COMMON KNEE INJURIES

Dislocation of the knee cap, ligament and meniscal tear, patellar instability as well as sprains and fractions are some of the things that may cause knee pain. Since the knee is one of the most complex joints in the human body there are an immense number of things that can go wrong with it. In this text you can read more about five common knee injuries and get tips on how to treat them and keep them safe.

Knee Anatomy

We rely on our knees to handle multiple movements and tasks, such as heavy loads, twisting and lifting. In order for this to work on an optimal level, the knee consists of four crucial parts: bones, cartilage, ligaments and muscle/tendons. More specifically, the joint involves the lower end of the thighbone (femur), the upper end of the shinbone (tibia) and the kneecap (patella).

Tendons and ligaments work like strong ropes that connect the bones and muscles in the knee. The patella is attached to muscles through tendons and normally rests in a small channel at the bottom of the femur, which is called the trochlear groove. This, combined with a slippery substance called articular cartilage, allows the patella to easily move back and forth when you bend or straighten your knee. Additionally, there is a thin lining of tissue (synovium) that covers the surface of the joint that lubricates the cartilage, and a small pad of fat that cushions the kneecap while acting as a shock absorber.

Patellofemoral Pain Syndrome (PFPS) 

PFPS is a very broad term that is used to describe knee pain in the front of the knee and around the patella. It can affect both active and inactive people.

Common symptoms are pain in the front of the knee and stiffness

Symptoms may occur in either one or both knees and can often develop into anterior knee pain, which affects 22/1000 people a year. The most common signs relate to diffuse pain located under, slightly above or below the kneecap that starts gradually and is frequently activity-related. The pain may also arise from longer periods of sitting or standing up afterwards, such as one does in the cinema or on an airplane. The symptoms of stiffness and the occasional sensation of swelling can create complications with everyday activities, such as kneeling or crouching and climbing stairs (mainly down). Another indicator may be that the knee gives out while walking down an incline or ascending stairs. Additionally, PFPS may eventually lead to osteoarthritis according to some studies.

A change in activity frequency may trigger the condition

There are many factors that can contribute to the development of injury, although the pain is usually not associated with an accident. The most common origin of the problem is located within the alignment of the kneecap and the overuse from vigorous athletics or training. This may be in the form of stress on the joint through jogging, squatting, improper training techniques or a drastic change in activity frequency. The pain is generated when nerves identify discomfort in the bone around the knee cap and soft tissues such as tendons, the fat pad that supports the patella or the synovial tissue.

Another condition called chondromalacia patella may also be present, which is the softening of the articular cartilage beneath the kneecap. The difference between these injuries is that no nerves are included in this scenario, therefore not causing any direct pain, but it may lead to inflammation of the synovium and pain in the surrounding bones. The syndrome may also arise when the patella is forced outside of the trochlear grove when the knee is bent, which is called patellar malalignment. This is commonly triggered through quadriceps imbalance, hamstring tightness or hyper pronation.

The right home rehab can keep the pain away

The condition is successfully treated in over 2/3 of patients through rehabilitation and simple home treatment. This could include stretching and strengthening of the hip muscles, changing footwear to match the activity or changing your training routine to low-impact activities, such as biking or swimming. The mission with these changes is to place less stress on your knee joints, relieve pain and while restoring range of motion and strength.

Studies have also shown positive results through patellar braces and foot orthosis. Rehband’s Insoles can take stress off your lower leg through aligning your feet and ankle, while there are braces that stabilize the patella in the trochlear and provides support for the joint, such as the UD Patella Stabilizing Knee Brace, QD Knee Sleeve or the UD Knee Sleeve Patella Opening.

Sources

Boling, M., Padua, D., Marshall, S., Guskiewicz, K., Pyne, S., & Beutler, A. (2010). Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports, 20(5), 725-730. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2009.00996.x/full

Orthoinfo, Patellofemoral Pain Syndrome. By the American Academy of Orthopaedic Surgeons (AAOS). Available at: https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy, 22(10), 2264-2274. Available at: https://link.springer.com/article/10.1007/s00167-013-2759-6

Robinson, R. L., & Nee, R. J. (2007). Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. Journal of orthopaedic & sports physical therapy, 37(5), 232-238. Available at: https://www.jospt.org/doi/abs/10.2519/jospt.2007.2439?code=jospt-site

Thomeé, R., Augustsson, J., & Karlsson, J. (1999). Patellofemoral pain syndrome. Sports medicine, 28(4), 245-262. Available at: https://link.springer.com/article/10.2165/00007256-199928040-00003

Waryasz, G. R., & McDermott, A. Y. (2008). Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine, 7(1), 9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443365/

 

Runner’s Knee

Runner’s Knee/ITBS Iliotibial Band Syndrome is a common overuse injury or pain condition among runners today. It occurs when the IT-band, the long tendon which runs along the outside of the thigh from the pelvis and attaches just below the knee, is tight or inflamed. When the IT-band isn’t working properly, movement of the knee, and therefore running, becomes painful. Mainly affects runners and orienteers, and is found among both joggers and top-level sportsmen and women.

Symptoms

– Pain during running, particularly after a couple of kilometres (other activities such as ballgames do not cause these symptoms as frequently). – Tenderness on the outside of the leg, a few centimetres above the knee.

Possible Causes

-When there’s a rapid increase in training and exercise -Stiff and tense muscles in the thighs and hips. -Poor footwear -Unilateral running on sloping ground, e.g. the roadside

Treatment

-Correct anything which may trigger the symptoms (both external and internal factors) -Alternative training such as cycling -Gradual increase in running   -Stretching of tense muscles -Choosing the right shoes -Insoles

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Made with 78% Recycled Polyamide and 22 % Elastane, the tights are combined with 2 mm perforated SBR/Neoprene. The innovative construction offers a unique combination of compression, warmth and breathability. The precise position of the warming elements has a proven effect for Runner’s Knee symptoms. Tailor-made in graded compression for great fit in motion. Apart from their medical function and slim look, they include features such as flatlock stitches, a breathable stretch material for perfect comfort and reflective elements. The reflectors are designed in the same shape as the perforated holes for a complete visual balance in both light and dark.

 

Osgood-Schlatter Disease

The Osgood-Schlatter Disease (OSD), also known as apophysitis of the tibial tubercle, can develop a painful, bony bump on the point where the patellar tendon attaches to the shinbone. The condition manly affects young adolescents who participate in activities that include running, jumping and swift changes in directions.

The symptoms decrease and improve spontaneously over time and the prognosis of the condition is generally positive, although it may take a number of years to heal completely.

The condition usually develops in one knee, but may affect both. Common indicators are pain, swelling and occasionally a bulge that may appear just below the knee cap. The symptoms vary between patients since the growth stage in life is very different for most individuals. However, symptoms usually completely disappear when the child reaches the end of their puberty growth spurt, which is around the age of 12-14 for girls and age 14-16 for boys.

Can be developed by tension on the bones growth plates

The condition usually occurs when the bones, tendons, muscles and other structures around the knee change rapidly during growth spurs. There are certain developing areas of the bones that are called growth plates, which are areas of cartilage on the bones that work as attachment sites for tendons. These tendons connect the muscles to the bone and the plates turn into solid bones when the child is fully grown.

One of the growth plates is located on the top of the tibia; a bony bump called tibial tubercle, which attaches to the muscles in the front of the thighs (quadriceps).  This is what normally causes the pain: through creating a repetitive traction from the quadriceps muscles, through the patellar tendon, which eventually pulls on the tibial tubercle and may cause an inflammation. The pain is often highlighted in the case of increased exercise without rest and recovery periods, however less active teenagers may also experience this problem.

Treatment

Symptoms of OSD usually disappear spontaneously along with the skeletal maturity and treatment is usually symptomatic, which basically aims to maximise comfort and well being of the patient throughout any activity by reducing the symptoms. These may be activity modifications such as reducing weekly training and competition sessions, providing NSAIDs, icing or stretching to correct underlying biomechanical factors. Using braces that provide heat and stability while reducing tension on the patella tendon also protects your knees and reduces symptoms, such as the UD Knee Sleeve Patella Opening. Additionally, this may be achieved through using a UD Knee Strap or special footwear and Insoles that take pressure off the knee. For adults who have continued symptoms here is surgical treatment available, normally in the form of arthroscopic techniques.

Sources

Bloom, O. J., & Mackler, L. (2004). What is the best treatment for Osgood-Schlatter disease? Clinical Inquiries, 2004 (MU). Available at: https://mospace.umsystem.edu/xmlui/handle/10355/3208

Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of Osgood–Schlatter disease: review of the literature. Musculoskeletal surgery, 101(3), 195-200. Available at: https://link.springer.com/article/10.1007/s12306-017-0479-7

Orthoinfo, Osgood-Schlatter Disease (Knee Pain). By the American Academy of Orthopaedic Surgeons (AAOS). Available at: https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/

Smith, J., & Bhimji, S. (2017). Osgood Schlatter Disease. Available at: http://europepmc.org/abstract/med/28723024

 

Damage to the Meniscus

Meniscus tears are very common and can vary widely in size and severity. The meniscus is a C-shaped disk of rubbery cartilage that lies between the tibia and femur, and works as a shock absorber for the knee joint. Each knee includes two menisci – one on the outside of the knee (the lateral meniscus) and one on the inside (the medial meniscus), which provide stability and cushioning for the knee.

Symptoms

Tears of the meniscus frequently appear very suddenly while playing sport and the first symptoms are severe pain over the joint space, stiffness and in some cases the feeling of a “pop” and swelling. Some players may continue the activity straight after the injury, but the damage will cause reduced strength and mobility in the knee and front thigh muscle. Additional pain may occur while twisting, deep knee bending or hyperextending your knee. There are also cases where a piece of the cartilage breaks off and is stuck in the joint, causing the patient to feel a locking sensation that prevents a full extension of the leg.

Possible causes

The tear is usually caused by a single injury that may be triggered by a violent twist in the knee while the foot is stable on the ground, or hyperextension while performing sports. This is more common among younger people. In middle-aged and elderly people, damage to the meniscus may be acquired with relatively little force, such as when standing up from crouching or deep knee-bending. Since the meniscus is weakened over the years, the injury may develop slowly and in some cases break, leaving worn edges. This may also be from a previous, barely noticeable tear, which reappears many years later from a minor accident.

Treatment

An MRI scan will indicate if the tear is a grade 1, 2 or 3. In general, surgical treatment is only acquired at grade 3, by removing parts or sewing the meniscus back together. It has also been shown that meniscus transplantation is a highly successful surgical treatment for patient with severe cartilage damage or irreparable menisci, to achieve long-term improvement that allows participation in sporting activities.

Most often the first treatment option chosen are nonsurgical treatments including rehabilitation programs that gradually increase in intensity. In these cases you may use a UD Hyper-X Knee Brace, a UD Stable Knee Brace or a UD X-Stable Knee Brace to provide strength and reduce pressure on the knee joint, while allowing balance and mobility until the rehabilitation is complete. Since that one third of the meniscus has a rich blood flow, many tears in this area may heal by themselves. However, increasing your blood flow, stability, and coordination while protecting your knee and reducing pain through using a QD Knee Sleeve, a RX Knee Sleeve or a UD Knee Sleeve Patella Opening may assist this process.

Sources

Orthoinfo, Meniscus Tears Overview. By the American Academy of Orthopaedic Surgeons (AAOS). Available at: https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears/

Stone, K. R., Pelsis, J. R., Surrette, S. T., Walgenbach, A. W., & Turek, T. J. (2015). Meniscus transplantation in an active population with moderate to severe cartilage damage. Knee Surgery, Sports Traumatology, Arthroscopy, 23(1), 251-257. Available at: https://link.springer.com/article/10.1007/s00167-014-3246-4

Cedars-Sinai, Medial and Lateral Meniscus Tears. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/m/medial-and-lateral-meniscus-tears.html

 

Jumper’s Knee

Jumper’s knee, or patellar tendinopathy, is a rupture or inflammation of the patellar tendon due to overloading. Patellar tendinopathy and PFPS are different injuries and therefore have different treatments, which is why it is important to distinguish the difference: that jumper’s knee is pain specifically manifested to the patellar tendon while PFPS is characterised by a dull pain that is behind or around the top of the kneecap. It often affects athletes who have a high demand on speed and power for the leg extensors, such as volleyball, basketball, handball and football players, as well as weightlifters.

Symptoms

The symptoms are usually serious, resulting in long-standing weakening of athletic performance. Some of the most common indicators are: pain and tenderness around the patellar tendon; pain while jumping, running or walking; pain when bending or strengthening your leg; stiffness in the morning and during or after exertion; and swelling under the patella.

Possible Causes

There are three sets of muscles that control the knee: the quadriceps that extends, the hamstrings that flex the knee and the gluteals that controls side movements and stability. In most cases the quadriceps is the stronger muscle and it attaches through the patellar tendon to the shin. Repeated stress on the patella tendon is the most common cause for jumper’s knee, such as frequent jumping on a hard surface that results in an overuse of the knee joint. This may also occur due to reduced strength in the front of the thigh or insufficient rehabilitation after a previous injury.

Treatment

You should avoid activity that causes pain, as it is with most injuries. However, treatment with painful eccentric quadriceps training while standing on a declined board has proven to reduce tendon pain significantly during activity and improved functions for athletes on a short-term basis. This, along with many other eccentric knee exercises and stretching, allows for the quadriceps to lengthen while the angle of the joint increases and is mostly used for treating patellar tendinopathy.

There are other options for treatment if symptoms continue, such as surgery or injections of platelet-rich plasma (PRP), which is aimed to induce healing in areas of degeneration. It has also been proven that using orthotics such as a UD Knee Strap, which reduces pressure on the patellar tendon, helps to treat and relieve pain for athletes that suffer from jumper’s knee.

Sources

Jonsson, P., & Alfredson, H. (2005). Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. British journal of sports medicine, 39(11), 847-850. Available at: http://bjsm.bmj.com/content/39/11/847

Kaux, J. F., Forthomme, B., Namurois, M. H., Bauvir, P., Defawe, N., Delvaux, F., … & Croisier, J. L. (2014). Description of a standardized rehabilitation program based on sub-maximal eccentric following a platelet-rich plasma infiltration for jumper’s knee. Muscles, ligaments and tendons journal, 4(1), 85. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049656/

Lian, Ø. B., Engebretsen, L., & Bahr, R. (2005). Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. The American journal of sports medicine, 33(4), 561-567. Available at: http://journals.sagepub.com/doi/abs/10.1177/0363546504270454

Vries, A., Zwerver, J., Diercks, R., Tak, I., Berkel, S., Cingel, R., … & Akker‐Scheek, I. (2016). Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial. Scandinavian journal of medicine & science in sports, 26(10), 1217-1224. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/sms.12556

 

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