February 15, 2007
Common Knee Problems
by Anne Kosacheff, Physical Therapist
Welcome back for the next installation of the 2007 “Physical Therapy for Healthy Joints” column! Today we will review some common problems with the knee joint. This column will focus specifically on “The Knee” joint, with an entire article on the “Patello-Femoral Joint” next month. In April, the column will have some easy exercises to keep your knee healthy.
There are three basic classifications of knee problems: meniscal, connective tissue (includes muscles, tendons and ligaments) and bony. All three are inter-related, so if you have a problem in one area, chances are there is a real or potential problem in another area.
The two menisci inside the knee provide cushioning and stability. These structures can be injured with twisting movements, hyperextension or hyper-flexion movements, sudden forceful pressure through the joint, or may wear away with general use.
There is only blood flow to the outer 1/3 of the menisci, so any injury to this area may heal without surgical intervention. Any injury to the remaining 2/3 will not heal.
A torn area that does not heal needs to be removed by an orthopedic surgeon. This procedure is called an “arthroscopic debridement.” If the loose piece is allowed to flap around inside the joint, it can cause further damage to the joint surfaces, and may lead to more problems down the road.
It is especially important to have the procedure done if your knee is “locking up.” This is a sign there is significant damage to the meniscus.
To complicate the picture, a locking knee can also be caused by problems in the patello-femoral joint. We will look at this issue next month.
When you tell a provider about your knee problem, the symptoms you report can SOUND like a meniscal injury to your therapist or medical provider, but can actually be caused by an imbalance in your muscles.
Your hamstrings travel down the back of your leg from your hip to just below your knee. They wrap around toward the sides of your knee, and allow your lower leg to twist a bit.
This motion is important for those of you involved in sports, or walking on the tundra. Imagine how hard it would be to play basketball or go berry picking if your knee was a simple hinge joint, only allowing flexing and extending!
If your hamstrings are tight or strained, you may feel pain at their insertion—close to the joint line on the medial and lateral part of your knee. This is often the site of pain when there is a meniscal injury. Also, tight hamstrings put pressure on your knee joint to flex (bend).
When you stand up, your quadriceps move your knee into an extended (straight) position. If your hamstrings are unable to fully relax, the combined pressure in the knee caused by both muscles working at the same time increases the wear and tear on your cartilage, and can cause early or excessive degeneration.
Over time, this can lead to irreversible bony changes commonly know as arthritis. Degenerative changes in the joint surfaces (known as “degenerative arthritis”) cannot be reversed, but in many cases can be prevented.
IMPORTANT! Not all joint pain is caused by degenerative changes. Joint pain MAY resolve if it is treated quickly. X-rays can show degenerative changes in the joint, but the changes may not be apparent for some time after an injury.
Last month we talked about the bones in the knee being lined with cartilage. This cartilage allows the joint surfaces to slide and glide smoothly and easily. Once this cartilage is worn away, it does not regenerate.
Some people seem to have stronger cartilage than others and can withstand more wear and tear in their joints.
Regardless of your genetic makeup, it is important to protect the cartilage in your body. You get what you are born with, and that is it! If you are asking your legs to carry 20, 30, 40 extra pounds around all day, every day, imagine what is happening to your poor menisci, and your cartilage!
These are just some of the common problems people have with their knees. If you have any questions about specific problems you are having, please call the Physical Therapy Department at 543-6342 to set up an appointment.
We also travel to the subregional clinics on a regular basis, and are happy to see you closer to home.
Look for more information next month about the patello femoral joint!