Ouuch! Is that you on bending down, walking, running or climbing stairs? Knee pain is very common and stems from many different causes. They include arthritis, ligament injuries, cartilage injuries/meniscal tear, patellar tendonitis (tendinitis), baker's cyst, bursitis, chrodromalacia patella or even wear and tear from overuse of the joint. These problems can cause stiffness, inflammation, swelling, excruciating pain and difficulty with mobility of the knee. Like so many other things people take for granted, you only realise how much you need your knees when they're gone.
How does that happen? Here are some cautionary tales and some precautions you can take to keep your knees in good shape.
Football
For DOMA president Gregory Aboud, a Saturday afternoon of football with the boys turned into a disaster when a "bad move" by one of the opposing players caused him to injure his right knee badly. Aboud explained after visiting the doctor, it was found the interior and exterior ligaments were damaged, the meniscus cartilage severely torn and the anterior cruciate ligament (ACL) completely severed. The meniscus is cartilage tissue which acts like a shock absorber in the knee joint. Without out it, the knee is less able to sustain the load of walking, running, or other activities.
On the advice of his doctor, this called for immediate surgery. Aboud's interior and exterior ligaments were repaired and the damaged meniscus removed.
"My ACL was not repaired but I have managed to exist without it having strengthened the muscle groups in the upper leg," said Aboud. He regained some mobility ten days after surgery, but full use of the joint came only after therapy, which took eight to ten weeks to complete. With his knee good as new, Aboud still enjoys occasional sports.
Jumping
Metro magazine editor Laura Dowrich-Phillips had to have a total meniscectomy–removal of the meniscus cartilage.
She is now worried about getting osteoarthritis, as without the meniscus degeneration of the knee joint may happen faster than with an intact meniscus.
Dowrich-Phillips was enjoying her African dance class when, attempting a high jump, she felt something pop in her right knee as she landed.
"I could not walk....I was in excruciating pain," said Dowrich-Phillips.
Her GP only told her to administer the cold compression method (icing). This approach brought some relief but in no time she was back to square one.
"One day I was reaching for something and I heard the same pop again. I later found out that the meniscus cartilage became caught between the thigh and the shinbone," said Dowrich-Phillips.
This time her doctor said surgery was the best bet. However, owing to the time between the actual injury and her surgery, Dowrich-Phillips had to have her meniscus removed completely as her doctor explained it had become "too dry" to stretch.
Until she can have a meniscus transplant, Dowrich-Phillips is trying to maintain a healthy weight. According to research, your knees bear the brunt of your body weight. Every extra pound adds up to three pounds of pressure on your knee joints when you walk, and ten pounds when you run.
Dowrich-Phillips also does low-impact exercises, which she says assisted greatly with pain relief.
Running
When managing director of Global Voices Online Georgia Popplewell decided to take up running in her forties, wearing the wrong shoes cost her a trip to the doctor's office.
"I blame it on a pair of minimalist running shoes I bought quite by accident: I was looking for athletic footwear that didn't look like traditional athletic footwear. The ones I found had thin soles like sprinting shoes and a mesh upper and came with literature about minimalist running. Next thing I knew, I was running," said Popplewell.
Running became a regular activity, but just as Popplewell was getting ready to take part in her third 5k run, one night after a savannah run, both knees became extremely swollen and painful.
"Truth be told, I had been experiencing some soreness, especially in my left knee, which I attributed to my laziness about stretching properly after running. I got myself a knee brace and took abreak from running, assuming that rest was all I needed," said Popplewell.
A few weeks later, while on a trip to East Africa Popplwell did a bit too much dancing, followed by "much abuse on rocky mountain trails. By the end of the trip I'd reached the point where the mere sight of a staircase made my heart sink, as I knew it would take me ten minutes to climb it," she recalled.
A sports physician diagnosed bilateral osteoarthritis Grade I-II. This meant the cartilage in her knee joints was wearing thin, and the synovial fluid in the joint cavity was deteriorating and no longer doing a good job of lubricating and cushioning the joint.
Popplewell did not need surgery but she received injections of Synvisc,a synthetic synovial fluid, to help regenerate the existing fluid, followed by physical therapy. Physiotherapy comprises mainly exercises to strengthen her quadriceps muscles–this she has to do daily for the rest of her life. She has also added swimming for a total body workout and occasionally does bike riding.
Your knees in their hands
Physiotherapist Kristi Maingot of Renew, a physiotherapy clinic in St Clair, said many people could end up in Popplewell's position if they were not careful, and at no time must one ignore any kind of discomfort in the knee or other joint areas.
She said other low-impact workout exercises Popplewell can add to her exercise regime included strength training, yoga, water aerobics and pilates, to name a few.
At the Fracture and Orthopaedic Clinic, also in St Clair, orthopaedic surgeon Dr Derrick Lousaing said people seek knee surgery for several reasons: trauma due to sporting or vehicular accident injuries; disease processes that affect either the bone around the joint or the cartilage, like inflammatory arthritis or degenerative arthritis; and neoplasms– growths that are cancerous or benign.
Asked how long it takes before a patient can regain full use of their knee joints after surgery, Lousaing said if it involves some sort of fixation or ligament reconstruction or a joint replacement, patients are usually mobilised almost immediately after surgery.
"Physiotherapy starts immediately and once that begins, it is dependent on the extent of biological healing that will dictate the pace of progress," said Lousaing. "If one can achieve good pain relief then the rehab process becomes easier and the progress is usually more rapid and complete."
Pain-relieving techniques include oral medication, icing, occasional heat, electrical stimulation and ultrasound therapy machines.
Exercise is also very important: surgery without rehabilitation would not be that successful. But not all knee surgery has to be major.
"The whole idea behind the operative procedure is to try and restore the patient to their premorbid status. Since in some instances that may not always be possible, all particulars are outlined to the patient and they are well aware of what the objective of the surgery should be or can be and their objective and that of the surgeon's should be fully understood prior to surgery," said Lousaing.
"There are some procedures that can be done quite comfortably as out-patient procedures. It depends largely, though, on a patient's support at home."
Keeping your knees nice
Asked what people can do to maintain healthy knees, Maingot said because we really have no control over what can happen to tendons and ligaments, focus should be placed on strengthening muscles to support them.
Lousaing said the list must be divided into patient factors and external factors.
"Patient factors are keeping your weight to an optimum and exercising regularly–low-impact exercises. Another important factor for patients is the natural alignment of their knee joints. Most patients are not always naturally aligned with regards to their knee joints and that misalignment can be responsible for a lot of the problems that may exist over time," said Lousaing.
Among the external factors are age and injury. He pointed out activities many people could do in their youth may become difficult and risky with age.
"So if you played football three or four times a week when you were younger, you have got to reduce the amount of days you do so now, when you are older, to avoid joint injuries," advised Lousaing. "Being a little more selective with your activities by selecting appropriate ones that will decrease impact might be able to keep your knee joints much healthier for a longer period. Early care can also save you continuous visits to the doctor's office and in some instances, prevent you from having to do surgery at all."