Making the Most of Your Knees

 

Fundamental to your ability to walk and run is the efficient use of energy.  Injuries to the knee joints can have a significant impact on the amount of energy required to walk and run.  Your athletic performance may erode with the inefficient mechanics of a leg affected by knee pain.

 

The knee’s health affects the muscles and tendons that cross it.  As knee pain becomes a chronic issue, a downward spiral occurs.  The muscles around the knee weaken, resulting in more pressure across the knee joint, which results in more pain.  This pain leads to greater weakness.  This negative feedback cycle typically occurs over a couple of months.  The consequences are frustration and festering pain in the knee.

 

The first step in healing is identifying the source of the pain.  Central to the diagnosis is deciding whether the knee is the source of the pain or whether it is referred from another area such as the hip.  A proper physical examination can usually narrow down whether the cause is inside or outside of the knee joint.  Pain sources outside of the knee joint such as tendonitis are typically more responsive to nonoperative treatment. Further studies such as x-rays and an MRI scan maybe helpful.  Common disorders of the knee include tendonitis, cartilage tears, loose bodies, and ligament sprains.  Less common disorders of the knee comprise bone bruises and scar tissue.

 

With the exception of some ligament tears, most knee disorders can be initially managed without surgery.  The opinion of a physical therapist may be beneficial.  Central to any recovery plan is treating the inflammatory component of the knee pain while restoring the muscle endurance and strength about the knee joint.  Simple icing for 20 minutes is the most effective anti-inflammatory regimen.  Recent research supports the use of certain antiinflammatory medications which do not endanger the native cartilage.  Foot orthotics may benefit the knee by correcting lower extremity alignment, load bearing, and stride dynamics.

 

The rehabilitation program should encompass a low impact regimen that limits forces across the knee.  Certain exercises such as lunges, squats, and extensions may significantly increase forces across the knee leading to more inflammation and pain.  Aqua therapy that restores endurance and limits the influence of gravity is a very efficient mode of rehabilitation.  In situations of cartilage deficiency or injury, the motion of cycling may benefit the health of the cartilage tissue.

 

The use of over-the-counter medications such as nonsteroidal antiinflammatories (“NSAIDs”) should be reviewed with your physician.  Side-effects should be balanced with the benefits of less pain and inflammation.  Certain supplements containing glucosamine and chondroitin may provide moderate relief to individuals with cartilage wear and tear.  While the side effects of these supplements are considered mild, their mechanism of action and true benefit are unknown.  A recently introduced medical food supplement, flavocoxid, is derived from plants and is thought to offer the benefits of traditional NSAIDs without the side effect profile.  Most of these supplements have never been fully evaluated by the FDA so consult your physician on their use.

 

Occasionally, surgery is needed to address the source of knee pain.  Arthroscopy or an arthroscopically assisted surgery is typically available for most knee problems.  A formal physical therapy rehabilitation program should be requested after any procedure to reduce the risk of reinjury or the formation of abnormal scar tissue.  This postoperative protocol should also provide you with a maintenance program which promotes knee health and overall conditioning.

Knee Injury Management

 

Allston J. Stubbs, MD

 

 

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The North Carolina Sports Medicine Institute is an orthopaedic sports medicine clinic based in Winston-Salem, North Carolina.  Its philosophy is to provide premium orthopaedic treatment “For the Athlete in All of Us”.  Allston J. Stubbs, M.D., an attending surgeon at the clinic, has the highest level of adult and pediatric orthopaedic sports medicine training.

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Endurance Magazine

February 2007

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