Dr Knee

Basics of Knee Replacemnet Surgery

2010-08-03T14:52:00.000-05:00

Knee replacement surgery is the most common joint replacement procedure. It is medically known as Knee Arthroplasty. The procedure is done if patients are still feeling the pain symptoms during normal activities. The practice is done for patients who have knee diseases like osteoarthritis, rheumatoid arthritis and arthritis.

It can also be applied to patients who have knee injuries. There are two kinds of knee replacement. It can be partial or total replacement. The surgery depends on the severity of the patient's disease or injury. The replacement can also be either metal or plastic.

Normally, the replacement can last for ten to fifteen years. There are non operative treatments to avoid the procedure. Patients are given physiotherapy or physical therapy or they can also do special exercises like walking aids. Taking medicines are also medically advised by their respective physicians. However, if these non operatives can no longer cure the patients, surgery is done.

The traditional procedure of the surgery is when the doctor cuts the knee about ten to thirty centimeters long, until they will reach the knee joint. The worn or damaged parts are removed from the thigh to the shin bone of the patient. Physicians will then, shape the damaged surfaced with the metal or plastic replacement. Once they are done with the fitting process, they will put the knee replacement. The cut will be stitched and closed out.

Nowadays, they have discovered a new method of doing the surgery. The recent medical advances are discovered to lessen the tissue trauma or the surgery marks for the patients. They call it Minimally Invasive Surgery. It is done by just making a small incision and by going between the fibers and the muscles without cutting the tendons.

After the surgery, the patients are encouraged to walk with aids in sticks or walkers. They will also have physical therapists to assist them. It will take time for patients to fully recover. Perseverance and patience are advised for these patients.

Well, in some parts of the world where the surgeries are highly specialized and where everything is governed by robots, knee replacement surgery is not considered a major operation. They categorize it under repairs, whereas other types of surgeries require maximum hands-on operation. It is also important to know the extent of wellness the operation will do to you at the same time the things that you can or can't do.

It is recommended to have an overall examination in a timely manner to avoid misinterpretation and assumptions. It is highly recommended by doctors to immediately seek medical assistance if knee pain is present or felt. It can be just a simple pain but it may give a major medical problem to one's health that can lead to this so called knee replacement surgery.

It is a must that we have to be very vigilant in times of body pains. We do not know what is going on inside our body. What we refer to as a simple muscle or knee pain might already a fatal damage inside. If anything happens or you feel something different, have a check up with your doctor at once to avoid severe complications.

Total Knee Replacement - Why You Shouldn't Wait

2010-08-01T14:48:00.000-05:00

Undergoing surgery is not something that anyone looks forward to. Sometimes people will learn to live with pain rather than going under the knife to repair any damage but when it comes to your mobility it's never a good idea to wait. Total knee replacement becomes necessary when the patient's mobility is hampered and typically more damaged is caused when arthritic conditions are ignored. This is especially true for female patients. It is thought that women can bear more pain than men so they wait longer to consider surgery.

What is a total knee replacement?

A total knee replacement is a surgical procedure that replaces the ends of the damaged femur (thigh bone) and the tibia (shin bone) and creates a smooth knee joint. The prosthetic components are made from metal or plastic and are secured to the bone with cement. Depending on the extent of the damage, a partial knee replacement or uni-compartmental replacement can be done in which only a portion of the joint is replaced. (The knee is comprised of three compartments).

What causes degeneration in the knee joint?

When bones become degenerative it is most commonly associated to osteoarthritis. Osteoarthritis, also referred to as "wear and tear" arthritis is common in older patients and is caused by aging joints, obesity and prior injuries. Symptoms associated with osteoarthritis are joint pain and stiffness and decreased mobility. Weight loss can improve osteoarthritis and has been shown to decrease symptoms.

What to expect after Surgery

After undergoing a total knee replacement, patients are instructed by their physician to under go physical therapy to strengthen the surrounding muscles and ligaments. Depending on the amount of trauma, rehabilitation time will vary in patients. Rehabilitation is extensive but is necessary in the process. It is very important to manage weight gain because one of the contributing factors to osteoarthritis is obesity. Throughout the recovery process it is vital to maintain constant communication with your doctor.

Exercise: Muscle Strengthening Aids New Knees

2009-02-03T05:01:00.000-05:00

A new study suggests that a carefully focused program of muscle strengthening can make an important difference in how well patients recover after knee replacement.

Patients who underwent six weeks of progressive muscle strengthening aimed at the quadriceps did much better than patients given conventional treatment. The study appears in the February issue of Arthritis Care & Research.

Almost 500,000 knee replacements are done in the United States each year, and patients often report that they still have problems doing things like walking and climbing.

For the study, more than 200 patients were divided into groups and given different treatments about four weeks after surgery.

One received conventional treatment. Another was also given quadriceps strengthening, while a third was given the strengthening and electrical stimulation to make the muscles contract.

While the electrical stimulation did not appear to make a difference, the muscle strengthening appeared to bring the patients back to a level of functioning almost normal for their age.

One of the authors, Lynn Snyder-Mackler of the University of Delaware, said in an e-mail message that knee replacement patients and their doctors should not underestimate the ability “to really improve their function.”

Cure Knee Pain With CFA Supplements

2008-11-17T15:32:00.001-05:00

In our culture, fitness is the symbol of youth and vitality. However, for some people exercising comes with a price. Long-time runners often complain of knee pain. Some give into the pain and stop their workouts. Others say, "No pain. No gain." Wouldn't it be great if you could cure knee pain and continue the healthy lifestyle that you love? There is an answer: cetylated fatty acid (CFA) supplements.
Cetylated fatty acids lubricate cell membranes, allowing your joints to move freely again. For runners and people who are on their feet all day, it can cure knee pain so they can live active, healthy lives. CFA's have been medically and clinically proven to provide significant improvement in as little as 30 minutes.
The good news is that CFA's like Celadrin are available in topical and oral supplements. People who have taken CFA supplements report these benefits:
• Fast-acting relief. In a double-blind clinical study, subjects who took CFA supplements experienced relief in less than half an hour. Subjects who took placebos experienced no relief. • Available in over-the-counter oral and topical treatments. The great news is that you don't need a prescription to cure knee pain with CFA supplements. • 100% improvement in clinical trials. All patients who took CFA supplements experienced speedy relief from joint pain. Cetylated fatty acids lubricate the joints while combating inflammation. • No reported side effects. Cetylated fatty acids are safe and comply with FDA requirements. • Restored flexibility. CFA supplements help rebuild flexibility in knee joints and provide long-term relief for people who use it regularly.
Cetylated fatty acids enhance cell membranes and promote elasticity in the joints. As CFA's lubricate the joints, the joints are cushioned from the stress and strain of everyday impact. For runners, CFA's are the key to regaining the mobility and flexibility necessary for working out. Why miss out on life when you can live it to the fullest?
Here are some conditions that can benefit from CFA supplements:
• Sports injuries. CFA's can mend and repair a variety of sports injuries by reducing inflammation and relieving the pain. • Knee injuries. CFA's repair the wear and tear of knee impact and provide fast and long-term relief for common knee pain. They also prevent re-injury by lubricating joints. • Elbow pain. CFA's reduce swelling and provide relief to painful elbows. Used daily, you'll notice significant improvements in flexibility and movement. • Joint problems. CFA's lubricate the joints and provide a fluid cushion to prevent re-injury. • Lower back pain. CFA's relieve the pain and inflammation of back pain due to stress and injury. • Psoriasis. CFA's reduce inflammation both internally and externally, relieving pain and soreness associated with skin conditions.
CFA supplements are your key to an active life. Work out. Run a marathon. Take a hike. Don't let knee and joint pain keep you down. For people who want to cure knee pain, cetylated fatty acids are the answer. By reducing inflammation, providing lubrication, and healing tender joints, CFA supplements can help you live life to the fullest. Why let a little knee pain ruin your day? Try all-natural cetylated fatty acids, and your knee pain will be a thing of the past.

Knee Pain Relief - Jumper's Knee - The Benefits of Knee Braces

2008-11-17T15:30:00.001-05:00

Patellar tendonitis, which is also known as "jumper's knee," happens quite frequently to athletes who play in sports were jumping is required. The patellar tendon runs along the top of the knee and connects the kneecap to the shin bone. As you can imagine, any inflammation or stretching of this ligament can cause some pain to the patient.
Jumper's knee happens when someone puts too much strain on the patellar ligament. Runners, basketball players, volleyball players and soccer players are prime targets when it comes to getting patellar tendonitis; although it can strike anyone if enough strain is put on the ligament. If you suspect you may have patellar tendonitis, you can usually feel pain when you press on the tendon that directly covers the knee. You may also experience swelling and stiffness. Sufferers of this form of tendonitis will usually feel pain when bending at the knee. This usually occurs when the patient kneels down or jumps.
Treatment for patellar tendonitis varies, depending on the severity of the case. In most cases, your doctor will take an X-ray of the knee, just to make sure there isn't any damage to the joint or bones of the knee. In some cases you may have to undergo an MRI. An MRI helps doctors assess whether the tendon, or determine whether it is aggravated. Once the doctor can make an accurate assessment, they will recommend a suitable treatment plan.
Applying ice to the tendon will help in most cases. Ice helps to control and minimize the swelling of the tendon. This will cut down on pain, and allow the tendon to relax and heal more quickly. Anti-inflammatory Motrin and Ibuprofen are prime examples of anti-inflammatory drugs. These drugs will help decrease swelling and control the pain. (Before you take any of these medications, you should consult with your doctor first.)
Rest is one of the best cures for tendonitis. Stay away from any activity that causes pain or that can irritate the tendon further. Allow your body to heal naturally by giving it proper rest.
A knee brace can help provide support to the knee. Many tendonitis sufferers use them not only when they have a problem, but also to prevent the problem from occurring in the first place. A well designed knee brace can be an invaluable tool to the patellar tendonitis sufferer.
Jumper's knee can often be painful, without a doubt. Avoiding having to suffer from it is a key element, especially if you rely on your knee for sporting activities. Make sure you stretch before you have to put your knee to use, and wear a knee brace when possible. This will help cut down on the chances that you will suffer from Jumper's knee in the future.

Knee Pain Relief - How to Survive Meniscus Tear Knee Pain - Knee Braces That Help Provide Support

2008-10-17T15:29:00.000-05:00

Are you looking for a way to survive your knee pain after you have injured your meniscus?
If you would like free information on how to help reduce this kind of knee pain then read on...
Your meniscus is a shock-absorbing cartilage found in your knee. Tears occur most commonly when a person excessively twists or over-flexing their knee joint. Often times it is a sports related injury.
There is a meniscus located in two parts of each of your knees. One provides shock absorption on the outside aspect (also known as the lateral aspect), and the other is located on the medial aspect (inside portion of the knee). It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other. In other words, if a person was somehow unfortunate enough to be born without their menisci, their weight would fall squarely upon their bones and this would promote boney fractures and a ton of knee joint pain.
Even a very small tear to the mensicus can cause a lot of pain, which is the overall reason why the health of your meniscus is vitally important. If an individual is older and they have brittle cartilage, they can be more prone to a meniscus tear.
Symptoms include:
A popping feeling can occur at the time of injury
Knee joint pain When pressure is applied to the knee joint, knee pain can occur at the space between the bones.
A locking sensation can occur at the knee joint
Recurrent knee-catching
Diagnosis
When you see your physician after a knee injury and you are concerned about a meniscal tear, he/she will look at your history, and can perform a manual test like the Apley's compression test, or the McMurray's test. Your physician may also use an X-ray or MRI determine the severity of your knee injury. Surgery is not always required, unless the damage is extensive.
Treatment
Icing can help reduce knee swelling and reduce knee pain after a mensical tear. In addition, it is important to stay away from any activity that inflames your knee pain.
A well designed knee support can also help patients who have suffered a knee injury, such as a meniscal tear. Excessive side to side movements can be restricted and the support a knee brace can provide can reduce your knee pain.
If you are an active person, you can use knee braces for a prophylactic purpose. When you use a knee support when you are healthy you may help prevent a knee tear. A well designed knee brace can be a very useful adjunct to the health of your knee.
A good physician will tell you that they use surgery as a last resort; telling you that conservative measures should be considered first:
A meniscus repair can be used to help treat your meniscus, but more often a meniscectomy is performed, which removes the damaged part of the meniscus.
If you suffer a meniscal tear once, you are more likely to have further problems, such as arthritis. Prevention is the best method to avoid such an injury. Making lifestyle choices that can help prevent this injury are recommended, such as staying in shape. The extra weight can only be an increased burden upon your meniscii.

Chondromalacia - Cause of Anterior Knee Pain in Middle Aged Women

2008-10-14T15:31:00.000-05:00

According to the University of Virginia Health System:
Arthritis: Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight.
Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.
After walking for 6 hours a day, five or six days a week for twenty years, tearing my patellar tendon, having surgery for that and just seeing the years fly by like we all do, this is where I found myself. Knees that were bone on bone, my right kneecap 1/3 worn off, hurting all day and night if I wasn't taking some kind of pain killer every four or five hours.
What do you do? Just keep going and taking pills until the knees finally totally wear out and you either go sit in a chair or get knee replacement. At least that is what I thought and is what I planned to do.
Until. Until a friend shared something with me that I thought was nuts. "Sure Steve, that will work!" (sarcastically) But, what did I have to lose? Nothing but knee pain, so I tried it. He was right and I was wrong, did it ever work! To the tune of pain free with the same knees and feeling at sixty like I did in my twenties, NO PAIN! Amazing, yet true.
I would enjoy helping you achieve this same level of feeling good without prescription meds or pain killers of any kind. Get in touch and let's get you started too.
Doug Sandquist is a mail carrier in Omaha who has dealt with knee pain and surgery for many years. Having found a way to be PAIN FREE WITH MY REAL KNEES I want to help others reach that same level of healing. Isn't it time for you to start on the road to less pain?

Jumping - Daily Functioning of the Knee

2008-08-21T00:44:00.001-05:00

Jumping
It’s hard not to feel a twinge of envy when you watch your favorite six-year-old leap off the furniture, knowing the only damage she’s likely to cause is to Mom’s favorite breakable. As we get older, the impact of jumping is likely to have far more painful consequences than paying for repairs out of our allowance money. The harsh impact combined with the potential for twisting and tearing, makes jumping a risky business indeed. Still, some of us can’t resist. We rise into the air on driveway basketball courts and in funk-music-driven aerobics classes. Sometimes we land easily, sometimes we don’t.

When you jump, even a good landing may compromise your knee joint. Those strong quadriceps muscles contract on landing and pull hard at the patellar tendon’s insertion on the tibial tuberosity (the little bump at the top of the tibia). This may cause jumper’s knee (inflammation of the patellar tendon). Of course, if you land off your intended, balanced course, you will strain all elements of your knee joint. The correct shoes and corrective knee bands can reduce knee injury when jumping.

Stair Climbing - Daily Functioning of the Knee

2008-08-21T00:43:00.002-05:00

Stair Climbing
Once used primarily by athletes in training, stair climbing has become popular with exercisers who take step classes in gyms and with aerobic enthusiasts who use the outdoor stairs at beaches, hills, and high school or college stadiums. A lot of them end up limping into the doctor’s office with knees that just can’t take the strain. With stair climbing, the knee moves quite a bit and is under a great deal of pressure. The more the knee is flexed, the tighter the patellar tendon is stretched, pushing on the patella. When the tendon stretches out, the area where it attaches becomes inflamed, and tracking of the patella goes off course. It drifts, slips, and tilts, resulting in patellofemoral syndrome (runner’s knee) or, in more extreme cases, chondromalacia patellae (wearing out of the cartilage on the back of the patella). Extreme wear and tear on the cartilage and menisci (the cushioning discs between the femur and the tibia), over time, roughen the glassy cartilage surface and decrease the protection it and the menisci offer. Eventually, bone may meet bone, causing painful arthritis. Stair climbing may increase the force of the patella on the femur up to four times body weight. To help keep the exercise as safe for your knees as it is good for your metabolism and cardiac function, take care to give your knees a rest (don’t do the same exercise two days in a row), alternate stair climbing with other types of exercise, reduce your speed while climbing, and pay immediate heed when your knees start to ache or swell.

Squatting - Daily Functioning of the Knee

2008-08-21T00:43:00.001-05:00

Squatting
In some cultures squatting is the preferred method of sitting and is practically an art form. People in those cultures can sustain the posture for lengthy periods of time—astonishing to the average American. Squatting is sometimes advocated for pregnant women as a way to ease the eventual difficulties of labor. When regular squatting is practiced from childhood, the knee suffers no ill effects. However, if you use this motion only occasionally—or incorporate it suddenly into your daily routine—it can cause problems. Certainly you may occasionally squat to pick up an errant sock or a sleeping child from the floor. Mostly, though, squatting in this country occurs during exercise. A well-executed squat is an excellent muscle-toner and muscle stabilizer, but a poorly executed one can create problems. Deep knee bends to a squatting position—once the cornerstone of military inspired exercise regimes—have now been determined to do more harm than good by jamming the patella into the femur, and subluxing (partially dislocating) the femur from the tibia—in this case, slipping the femur over the tibia, outside its normal anatomical placement. Squatting may increase the forces on the knee joint up to eight times body weight.

Jogging and Running - Daily Functioning of the Knee

2008-08-21T00:42:00.001-05:00

Jogging and Running
Jogging and running have benefits for both body and mind. Great calorie burners, they also clear your mind and renew your spirit, offering the much vaunted “runner’s high.” They can, however, take a real toll on the knees unless you take precautions. As discussed in the preceding section, good shoes are a must, and you should replace them regularly if you are a frequent or long-distance runner. Carefully consider your running surface—a dirt track is better than a concrete one, and flat or uphill running is preferable to downhill. Most runners do pay attention to these factors.

Another predictor of potential knee problems as a runner is your physical build. Q angle (quadriceps angle) is measured by drawing a line from your anterior iliac spine (the bump on your pelvis above and in front of your hip joint) to the center of your kneecap, and a second line from your kneecap to the tibial tuberosity (the little bump at the top of the tibia where the patellar tendon attaches to your tibia). A wide Q angle would be more than 15 degrees and might be found on extremely broad-hipped women. Such an angle may increase the likelihood of “runner’s knee” (patellofemoral syndrome), because it predisposes a person to run with the knees pushed inward (knock kneed). The resultant strain loosens the patellar tendon and its collagenous attachments and weakens their hold on the patella. The patella may then move off its track on the femur, resulting in pain and inflammation. A wide Q angle does not always cause pain and is not a reason to stop running, however; its effects can be adjusted by the use of orthotics or braces.

Shoes - Daily Functioning of the Knee

2008-08-21T00:41:00.000-05:00

Shoes
The common shoe offender to knee health is, of course, high heels. Their negative impact is compound. First, they position the foot so that its usefulness as a shock absorber is greatly diminished. This problem is exacerbated by the fact that the shoes themselves are often thin-soled and unpadded, offering no cushion between the foot and the pavement. Second, they create stress for the knee by causing prolonged muscle contraction and fatigue. Third, over the long haul, constant wearing of high heels can create a permanent tightening and shortening of the Achilles tendons, so that any shoes other than high heels become difficult and painful to wear.

Another source of problems is worn-out or improperly fitted athletic shoes. Designed to compensate for the impact caused by running, jogging, or jumping, shoes that become worn down create problems in two ways. First, a reduction in the cushion increases the impact on the knees. Second, soles worn down on their sides, heel, or toe may magnify the slight imperfection in gait that caused uneven wear in the first place. A shoe that fits poorly may cause poor toe-off (the beginning of a step) or excess muscle strain.

Irregular Gait - Daily Functioning of the Knee

2008-08-21T00:40:00.000-05:00

Irregular Gait
Gait is simply the way in which a person walks. In a perfect gait cycle, the pushing off and landing motions of the heel and toe are in balance, contributing to an even stride. Many people, however, unconsciously favor the heel or toe when they walk, contributing to an uneven and uncomfortable gait cycle. Plantar flexion, favoring the toe, occurs when the foot is angled down at the ankle from heel to toes (at its most extreme, walking on tiptoe). This causes the knee to hyperextend (literally straighten too far), putting extreme pressure on the joint itself as well as its individual anatomical parts. The tendons, ligaments, and joint capsule are stretched so that they move out of place, resulting in a sprain or strain. Dorsiflexion, favoring the heel, occurs when the foot is angled up from the ankle (at its most extreme, walking on the heels alone) so that the person falls forward, straining the quadriceps (thigh) muscles. Excess dorsiflexion keeps the quadriceps contracted in order to keep the individual from falling over and inhibits normal straightening of the knee. Both of these gait deviations are commonly seen in people who have had a stroke, brain injury, or spinal cord injury and in children with cerebral palsy

Walking - Daily Functioning of the Knee

2008-08-21T00:30:00.000-05:00

Walking
No movement or exercise is easier on the knees than a well-paced, well-executed walk in good, comfortable shoes. Some factors, however, can make this most natural of motions hazardous to knee health, and I discuss those next.

Anatomy Of The Knee

2008-08-21T00:28:00.001-05:00

The knee is made up of bones, ligaments, tendons, cartilage, and a joint capsule, all of which are composed of collagen. Ligaments connect bone to bone. Tendons attach muscle to bone. Cartilage is the smooth, fibrous connective tissue covering bones that allows easy, gliding movement.

Collagen is the fibrous protein constituent of connective tissue present throughout the body. As we age, the most obvious sign of collagen breakdown is in the face, where it leads to the sagging that keeps plastic surgeons in business. Less obviously, however, collagen breaks down throughout the body and contributes to a variety of age-related injuries and conditions. These keep orthopedic surgeons in business. However, treatments and methods other than surgery may do a better job of preserving and rejuvenating the knee.

The knee joint is a link between the thighbone—the femur—and the two bones of the lower leg—the tibia (large and on the inside) and the fibula (small and on the outside). The attaching ligaments on the outer surfaces of the knee are the medial collateral ligament (connecting the tibia to the femur) and the lateral collateral ligament (connecting the fibula to the femur). The patellar tendon attaches the quadriceps muscles of the thigh to the tibia, enabling extension of the knee. Inside the knee joint, two ligaments stretch between the femur and tibia—the anterior cruciate ligament and, behind it, the posterior cruciate ligament. Covering the ends of the bones is articular cartilage, which provides a smooth surface to facilitate motion. Articular cartilage is so named because when bones move against each other, they are said to articulate. In the knee, auricular cartilage covers the end of the femur, the top of the tibia, and the back of the patella (the kneecap). In the middle of the knee joint are the menisci, which are collagenous disc-shaped cushions that act as shock absorbers.

Unlike a ball joint, such as the hip, which sits in a deep pocket (the acetabulum of the pelvis), the knee doesn’t have much protection from trauma and stress. It is designed to move mostly in one plane like a hinge. Because of this inherent limitation of movement, strong knee ligaments are extremely important for knee health.

Side-to-side stresses are controlled by the medial and lateral collateral ligaments; front-to-back motion is handled by the anterior and posterior cruciate ligaments, which ensure that the tibia doesn’t slide backward or forward in relation to the femur. When these ligaments become lax, or are torn, bone movement may become excessive and damaging, and painful arthritis can begin.

HOW THE KNEE WORKS (AND DOESN’T)

2008-08-21T00:15:00.000-05:00

The skeletal structure has two primary types of joints—the ball joint, exemplified by the shoulder, which allows free rotation (a freedom that comes with its own set of problems and injuries, by the way); and the hinge joint, illustrated by the knee, which operates primarily in a single plane (bent to straight) with only a slight rotational or pivoting motion. This restriction of movement is what makes the knee so vulnerable to traumatic injury. Additionally, the knee is regularly subjected to the stress of both supporting body weight and absorbing shock from intermittent impacts such as jumping, walking, and running. Over time these stresses cause a loosening of the connective ligaments, the tendons, and the joint capsule that holds the knee together. Along with a wearing away of cushioning cartilage and collagen, this loosening leads to the pain and dysfunction of bone meeting bone. At its worst, this condition manifests as arthritis.

Knee Replacement

2008-03-11T13:41:00.000-05:00

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

2008-03-11T13:40:00.001-05:00

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?

2008-03-11T13:40:00.000-05:00

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

2008-03-11T13:39:00.000-05:00

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

2008-03-11T13:38:00.000-05:00

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

2008-03-11T13:37:00.001-05:00

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

2008-03-11T13:37:00.000-05:00

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.

Mechanical

" 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.

Illnesses

" 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

2008-03-11T13:36:00.000-05:00

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.

Causes

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.

Osteoarthritis

2007-09-09T02:18:00.002-05:00

Osteoarthritis – A disease in which the cartilage that cushions
the ends of the bones is lost, leading to joint pain and
stiffness. The most common form of arthritis, osteoarthritis
grows more common with age.

Osgood-Schlatter disease

2007-09-09T02:18:00.001-05:00

Osgood-Schlatter disease – A disease often caused by repetitive
stress or tension on part of the growth area of the upper
tibia (the apophysis). It is characterized by inflammation of
the patellar tendon and surrounding soft tissues at the point
where the tendon attaches to the tibia. The disease may also
be associated with an injury in which the tendon is stretched
so much that it tears away from the synovium.

Orthopaedic surgeon

2007-09-09T02:17:00.004-05:00

Orthopaedic surgeon – A doctor who has been trained in the
nonsurgical and surgical treatment of bones, joints, and soft
tissues such as ligaments, tendons, and muscles.

Meniscus

2007-09-09T02:17:00.003-05:00

Meniscus – A pad of connective tissue that separates the
bones of the knee. The menisci (plural) are divided into two
crescent-shaped discs (the lateral and medial) positioned
between the tibia and femur on the outer and inner sides of
each knee. The two menisci in each knee act as shock
absorbers, cushioning the lower part of the leg from the
weight of the rest of the body as well as enhancing stabil

Medial collateral ligament (MCL)

2007-09-09T02:17:00.001-05:00

Medial collateral ligament (MCL) – The ligament that runs
along the inside of the knee joint, providing stability to the
outer (medial) part of the knee.

Magnetic resonance imaging (MRI)

2007-09-09T02:16:00.006-05:00

Magnetic resonance imaging (MRI) – A procedure that uses
a powerful magnet linked to a computer to create pictures of
areas inside the knee. Magnetic energy stimulates knee tissue
to produce signals that are detected by a scanner and analyzed
by a computer. This creates a series of cross-sectional
images of a specific part of the knee. An MRI is particularly
useful for detecting soft tissue damage or disease.

Lupus

2007-09-09T02:16:00.005-05:00

Lupus – An autoimmune disease characterized by destructive
inflammation of the skin, internal organs, and other
body systems as well as the joints.

Ligament

2007-09-09T02:16:00.003-05:00

Ligament – A tough band of connective tissue that connects
bones to bones.

Lateral collateral ligament (LCL)

2007-09-09T02:16:00.001-05:00

Lateral collateral ligament (LCL) – The ligament that runs
along the outside of the knee joint. It provides stability to the
outer (lateral) part of the knee.

Internist

2007-09-09T02:15:00.006-05:00

Internist – A doctor trained to diagnose and treat nonsurgical
diseases.

Iliotibial Band Syndrome

2007-09-09T02:15:00.005-05:00

Iliotibial Band Syndrome – An inflammatory condition in
the knee caused by the rubbing of a band of tissue over the
outer bone (lateral condyle) of the knee. Although iliotibial
band syndrome may be caused by direct injury to the knee,
it is most often caused by the stress of long-term overuse,
which sometimes results from sports training.

Hamstring

2007-09-09T02:15:00.003-05:00

Hamstring – Prominent tendons at the back of the knee.
Each knee has a pair of hamstrings that connect to the muscles
that flex the knee. The hamstring muscles, which bend
at the knee, run along the back of the thigh from the hip to
just below the knee.

Gout

2007-09-09T02:15:00.001-05:00

Gout – An acute and intensely painful form of arthritis.
This condition occurs when crystals of the bodily waste
product uric acid are deposited in the joints.

Femur

2007-09-09T02:14:00.005-05:00

Femur – The thigh bone or upper leg bone. The femur
is one of three bones (the other two are the tibia and the
patella) that join to form the knee joint.

Corticosteroids

2007-09-09T02:14:00.003-05:00

Corticosteroids – Powerful anti-inflammatory hormones
made naturally in the body or manmade for use as medicine.
Oral corticosteroids may be used to treat systemic
inflammatory diseases, such as rheumatoid arthritis or
lupus. Corticosteroid injections may be used to reduce
inflammation in a joint with arthritis, such as the knee.

Computerized axial tomography (CAT) scan

2007-09-09T02:14:00.001-05:00

Computerized axial tomography (CAT) scan – A painless
procedure in which x rays are passed through the knee at different
angles, detected by a scanner, and analyzed by a computer.
This produces a series of clear cross-sectional images
(slices) of the knee tissues on a computer screen. CAT scan
images show soft tissues such as ligaments or muscles
more clearly than conventional x rays. The computer can
combine individual images to give a three-dimensional
view of the knee.

Cartilage

2007-09-09T02:13:00.003-05:00

Cartilage – A tough, elastic material that covers the ends of
the bones where they meet to form a joint. In the knee, cartilage
helps absorb shock and allows the joint to move smoothly.

Bone scan

2007-09-09T02:13:00.001-05:00

Bone scan (radionuclide scanning) – A technique for creating
images of bones on a computer screen or on film. Prior to
the procedure, a very small amount of radioactive dye is
injected into the bloodstream. The dye collects in the bones,
particularly in abnormal areas of the bones, and is detected
by a scanner. This test detects blood flow to the bone and cell
activity within the bone, and can show abnormalities in these
processes that may aid diagnosis.

Biopsy

2007-09-09T02:12:00.006-05:00

Biopsy – A procedure in which tissue is removed from the
body and studied under a microscope. A biopsy of joint tissue
may be used to diagnose some forms of arthritis.

Arthroscopy

2007-09-09T02:12:00.005-05:00

Arthroscopy – A surgical technique that involves making a
small incision in the skin over the joint. A small lighted tube
(arthroscope) with a camera is inserted through this incision.
It takes images of the inside of the joint and projects them
onto a television screen. While the arthroscope is inside the
knee joint, the surgeon may insert surgical tools through
additional small incisions to remove loose pieces of bone or
cartilage or to repair torn ligaments or menisci.

Avascular necrosis

2007-09-09T02:12:00.003-05:00

Avascular necrosis – A disease in which a temporary or permanent
loss of the blood supply to the bones causes the
bone tissue to die and the bone to collapse. This condition
is also known as osteonecrosis, aseptic necrosis, and
ischemic necrosis.

Arthritis

2007-09-09T02:12:00.001-05:00

Arthritis – A term used to refer to some 100 diseases that
affect the joints. These diseases cause pain, inflammation,
stiffness, damage, and/or malformation. The most common
forms of arthritis are osteoarthritis and rheumatoid arthritis.

Anterior cruciate ligament (ACL)

2007-09-09T02:11:00.004-05:00

Anterior cruciate ligament (ACL) – A ligament in the knee
that crosses from the underside of the femur to the top of
the tibia. The ligament limits rotation and the forward
movement of the tibia.

Ankylosing spondylitis

2007-09-09T02:11:00.003-05:00

Ankylosing spondylitis – An inflammatory form of arthritis
that primarily affects the spine, leading to stiffening and possible
fusion.

Arthritis Foundation

2007-09-09T02:11:00.001-05:00

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357–0669
Phone: 404–872–7100 or 800–568–4045 (free of charge)
or call your local chapter (listed in the telephone directory)
www.arthritis.org
The Foundation has several free brochures about the
various forms of arthritis that affect the knee, coping with
arthritis, arthritis treatment, and exercise. A free brochure
on protecting your joints is titled Using Your Joints Wisely.
The Foundation also can provide addresses and phone
numbers for local chapters and physician and clinic
referrals.

American Physical Therapy Association

2007-09-09T02:10:00.006-05:00

American Physical Therapy Association
1111 N. Fairfax Street
Alexandria, VA 22314
Phone: 703–684–2782 or
800–999–APTA (2782) (free of charge)
www.apta.org
The goal of the American Physical Therapy Association
is to foster advancements in physical therapy practice,
research, and education. The Association publishes a free
brochure titled Taking Care of the Knees.

American College of Rheumatology

2007-09-09T02:10:00.005-05:00

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345–4300
Phone: 404–633–3777
Fax: 404–633–1870
www.rheumatology.org
This national professional organization can provide
referrals to rheumatologists, and to allied health professionals
such as physical therapists. One-page fact sheets
are available on various forms of arthritis. Lists of specialists
by geographic area and fact sheets are also available
on this Web site.

American Academy of Orthopaedic Surgeons

2007-09-09T02:10:00.003-05:00

American Academy of Orthopaedic Surgeons
P.O. Box 1998
Des Plaines, IL 60017–1998
Phone: 847–823–7186 or
800–824–BONE (2663) (free of charge)
Fax: 847–823–8125
www.aaos.org
The Academy provides education and practice management
services for orthopaedic surgeons and allied health
professionals and patients. It also serves as an advocate
for improved patient care and informs the public about
the science of orthopaedics. The orthopaedist’s scope of
practice includes disorders of the body’s bones, joints, ligaments,
muscles, and tendons. The Academy produces
a variety of educational programs and informational
brochures that are available free to the public. For a
single copy of an AAOS brochure, send a self-addressed
stamped envelope to the address above or visit the AAOS
Web site.

NIH Osteoporosis and Related Bone Diseases

2007-09-09T02:10:00.001-05:00

NIH Osteoporosis and Related Bone Diseases
National Resource Center
2 AMS Circle
Bethesda, MD 20892–3676
Phone: 202–223–0344 or 800–624–BONE
TTY: 202–466–4315
Fax: 202–293–2356
NIAMSBoneInfo@mail.nih.gov
www.osteo.org
The NIH Osteoporosis and Related Bone
Diseases~National Resource Center provides patients,
health professionals, and the public with an important
link to resources and information on metabolic bone diseases.
The mission of NIH ORBD~NRC is to expand
awareness and enhance knowledge and understanding
of the prevention, early detection, and treatment of these
diseases as well as strategies for coping with them. The
Center provides information on osteoporosis, Paget’s disease
of bone, osteogenesis imperfecta, primary hyperparathyroidism,
and other metabolic bone diseases and
disorders.

National Institute of Arthritis and Musculoskeletal and Skin Diseases

2007-09-09T02:09:00.001-05:00

National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892–3675
Phone: 301–495–4484 or
877–22–NIAMS (226–4267) (free of charge)
TTY: 301–565–2966
Fax: 301–718–6366
NIAMSInfo@mail.nih.gov
www.niams.nih.gov
NIAMS provides information about various forms of
arthritis and other rheumatic diseases; as well as other
bone, muscle, joint, and skin diseases. It distributes
patient and professional education materials and refers
people to other sources of information. Additional information
and updates can also be found on the NIAMS
Web site.

What Research Is Being Conducted on Knee Problems?

2007-09-09T02:08:00.000-05:00

What Research Is Being Conducted on Knee Problems?
Studies of the various forms of arthritis are helping doctors
better understand these diseases and develop treatments to
stop or slow their progression and damage to joints, including
the knees.
Studies are also underway to discover and/or develop safer
and more effective pain relief, particularly for osteoarthritis
of the knee. In recent years, the nutritional supplement pair
glucosamine and chondroitin has shown some potential for
reducing the pain of osteoarthritis, though no conclusive
proof has emerged to date. Both of these nutrients are
found in small quantities in food and are components of
normal cartilage.
The recently concluded Glucosamine/Chondroitin Arthritis
Intervention Trial (GAIT), which was co-sponsored by
the National Center for Complementary and Alternative
Medicine and the National Institute of Arthritis and Musculoskeletal
and Skin Diseases, assessed the effectiveness and
safety of these supplements, when taken together or separately.
The trial found that the combination of glucosamine and
chondroitin sulfate did not provide significant relief from
osteoarthritis pain among all participants. However, a smaller
subgroup of study participants with moderate-to-severe pain
showed significant relief with the combined supplements.
The 4-year trial was conducted at 16 sites across the United
States. The results were published in the Feb. 23, 2006 edition
of the New England Journal of Medicine.
Scientists continue to experiment with procedures that may
help replace lost or damaged joint cartilage. One procedure
that has met with success involves growing a person’s own
cartilage cells in a dish and then grafting the new cartilage
onto damaged areas of the joint. While the procedure has
been successful in repairing cartilage injuries at the end of the
femur, at present it is not recommended for arthritis-related
damage, and its potential use in arthritis is still uncertain.
Other areas of research involve trying to better understand
how and why joint injuries occur and the measures that
should be taken to prevent them; investigating the role of
exercise in protecting the knee; and developing less invasive
surgeries and better joint prostheses.
In December 2003, NIAMS and other groups at the National
Institutes of Health sponsored the Consensus Development
Conference on Primary Total Knee Replacement. The conference
findings underscored the value of knee replacements
for end-stage arthritis, and identified avenues for further
research

What Types of Exercise Are Best for People With Knee Problems?

2007-09-09T02:07:00.000-05:00

What Types of Exercise Are Best for People With Knee Problems?
Ideally, everyone should get three types of exercise regularly:
• Range-of-motion exercises to help maintain normal
joint movement and relieve stiffness.
• Strengthening exercises to help keep or increase muscle
strength. Keeping muscles strong with exercises
such as walking up stairs, leg lifts, dips, or riding a
stationary bicycle helps support and protect the knee.
• Aerobic or endurance exercises to improve function
of the heart and circulation and to help control
weight. Weight control can be important to people
who have arthritis because extra weight puts pressure
on many joints. Some studies show that aerobic exercise
can reduce inflammation in some joints.
If you already have knee problems, your doctor or physical
therapist can help with a plan of exercise that will help the
knee(s) without increasing the risk of injury or further damage.
As a rule of thumb, you should choose gentle exercises
such as swimming, aquatic exercise, or walking over jarring
exercises such as jogging or high-impact aerobics.

How Can People Prevent Knee Problems?

2007-09-09T02:06:00.002-05:00

How Can People Prevent Knee Problems?
Some knee problems, such as those resulting from an accident,
cannot be foreseen or prevented. However, a person can
prevent many knee problems by following these suggestions:
• Before exercising or participating in sports, warm up
by walking or riding a stationary bicycle, then do
stretches. Stretching the muscles in the front of the
thigh (quadriceps) and back of the thigh (hamstrings)
reduces tension on the tendons and relieves
pressure on the knee during activity.
• Strengthen the leg muscles by doing specific exercises
(for example, by walking up stairs or hills, or by riding
a stationary bicycle). A supervised workout with
weights is another way to strengthen the leg muscles
that support the knee.
• Avoid sudden changes in the intensity of exercise.
Increase the force or duration of activity gradually.
• Wear shoes that both fit properly and are in good condition.
This will help maintain balance and leg alignment
when walking or running. Knee problems can
be caused by flat feet or overpronated feet (feet that
roll inward). People can often reduce some of these
problems by wearing special shoe inserts (orthotics).
• Maintain a healthy weight to reduce stress on the knee.
Obesity increases the risk of osteoarthritis of the knee.

What Kinds of Doctors Evaluate and Treat Knee Problems?

2007-09-09T02:06:00.001-05:00

What Kinds of Doctors Evaluate and Treat Knee Problems?
After an examination by your primary care physician, he or
she may refer you to a rheumatologist, an orthopaedic surgeon,
or both. A rheumatologist specializes in nonsurgical
treatment of arthritis and other rheumatic diseases. An
orthopaedic surgeon, or orthopaedist, specializes in nonsurgical
and surgical treatment of bones, joints, and soft tissues
such as ligaments, tendons, and muscles.
You may also be referred to a physiatrist. Specializing in
physical medicine and rehabilitation, physiatrists seek to
restore optimal function to people with injuries to the muscles,
bones, tissues, and nervous system.
Minor injuries or arthritis may be treated by an internist (a
doctor trained to diagnose and treat nonsurgical diseases)
or your primary care physician.

Plica Syndrome

2007-09-09T02:05:00.000-05:00

Plica Syndrome
Plica (PLI-kah) syndrome occurs when plicae (bands of synovial
tissue) are irritated by overuse or injury. Synovial plicae
are the remains of tissue pouches found in the early stages of
fetal development. As the fetus develops, these pouches normally
combine to form one large synovial cavity. If this
process is incomplete, plicae remain as four folds or bands of
synovial tissue within the knee. Injury, chronic overuse, or
inflammatory conditions are associated with this syndrome.
Symptoms
Symptoms of plica syndrome include pain and swelling, a
clicking sensation, and locking and weakness of the knee.
Diagnosis
Because the symptoms are similar to those of some other
knee problems, plica syndrome is often misdiagnosed. Diagnosis
usually depends on excluding other conditions that
cause similar symptoms.
Treatment
The goal of treatment is to reduce inflammation of the synovium
and thickening of the plicae. The doctor usually prescribes
medicine such as ibuprofen to reduce inflammation.
People are also advised to reduce activity, apply ice and an
elastic bandage to the knee, and do strengthening exercises.
A cortisone injection into the plica folds helps about half of
those treated. If treatment fails to relieve symptoms within
3 months, the doctor may recommend arthroscopic or open
surgery to remove the plicae.

Iliotibial Band Syndrome

2007-09-09T02:04:00.000-05:00

Iliotibial Band Syndrome
Iliotibial band syndrome is an inflammatory condition
caused when a band of tissue rubs over the outer bone (lateral
condyle) of the knee. Although iliotibial band syndrome
may be caused by direct injury to the knee, it is most often
caused by the stress of long-term overuse, such as sometimes
occurs in sports training and, particularly, in running.
Symptoms
A person with this syndrome feels an ache or burning sensation
at the side of the knee during activity. Pain may be localized
at the side of the knee or radiate up the side of the thigh.
A person may also feel a snap when the knee is bent and
then straightened. Swelling is usually absent and knee
motion is normal.
Diagnosis
The diagnosis of this disorder is typically based on the symptoms,
such as pain at the outer bone, and exclusion of other
conditions with similar symptoms.
Treatment
Usually, iliotibial band syndrome disappears if the person
reduces activity and performs stretching exercises followed by
muscle-strengthening exercises. In rare cases when the syndrome
doesn’t disappear, surgery may be necessary to split
the tendon so it isn’t stretched too tightly over the bone.
Osteochondritis Dissecans
Osteochondritis dissecans results from a loss of the blood
supply to an area of bone underneath a joint surface. It
usually involves the knee. The affected bone and its covering
of cartilage gradually loosen and cause pain. This problem
usually arises spontaneously in an active adolescent or young
adult. It may be due to a slight blockage of a small artery or
to an unrecognized injury or tiny fracture that damages the
overlying cartilage. A person with this condition may eventually
develop osteoarthritis.
Lack of a blood supply can cause bone to break down
(osteonecrosis4). The involvement of several joints or the
appearance of osteochondritis dissecans in several family
members may indicate that the disorder is inherited.
Symptoms
If normal healing doesn’t occur, cartilage separates from the
diseased bone and a fragment breaks loose into the knee
joint, causing weakness, sharp pain, and locking of the joint.
Diagnosis
An x ray, MRI, or arthroscopy can determine the condition
of the cartilage and can be used to diagnose osteochondritis
dissecans.
Treatment
If cartilage fragments have not broken loose, a surgeon may
fix them in place with pins or screws that are sunk into the
cartilage to stimulate a new blood supply. If fragments are
loose, the surgeon may scrape down the cavity to reach fresh
bone, add a bone graft, and fix the fragments in position.
Fragments that cannot be mended are removed, and the cavity
is drilled or scraped to stimulate new cartilage growth.
Research is being done to assess the use of cartilage cell and
other tissue transplants to treat this disorder.

Osgood-Schlatter Disease

2007-09-09T02:03:00.002-05:00

Osgood-Schlatter Disease
Osgood-Schlatter disease is a condition caused by repetitive
stress or tension on part of the growth area of the upper tibia
(the apophysis). It is characterized by inflammation of the
patellar tendon and surrounding soft tissues at the point
where the tendon attaches to the tibia. The disease may also
be associated with an injury in which the tendon is stretched
so much that it tears away from the tibia and takes a fragment
of bone with it. The disease most commonly affects
active young people, particularly boys between the ages of
10 and 15, who play games or sports that include frequent
running and jumping.
Symptoms
People with this disease experience pain just below the knee
joint that usually worsens with activity and is relieved by
rest. A bony bump that is particularly painful when pressed
may appear on the upper edge of the tibia (below the knee
cap). Usually, the motion of the knee is not affected. Pain
may last a few months and may recur until the child’s growth
is completed.
Diagnosis
Osgood-Schlatter disease is most often diagnosed by the
symptoms. An x ray may be normal, or show an injury, or,
more typically, show that the growth area is in fragments.
Treatment
Usually, the disease resolves without treatment. Applying ice
to the knee when pain begins helps relieve inflammation and
is sometimes used along with stretching and strengthening
exercises. The doctor may advise you to limit participation in
vigorous sports. Children who wish to continue moderate or
less stressful sports activities may need to wear knee pads for
protection and apply ice to the knee after activity. If there is
a great deal of pain, sports activities may be limited until discomfort
becomes tolerable.

Tendon Injuries

2007-09-09T02:03:00.001-05:00

Tendon Injuries
Knee tendon injuries range from tendinitis (inflammation
of a tendon) to a ruptured (torn) tendon. If a person overuses
a tendon during certain activities such as dancing, cycling,
or running, the tendon stretches and becomes inflamed. Tendinitis
of the patellar tendon is sometimes called jumper’s
knee because in sports that require jumping, such as basketball,
the muscle contraction and force of hitting the ground
after a jump strain the tendon. After repeated stress, the tendon
may become inflamed or tear.
Symptoms
People with tendinitis often have tenderness at the point
where the patellar tendon meets the bone. In addition, they
may feel pain during running, hurried walking, or jumping.
A complete rupture of the quadriceps or patellar tendon is
not only painful, but also makes it difficult for a person to
bend, extend, or lift the leg against gravity.
Diagnosis
If there is not much swelling, the doctor will be able to feel a
defect in the tendon near the tear during a physical examination.
An x ray will show that the patella is lower than normal
in a quadriceps tendon tear and higher than normal in a
patellar tendon tear. The doctor may use an MRI to confirm
a partial or total tear.
Treatment
Initially, the treatment for tendinitis involves rest, elevating
the knee, applying ice, and taking NSAID medications such
as aspirin or ibuprofen to relieve pain and decrease inflammation
and swelling. A series of rehabilitation exercises is
also useful. If the quadriceps or patellar tendon is completely
ruptured, a surgeon will reattach the ends. After surgery, a
cast is worn for 3 to 6 weeks and crutches are used. For a partial
tear, the doctor might apply a cast without performing
surgery.
Rehabilitating a partial or complete tear of a tendon requires
an exercise program that is similar to but less vigorous than
that prescribed for ligament injuries. The goals of exercise
are to restore the ability to bend and straighten the knee and
to strengthen the leg to prevent repeat injury. A rehabilitation
program may last 6 months, although people can return to
many activities before then.

Medial and Lateral Collateral Ligament Injuries

2007-09-09T02:02:00.000-05:00

Medial and Lateral Collateral Ligament Injuries The medial collateral ligament is more easily injured than the lateral collateral ligament. The cause of collateral ligament injuries is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports like football or hockey.

Symptoms
When injury to the medial collateral ligament occurs, you may feel a pop and the knee may buckle sideways. Pain and swelling are common.

Diagnosis
A thorough examination is needed to determine the kind and extent of the injury. In diagnosing a collateral ligament injury, the doctor exerts pressure on the side of the knee to determine the degree of pain and the looseness of the joint. An MRI is helpful in diagnosing injuries to these ligaments.

Treatment
Most sprains of the collateral ligaments will heal if you follow a prescribed exercise program. In addition to exercise, the doctor may recommend ice packs to reduce pain and swelling, and a small sleeve-type brace to protect and stabilize
the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be accompanied by a torn anterior cruciate ligament, which usually requires surgical repair.

Cruciate Ligament Injuries

2007-09-09T02:01:00.001-05:00

Cruciate Ligament Injuries
These are sometimes referred to as sprains.3 They don’t necessarily
cause pain, but they are disabling. The anterior cruciate
ligament is most often stretched or torn (or both) by a
sudden twisting motion (for example, when the feet are
planted one way and the knees are turned another). The
posterior cruciate ligament is most often injured by a direct
impact, such as in an automobile accident or football tackle.
Symptoms
You may hear a popping sound, and the leg may buckle
when you try to stand on it.
Diagnosis
The doctor may perform several tests to see whether the
parts of the knee stay in proper position when pressure is
applied in different directions. A thorough examination is
essential. An MRI is accurate in detecting a complete tear,
but arthroscopy may be the only reliable means of detecting
a partial one.
Treatment
For an incomplete tear, the doctor may recommend an exercise
program to strengthen surrounding muscles. The doctor
may also prescribe a brace to protect the knee during activity.
For a completely torn anterior cruciate ligament in an active
athlete and motivated person, the doctor is likely to recommend
surgery. The surgeon may reconstruct torn ligament
by using a piece (graft) of healthy tissue from you (autograft)
or from a cadaver (allograft). Although synthetic ligaments
have been tried in experiments, the results have not been as
good as with human tissue. One of the most important elements
in a successful recovery after cruciate ligament surgery
is a 4- to 6-month exercise and rehabilitation program that
may involve using special exercise equipment at a rehabilitation
or sports center. Successful surgery and rehabilitation
will allow the person to return to a normal lifestyle.

Meniscal Injuries (Injuries to the Menisci)

2007-09-09T02:00:00.001-05:00

Meniscal Injuries (Injuries to the Menisci)
The menisci can be easily injured by the force of rotating the
knee while bearing weight. A partial or total tear may occur
when a person quickly twists or rotates the upper leg while
the foot stays still (for example, when dribbling a basketball
around an opponent or turning to hit a tennis ball). If the
tear is tiny, the meniscus stays connected to the front and
back of the knee; if the tear is large, the meniscus may be
left hanging by a thread of cartilage. The seriousness of a
tear depends on its location and extent.
Symptoms
Generally, when people injure a meniscus, they feel some
pain, particularly when the knee is straightened. If the
pain is mild, the person may continue moving. Severe
pain may occur if a fragment of the meniscus catches
between the femur and the tibia. Swelling may occur soon
after injury if there is damage to blood vessels. Swelling
may also occur several hours later if there is inflammation
of the joint lining (synovium). Sometimes, an injury that
occurred in the past but was not treated becomes painful
months or years later, particularly if the knee is injured a
second time. After any injury, the knee may click, lock, feel
weak, or give way. Although symptoms of meniscal injury
may disappear on their own, they frequently persist or return
and require treatment.
Diagnosis
In addition to listening to your description of the onset of pain
and swelling, the doctor may perform a physical examination
and take x rays of the knee. An MRI may be recommended to
confirm the diagnosis. Occasionally, the doctor may use
arthroscopy to help diagnose a meniscal tear.
Treatment
If the tear is minor and the pain and other symptoms go
away, the doctor may recommend a muscle-strengthening
program. The following exercises after injury to the meniscus
are designed to build up the quadriceps and hamstring
muscles and increase flexibility and strength:
• warming up the joint by riding a stationary bicycle,
then straightening and raising the leg (but not
straightening it too much)
• extending the leg while sitting (a weight may be
worn on the ankle for this exercise)
• raising the leg while lying on the stomach
• exercising in a pool (walking as fast as possible in
chest-deep water, performing small flutter kicks
while holding onto the side of the pool, and raising
each leg to 90 degrees in chest-deep water while
pressing the back against the side of the pool).
Before beginning any type of exercise program, consult
your doctor or physical therapist to learn which exercises are
appropriate for you and how to do them correctly, because
doing the wrong exercise or exercising improperly can cause
problems. A health care professional can also advise you on
how to warm up safely and when to avoid exercising a joint
affected by arthritis.
If your lifestyle is limited by the symptoms or the problem,
the doctor may perform arthroscopic or open surgery to
see the extent of injury and to remove or repair the tear.
Most young athletes are able to return to active sports after
meniscus repair.
Recovery after surgical repair takes several weeks. The best
results of treatment for meniscal injury are obtained in people
who do not show articular cartilage changes and who
have an intact anterior cruciate ligament.

Chondromalacia

2007-09-09T01:59:00.002-05:00

Chondromalacia
Chondromalacia (KON-dro-mah-LAY-she-ah), also called
chondromalacia patellae, refers to softening of the articular
cartilage of the kneecap. This disorder occurs most often in
young adults and can be caused by injury, overuse, misalignment
of the patella, or muscle weakness. Instead of gliding
smoothly across the lower end of the thigh bone, the knee
cap rubs against it, thereby roughening the cartilage underneath
the knee cap. The damage may range from a slightly
abnormal surface of the cartilage to a surface that has been
worn away to the bone. Chondromalacia related to injury
occurs when a blow to the knee cap tears off either a small
piece of cartilage or a large fragment containing a piece of
bone (osteochondral fracture).
Symptoms
The most frequent symptom is a dull pain around or under
the knee cap that worsens when walking down stairs or hills.
A person may also feel pain when climbing stairs or when
the knee bears weight as it straightens. The disorder is common
in runners and is also seen in skiers, cyclists, and
soccer players.
Diagnosis
Your description of symptoms and an x ray usually help the
doctor make a diagnosis. Although arthroscopy can confirm
the diagnosis, it’s not performed unless conservative treatment
has failed.
Treatment
Many doctors recommend that people with chondromalacia
perform low-impact exercises that strengthen muscles, particularly
muscles of the the inner part of the quadriceps,
without injuring joints. Swimming, riding a stationary bicycle,
and using a cross-country ski machine are examples of
good exercises for this condition. Electrical stimulation may
also be used to strengthen the muscles.
Increasingly, doctors are using osteochondral grafting, in
which a plug of bone and healthy cartilage is harvested from
one area and transplanted to the injury site. Another relatively
new technique is known as autologous chondrocyte implantation,
or ACI. It involves harvesting healthy cartilage cells,
cultivating them in a lab and implanting them over the lesion.
If these treatments don’t improve the condition, the doctor
may perform arthroscopic surgery to smooth the surface of
the cartilage and “wash out” the cartilage fragments that
cause the joint to catch during bending and straightening.
In more severe cases, surgery may be necessary to correct the
angle of the knee cap and relieve friction between it and the
cartilage, or to reposition parts that are out of alignment.

Traetments

2007-09-09T01:59:00.001-05:00

DMARDs are a family of medicines that may be able to
slow or stop the immune system from attacking the joints.
This in turn prevents pain and swelling. DMARDs typically
require regular blood tests to monitor side effects. In addition
to relieving signs and symptoms, DMARDs may help to
retard or even stop joint damage from progressing. However,
DMARDs cannot fix joint damage that has already occurred.
Some of the most commonly prescribed DMARDs are
methotrexate, hydroxychloroquine, sulfasalazine, and
leflunomide.
Biologic response modifiers, or biologics, are a new family of
genetically engineered drugs that block specific molecular
pathways of the immune system that are involved in the
inflammatory process. They are often prescribed in combination
with DMARDs such as methotrexate. Because biologics
work by suppressing the immune system, they could be problematic
for patients who are prone to frequent infection.
They are typically administered by injection at home, or by
an intravenous infusion at a clinic. Some commonly prescribed
biologics include etanercept, adalimumab, infliximab,
and anakinra.
People with any type of arthritis may benefit from exercises
to strengthen the muscles that support the knee and weight
loss, if needed, to relieve excess stress on the joints.
If arthritis causes serious damage to a knee or there is incapacitating
pain or loss of use of the knee from arthritis, joint
surgery may be considered. Traditionally, this has been done
with what is known as a total knee replacement. However,
newer surgical procedures are continuously being developed
that include resurfacing or replacing only the damaged cartilage
surfaces while leaving the rest of the joint intact.

Treatment

2007-09-09T01:58:00.001-05:00

Treatment
Like the symptoms, treatment varies depending on the form
of arthritis affecting the knee. For osteoarthritis, treatment
is targeted at relieving symptoms and may include painreducing
medicines such as aspirin or acetaminophen
(Tylenol2); nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen (Motrin, Nuprin, Advil); or in some cases
injections of corticosteroid medications directly into the
knee joint. Other treatments for the pain of knee osteoarthritis
include injections of hyaluronic acid substitutes and the
nutritional supplements glucosamine and chondroitin sulphate.
For more information about the use of these two supplements,
see the section titled “What Research Is Being
Conducted on Knee Problems?”
People with diseases such as rheumatoid arthritis, ankylosing
spondylitis, or psoriatic arthritis often require disease-modifying
antirheumatic drugs (DMARDs) or biologic response
modifiers (biologics) to control the underlying disease that is
the source of their knee problems. These drugs are typically
prescribed after less potent treatments such as NSAIDs or
intra-articular injections are deemed ineffective.

Arthritis

2007-09-09T01:57:00.002-05:00

Arthritis
There are some 100 different forms of arthritis, rheumatic
diseases, and related conditions. Virtually all of them have
the potential to affect the knees in some way; however, the
following are the most common:
• osteoarthritis. Most people with knee problems have
a form of arthritis called osteoarthritis. In this disease,
the cartilage gradually wears away and changes occur
in the adjacent bone. Osteoarthritis may be caused by
joint injury or being overweight. It is associated with
aging and most typically begins in people age 50 years
or older. A young person who develops osteoarthritis
typically has had an injury to the knee or may have
an inherited form of the disease.
• rheumatoid arthritis. Rheumatoid arthritis, which
generally affects people at a younger age than
osteoarthritis, is an autoimmune disease. This means
it occurs as a result of the immune system attacking
components of the body. In rheumatoid arthritis, the
primary site of the immune system’s attack is the synovium,
the membrane that lines the joint. This attack
causes inflammation of the joint. It can lead to
destruction of the cartilage and bone and, in some
cases, muscles, tendons, and ligaments as well.
• other rheumatic diseases. These include:
– gout – an acute and intensely painful form of
arthritis that occurs when crystals of the bodily
waste product uric acid are deposited in the joints
– lupus – an autoimmune disease characterized by
destructive inflammation of the skin, internal
organs, and other body systems as well as the joints
– ankylosing spondylitis – an inflammatory form of
arthritis that primarily affects the spine, leading to
stiffening and in some cases fusing into a stooped
position
– psoriatic arthritis – a condition in which inflamed
joints produce symptoms of arthritis for patients
who have or will develop psoriasis
– infectious arthritis – a term describing forms of
arthritis that are caused by infectious agents, such
as bacteria or viruses. Prompt medical attention is
essential to treat the infection and minimize damage
to joints, particularly if fever is present.
Symptoms
The symptoms of arthritis are different for the different
forms. For example, people with rheumatoid arthritis, gout,
or other inflammatory conditions may find the knee swollen,
red, and even hot to the touch. Any form of arthritis can
cause the knee to be painful and stiff.
Diagnosis
The doctor may confirm the diagnosis by conducting a careful
history and physical examination. Blood tests may be
helpful for diagnosing rheumatoid arthritis, but other tests
may be needed too. Analyzing fluid from the knee joint, for
example, may be helpful in diagnosing gout. X rays may be
taken to determine loss or damage to cartilage or bone.

What Are Some Common Knee Injuries and Problems?

2007-09-09T01:57:00.001-05:00

What Are Some Common Knee Injuries and Problems?
There are many diseases and types of injuries that can affect
the knee. These are some of the most common, along with
their diagnoses and treatment.

How Are Knee Problems Diagnosed?

2007-09-09T01:56:00.000-05:00

How Are Knee Problems Diagnosed?

Doctors diagnose knee problems based on the findings of
the medical history, physical exam, and diagnostic tests.
Medical history
During the medical history, the doctor asks how long symptoms
have been present and what problems you are having
using your knee. In addition, the doctor will ask about any
injury, condition, or health problem that might be causing
the problem.
Physical examination
The doctor bends, straightens, rotates (turns), or presses
on the knee to feel for injury, and determine how well the
knee moves and where the pain is located. The doctor
may ask you to stand, walk, or squat to help assess the
knee’s function.
Diagnostic tests
Depending on the findings of the medical history and physical
exam, the doctor may use one or more tests to determine
the nature of a knee problem. Some of the more commonly
used tests include:
• X ray (radiography) – a procedure in which an x ray
beam is passed through the knee to produce a twodimensional
picture of the bones.
• Computerized axial tomography (CAT) scan – a
painless procedure in which x rays are passed through
the knee at different angles, detected by a scanner,
and analyzed by a computer. CAT scan images show
soft tissues such as ligaments or muscles more clearly
than conventional x rays. The computer can combine
individual images to give a three-dimensional view
of the knee.
• Bone scan (radionuclide scanning) – a technique
for creating images of bones on a computer screen or
on film. Prior to the procedure, a harmless radioactive
material is injected into your bloodstream. The material
collects in the bones, particularly in abnormal
areas of the bones, and is detected by a scanner.
• Magnetic resonance imaging (MRI) – a procedure
that uses a powerful magnet linked to a computer to
create pictures of areas inside the knee. During the
procedure, your leg is placed in a cylindrical chamber
where energy from a powerful magnet (rather than
x rays) is passed through the knee. An MRI is particularly
useful for detecting soft tissue damage.
• Arthroscopy – a surgical technique in which the doctor
manipulates a small, lighted optic tube (arthroscope)
that has been inserted into the joint through a
small incision in the knee. Images of the inside of the
knee joint are projected onto a television screen.
• Joint aspiration – a procedure that uses a syringe to
remove fluid buildup in a joint, and can reduce
swelling and relieve pressure. A laboratory analysis
of the fluid can determine the presence of a fracture,
an infection, or an inflammatory response.
• Biopsy – the examination of a piece of tissue under
the microscope.

What Are the Parts of the Knee?

2007-09-09T01:55:00.001-05:00

What Are the Parts of the Knee?
Like any joint, the knee is composed of bones and cartilage,
ligaments, tendons, and muscles.
Bones and cartilage
The knee joint is the junction of three bones: the femur
(thigh bone or upper leg bone), the tibia (shin bone or
larger bone of the lower leg), and the patella (knee cap).
The patella is 2 to 3 inches wide and 3 to 4 inches long.
It sits over the other bones at the front of the knee joint
and slides when the knee moves. It protects the knee and
gives leverage to muscles.
The ends of the three bones in the knee joint are covered
with articular cartilage, a tough, elastic material that helps
absorb shock and allows the knee joint to move smoothly.
Separating the bones of the knee are pads of connective
tissue called menisci (men-NISS-sky). The menisci are
two crescent-shaped discs (each called a meniscus
(men-NISS-kus) positioned between the tibia and femur
on the outer and inner sides of each knee. The two menisci
in each knee act as shock absorbers, cushioning the lower
part of the leg from the weight of the rest of the body as
well as enhancing stability.
Muscles
There are two groups of muscles at the knee. The four
quadriceps muscles on the front of the thigh work to
straighten the knee from a bent position. The hamstring
muscles, which run along the back of the thigh from the
hip to just below the knee, help to bend the knee.

Tendons and ligaments
The quadriceps tendon connects the quadriceps muscle to
the patella and provides the power to straighten the knee.
The following four ligaments connect the femur and tibia
and give the joint strength and stability:
• The medial collateral ligament (MCL), which runs
along the inside of the knee joint, provides stability
to the inner (medial) part of the knee.
• The lateral collateral ligament (LCL), which runs
along the outside of the knee joint, provides stability
to the outer (lateral) part of the knee.
• The anterior cruciate ligament (ACL), in the center
of the knee, limits rotation and the forward movement
of the tibia.
• The posterior cruciate ligament (PCL), also in the
center of the knee, limits backward movement of
the tibia.
The knee capsule is a protective, fiber-like structure that
wraps around the knee joint. Inside the capsule, the joint is
lined with a thin, soft tissue called synovium.

What Causes Knee Problems?

2007-09-09T01:53:00.002-05:00

What Causes Knee Problems?
Knee problems can be the result of disease or injury.
Disease
A number of diseases can affect the knee. The most common
is arthritis. Although arthritis technically means “joint
inflammation,” the term is used loosely to describe many different
diseases that can affect the joints. We’ll describe some
of the most common forms of arthritis and their effects on
the knees a bit later in the booklet.
Injury
Knee injuries can occur as the result of a direct blow or sudden
movements that strain the knee beyond its normal range
of motion. Sometimes knees are injured slowly over time.

Problems with the hips or feet, for example, can cause you to
walk awkwardly, which throws off the alignment of the knees
and leads to damage. Knee problems can also be the result of
a lifetime of normal wear and tear. Much like the treads on a
tire, the joint simply wears out over time. We’ll discuss some
of the most common knee injuries later in this booklet, but
first we’ll take a look at the structure of the knee joint.

Joint Basics

2007-09-09T01:53:00.001-05:00

Joint Basics
The point at which two or more bones are connected is
called a joint. In all joints, the bones are kept from grinding
against each other by lining called cartilage. Bones are
joined to bones by strong, elastic bands of tissue called ligaments.
Muscles are connected to bones by tough cords of
tissue called tendons. Muscles pull on tendons to move
joints. While muscles are not technically part of a joint,
they’re important because strong muscles help support
and protect joints.

What Do the Knees Do? How Do They Work?

2007-09-09T01:52:00.000-05:00

What Do the Knees Do? How Do They Work?
The knee is the joint where the bones of the upper leg meet
the bones of the lower leg, allowing hinge-like movement
while providing stability and strength to support the weight
of the body. Flexibility, strength, and stability are needed for
standing and for motions like walking, running, crouching,
jumping, and turning.
Several kinds of supporting and moving parts, including
bones, cartilage, muscles, ligaments, and tendons, help the
knees do their job. (See Joint Basics, below.) Each of these
structures is subject to disease and injury. When a knee problem
affects your ability to do things, it can have a big impact
on your life. Knee problems can interfere with many things,
from participation in sports to simply getting up from a chair
and walking.

9 Delicious Ways to Fight Arthritis- Way 9

2007-09-02T11:45:00.000-05:00

Green tea.

This mild, slightly astringent tea contains hundreds of powerful antioxidant chemicals called polyphenols and has been cited for helping prevent problems ranging from cancer to heart disease. But studies also suggest green tea may help prevent or ease symptoms of rheumatoid arthritis. In one study of induced arthritis in mice, green tea cut the disease onset rate almost in half, and follow-up studies by the same researchers, at Case Western Reserve University, in Ohio, show promise in humans.

Boil water briskly. Tea tastes best when water is at the boiling point, which allows tea to release its flavorful compounds quickly. Water that's cooler than that tends to release flavors more slowly, weakening the tea.

Keep steeping short. Let tea steep in hot water for about three minutes -- and no longer than five. This brief steeping time allows tea to acquire a full-bodied flavor and release its nutrients, but withholds compounds that make tea taste bitter.

Get a bag bonus. Tea purists favor the fresher flavor of loose tea, but some experts suggest that tea bags release more beneficial nutrients because smaller, ground-up particles expose more of the tea leaves' surface area to hot water.

9 Delicious Ways to Fight Arthritis- Way 8

2007-09-01T11:45:00.000-05:00

Lentils.

These dried legumes, with their rainbow of earthy colors, are prime sources of folate, with a single cup providing about 90 percent of your daily needs. But lentils also provide one of the richest plant-based sources of protein, contain large amounts of soluble dietary fiber, and hold significant stores of vitamin B6. These and other nutrients make lentils protect the body against heart disease and cancer in addition to arthritis.

Try a few soups. Not many people know a lot of lentil recipes. The most common usage -- soup -- is probably the best place to start for those new to the food. You might be surprised at how easy and tasty lentil soups can be. Add cooked lentils to water or broth, chop in carrots, celery, onions, and a lean meat, add some simple herbs and seasonings, and you are well on your way to a great meal.

Buy in bags. Though sometimes sold in bulk from bins, it's best to buy lentils in plastic bags, preferably with most beans shielded from light. Reason: Exposure to light and air degrades nutrients (especially vitamin B6) and open bins invite contamination by insects.

Pick the best beans. Even bagged products aren't pristine: Sort through lentils before you use them by spreading them on a baking sheet and picking out those that are shriveled or off-color, along with any small stones that may have gotten mixed in. After that, there's no need to soak, but you should swish beans in a water-filled bowl, discard any floaters, and rinse under cold water in a strainer before cooking.

Minimize gas. Thoroughly drain lentils before eating or adding to other dishes: Beans are famous for causing gas due to sugars they contain that the body can't digest, but these sugars are soluble in water and leach out when lentils are cooked.

9 Delicious Ways to Fight Arthritis- Way 7

2007-08-31T11:45:00.000-05:00

Cheese.

Hard or soft, fresh or ripened, cheese in all its variety is an excellent source of calcium for bones, and protein for muscles and other joint-supporting tissues. Depending on type, cheeses (especially hard varieties such as cheddar and Colby) are also a good source of vitamin B6 and folate. The sheer abundance of cheeses makes it easy to get more in your diet -- by, for example, slicing hard cheeses onto crackers or grating them into casseroles, or spreading soft cheeses such as cottage cheese or Brie onto fruits or vegetables.

Grease your grater. When you have arthritis, grating cheese is hard enough without the grater becoming clogged. To make the job easier, give the grater a light coating of oil, which keeps the cheese from sticking and makes it easier to rinse the grater clean.

Lengthen shelf life. Hard cheeses that are well wrapped and unsliced can last up to six weeks in the refrigerator. (Chilled soft cheeses are best used within a week.) To make cheese last even longer, throw it in the freezer, but expect thawed soft cheese to separate slightly and hard cheese to be crumbly -- ideal for melting into casseroles and sauces but not as good for nibbling.

Let it warm. Cheese tastes best when served at room temperature, so if you've been storing it in the refrigerator, take cheese out and let stand at least one hour before serving to enjoy its full flavor.

Have a daily cheese platter. Healthy eaters know that every dinner table should have a plate of fresh raw vegetables in addition to all the prepared foods. Consider adding a large hunk of cheese to the platter each night, along with a knife. Sitting there in front of you, it's hard to resist slicing a piece off a few times to round out the meal.

9 Delicious Ways to Fight Arthritis- Way 6

2007-08-30T11:45:00.000-05:00

Sweet potatoes.

These tropical root vegetables (which, technically, not related to white baking potatoes) are such a nutritional powerhouse, they once topped a list of vegetables ranked according to nutritional value by the Center for Science in the Public Interest. Sweet potatoes are a rich source of vitamin C, folate, vitamin B6, and dietary fiber, among other nutrients.

Buy fresh. Though you'll benefit from eating sweet potatoes in any form, fresh potatoes are better than canned products, which are packed in a heavy syrup that leaches the vegetable's most valuable nutrients, including vitamins B and C.

Keep cool, not cold. Store sweet potatoes someplace dark, dry, and cool -- preferably between 55 and 60 degrees -- but not in the refrigerator: Cold temperatures damage cells, causing the potato to harden and lose some of its nutritional value.

Maximize nutrients. Eat cooked potatoes with their skin -- an especially rich source of nutrients and fiber. Handle gently to avoid bruising, then bake or boil, and serve with a touch of fat from butter, oil, or another dish and some salt and pepper.

9 Delicious Ways to Fight Arthritis- Way 5

2007-08-29T11:45:00.000-05:00

Soy products.

Once relegated to the shelves of health-food stores, soy products such as tofu and tempeh have reached the mainstream largely because they've been shown to have cardiovascular benefits. But soybeans also protect bones, thanks to compounds called isoflavones and significant amounts of both vitamin E and calcium. Long a staple of Asian diets, soy can also be found in soy milk -- a boon for people who want to avoid lactose or cholesterol in regular milk.

Make the most of milk. Use soy milk (now sold in many supermarkets next to cow's milk) for puddings, baked goods, cereal, shakes -- just about anywhere you'd use regular milk. But don't mix it with coffee or other acidic foods, which tend to make soy milk curdle.

Try them whole. Trust us: Whole soy beans, sprinkled with a little salt and pepper, are delicious. They look like large sweet peas but have an even gentler, milder flavor -- nothing at all like the better known but more intimidating products like tofu. Check the freezer aisle for edamame (pronounced "ed-ah-MAH-may") -- they come both in their pods, or shelled. They cook up fast -- about five minutes in boiling water and two minutes in the microwave -- and can be eaten hot or cold as snacks or appetizers, or tossed into salads, stir-fries, casseroles, or soups.

Give tofu a few more chances. Many people don't know what to make of tofu. It's an odd color for a vegetable-derived food (white), an odd texture (smooth and moist), and comes in an odd form (usually, a block). Get past all that. Tofu is easy to work with, extraordinarily healthy, and takes on the flavors around it. Easy ideas: Drop half-inch cubes into most any soup; stir into tomato sauces, breaking it up into small pieces; or just cut into cubes, cover with chopped scallions and soy sauce, and eat at room temperature as is.

9 Delicious Ways to Fight Arthritis- Way 4

2007-08-28T11:45:00.000-05:00

Shrimp.

Taste and convenience make shrimp the most popular shellfish around. But shrimp also deserves acclaim as one of the few major dietary sources of vitamin D, with three ounces providing 30 percent of the recommended daily amount -- more than a cup of fortified milk. Shrimp also contains omega-3 fatty acids and vitamin C, along with other nutrients essential for general health, including iron and vitamin B12.

Select by senses. When buying fresh raw shrimp, look for flesh that's moist, firm, and translucent, without spots or patches of blackness. Then put your nose to work: Shrimp should smell fresh and not give off an ammonia-like smell, which is a sign of deterioration. If you're buying shrimp frozen, squeeze the package and listen: The crunch of ice crystals means the shrimp was probably partially thawed, then refrozen -- a sign you should find another (less crunchy) package.

Eat or freeze. When you get shrimp home, rinse under cold water and store in the refrigerator for up to two days. If you plan to store beyond that, stick to frozen shrimp, which will keep in the freezer for up to six months.

Cook quickly. Overcooking makes shrimp tough, so it's best to cook it fast, boiling in water until shells turn pink and flesh becomes opaque, stirring occasionally. Rinse under cold water and serve alone, as part of a seafood chowder, or chilled. Shrimp can also be broiled, grilled, or stir-fried.

9 Delicious Ways to Fight Arthritis- Way 3

2007-08-27T11:45:00.000-05:00

Sweet peppers.

A single green pepper contains 176 percent of your daily needs for vitamin C -- and colorful red and yellow varieties have more than double that amount. That makes them richer in C than citrus fruits, but sweet peppers are also excellent sources of vitamin B6 and folate.

Lock in nutrients. Store peppers in the refrigerator: The tough, waxy outer shell of bell peppers naturally protects nutrients from degrading due to exposure to oxygen, but you'll boost the holding power of chemicals in the skin by keeping them cold.

Separate seeds. Whether cutting into crudités, tossing into salads, or stuffing whole, you'll want to remove tough and bitter-tasting seeds. They're easily cut when slicing, but when retaining an entire bell for stuffing, cut a circle around the stem at the top of the pepper, lift out the attached membranes, and scoop remaining seeds and membranes with a thick-handled spoon.

Jam them in the juicer. You might not think of peppers as juicer giants, but they can add zest to drinks made from other fruits and vegetables, such as carrots.

Cook as a side dish. Tired of the same old vegetables at dinner? Slice a pepper or two and do a fast sauté in olive oil, adding a pinch of salt, pepper, and your favorite herb. The heat releases the sweetness, making sautéed peppers a wonderful counterpart to meats and starches.

9 Delicious Ways to Fight Arthritis- Way 2

2007-08-26T11:45:00.000-05:00

Bananas.

Bananas are perhaps best known for packing potassium, but they're also good sources of arthritis-fighting vitamin B6, folate, and vitamin C. What's more, this easily digested, dense fruit is a prime source of soluble fiber, an important part of your diet if you're trying to lose weight because it helps you feel full without adding calories.

Control ripeness. Bananas are sweetest and easiest to digest when brightly yellowed to full ripeness. To hasten or prolong the period of perfection, put green bananas in a brown paper bag, which encourages natural gases from the bananas to speed the ripening process. Rapidly ripening fruits should be put in the refrigerator, which turns the peel brown, but preserves the fruit inside.

Preserve pieces. Bananas are wonderful additions to salads or desserts, but tend to turn brown faster than other ingredients. Try tossing bananas with a mixture of lemon juice and water -- the acid will help preserve them.

Turn into drinks. Bananas, particularly ripe ones, make great blender drinks. Combine a banana, a peach or some berries, a few ounces of milk, a few ounces of fruit juice, and an ice cube, and blend for a delicious, healthy drink that is jam-packed with arthritis-friendly nutrients.

9 Delicious Ways to Fight Arthritis- Way 1

2007-08-25T11:43:00.000-05:00

Super Sources
It's easy to make nutrients part of a sensible daily diet once you learn there's such a variety of them within virtually every food group. As with any nutrient, certain foods will always be richer sources than others. Below are super sources of the nutrients that battle arthritis best.

1. Salmon. Salmon is among the richest sources of healthy fats, making it an ideal source of omega-3 fatty acids, especially because it's less likely than other cold-water fish to harbor high levels of toxic mercury. In addition to its fatty oils, salmon contains calcium, vitamin D, and folate. Besides helping with arthritis, eating salmon may protect the cardiovascular system by preventing blood clots, repairing artery damage, raising levels of good cholesterol, and lowering blood pressure.

Focus on freshness. To avoid bacterial contamination, look for glossy fish that are wrapped to prevent contact with other fish. If you're buying fish whole, eyes should be clear and bright, not opaque or sunken, and flesh should not be slimy or slippery. Cuts like steaks and fillets should be dense and moist. In all cases, flesh should be firm and spring back if you press it.

Use quickly. Fresh fish spoils fast, so if you can't eat salmon within a day after purchase, double its shelf life by cooking it right away and storing it in the refrigerator. (It is delicious served cold with cucumbers and dill.)

Tame total fat. While you want the beneficial omega-3s in fish oil, the fat in fish is also loaded with calories. To keep from adding still more calories during preparation, cook salmon using low-fat methods such as baking, poaching, broiling, or steaming, and season with spices such as dill, parsley, cilantro, tarragon, or thyme.

Cook by color. Following the rule of thumb for cooking fish -- to wait until flesh is opaque white or light gray -- is a tougher call with pink-hued salmon. To ensure doneness, cook salmon until it's opaque in its thickest part, with juices clear and watery, and flesh flaking easily with the gentle turn of a fork.

Hip Adduction

2007-07-31T13:40:00.000-05:00

Hip Adduction

Lie on left side with top leg on chair. Slowly raise the bottom leg up to the chair seat. Hold leg up for six seconds. Do six repeats and then switch sides.

Quadricep Set --Knee Extension

2007-07-30T13:37:00.000-05:00

Quadricep Set --Knee Extension

Lie on your back and slowly press left knee into the mat. Then tighten the muscles on front of your thigh. Try not to hold your breath. Hold the muscles tight for six seconds. Repeat six times and then tighten right leg muscle.

Hip Abduction

2007-07-29T13:39:00.000-05:00

Hip Abduction

Lie on left side with bottom knee bent, Raise top leg. Keep knee straight and toes pointed forward. Do not let top hip roll backward. Hold this position for six seconds. Do six repeats and then switch sides. Progress slowly to just under 1 Kg at the ankle.(Check weights with physiotherapist.)

Straight Leg Raise -- With Internal and External Rotation

2007-07-28T13:36:00.000-05:00

Straight Leg Raise -- With Internal and External Rotation

Lie on back, with right knee bent and foot flat. Move left foot to 10 o'clock position. Lift left leg in air about thirty centimetres (twelve inches). Keep your left knee straight. Hold this position for six seconds. Then move left foot to 2 o'clock position. Lift the leg up 30 centimetres and hold. Repeat this exercise six times and then switch legs. Slowly add weights to ankle.(Check weights with physiotherapist.)

Straight Leg Raise --Knee Extension Raise

2007-07-27T13:35:00.000-05:00

Straight Leg Raise --Knee Extension Raise

Lie on back, with right knee bent and right foot flat on ground. Gradually lift the left leg up about thirty centimetres (twelve inches) in the air. Keep the knee straight and the toes pointed up. Hold this elevated position for six seconds. Slowly return leg to ground and start again. Repeat six times, and then start again by lifting the right leg. Slowly add weights to ankles to increase resistance.

Fitness for Life

2007-07-26T11:22:00.000-05:00

Fitness for Life

Follow this expert advice to get back on the exercise wagon—and make workouts a routine part of your life.

Eighty-eight percent of Health subscribers want to make exercise part of their daily lives, according to our recent Women in Motion study. So why do half of the people who begin exercise programs drop out before the 6-month mark? One reason is lack of motivation. If exercise is on the bottom of your to-do list, follow these five easy tips to make exercise a daily habit.
Treat your workouts like a standing appointment.Things happen, and workouts are usually the first thing cut if your time is short. If you write down your workouts in your daily planner, you’re more likely to view exercise as a non-negotiable.

Customize your workouts based on your mood.If you’re tired, instead of lifting weights, try shooting some hoops. Stressed? Try yoga or Pilates. By fitting the workout with your mood, you’ll increase your workout variety. And variety is vital to staying motivated. “You also need a backup plan if the gym is too crowded,” says Dr. John Raglin, professor of kinesiology at Indiana University. “You don’t want to increase an already frustrating day if someone is on your favorite machine.” Take time to plan out several workout routines so you always have a plan B.
Make your exercise goals realistic.“It takes the average adult 15 years to gain 10 to 15 pounds,” Raglin says. “You can’t expect to lose it all in 2 months.” Guilt and weight loss are not effective long-term motivators. Change your perspective to include exercising for good health, not simply for weight loss. Set smaller goals, such as running a 5K or joining a tennis league. Once you accomplish several smaller goals, you’ll be more likely to stay motivated to train for that marathon you’ve always wanted to run.

Find an exercise buddy.Exercise can be a challenge—one you don’t want to conquer alone. Friends can hold you accountable and give you increased obligation not to skip your workouts. “Exercising with other people gives you a connection, “ says Cotton, who is also a spokesman for the American Council on Exercise.

Reward yourself.You’ll do anything for a double scoop of butter pecan ice cream, right? So if you exercise four times in a given week, treat yourself. If a massage is more up your alley, schedule an appointment. Figure out which rewards will motivate you. Once you accomplish your exercise goals, be sure to take the time to reward yourself for a job well done.

If you’ve experienced exercise burnout, it may seem hard to get back in the saddle. Sit down and analyze what caused your exercise program to fail. Were you bored? Did you quit when you didn’t reach your weight-loss goal? Do you have too many work and home commitments at odds, causing you stress? Were your workouts too hard, making you dread exercise? Once you’ve pinpointed what caused you to fail, make a new exercise plan with realistic goals. “You will gain new insight every time you fail,” Raglin says. “Fail and try again. You have plenty of chances.”

ACL Reconstruction

2007-07-22T04:21:00.000-05:00

When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shinbone. An anterior cruciate ligament (ACL) unravels like a braided rope when it's torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear.

ACL TEAR
Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. Young people (age 15-25) who participate in basketball and other sports that require pivoting are especially vulnerable. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell.

First treatment includes rest, ice compression and elevation (RICE) plus a brace to immobilize the knee, crutches and pain relievers. Get to your doctor right away to evaluate your condition.

EVALUATION
Your doctor may conduct physical tests and take X-rays to determine the extent of damage to your ACL. Most of the time, you need reconstruction surgery. Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shinbone.
In a few cases when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated nonsurgically with a program of muscle strengthening.

OUTCOME
Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. After ACL reconstruction, you'll need to do rehabilitation exercises to gradually return your knee to full flexibility and stability. Building strength in your thigh and calf muscles helps support the reconstructed structure. You may need to use a knee brace for awhile and will probably have to stay out of sports for about one year after the surgery.

ACL Injury: Potential Operative Complications

2007-07-21T04:31:00.000-05:00

The incidence of infection after arthroscopic ACL reconstruction has a reported range of 0.2 percent to 0.48 percent. There have also been several reported deaths linked to bacterial infection from allograft tissue due to improper procurement and sterilization techniques.

Allografts specifically are associated with risk of viral transmission, including HIV and Hepatitis C, despite careful screening and processing. The chance of obtaining a bone allograft from an HIV-infected donor is calculated to be less than 1 in a million.

Rare risks include bleeding from acute injury to the popliteal artery (overall incidence is 0.01 percent) and weakness or paralysis of the leg or foot. It is not uncommon to have numbness of the outer part of the upper leg next to the incision, which may be temporary or permanent.

A blood clot in the veins of the calf or thigh is a potentially life-threatening complication. A blood clot may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke. This risk of deep vein thrombosis is reported to be approximately 0.12 percent.

Recurrent instability due to rupture or stretching of the reconstructed ligament or poor surgical technique (reported to be as low as 2.5 percent and as high as 10 percent) is possible. Knee stiffness or loss of motion has been reported at between 5 percent and 25 percent. Rupture of the patellar tendon (patellar tendon autograft) or patella fracture (patellar tendon or quadriceps tendon autografts) may occur due to weakening at the site of graft harvest.

In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The ACL surgery can be delayed until the child is closer to reaching skeletal maturity. Alternatively, the surgeon may be able to modify the technique of ACL reconstruction to decrease the risk of growth plate injury.

Postoperative anterior knee pain is especially common after patellar tendon autograft ACL reconstruction. The incidence of pain behind the kneecap varies between 4 percent and 56 percent in studies, whereas the incidence of kneeling pain may be as high as 42 percent after patellar tendon autograft ACL reconstruction.

ACL Injury: Operative Procedure

2007-07-20T04:26:00.000-05:00

Before any surgical treatment, the patient is usually sent to physical therapy. Patients who have a stiff, swollen knee lacking full range of motion at the time of ACL surgery may have significant problems regaining their motion after surgery It usually takes three or more weeks from the time of injury to achieve full range of motion. It is also recommended that some ligament injuries be braced and allowed to heal prior to ACL surgery.

The patient, the surgeon and the anesthesiologist select the anesthesia used for surgery. Patients may benefit from an anesthetic block of the nerves of the leg to decrease postoperative pain. The surgery usually begins with an examination of the patient's knee while the patient is relaxed due the effects of anesthesia. This final examination is used to verify that the ACL is torn and also to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed postoperatively. If the physical exam strongly suggests the ACL is torn, the selected tendon is harvested (for an autograft) or thawed (for an allograft) and the graft is prepared to the correct size for the patient.

After the graft has been prepared, the surgeon places an arthroscope into the joint. Small (one-centimeter) incisions called portals are made in the front of the knee to insert the arthroscope and instruments and the surgeon examines the condition of the knee.

Meniscus and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed. In the most common ACL reconstruction technique, bone tunnels are drilled into the tibia and the femur to place the ACL graft in almost the same position as the torn ACL. A long needle is then passed through the tunnel of the tibia, up through the femoral tunnel, and then out through the skin of the thigh. The sutures of the graft are placed through the eye of the needle and the graft is pulled into position up through the tibial tunnel and then up into the femoral tunnel. The graft is held under tension as it is fixed in place using interference screws, spiked washers, posts or staples. The devices used to hold the graft in place are generally not removed. Variations on this surgical technique include the "two-incision" and "over-the-top" types of ACL reconstructions, which may be used because of the preference of the surgeon or special circumstances (revision ACL reconstruction, open growth plates).

Before the surgery is complete, the surgeon will probe the graft to make sure it has good tension , verify that the knee has full range of motion and perform tests such as the Lachman's test to assess graft stability. The skin is closed and dressings (and perhaps a postoperative brace and cold therapy device, depending on surgeon preference) are applied. The patient will usually go home on the same day of the surgery.

TREATMENT OPTIONS FOR OSTEOARTHRITIS OF THE KNEE

2007-07-19T02:04:00.000-05:00

TREATMENT OPTIONS FOR OSTEOARTHRITIS OF THE KNEE

In order to better understand the treatment options for osteoarthritis of the knee, it is important to understand basic knee anatomy and the function of articular cartilage. Please review the sections on knee anatomy as well as the introduction to osteoarthritis of the knee before reading this section.

Osteoarthritis is a chronic disorder that gradually progresses over time. In the knee, the symptoms of osteoarthritis may include pain, stiffness, swelling, "locking," and "catching". These symptoms may progress to an eventual limitation of activities whether it is an inability to run or an inability to walk up and down stairs. There is no cure for osteoarthritis of the knee. The therapies currently available are used only to treat the symptoms.

The 3 main goals of treatment for osteoarthritis of the knee are:
1. To decrease pain2. To maintain or improve range of motion of the knee (ability to bend and straighten the knee)3. To maintain or improve function (ability to climb stairs, run, jump, play sports, etc.)

There are many treatment options available and often, many different types of therapy must be used together to improve symptoms. The severity of an individual's symptoms

The treatment options available to individuals with osteoarthritis of the knee can be divided into the following categories;

Education and Biomechanical Treatment Options
• Educational Resources
• Lifestyle Modifications
• Physical Therapy
• Supportive Devices (Canes, Braces, Orthotics)

Medications and Nutritional Supplements
• Nutritional Supplements and Nutritional Supplement Fact Sheet
• Oral Medications (Pills)
• Topical Medications (Ointments and Creams)
• Knee Injections

Surgical Treatment Options

• Introduction to Surgical Treatment Options for Osteoarthritis of the Knee
• Arthroscopic Knee Surgery and Abrasion Arthroplasty• Osteotomy
• Total Knee Replacement Surgery
• Partial Knee Replacement Surgery
• Articular Cartilage Transplantation and Cellular Implant Surgery

OSGOOD - SCHLATTER'S KNEE PAIN

2007-07-19T01:58:00.000-05:00

This section covers Osgood-Schlatter's Knee Pain that occurs as a result of overuse ("too much activity, too soon"). In order to better understand Osgood-Schlatter's Knee Pain it is important to understand the anatomy and function of the knee and the patellar tendon.

The patellar tendon is a thick rope-like structure that connects the bottom of the kneecap (patella) to the top of the large shin bone (tibia). The powerful muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella. OSKP is caused by inflammation (irritation) where the patellar tendon attaches to the tibia.

Osgood-Schlatter's Knee Pain (OSKP), also known as Osgood-Schlatter's disease, is common in rapidly growing, active young teenagers and pre-teenagers. Pain from OSKP is usually felt 2-3 finger widths below the bottom of the patella. There may be swelling in the area and it can be sensitive to touch. The pain can be mild or in some cases the pain can be so bad that it prevents athletes from playing their sport.

OSKP is usually occurs as a result of overdoing an activity and placing too much stress on growing bones. Activities that include a lot of running, jumping or stopping and starting can make OSKP worse. OSKP can be prevented by easing into these types of activities and by using good training techniques. Off-season strength training of the legs, particularly the quadriceps muscles, can also help.

Examination techniques that detect tenderness and swelling at the attachment site of the patellar tendon to the tibia are helpful in determining if someone has OSKP. X-rays are occasionally done to make sure that the patellar tendon does not have any calcium in it. Other tests such as diagnostic ultrasound or Magnetic Resonance Imaging (MRI) are rarely required to rule out more extensive damage to the patellar tendon.

The treatment of OSKP may include relative rest, icing, medications to reduce inflammation and pain, stretching and strengthening exercises. Rarely is complete rest or the use of a knee brace or cast necessary. Sometimes OSKP will even go away on it's own. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

QUADRICEPS TENDINITIS

2007-07-19T01:49:00.000-05:00

In order to better understand quadriceps tendinitis it is important to understand the anatomy and function of the knee and the quadriceps tendon.

The kneecap (patella) is a small bone in the front of the knee. It glides up and down a groove in the thigh bone (femur) as the knee bends and straightens. Tendons connect muscles to bone. The strong quadriceps muscles on the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon covers the patella and continues down to form the "rope-like" patellar tendon. The patellar tendon in turn, attaches to the shin bone (tibia). The quadriceps muscles, straighten the knee by pulling at the patella via the quadriceps tendon. Quadriceps tendinitis is the term used to describe inflammation of the quadriceps tendon.

Quadriceps tendinitis usually occurs as a result of overdoing an activity and placing too much stress on the quadriceps tendon before it is strong enough to handle the stress. This overuse results in 'micro tears' in the quadriceps tendon which leads to inflammation and pain. Over time damage to the quadriceps tendon can occur. In extreme cases, the quadriceps tendon may become damaged to the point of complete rupture.

Quadriceps tendinitis is common in people involved in activities that include a lot of running, jumping, stopping and starting. Pain from quadriceps tendinitis is felt in the area just above the patella. There may be swelling in and around the quadriceps tendon and it may be sensitive to touch. The pain can be mild or in some cases the pain can be so bad that it prevents athletes from playing their sport.

Examination techniques that detect tenderness and swelling in or around the quadriceps tendon are helpful in determining if someone has quadriceps tendinitis. X-rays are occasionally done to make sure that the quadriceps tendon does not have any calcium in it. Other tests such as diagnostic ultrasound or Magnetic Resonance Imaging (MRI) are sometimes used to rule out more extensive damage to the quadriceps tendon.

Treatment of quadriceps tendinitis may include relative rest, icing, medications to reduce inflammation and pain, stretching and strengthening exercises. Quadriceps tendinitis may be prevented by easing into jumping or running sports and by using good training techniques. Off-season strength training of the legs, particularly the quadriceps muscles, can also help. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

PREPATELLAR BURSITIS

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PREPATELLAR BURSITIS

This section covers bursitis of the prepatellar bursa that occurs after an injury or trauma (traumatic prepatellar bursitis). In order to better understand traumatic prepatellar bursitis it is important to understand the anatomy and function of the knee and the patella. Please review the section on knee anatomy before reviewing this section.
The kneecap (patella) is a small bone in the front of the knee. It glides up and down a groove in the thighbone (femur) as the knee bends and straightens. The patellar tendon is a thick, ropelike structure that connects the bottom of the patella to the top of the large shinbone (tibia). The powerful muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella.

A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the one that is most commonly injured is the bursa in front of the patella, the prepatellar bursa.

The prepatellar bursa is usually very thin. When irritated or injured the prepatellar bursa can fill with fluid or blood and become large and painful. If repeatedly irritated or injured, the walls of the bursa may thicken and have irregular areas of scar tissue that are often mistaken as "bone chips". Calcium may also collect inside the bursa.

After a direct blow to the front of the knee the prepatellar bursa can become swollen. This can occur immediately or over a couple of hours. The degree of swelling can vary. The front of the knee is usually very painful to touch and it can also be painful to move. In addition, the area around the prepatellar bursa may be warm. If there is significant swelling or pain X-rays are usually performed to rule out a broken or chipped patella.

Depending on the severity of the injury, the treatment of traumatic prepatellar bursitis may include resting the knee, applying ice packs to the area, light compression of the knee with a tensor bandage and elevation of the injured leg. Medications to help reduce the swelling and pain may also be required. If there is a large amount of swelling and the knee is uncomfortable the bursa may need to be drained by a doctor.

After the swelling comes down and the bursa is less painful, padding the area may be required for some types of work, sports and recreational activities like gardening. In rare cases surgery is required to remove a prepatellar bursa that remains swollen or is repeatedly irritated or injured.

Complications of traumatic prepatellar bursitis include repeated irritation or injury, persistent pain and/or swelling or infection in the bursa. These complications require different types of treatment. Doctors and physiotherapists trained in treating these types of injuries can outline an individualized treatment for traumatic prepatellar bursitis.

ILIOTIBIAL BAND SYNDROME

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ILIOTIBIAL BAND SYNDROME

Iliotibial band syndrome (ITBS) is a common cause of pain in the outer (lateral) side of the knee. ITBS is also a common overuse injury in runners. In order to better understand ITBS it is important to understand the anatomy and function of the knee. Please review the section on knee anatomy before reviewing this section.

The knee joint is made up of four bones, which are connected by muscles, ligaments, and tendons. The femur is the large bone in the thigh. The tibia is the large shinbone. The fibula is the smaller shinbone, located next to the tibia. The patella, otherwise known as the kneecap, is the small bone in the front of the knee. It slides up and down in a groove in the femur (the femoral groove) as the knee bends and straightens.

The iliotibial band is a belt-like band of tissue that runs from a muscle on the outer side of the hip, the tensor fascia lata, down the outer side of the thigh and attaches to the outer side of the patella and the tibia. Other muscles of the hip also attach to the iliotibial band and together with the tensor fascia lata control outward hip movement (abduction). The iliotibial band also provides stability to the lateral side of the knee.

A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee. There is a bursa that protects the iliotibial band from the underlying femur. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become painful.

The end of the femur has two large projections called epicondyles. When the knee is fully straight (extended) the iliotibial band lies in front of the lateral epicondyle of the femur. As the knee bends (flexes), the iliotibial band slips over the lateral epicondyle and ends up behind it. Friction occurs where the iliotibial band passes over the lateral femoral condyle. This friction can result in inflammation of the bursa that separates the iliotibial band from the underlying bone, or the iliotibial band itself.

ITBS is usually the result of overuse or over training. ITBS is found predominantly in runners and is often associated with changes in training such as a sudden increase in distance or intensity. Running on uneven surfaces such as the shoulder of the road may also cause ITBS, most commonly in the "downhill" leg. Other predisposing factors include prominent lateral femoral condyles or tight iliotibial bands.

As mentioned above, the pain from ITBS is felt on the lateral aspect of the knee. The pain may also radiate up the lateral aspect of the thigh or around to the front of the knee. The pain is usually made worse by repetitive flexion and extension movements of the knee. Initially, the pain may only be felt during a run. If training continues, pain may be felt even at rest.
On examination of the knee the iliotibial band is usually tight. There is often tenderness of the iliotibial band where it passes over the lateral femoral condyle. When pressure is applied to the lateral femoral condyle and the knee is repetitively flexed and extended the pain that is felt during training can often be reproduced. X-rays are usually normal.

Treatment of ITBS may include relative rest, icing, medications to reduce inflammation and pain, stretching, and strengthening exercises. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

Meniscal Injuries

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Meniscal injuries are often associated with a ligament tear of the knee. An injury to one of the main supporting ligaments of the knee can result in an unstable knee increasing the chance of tearing a meniscus. When a meniscus is injured the knee often becomes painful and/or swollen. The pain is usually made worse by specific movements such as bending or twisting the knee. Certain maneuvers may produce a "click", "pop" or sharp pain which is often localized to the medial or lateral joint line (the space between the thigh bone and the shin bone). Swelling can be caused from irritation of the knee joint by the torn meniscus.

X-rays cannot detect meniscal injuries but are useful to rule out wear and tear arthritis (osteoarthritis), loose pieces of bone or a broken bone which may mimic a "torn cartilage". Occasionally a special test called Magnetic Resonance Imaging (MRI) is required. Arthroscopic surgery is helpful in both the diagnosis and treatment of these injuries.

Initially the treatment of meniscus injuries may include activity modification, ice, medication (to reduce pain and/or swelling) and physiotherapy. If a torn meniscus does not heal, and pain, swelling or intermittent catching persists, arthroscopic surgery may be necessary. Arthroscopic surgery is usually required if the knee remains locked.

MENISCUS (CARTILAGE) INJURIES

2007-07-19T01:38:00.000-05:00

MENISCUS (CARTILAGE) INJURIES

The meniscus is a "C" shaped "shock absorber" which lies between the thigh bone (femur) and the shin bone (tibia). There is a meniscus on the inner (medial) side of the knee and one on the outer (lateral) side of the knee. Injuries to either the medial meniscus or the lateral meniscus are common and are often referred to as a "torn cartilage". Injuries to the menisci often result in pain and swelling in the knee. If the torn piece of meniscus is large, it may cause the knee to catch, lock, or give way (For more anatomy, click here).

Catching occurs when the torn fragment briefly lodges between the bones then works its way out. If the fragment does not work its way out the knee will remain "locked", meaning the knee cannot fully bend or straighten. Locking can be brief (lasting seconds or minutes) or persistent (lasting weeks). Giving way occurs when the torn piece of meniscus slips out of place which causes pain and reflex relaxation of the thigh muscles. When the muscles relax the knee "gives way" or "gives out."

The most common cause of sudden (acute) meniscal tears in younger people is a combined loading and twisting injury to the knee. However, the medial or lateral meniscus can undergo a degenerative tear without any significant injury to the knee. The medial meniscus is more frequently injured than the lateral meniscus.