Knee Pain

What it is
The knee is a modified hinge joint between the upper end of the tibia (shin bone), the lower end of the femur (thigh bone) and the patella (knee bone) at the front. Each bony surface is protected by slippery cartilage, and the joint lined with a synovial membrane which secretes fluid to oil and cushion knee movements. The ends of the tibia and femur are further protected by two crescent-shaped discs of cartilage, the medial and lateral menisci, that act like washers to reduce friction when the bones move together.

Strong fibrous bands of tissue hold the joint together, including the knee capsule, collateral ligaments at the side of the joint, plus two ligaments inside the joint itself (cruciate ligaments). These maintain stability and allow the joint to bend while stopping the ends of the bones from moving excessively back and forth or side to side. Strong muscles in the thigh attach to the bones via tendons near the knee joint and work together to move the joint.

The hamstring muscles at the back of the thigh bend the knee, while the quadriceps muscles in the front of the thigh straighten it. Fluid filled sacs (bursas) above and below the knee help to prevent tendons and muscles from rubbing at pressure points.

Pain around the knee can be due to a number of conditions, including arthritis, sports injuries such as strained muscle, sprained ligaments or torn cartilage (meniscus) and bursitis (eg Housemaid’s Knee).

The usual cause of a knee strain, sprain or torn cartilage is a sudden twisting movement when playing sport or during a fall. Soft tissue damage causes inflammation resulting in swelling, bruising, tenderness, stiffness and a reduction in mobility. The fluid-filled space surrounding the knee (bursa) usually also fills with inflammatory fluid (effusion) and cause dramatic ballooning of the joint. Immediate treatment is vital to minimise inflammation and swelling and to hasten healing. This will reduce the amount of time you are out of action.

Torn cartilage
The crescent-shaped medial and lateral menisci tear when a sustained, rotational strain is placed on a knee that is weight-bearing and flexed. This can cause a longitudinal split or a bucket-handle tear. Pain, swelling and instability occur initially, and later the knee may keep swelling, buckle, give way – especially when twisting – or “lock” so it can be flexed, but not fully extended when the torn piece of cartilage becomes trapped between the joint surfaces. Once a meniscus is torn, it will not heal as it does not have a blood supply. If the tear is removed, however, the meniscus may regenerate.

First Aid for Knee Injuries
Immediate treatment will minimise inflammation and swelling and hasten healing to reduce the amount of time you are out of action. To treat sprains and strains, just remember RICE:

Rest - for at least 24 hours to prevent further damage. Once pain and swelling start to subside, you may be able to start gentle exercise, but always follow medical advice. More severe injuries need to rest longer and may require immobilisation in a cast.
Ice: Apply an ice-pack (eg bag of frozen peas wrapped in a clean cloth) to the sprain or strain as quickly as possible to reduce bruising and swelling. Don’t place ice directly on the skin as this can cause a cold burn. An ice-pack should only be applied for up to 10 minutes at time - remove for a few minutes before re-applying again if necessary.
Compression: An elasticated compression bandage will minimise swelling. This is best applied by someone with first aid training, as a bandage that is too tight will do more harm than good. Signs that a knee bandage is too tight include pins and needles, pain, blueness or numbness in the lower leg. Tubular compression supports are also available.
Elevate: Elevating the leg will reduce swelling eg prop your foot up on a chair with a cushion placed under the heel for support.
Anti-inflammatory painkillers - eg ibuprofen - by mouth or rubbed on in the form of a sports gel will help to reduce pain.

Seek medical advice if:
- Pain or swelling is severe.
- You think a muscle or ligament may be torn - eg if you can’t bend a joint properly, or if a muscle seems to be oddly bunched or excessively painful.
- There is a flesh wound or bleeding - especially if your tetanus is not up-to-date.
- There is a possibility of a bone fracture (signs to look out for include bone tenderness with swelling, increased pain on movement and, in some cases, deformity).
- You are unsure how serious an injury is.

Further Self Help for knee pain
The knee joints have to work harder if you are overweight, so try to lose any extra pounds.

Exercises will help to reduce stiffness, improve mobility
and strengthen the thigh muscles that stabilise the knee.
A physiotherapist who specialises in sports’ injuries can recommend individual approaches likely to get you back
to work as soon as possible.

Supplements containing glucosamine sulphate are widely taken to supply building blocks needed for regeneration and repair of damaged joints, torn cartilage, sprained ligaments and strained tendons.

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