Treating Knee Injuries Before They Become Serious
If you enjoying running outdoors, jogging on a treadmill
, or even working out on an elliptical, sometimes knee injuries can occur, just from excessive use of the joint and surrounding muscles. It is not uncommon, and if you treat them quickly and accurately, they do not have to become a permanent pain.While direct blows to the knee can occur, it is much more susceptible to twisting or stretching injuries, taking the joint through a greater range of motion than it can tolerate. If it is stressed from a specific direction, then the ligament trying to hold it in place against that force can tear.
Ligament stretching or tears are called sprains. These sprains are graded as first, second, or third degree based upon how much damage has occurred.
Grade-one sprains stretch the ligament but do not tear the fibers; grade-two sprains partially tear the fibers, but the ligament remains intact; and grade-three tears completely disrupt the ligament. Twisting injuries put stress on the cartilage or meniscus, and can pinch it between the tibial surface and the edges of the femoral condyle, which causes tears.
Injuries of the muscles and tendons surrounding the knee are caused by acute hyperflexion or hyperextension, or by overuse. These injuries are called strains.
Strains are graded similarly to sprains, with first-degree strains stretching muscle or tendon fibers but not tearing them, second-degree strains partially tearing the muscle tendon unit, and third-degree strains completely tearing it. There can be inflammation of the bursas that can occur because of chronic use and abuse.
Acute injuries fall into two groups: those where there is almost immediate swelling in the joint associated with the inability to bend the knee and bear weight, and those in which there is discomfort and perhaps localized pain to one side of the knee, but with minimal swelling and minimal effects on walking. They can cause pain and swelling, with difficulty bending the joint and bearing any weight.
If the swelling occurs immediately, it may suggest a ligament tear or fracture. If the swelling arises over a period of many hours, meniscal or cartilage injuries may be the cause.
However, pain may involve more than one structure and the symptoms may not present classically. Longer-term symptoms that point to knee problems will include pain and swelling in addition to other complaints.
The initial evaluation by the physician or health-care provider will begin with a medical history. Whether the evaluation is occurring immediately after the injury or weeks later, the physician may ask about the mechanism of injury to help isolate what structures in the knee might be damaged.
Was it a twisting injury that causes a cartilage or meniscus tear? Was there an injury associated with a planted foot to place stress and potentially tear a ligament?
Further questions will address other symptoms. Was swelling present, and if so, did it occur right away or was it delayed by hours?
Did the injury prevent weight-bearing or walking? Does going up or down steps cause pain?
Is there associated hip or ankle pain? Make sure that you know the answers to these questions when you seek treatment.
Physical examination of the knee begins with inspection, in which the physician will look at the bones and make certain they are where they belong. With fractures of the kneecap or patellar tendon injuries, the kneecap can slide high out of position.
Also, patellar dislocations, where the kneecap slides to the outside or lateral part of the knee, are easily evident on inspection. Looking at how the joint is held is also important.
If it is held slightly flexed, it can be a clue that there is fluid in the joint space, since joint space is maximal at fifteen degrees of flexion. Palpation (feeling) is the next part of the exam, and knowing the anatomy, the physician can feel where any pain might exist, and correlate that to the underlying structures like ligaments or muscle-insertion points.
Sometimes X-rays are required to make certain there are no broken bones, but often with stress or overuse injuries where no direct blow has occurred, plain X-rays may not be needed and imaging of the knee may wait until a later date, where an MRI might be considered. Make sure that you do not put any weight on the injury, and begin to ice it right away.
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