designs attempt to control motion in the rear and midfoot to reduce excessive motion of the leg. These shoes may be effective in reducing knee pain with activity. A referral to a specialty shoe store or to an orthotics specialist may be indicated if the patient does not receive significant relief with a standard athletic shoe. An orthotic is a custom-made shoe insert that can be very effective in controlling pain from knee osteoarthritis by improving the alignment of the lower extremity and by reducing excessive force on the knee joint.

Taking Breaks and Resting the Knee

After the initial 2-3 day period, you should be aiming to return to normal activity as soon as possible, as prolonging rest or immobilization has been shown to worsen knee pain and can lead to more long-term disability. Studies have shown that those who are instructed to rest after sustaining a knee injury become more frail and significantly weaker in both the injured and uninjured leg, compared to those who are given exercise therapy. It is strongly advised that there should be some level of activity, even if you cannot put weight on your knee, with options such as swimming or using a bicycle having proven to be ideal for maintaining strength in the muscles around the knee. Step-by-step instructions to program your body to accept greater amounts of exercise while gradually intensifying the activity have also been proven to be the most successful way to return to normal and prevent re-injury of the knee.

If you have a painful knee, the first step to prevent further injury is to rest, as staying active at this point will increase the severity of any injury. You should avoid putting weight on your knee as much as possible in order to stop further damage to the knee joint. Actions such as walking, standing, or going up and down stairs will make the injury last longer or worsen the knee pain. It is also recommended to avoid sitting in the same position for more than 30 minutes, as this will cause your knee to stiffen up and hence become more painful. Currently, there is no specific advice on how much rest is appropriate, but it is recommended that those with severe knee pain should rest as much as possible for the first 2-3 days, as this has been proven to help mild to moderate injuries.

Seeking Professional Help

A treatment plan will then be formulated according to the diagnosis. If the problem is deemed to be an acute injury, a short course of treatment may be all that is necessary. If, however, it is a long-term degenerative condition or chronic overuse problem, a more prolonged treatment strategy may be required. This may involve a variety of the treatment options mentioned above and will often be a trial and error process to find what works best for the individual.

If you are experiencing significant pain and discomfort in your knee and have tried different modifications without success, it may be time to visit a knee pain specialist. Consulting a specialist will usually involve a physical assessment in addition to a detailed history taking of the problem. X-rays or MRIs are often used to confirm a diagnosis.

Consulting a Knee Pain Specialist

The knee specialist may need to refer the patient to other physicians for opinions and this process entails good communication and a clear understanding of the patient’s condition. A knee joint is supported by four main ligaments and an injury can be serious when the ligament is completely torn. One useful method to establish the extent of ligament injury is through an MRI scan. An MRI provides better visualization of the knee joint compared to a normal x-ray and is useful in identifying injuries to the ligament and meniscus, articular cartilage damage, knee synovitis and tracking of the patella. An MRI will help the doctor recommend the most suitable treatment. For example, a patient with an acute ACL tear and a bucket handle meniscus tear would require surgery and the MRI aids the surgeon in pre-operative planning and giving a more accurate prognosis to the patient.

Although it is possible to talk to a general practitioner about knee pain, it is ideal to consult a knee specialist when the pain is chronic. With their deep understanding of the knee joint and the various knee ligament injuries, the knee specialist can provide a more specific diagnosis and treatment for the condition. In knee pain Singapore, a knee specialist would most likely refer to an orthopedic surgeon who has taken additional training in knee surgery for chronic cases. Recently, there has also been an increase in sports medicine or physiatrist doctors with expertise in managing sports injuries. Among physicians, the sports medicine specialist tends to spend the most time with patients discussing non-operative treatments and whether to eventually refer to a surgeon. For patients desiring a quick fix or with chronic injuries, it is not unusual to seek multiple opinions from different specialists regarding the best treatment. The increasing time and monetary costs of seeking multiple opinions is a drawback to the patient, but it allows the patient to be better informed of his treatment options and prognosis.

Treatment Options for Knee Pain

An often effective way to reduce knee pain is to strengthen the muscles that support the knee, specifically the quadriceps. Research has shown that for every 1 lb. of strength gained in the quadriceps, there is a 4 lb. decrease in the load exerted on the knee. This is obviously beneficial for patients with arthritis, but the exercise must be done in a way where the knee is not being further damaged. This can mean switching to alternative exercises or using aids like tape or a brace. A specialist in sports or musculoskeletal medicine can advise patients on what exercises to avoid and provide a detailed plan for exercises that will not further damage the knee. Exercising under the guidance of a physiotherapist is a good way to ensure the exercises are done correctly.

There are many treatment options for knee pain, but the effectiveness of each method can vary greatly depending on the patient. Several factors that can determine the success of treatment include the patient’s age, occupation, severity of pain, and whether the pain is from a one-time injury or long-term damage such as arthritis.

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