Tuesday, March 11, 2008

Knee Replacement

Having a knee replacement takes not only certain physical preparation but mental preparation as well. Before having the surgery it is important to have your home laid out for simplicity and easy navigation.

Find a chair that you will be spending a majority of your time in when you arrive home. preferably, its a recliner as you do not want to have your leg in a dependent position where gravity affects the pooling of the blood. Once your chair is designated be sure its of proper height and does not rock. Building a platform prior to surgery to place under the chair is an idea that many have used in the past with great success to raise its height for easier transfers.

Hopefully you have been given an exercise handout prior to surgery to begin preparing your body for the surgery. Completing basic exercises to the affected limb or limbs will greatly assist you in the post-surgical recovery as its known that muscle has memory, and will return to normal function and strength much sooner if exercised in the same manner prior to surgery. The time varies, but 3-5 weeks out should have you prepared and ready following a written exercise program.

Please be sure to have a quality cold pack or other cooling system ready when you get home. Your knee will recover and respond much faster and pain relief will be kept to a minimum with an effective cold pack. Check your local drugstore or better yet a local medical supply will have a larger selection. I see many patients trying to ice down a knee with a small bag of peas and carrots this is something I do not recommend, your knee will need better coverage than that.

Have your meals prepared or have someone that will be staying with you for the first 10 days to 2 weeks home, as the last thing you want to do is stand on your surgical leg in the kitchen preparing meals, believe me it will only take one episode of meal preparation to understand the importance of having food prepared or someone assisting you with it.

Make sure you bring home your compression stockings that are issued at the hospital, many leave them and find they would have come in handy at home. The stockings are to curb edema and to prevent DVT. Take your pain medication as prescribed as well. Many try to get off the pain medication too soon only to be very uncomfortable you will need the pain medication anywhere from 4-6 weeks out from surgery.

And most of all, complete the exercises that have been prescribed by your therapist. your final outcome will be only as good as the time you put into the exercise program. You will see a big change in your overall condition within 6 weeks after surgery if not sooner remember, everyone is different and what your neighbor did and experienced down the street will be different from your experience.

Knee Osteoarthritis

Osteoarthritis, or degenerative joint disease, affects the elderly in parts of the body where it hurts the most. A person suffering from knee osteoarthritis will most likely equate it with cardiovascular disease because the breakdown of articular cartilage of knee joints restricts movement and the patient has to follow a set regimen affecting his lifestyle.

Knee Osteoarthritis is due to injury, congenital disorder, or obesity. The deterioration of articular cartilage, a smooth and fibrous connective tissue that acts as a protective cushion, narrows the joint space between bones. In time, the cartilage becomes grooved and fragmented and surrounding bones thicken or sprout into spurs. Sometimes, there is additional swelling in the knees caused when synovium, a membrane producing a thick fluid to nourish the cartilage, becomes inflamed and produces additional fluid known as ‘water of the knee’. Changes occur due to constant rubbing of joint bones leading to deformity of joints that is equally painful.

Knee osteoarthritis is diagnosed through physical and pathological examinations of joints on either side of knee including hip joints, checking on posture, and gait. Once knee Osteoarthritis is confirmed, a treatment is suggested depending on nature and extent of damage and on the personal physical history of patient. Women over 60 years of age are high risk factors for knee osteoarthritis as they spend major portion of their lives doing physically demanding work that has direct relationship with knee Osteoarthritis. Wearing high heeled shoes also aggravates the pain. In youngsters, knee osteoarthritis is hereditary or due to some injury.

Precautions such as weight reduction, changing work routine, postures, diet, avoiding injuries, participating in physiotherapy, and exercise are advised. Other methods of relief such as acupuncture, ointments, prescription drugs, magnetic pulse therapy, vitamin regimes, and topical pain relievers are temporary. Using prescription drugs and surgery should be a mutual decision between patient and doctor.

What Is Anterior Knee Pain?

Knee pain has can be dressed up in many different guises. Whatever someone decides to call it, all we need to know is that it usually occurs on the front of the knee and it hurts!

The pain is normally associated with running, walking down hills/stairs, or sitting with a bent knee for long periods of time. This is due to an alteration in the biomechanics of the knee which is usually caused by an imbalance in the soft tissue structures.

The pain within the knee joint usually increases when the quadriceps muscles work eccentrically (meaning the muscles working as they get lengthened). This exerts a large force through the patella (knee cap) when the muscles are used this way. The large force presses the patella against the femoral groove, which if not located correctly causes pain.

Mal-tracking of the patella within the femoral groove is the most common cause of anterior knee pain. This is like a train being driven off its rails which will lead to a bumpy and uncomfortable ride! An imbalance in the pull of the quadriceps muscles (vastus medialis, vastus lateralis, vastus intermedius and rectus femoris) which attach to the patella can alter its position.

The angle of pull of the quadriceps muscle through the patella is known as the Q-angle. The Q-angle is determined by drawing a line from the ASIS (bony point on the front of the pelvis) to the midpoint of the patella with a second line being drawn from the centre of the tibial tubercle (flat piece of bone below the knee cap) to the middle of the patella. The point where these two lines cross is known as the Q-angle which should be 13Ú in males and 18Ú in females. Anything outside these ranges could be the cause behind knee pain. Note when performing these tests the leg should be relaxed.

One of the main culprits behind the altered positioning of the patella is a weakness in vastus medialis obliqus (VMO). This muscle attaches medially (to the inside) on the patella with weakness here allowing the patella to drift laterally (outwards). This muscle is the first of the muscles to waste following injury and lack of use of the quadriceps muscles. The quadriceps muscles can start wasting within 24 hours of non-use! Treatment may therefore consist of strengthening of the VMO muscle to alter the pull of the quadriceps on the patella thus correcting its position.

Likewise shortening of vastus lateralis which attached to the lateral aspect of the patella may also result in an outward pull on the patella again affecting the Q-angle. Treatment here would consist of heat, stretching and massage to normalise the length of the muscle. In extreme cases surgery may be required to ’release’ the muscle to allow the patella to re-position itself correctly.

Other causes of anterior knee pain from the patella-femoral joint include

" Tightness in certain structures (e.g. calf and hamstring muscles).

" Altered hip, knee or foot posture.

" Anatomic variations such as a shallow patella-femoral groove.

If knee pain is left untreated the articular surfaces of the patella-femoral joint may, in some cases, become affected and worn, exacerbating the problem.

These are just a couple of examples of causes of anterior knee pain. To have your specific condition diagnosed correctly it is advised that you seek medical advice from a professionally qualified practitioner.

Understand Knee Rehabilitation

James had injured his knee on a rambling trip in France. After consulting his family doctor he was advised to work out on an exercise bike. This just made the knee worse so he consulted a second doctor who sent him for physiotherapy. The physiotherapist referred him to a gym, where the fitness manager put him through a rigorous programme of exercise with a rowing machine, treadmill and cross-trainer. Imagine his misery when instead of the knee getting better it swelled up, became much more painful and he found himself wondering if he should buy a walking cane and move to a downstairs apartment. What was going on?

Well, knee rehabilitation after injury or surgery is not just a case of going to the gym and pushing through the pain. In this case, none of the medical people had made a proper diagnosis, but even without a diagnosis the knee itself was making it clear that the exercise regime was inappropriate.

You see, the body follows a natural progression of healing. Each step of the rehabilitation programme needs to be in sympathy with this healing process. If not, one can do a lot of harm.

After any insult to the knee the inflamed joint lining produces increased fluid and a cascade of chemicals that appear one after the other in a specific sequence. The early part of this cascade encourages blood vessels to dilate and become leaky. Blood plasma containing immune cells leak out of the blood to enter the damaged area and try to clean it up and prevent infection. This whole process contributes to the knee feeling swollen, hot, red and painful. This is called inflammation. Different chemicals emerge later in the cascade to promote closing up of the injury and enhance healing through formation of scar tissue to replace damaged or missing tissues caused by the original injury.

If the knee keeps getting stressed, then the choreography breaks down and the inflammation cascade occurs at the same time as the scarring cascade. This can sometimes prove disastrous, with a hot swollen painful knee stiffening up with sticky adhesions within the knee cavity and the lubricating pouches around the knee, tying previously mobile tissues together and reducing movement within the joint. Without the right attention these adhesions can turn into scar tissue.

To give your knee the best chance of benefiting from a rehabilitation programme you must clearly identify what phase of rehabilitation your knee is in. You need to know what the phases are and the dos and don’ts of each phase. You need to be able to recognise when you have pushed things too far for that phase and what to do about it if you do.

In the early stages of rehabilitation after injury or surgery be sensitive to the fact that the knee lining is likely to be inflamed. The swelling and pain that are normal in this phase may cause the muscles, especially the quads muscles, to become inhibited and unable to contract properly. Gentle sustained stretches ensure that the tendons of the inhibited muscles do not shorten and limit movement in the future. Gentle progressive movement is necessary and really important to lubricate the joint properly and to break down any adhesions. Simple ’balance’ exercises improve balance and position sense in the knee, both of which can easily be lost at this stage leading to re-injury. Rest, ice, compression dressings and elevation are needed after each session to try and minimise swelling. While the inflammation settles you may have to limit some activities and then build these activities up again gradually during the later healing stage.

Only when you have close to full range of movement should you start to concentrate on rebuilding strength. Keep in mind when starting strength training that muscles act in complementary sets. For example, you need to exercise the muscles that bend the knee as well as those that straighten it. Too much emphasis on one set of mucles may lead the complementary set to weaken which destabilises the knee. The quality and timing of the muscle contraction is also important in re-building muscle strength efficiently.

Under ideal conditions, rehabilitation would progress smoothly from strength training to endurance training and then back to full activities. But moving to endurance training too early can again trigger an inflammatory response and set rehabilitation right back with more swelling, pain, muscle inhibition and loss of the range of motion you may already have regained. This is what happened in James’s case. He had already lost time off work, and had now wasted all his efforts in going to the gym.

In this scenario, pushing through the pain is not going to fix the knee. It will only make things worse. With knees, repeating cycles of healing and then renewed inflammation signify that you are pushing too hard and are not being careful enough in your rehabilitation programme. Back off right down again to the first stage of rehabilitation. Return your focus to dealing with the inflammation not the strengthening or endurance. While that might seem like a step backwards, it is really a step forwards towards your ultimate goal of getting better.

Start again with rest, ice, elevation, compression, and possibly anti-inflammatory medication. Stretches and gentle flexibility exercises should be continued, but only when the inflammation settles should you return to strength and endurance training. If you cannot manage this on your own, a good physiotherapist with experience in knee rehabilitation should be able to resolve the problem before things deteriorate too far.

Cure Knee Pain

The snake crossed my horse path, next thing I was flying in the air heating the ground real bad. The first thing I felt was a sharp pain in my left knee. It felt like my knee had been torn apart. I could not walk let alone ride my horse. I was really terrified that I will not be able to ride again. Naturally I turned to classic medical treatment to cure my sour knee but they failed to fix it. To cut a long story short I have manage eventually to find the cure by my self and I want to share it with you.

The first thing I thought post the accident was: OK, I have a decent medical care insurance I will get my knee fixed in no time. I have scheduled a date for preliminary exploratory surgery. When I woke up my knee hearts even more, but the worst was still to come. My doctor told me that the damage to my knee is irreversible and that I will never be able to ride horses again. Moreover, I had to wear supporting device for the rest of my life.

For the first time in my life I felt defeated. If the best medical treatment could not cure my knee I will probably have to stay cripple for the rest of my life. These were the worst days of my life: I could hardly walk, and could not dance or ride my horse. Then one day we went to visit an old friend just to find that his wife happened to be physician therapist. Once I have told her my sad story she said that I will walk normally again and more important ride my horse again.

She has really inspired me not to give up and to try a different way then the classical medical way of thinking. In the next couple of weeks I have learned that by exercising correctly I could reverse my knee condition. This was holistic exercise technique called Pilates. An amazing program that I could easily squeeze into my tide daily scheduled. These are some basic exercise with two main aims: first to strengthen the mussels related to my knee movements and the second one is to make my knee more elastic.

That really helped my. Today, my knee is very strong and my supporting mussels are stronger and can naturally support it. I have got rid of the knee supporting device and went back to my normal life. With one exception: continue to exercise every day.

Knee Physical Therapy

What is the largest joint in our body? Answer: The Knee.

The knee is the connecting point of a total of three bones in our legs: the lower end of the thigh bone or the femur, the upper end of the shinbone or the tibia, and the knee cap or the patella. Other parts of the knee are the cartilage or the shock absorbing cushions in between muscles, the tendons or the cords connecting muscles to bones, and the ligament or the bands connecting our bones to other bones. Any damage to all of these parts are accounted for by a Knee physical therapy, and just the ligament alone is so vulnerable to pulling, stretching and tearing, and with each knee having four major supporting ligaments: the anterior cruciate ligament or ACL at the center of knee, the posterior cruciate ligament or PCL also at the center, the lateral collateral ligament or LCL at the outer knee, and the medial collateral ligament or MCL at the inner knee – Oh the pains of a sprain! and much more other knee ailments. Knee physical therapy deals with damages to all these bones and parts altogether – so what better reason to take care of it!

Knee physical therapy injury prevention itself does so much in providing a better health for our knees. Being one of the most easily injured joints in the human body, the knee rightly deserves its warm- ups, before it lies fateful to Cartilage Injuries, Chrondromalacia, Tendon Injuries, Iliotibial Band Syndrome, Osgood-Schlatter Disease, Osteochondritis Dissecans, Plica Syndrome, or Arthritis.

If you are already suffering from any of these, then you should be in luck for knee physical therapy. Whether you are lying cooperatively on an injury RICE (rest, ice, compression, elevation), or just watching your way for tripping stones, whether you have knee injury or knee pain, recovering from injury, or plainly trying to avoid it – Knee physical therapy can handle it all, as long as you get it immediately.

Yes there are other procedures to hold your back beyond a knee physical therapy, yet should you go that extra mile of surgery, arthroscopy, or knee replacement? Knee physical therapy offers easy access to prevention, emergency, or rehabilitation. Following simpler processes such as evaluation, therapy, education, and aftercare, knee physical therapy can literally make you good to go. Try to jump, stand, run, and pivot – jump for joy if you have a healthy knee!

Relief Of Knee Pain

Our knees share the burden of carrying the body’s weight, enabling us natural movement. Stiff, hurt knees are unable to perform this basic task, this results with physical and mental consequence. More about that and some useful ideas forms this article.

The joints were designed to supply maximum flexibility, stability, support, and defense to the body. These roles are extremely important in terms of natural painless movement. The knee joints cartilage is made of 85% water, this slightly drops down as we age, and is one of the only tissues in the body which has no blood support.

Actually, two long bones meet at the knee, the Femur from above and the Tibia from underneath. They are structurally corresponding but need two cartilages on the sides to fully coordinate between them. Other important elements, in supporting the knee, are the muscles, and the ligaments.

Knee pain should not be related only to old, sick people. Knee pains have many reasons resulting from two main aspects: mechanical and general diseases, which are common to all ages.


" Posture - The body weight is designed to go through a certain point at the knee. Once changing it the new area is not suitable for carrying all the weight and this could lead to erosion of the knee and pains. Too curved or too flat foot could lead to wrong posture and pains as well.
" Over Weight - Over weight causes erosion and pains in most of the body’s joints.
" Sports Injuries - Sports like ski, ball games, and judo are the cause of many knee injuries as a result of a sudden twist or direct hit.


" Inflammation of the Joints - Chronic state of inflammation which affects the body and the knee.
" Degeneration of the Cartilage of the Joints - Caused by erosion of the cartilage which could end in losing most of the cartilage. It is common for people over 70 years old, for as we age the percentage of water drops and leads to this phenomenon.
" Others - Gout, Diabetes, and unbalanced releasing of the growth hormone.

There are many treatments for the injuries and pains we have discussed, from physical rehabilitation of the knee to a traumatic injury which requires emergency surgery. Pains which result from chronic state of inflammation are usually treated with anti-inflammatory medicines. Some will even need joints replacement.

An advanced approach related to several techniques and curing attitudes claims that first thing to be done is correct the structural irregulars, in the joints and muscles which cause pains. Then, work on the supported systems for long terms results. Mainly, strengthen of the supported muscles and a better blood supply to the hurt tissue.

Knee Pain, Knee Injuries and Iliotibial Band Syndrom

Knee pain and knee injuries, as a result of Iliotibial Band Syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints.

Knee pain and knee injuries are very common among runners and cyclists. However, they don’t usually occur in an instant, like a hamstring strain or groin pull, but commonly start off as a twinge or niggle, and progress quickly to a debilitating sports injury that can sideline the best of us for weeks.

For those who aren’t familiar with Iliotibial Band Syndrome, let’s start by having a look at the muscle responsible for the problem. The iliotibial band is actually a thick tendon-like portion of another muscle called the tensor fasciae latae. This band passes down the outside of the thigh and inserts just below the knee.

If you look at the anterior (front) view of the right thigh muscles and follow the tendon of this muscle down, you’ll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band. Or iliotibial tract, as it is labelled in the diagram.

The knee pain occurs when the tensor fasciae latae muscle and iliotibial band become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.


There are two main causes of knee pain associated with iliotibial band syndrome. The first is "overload" and the second is "biomechanical errors."

Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner’s injury. When the tensor fasciae latae muscle and iliotibial band become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in-turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.

Overload on the ITB can be caused by a number of things. They include:

  • Exercising on hard surfaces, like concrete;

  • Exercising on uneven ground;

  • Beginning an exercise program after a long lay-off period;

  • Increasing exercise intensity or duration too quickly;

  • Exercising in worn out or ill fitting shoes; and

  • Excessive uphill or downhill running.

Biomechanical errors include:

  • Leg length differences;

  • Tight, stiff muscles in the leg;

  • Muscle imbalances;

  • Foot structure problems such as flat feet; and

  • Gait, or running style problems such as pronation.

Treatment For Iliotibial Band Syndrome

Firstly, be sure to remove the cause of the problem. Whether is be an overload problem, or a biomechanical problem, make sure steps are taken to remove the cause.

The basic treatment for knee pain that results from ITB Syndrome is no different to most other soft tissue injuries. Immediately following the onset of any knee pain, the R.I.C.E.R. regime should be applied. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

Article by Brad Walker. Brad is an internationally recognized stretching and sports injury consultant with 20 years of practical experience in the health and fitness industry. Brad is a Health Science graduate of the University of New England and has postgraduate accreditations in athletics, swimming and triathlon coaching. He has worked with elite level and world champion athletes and lectures for Sports Medicine Australia on injury prevention. Brad is also the author of The Stretching Handbook, The Anatomy of Stretching and The Anatomy of Sports Injuries.