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The knee is one of the busiest joints in our bodies. Knees bear a lot of weight and, in nearly every activity, withstand a lot of force.
Connective tissues stabilize the knee, and cartilage prevents bone-to-bone contact. The knee is primarily designed to bend forward and back. Although it can move in other directions, that mobility is a bit more limited.
The knee’s overall robust functionality can expose it to injury and inflammation, and knee pain can occur in many ways. In particular, sports and other intense activity—twisting, pivoting, flexing side-to-side—can place difficult demands on the knee. When those forces, perhaps combined with wear and tear, exceed the knee’s capability, the result is pain.
Depending on the nature of the injury, pain can be sudden, or can increase gradually over time. What sort of medical response do these situations require? The good news: for most weekend warriors, knee pain can be improved without surgery.
Sports and the Knee
Young athletes’ knee bones are more flexible, supple, and typically quite healthy; in general, they’ve not yet begun to experience degenerative issues such as arthritis or reduced blood flow.
Knee pain in younger athletes mainly results from overuse—for example, runner’s knee, when the kneecap repeatedly rubs against the lower thighbone, leading to painful tendonitis. Impact on the bent knee occurs repeatedly in sports like soccer and basketball. But runner’s knee is not confined to the young athlete—weekend warriors and professional athletes of all ages experience this condition. It’s generally the result of poor mechanics rather than structural issues.
Contact sports can bring additional hazards. Football is the classic example: the knee may be hit in a way that forces it in an unnatural direction, causing traumatic ligament injury—damage to tissue that connects bone to bone.
Ruptures and Sprains
Rupture is a severe form of injury that occurs when ligament is completely torn from bone. Within the knee, a common rupture is a tear of the anterior cruciate ligament, or ACL. ACL tears can be severely painful, immediately debilitating, and usually require surgical repair.
More frequently, we see a milder form of ligament injury, a sprain. When ligaments are briefly stretched beyond their capacity, micro-tears set up an inflammatory response—pain and swelling.
For weekend warriors, sprains and overuse injuries generally respond well to rest, ice, and anti-inflammatory medications. Depending on the injury’s severity, physical therapy may help keep the knee moving and building strength as it heals.
Younger athletes may also experience what’s commonly called growing pains. Although it’s not entirely clear what occurs at the cellular level, we do know that different parts of the body develop at different rates. When growth in one area of the skeleton progresses faster than in another, the slower areas are forced to stretch, which can result in severe short-term pain. As soon as the skeleton stabilizes, the pain disappears, typically at the onset of puberty.
Good news: for most weekend athletes, knee pain can be improved without surgery. The sooner you seek orthopedic advice, the sooner you can feel better. More from @drevanortho https://bit.ly/3fOaWhh via @MedStarWHC
The knee experiences physical changes as it ages and blood flow naturally slows. This aging process can weaken connective tissues in the knee and create potential for a meniscal tear, another common sports injury.
The meniscus is fibrous knee cartilage that acts as a shock absorber between the thighbone and shinbone. Abnormal movement such as twisting may stress it beyond its capacity and cause a tear, and expected lack of blood supply makes healing more unpredictable.
Many meniscal tears do not require surgery. Like sprains, they can become painless with time, as immobilization and therapy help strengthen the surrounding muscle. Therapy can also prevent future injuries.
But, unlike tendons and ligaments, cartilage cannot heal. Meniscal tears and injuries to ligaments may need arthroscopic surgery so these structures can continue to protect cartilage, which has less capacity for healing.
Particularly in older athletes or weekend warriors, arthritis and osteoporosis can contribute to knee problems.
Layers of slippery, flexible cartilage allow a healthy joint to move freely and prevent bones from rubbing together. But when arthritis degrades the cartilage, the risk of bone-to-bone contact increases, resulting in pain.
Osteoporosis, also a function of aging, causes less dense, weakened bone. Most individuals will experience it, but women are particularly prone. Although osteoporosis itself is not painful, it renders bones brittle and more likely to break, and resulting fractures cause pain and loss of mobility.
While we have medications that can slow the progress of osteoporosis and help strengthen bone, the obvious best strategy is prevention. For most people, that means getting enough calcium and vitamin D. It’s difficult to get too much of these—use of supplements carries almost no risk, as normal kidney function eliminates anything that the body can’t use.
Vitamin D and calcium are especially important for women, and a regular regimen should be adopted long before a woman becomes at risk for osteoporosis.
When Is Surgery Appropriate?
Patients often fear that, if they see an orthopedic surgeon, they will hear that they require surgery.
Surgery is appropriate for ruptured ligaments, or when degenerative disease has destroyed bone or cartilage beyond its capacity to renew itself. Artificial knee joints keep millions pursuing physical activities without pain.
But my job is to try to avoid surgery—determining the best course of action by considering the patient’s situation and all the rehabilitative resources we can offer. In most cases, we can mitigate knee pain without surgery.
To evaluate knee injury and level of pain, we begin by listening to the patient, establishing a medical history, conducting a physical exam, and taking into consideration the patient’s age, activity, and other risk factors. We generally order routine X-rays and may add an MRI and CT scan, depending on the nature of the problem.
Physical therapy can be a valuable first line of defense in defeating pain. Conditioning the muscles around the joint improves stability and motion and can help improve the athlete’s overall quality of life. Patients who follow their tailored regimen are typically quite successful at keeping knee pain under control for years.
We can also administer steroid injections that often bring long-lasting relief, as well as anti-inflammatory medications and topical creams. Bracing the knee may also be helpful to add stability; fitting of a knee brace is best done in the healthcare setting so the brace is well customized to the patient’s knee and lifestyle.
Also, we often recommend modifying activity frequency or intensity to help reduce knee pain.
Excess weight also can be a contributing factor to stress on the knee joint. In these cases, losing weight is almost always advisable, and an improved diet can contribute not just to knee health but to better health overall. Adding a regimen of total-body conditioning can also benefit knee health; for example, activating a strong, stable core can help keep joints performing well.
And among its many other negative points, smoking can be quite detrimental to joints. As a vasoconstrictor reducing blood flow throughout the body, nicotine only worsens joint problems.
When to Seek Help
Most athletes—whether professionals or weekend warriors—have a good idea how “the day after” the game should feel. Normal stiffness or a slight ache that disappears with over-the-counter pain relief can often be expected. But if you experience stubborn or increasing pain or discomfort in the knee, it makes sense to reach out to an orthopedic surgeon for help.
The orthopedic team at MedStar Washington Hospital Center is a powerful, cohesive group of professionals that offers decades of experience. Our multidisciplinary experts share information and determine the best approach for every patient.
Keep in mind: in most cases, we can relieve knee pain without surgery. So don’t hesitate to have unusual or persistent knee pain checked by a physician. The sooner your knee is in good shape, the sooner you can safely get back to weekend activities with less pain and improved performance.