Long term Knee pain

Introduction

Long term knee joint pain, medically termed as chronic osteoarthritis is a common problem for most of the elder population. There are multiple reasons for the occurrence of this condition. Most of the people suffering from this condition are forced to live with pain and a make a lot of compromise in their social and personal activities. This produces a huge amount of stress in knee pain sufferers. When we look in to this issue with an intellectual eye, we can find some solution just by making people understand what their real problem is and how they have to deal with their pain, in short the article is aimed on creating a reasonable awareness on knee joint pain and not focused on any specific treatment.

Anatomy of knee joint (figure 1)

Figure 1 anatomy of knee joint

Let us have an idea of basic knee joint anatomy. Human knee joint is formed by three bones.

1.       Femur 

2.       Tibia 

3.       Patella

They are united by ligaments and muscles that give the joint, its integrity.

Capsule

The joint is covered by an articular capsule that acts as a protective covering. The synovial fluid placed inside the capsule lubricates the joint during its movement.

Bursae

These are fluid filled sacs and they are placed between the muscle tendon and bones. There are numerous bursae that surround the knee joint.

Cartilage

This is a thin elastic tissue placed between the bony ends for shock absorption and protection of bones from abnormal frictional forces. The cartilage has a tendency to wear over the years.

Muscles(figure 2)

The main muscle groups are quadriceps (front of thigh) and hamstrings (back of thigh). Any pain or inactivity following a period of immobilization decreases the activity and nutrition of the quadriceps muscle in particular, which leads to further problems.

Figure 2 Muscles of knee joint

Causes of knee joint pain

1.       Post traumatic knee pain (pain occurs after an injury)

2.       Ligament injuries

3.       Obesity

4.       Degeneration of joints (commonly called as osteoarthritis)

5.       Muscle imbalances

6.       Bursitis (injury leading to inflammation of bursae)

7.       Dislocation of the knee cap

What happens in the knee joint when an injury occurs?

When any abnormal force is encountered by the knee joint and the protection from the muscles and ligaments fail, the knee is injured. The initial reaction will be pain and swelling. Then the internal damage (fracture, ligament injury, prolonged abnormal or uneven stress to the knee joint etc.,) will be diagnosed and the knee joint will be treated for it. Now the pain gradually decreases and the person recovers from the injury. The muscles particularly the quadriceps will be weakened and its efficiency compromised. Usually quadriceps facilitation or strengthening program will be pursued to improve the function of quadriceps muscle and maintain full functional knee joint range of motion by improving flexibility of the hamstrings. This is the normal treatment program.

If there is treatment then why majority of people suffer from long term knee pain?

The main reason is early cessation of quadriceps rehabilitation.  First of all we have to understand that knee joint is a weight bearing joint and should be fully functional when a person walks. If the quadriceps muscle is mildly weak then it cannot efficiently pull the bones of leg when it contracts (see figure 2b). This will make the body’s weight fall unevenly through the joint and stress a particular point causing further strain to the knee joint and accentuate quadriceps weakness, further restricted joint range of motion and tightness of hamstrings. This cyclic reaction (figure 3) causes long term and uncontrollable knee pain.

Figure 3 vicious cycle of long term knee pain

Tips for knee pain sufferers

1.       Continue quadriceps exercise and hamstring flexibility till you attain full flexibility and strength following your injury.

How to test this?

a.       When you are sitting with your leg straight at the knee, you should be able to touch the floor with the back of your knee. This gives an impression of your knee flexibility.

b.      If you get knee buckling when you are standing or walking it indicates insufficient quadriceps strength.

c.       Lift your leg straight when you are lying. If you can’t hold your knee without a bend it indicates insufficient quadriceps strength.

d.      If you have any of the above you have to consult your physiotherapist for further management and rehabilitation.

2.       Avoid prolonged standing and single leg standing.

3.       Never carry heavy weight on one hand. The weight shift towards one side of the body may injure your knee further.

4.       When walking, use cane on the unaffected side hand if you have one sided knee pain.
     
       For more on this please log on to www.xpertphysio.com