FAQ Category: Knee

Both types of exercises (running and machines at the gym) are repetitive in nature. But there’s one key difference. Running involves a ground force reaction. This refers to the stress and load through the ankle, knee, hip, and sacroiliac joint as the heel strikes the ground over and over again. Whereas the elliptical and cross-country equipment is low-impact, running is a high-impact activity.

Before continuing to aggravate your symptoms, it might be a good idea to get an accurate assessment of what’s going on. A physical therapist, chiropractor, or orthopedic surgeon can help you with this. A thorough exam will be done, including a history and some screening questions. The screening survey helps identify the possibility of a more serious cause of the problem such as a tumor, infection, or fracture.

The exam will continue with an evaluation of posture, range-of-motion, muscle strength, and joint stability. Special tests are usually performed to help identify impairment of the soft tissues around the knee.

Knee pain can be caused by disc problems, or hip, SIJ or ankle joint problems. The examiner will perform a regional interdependent exam involving both legs. Muscle flexibility, alignment, and exam of the joints above and below the knee will be done.

If there are no positive findings, the examiner will broaden the regional exam to include the sacrum and SIJ. There are numerous reliable and valid tests that can be done to isolate the exact location of the problem. Once this step is completed, then a specific treatment plan can be put into place to help you get back up and running.

Pain or other symptoms experienced at a site remote from the cause of the problem is called referred pain. It is a fairly common problem that physical therapists are trained to watch out for. For example, knee pain can occur as a result of low back, hip, sacroiliac, or ankle impairments.

With any musculoskeletal problem, therapists conduct a thorough screening exam to make sure the problem has a musculoskeletal origin and is within the scope of their practice. To do this, they use a screening model that includes past medical history, risk factors, clinical presentation, and associated signs and symptoms.

An understanding of the clinical presentation comes from a broad exam referred to as a regional interdependence exam. By expanding the exam to include a broad region (not just a single joint), problems like this can be identified quickly and treated appropriately. This helps prevent delays and the extra cost of treating the wrong thing.

Many patients are afraid to attempt kneeling on their partial knee replacement. There is a concern that they might damage the new joint. And for those people who can no longer kneel before the surgery, there is the nagging fear that once they get down on the knee, they won’t be able to get back up.

Until recently, we weren’t even sure why patients couldn’t kneel after this surgery. There was wide speculation that it could be the location of the scar, pain, loss of knee motion, and/or numbness from nerve damage. But a study by physical therapists has shed some new light on this problem.

Practice kneeling (getting down and getting up) under the guidance of a physical therapist was very helpful in restoring this valuable skill. The therapist showed them how to kneel on a soft mat using arm support to aid in getting up and down. Kneeling was done on both knees. Limited knee flexion prevented sitting back fully on the heels. The therapist also offered feedback on proper posture and alignment and answered any questions the patients had.

There was no link between scar position, numbness, and range of motion and a change in kneeling ability. Sensitivity of the knee near the kneeling area from nerve injury was unpleasant, but didn’t affect kneeling ability. It appears that the key factors were to reduce fear and provide direction on how to kneel safely and easily.

Patient range-of-motion was not significantly different before and after surgery. This finding suggests that a loss of motion is not the reason patients can’t or don’t kneel after partial knee replacement. And problems in other joints were not a barrier to kneeling. Patients with arthritis in other joints reported being able to kneel using the therapist’s suggestions.

For older adults who want to play with grandchildren on the floor, it may be helpful to place yourself close to something you can use to lower yourself down and pull yourself back up. This could be a kitchen chair, the couch, or doorknob or handle. Until you practice enough to become sure of yourself, you may want to stay off the floor slightly. You can use a low chair (also placed strategically so you can get up and down.

But before trying this skill, make sure your orthopedic surgeon approves. Not all implants are designed for kneeling. You may want to schedule a follow-up appointment with the therapist who helped you with your rehab. Having a supervised session may be the best way to accomplish this task safely and easily.

Not necessarily. If the surgeon approved kneeling, she just may need a little help getting started. Kneeling is not possible with all implants. At least one study has shown it is okay to kneel with the Oxford® Partial Knee Replacement from Biomet Orthopedics. This partial knee implant was first approved for use in the United States by the Food and Drug Administration in 2004. Since then, it has become increasingly more popular.

It is designed to repair only the medial side of the knee (side closest to the other knee). About one in four patients with osteoarthritis have limited knee arthritis, known as medial compartment arthritis. A partial knee replacement replaces only one side of the knee joint. A total knee replacement removes all the knee joint surfaces.

Some advantages of the Oxford® partial knee replacement are that it removes 75 per cent less bone and cartilage than a total knee replacement. The implant is much smaller than a total knee implant. And the knee is less painful afterwards making recovery much faster.

By keeping all of the undamaged parts, the joint may bend and function more naturally compared to a total knee replacement. In theory, kneeling should be possible when it might not be allowed with other types of implants.

Many patients need a little help learning how to do this activity. If they have arthritis in other joints, a soft pad placed under the knees helps. Using the arms to support and guide the body down into the kneeling position is one other technique that helps. Patients are cautioned to put weight on both knees at the same time.

If you do not feel comfortable helping her regain this valuable skill, then consider making one or two appointments with the physical therapist. Education and supervised intervention after a partial knee replacement can make a difference. Practice kneeling (getting down and getting up) under the guidance of a physical therapist is very helpful in restoring this valuable skill.

The treatment of meniscus injuries has progressed and changed over the years. Meniscectomy (removing the meniscus) was the first procedure used. But long-term studies showed degeneration of the joint cartilage as a result. Meniscal repair is now performed whenever possible.

Symptoms such as knee swelling with activity, crepitus, and pain along the joint line can occur after meniscectomy (removal of the meniscus). Crepitus is the snapping or crackling felt or heard in the joint. When persistent pain with any of these other symptoms occur post-meniscectomy, a chondral defect (lesion in the joint cartilage) is suspected.

You may want to see your orthopedic surgeon for a follow-up exam. X-rays or more advanced imaging will show the location, size, and depth of any chondral defect. There are surgical procedures available now to repair and restore this layer of cartilage.

Meniscal autologous transplantation (MAT), osteochondral allograft(OA), andautologous chondrocyte implantation (ACI) are three of the newer repair methods. MAT repairs the meniscus. OA and ACI are used to repair damage that goes deeper into the cartilage layer underneath the meniscus.

Meniscal allograft transplantation (MAT) is a fairly new way to repair (rather than remove) damaged meniscus in the knee. It is an example of how the treatment of meniscus injuries has progressed and changed over the years. Meniscectomy (removing the meniscus) was the first procedure used. But long-term studies showed degeneration of the joint cartilage occurred as a result.

Researchers have been able to discover a way to transplant meniscal cells to help repair damaged areas of the meniscus. The transplanted cells can come from a healthy part of the patient’s own meniscus. This would be called an autologous transplant. Cells harvested from a donor can also be used. This type of transplant is called an allograft.

Rehab would be the same following either type of meniscal transplantation (autologous or allograft). According to a recent study from the Navy Medical Center in Bethesda, Maryland, a six-week rehab protocol begins with nonweight-bearing exercises using a continuous passive motion(CPM) machine.

The leg is placed in the CPM. The device slowly and steadily bends and straightens the knee joint. The amount of movement is regulated and progressed by five- to 10-degrees at a time. The unit is used for two hours at a time, and then the patient is given a rest. The patient spends a total of six to eight hours a day using the CPM. When out of the CPM device, the patients wear a hinged-knee brace with the knee held in a straight position.

The CPM unit is discontinued when the patient has 90-degrees of knee flexion. The brace is unlocked to allow some motion at the end of four weeks. Increasing amounts of active knee flexion are allowed as muscle control is improved. A physical therapist will guide you through this process. Patients are expected to regain full motion in eight to 12-weeks. With consistent attention to a home program, strength, motion, and function are fully restored by nine to 12-months.

Studies show that athletes involved in noncontact jumping sports have the highest rate of anterior cruciate ligament (ACL) injuries. The main mechanism of injury is called plant-and-cut maneuvers. There is too much load on the knee with the foot planted on the ground while the player changes direction quickly.

Dancers do have far fewer ACL injuries compared to athletes involved in jumping activities. The difference may be because dancers perform many more jumps in a daily 90-minute technique class compared to a 90-work-out on the basketball court.

The rigorous dance training may be enough to prevent ACL injuries. This is true even though load on the knee during jump landings in dance can put up to 12 times the dancer’s body weight in force on the knee joint. Dance training focuses on balance, alignment, footwork, and control. All of these skills may improve balance to a precise level needed to land single-leg jumps without injury.

Unlike athletes who don’t know what will happen next on the court, dancers practice the same steps in a routine. There are no surprise or unexpected movements to respond to. Basketball players collide with each other often. Contact with another dancer is rarely the cause of an ACL injury.

Practice, timing, alignment, balance, and posture may be the key factors. A focus on these variables during basketball practice may help reduce injuries in athletes involved in jumping activities.

You may be referring to supports used to help prevent or relieve pain from injuries during athletic events such as football, basketball, baseball, soccer, and volleyball. The commonly used knee strap is often seen on athletes with knee disorders such as chondromalacia patella, Osgood Schlatter’s disease, and runners and jumper’s knee.

You may even see older adults with arthritis and knee degeneration using such supports. In the case of the knee strap, it stabilizes and tightens up the patella (kneecap) by putting pressure on the patellar tendon just below the kneecap. This can help reduce inflammation and improves stability of the knee. This type of support can help keep the knee from giving out from under you. Many people can regain enough normal mobility that they are able to return to their regular activities.

The upper arm strap you see on athletes is worn above the biceps or triceps muscle. It puts pressue on the tendon fibers to help keep them from pulling and tearing. Sometimes swimmers use these to prevent painful swimmer’s arm. Anytime athletes participate in sports involving over use of the arm, the strap can help reduce the risk of painful tendinitis.

PFPS causes pain around and under the patella (kneecap). Activities that increase the load on this joint aggravate the condition. For example, many patients with PFPS report that walking, running, and using stairs make their symptoms worse. Moving the knee after a long period of sitting can also cause pain.

Nonpharmacologic treatment for this problem include exercise therapy, manual therapy, and ultrasound or other physical agents. It sounds like you’ve tried the most common conservative treatment for PFPS. Specific exercises, taping, and manual therapy to mobilize (move) the patella have some reported success. A more recent study has been published that also supports the need to strengthen hip muscles (abductors and external rotators).

Taping may be helpful but at present, there are no high quality reviews of studies to provide evidence supporting patellar taping. This does not necessarily mean taping does not work for this problem. Many athletes and active young adults with PFPS seem to find the best results using a combination of treatment methods.

The same group of interventions doesn’t always work for everyone. It usually takes a period of trial and error to find the right mix for each person. A physical therapist can help you with this. The therapist will evaluate you carefully for any postural, neuromuscular, or structural causes of your PFPS.

Treatment begins with efforts to restore normal flexibility, alignment, strength, and endurance. Adjustments to the treatment program and progression of the exercises should include specific sports training to help you advance in your athletic pursuits.

Actually, there has been some debate about whether oral contraceptives (birth control pills) may increase the risk of knee (anterior cruciate ligament or ACL) injuries. Scientists are studying whether or not ups and downs in hormone levels could be a risk factor for ACL injuries.

The basis for the possible link between hormones and knee injuries was discovered several years ago. Researchers found receptors on ACL for two hormones: estrogen and relaxin. Relaxin does produce a relaxation effect on ligaments. But the exact meaning of this relationship remains unknown.

A recent study comparing women taking oral contraceptives and who had ACL injuries with women taking oral contraceptives without ACl injuries did not find any effect caused by the birth control pills. All the women included in the study were either dancers or jumping athletes.

What they did find was that dancers had a low rate of ACL injuries. The authors offered several theories for the low rate of ACL injuries among dancers. First, dance training focuses on balance, alignment, footwork, and control. All of these skills may improve balance to a precise level needed to land single-leg jumps without injury. Second, dancers practice hundreds of jumps every day.

Third, jump practice progresses over time with supervision and guidance of an experienced dance instructor. And finally, unlike athletes, dancers practice the same steps in a routine. There are no surprise or unexpected movements to respond to. Rarely is there contact between two female dancers to cause an ACL injury.

The low incidence of ACL injuries among dancers points to different training techniques between dancers and other athletes. For dancers, monitoring fatigue and focusing more attention on reducing fatigue may be of benefit. Taking oral contraceptives is not advised for the purpose of preventing injuries.

Your first step should be to see your doctor for a follow-up exam. There may be a treatable reason for the knee instability you are experiencing. You many need a second course of physical therapy. An ongoing home program of exercise and activity modification may be required.

Frequent giving way of the knee suggests knee joint instability. An arthroscopic exam and/or X-rays may be helpful in diagnosing the problem. It’s possible there is a secondary meniscal tear. Or the ACL tear has become unstable resulting in this problem.

Sometimes, despite all efforts to avoid surgery, an operative procedure to repair the problem is really the best course of action. The long-term effects of any treatment approach selected should be considered. Chronic knee instability can lead to further injury. Some type of early intervention may help prevent future problems.

Different orthopedic surgeons may assess meniscal tears slightly differently. A minor tear may be one that repairs itself without surgery. The body has a limited ability to heal itself when the damage is not too severe. In the case of a meniscal tear, a partial tear that only involves part of the meniscus or a tear that doesn’t go through the full thickness of the meniscus may be labelled minor.

The surgeon can use an arthroscope to look at the full extent of the injury in order to advise the patient whether to repair or remove the torn cartilage. Location, depth, and extent of the injury are all evaluated and considered in the diagnostic process.

Meniscal tears and meniscectomy (removing a torn meniscus) are both risk factors for developing osteoarthritis of the knee. So care is taken to try and rehab first, repair second, and remove only if necessary.

Surgery is done in the most antiseptic conditions possible. All instruments used during surgery are sterilized, disposable equipment is all sealed until use, and the surgeons and nurses are covered in sterile clothing and use sterile gloves whenever they may have to touch the patients. They also wear masks to keep from coughing or sneezing, or even just breathing, germs into the air. As well, the ventilation system is specially designed to not allow “dirty” air into the operating room.

Despite all those precautions, infections can still happen. Sometimes the cause can be found, other times it can’t. One common reason for an infection in a joint replacement is if the patient already has an infection somewhere else in the body. It doesn’t have to be obvious and no-one may even be aware of it.

Many patient have to wait a while before they finally get their surgery date and they prepare for the surgery. Unfortunately, if they do have an infection, it’s very likely the surgeon will postpone the surgery. This is very upsetting if you’ve been waiting, so some people may be tempted to not alert the surgeon to the infection. This can be dangerous and result not only in an infection in the joint, but in life-threatening complications.

Any surgery has risks and the bigger the surgery, the more the risk. A knee replacement is a fairly routine surgery for orthopedic surgeons, but it’s still a major surgery.

Most of the possible complications are the same for just about any other surgery: infection, blood clots in the legs, and pneumonia (if you can’t get up and about, and can’t do the deep breathing exercises after having a general anesthetic). Complications specific to the replacement is loosening of the prosthesis, weakness or breakdown of the bone around the replacement, and stiffness in the knee.

Pain pumps are used now to deliver drugs directly to the joint. The pump is designed to make it possible to release a small amount of numbing agent and narcotic to the surgical site. The goals are good pain relief and less need for strong narcotic medications.

They seem to work well, especially in the first 24 to 48 hours. Patients are able to sleep better and function better. Some studies show faster recovery in rehab. With less pain, the patient can move better and with less stiffness and fewer compensatory movement patterns.

It sounds like your previous experience went well for you. But many times we don’t recall the extent of pain and dysfunction experienced years before. So give it a try at least for 24 hours and see how you like it. Anything that gets you up and moving again is worth a second look.

Hamstring injuries are very common among athletes and sports participants. They can be very mild or very disabling. Sprinters are especially susceptible. At full speed, the hamstring muscle contracts very fast to generate power needed for the run.

During sprinting, the hamstrings swing the thigh forward while bending the knee at the same time. When everything is in balance, the body’s center of gravity moves forward very smoothly and very quickly.

Any muscle deficit or imbalance of the hamstrings as they function in both capacities (as hip extensors and knee flexors) can lead to an injury. Olympic contenders have finely tuned bodies. They train every day and benefit from the expert advice of their trainers and coaches. The benefit of these counselors keeps the athlete in top shape and in the game (or in this case, on the track).

If there was a preseason loss of muscle strength in either concentric hip extension or eccentric knee flexion, the risk of a hamstring injury goes up. Concentric refers to muscle contractions as the muscle is shortening. An eccentric contraction is the action of a shortened muscle lengthening.

The length of time it takes to recover from a muscle injury depends on many factors. The degree of injury (mild sprain to complete rupture), strength, and flexibility all contribute to recovery. Other factors such as nutrition, fatigue, and intensity of preinjury training schedule can make a difference.

The 400 meter is the longest of the track events for sprint. Even though it still qualifies as a sprint event, the length of the course requires power, speed, and good technique. The runner has to break fast and push hard until the straight part of the track is reached. The pace is a little more relaxed but picks up again with increasing speed toward the finish line.

Hamstring injuries are very common among athletes and sports participants, especially sprinters. They can be very mild or very disabling. Throughout the race, the hamstring muscle carries out two functions.

It contracts concentrically to extend the hip and eccentrically to flex the knee. Concentric refers to muscle contractions as the muscle is shortening. An eccentric contraction is the action of a shortened muscle lengthening.

At full speed, the hamstring muscle contracts very fast to generate power needed for the run. If there is a preseason loss of muscle strength in either concentric hip extension or eccentric hip flexion, the risk of a hamstring injury goes up.

If you are working with an athletic trainer or physical therapist, it would be a good idea to have some muscle testing done. Any muscle deficit or imbalance can be addressed. Training should include weights, circuit training, leg and arm conditioning, plyometrics, and extensive stretching exercises.

Volleyball has become a very popular sport for men and women. The ability to jump and land is very crucial for this game. And the most common injury is the jump landing sequence. In fact, acute injuries of the ligaments, tendons, and muscles among volleyball players are equal to those reported in ice hockey and soccer.

Players must be able to jump up high in the air, land safely, and immediately be ready to spike, block, or return the ball across the net. They are encouraged to control their vertical jumps keeping to a height that will place the top of their heads below the top of the net.

Spiking or blocking the ball requires vertical jumps and jump-landing sequences. The player must complete this series of movements with energy and force but dissipate the kinetic energy generated during the jump upon landing. Injury is more likely if the force of the impact on landing is not reduced or balanced.

Foot placement on landing is important. Most players use both feet to propel themselves up into the air. The landing may be with both feet at the same time but usually one-foot lands first and in front of the other.

Research shows fewer injuries when players consistently use a two-footed landing. Landing on one foot means that all the force generated by two feet going up is now dissipated through one leg upon landing. The risk of losing balance and/or incurring an injury is much greater with a unilateral landing pattern.

And it’s much easier to get into a position of no return when landing on one foot. This means the feet are spread so far apart that the player either loses balance and falls or a musculoskeletal injury occurs.

It’s not entirely clear what is the best strategy for preventing lower extremity injuries from jump landings. A program of strengthening and physical training seems the most practical and likely to be effective. Practicing safe landing techniques on both feet is advised. The knees should be slightly flexed and toes pointed so that the landing occurs from toe-to-heel.

Using a toe-heel contact pattern with more knee flexion whenever possible has been shown to reduce injuries. This technique requires greater muscular strength and coordination. The player must use just the right amount of knee flexion to complete a safe landing but not so much that they can’t execute the next move quickly. For now, it looks like strength-training, conditioning, and modifying jump-landing techniques is the best way to prevent knee injuries.

Fatigue may be a factor — at least according to several studies on the effect of fatigue on the knee. It appears that fatigue leads to a decreased sense of joint position called proprioception. The number of fibers that get activated is reduced with fatigue, too.

When jumping, cutting, pivoting, and shifting weight suddenly through the foot and leg, the knee can get injured. Adding fatigue as a factor increases the risk of injury. With fatigue comes decreased neuromuscular control and a decreased ability to control movements. Landing forces can exceed the muscular control needed to slow the movement and avoid injury.

This is just one of many possible explanations. Limited information on the status of the muscles and their function right before injury make it difficult to find out exactly what went wrong. But scientists are studying large groups of athletes then taking a look back at the data after someone gets hurt. The hope is to identify possible risk factors and reduce as many as possible.

The shin bone, called the tibia is one of the bones that is most commonly broken. Because of this, doctors and surgeons have a lot of experience in treating broken tibias. One thing they know is that if the tibia is broken in the lower third, the part of the shin bone closest to the foot, it is harder to treat and keep straight than if it happens higher on the bone.

Although your daughter had surgery on the leg, there are many variables that can affect if the surgery is completely successful or not. These include the type of hardware (screws, nails, and/or plates) that are used, the amount of damage to the bone and the surrounding tissue, and if there is an infection.