arthritis and tendinitis

8/8/2019 Arthritis and Tendinitis

http://slidepdf.com/reader/full/arthritis-and-tendinitis 1/60

Arthritis and Tendinitis

What Is Tendinitis?

Tendinitis is an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle.

What Causes Tendinitis?

Tendinitis is most often caused by repetitive, minor impact on the affected area, or from a sudden more

serious injury.

There are many activities that can cause tendinitis, including:

y Gardening

y Raking

y Carpentry

y Shoveling

y Painting

y Scrubbing

y Tennis

y Golf

y Skiing

y Throwing and pitching

Incorrect posture at work or home or poor stretching or conditioning before exercise or playing sports also

increases a person's risk. Other risk factors for tendinitis, include:

DOCTOR recommended reading Achilles Tendon Problems

What is the Achilles tendon?

The Achilles tendon connects the calf muscle to the heel bone. It is the biggest tendon in the human body and allows you to rise up

on your toes and push off while walking or running.

What are common Achilles tendon problems?

The two main problems found in the Achilles tendon are:

y Achilles tendinopathy. Achilles tendinopathy refers to one of two conditions:

y Achilles tendon tear or rupture. An Achilles tendon can partially tear or completely tear (rupture). While a partial tear may cause

mild or no symptoms, a complete rupture causes pain and sudden loss of strength and movement.

Read more about Achilles tendon problems

Related Tendonitis Terms

patellar , relief , treatment, knee, biceps, de Quervain's, tennis elbow, symptoms

y An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint)

that stresses soft-tissue structures

y Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or

unusual medication reactions



Occasionally an infection can cause tendinitis.

Who Gets Tendinitis?

Anyone can get tendinitis, but it is more common in adults, especially those over 40 years of age. As

tendons age they tolerate less stress, are less elastic, and are easier to tear.

Where Does TendinitisOccur?

Tendinitis can occur in almost any area of the body where a tendon connects a bone to a muscle. The

most common places are:

y Base of the thumb

y Elbow

y Shoulder

y Hip

y Knee

y Achilles tendon

What Are the Symptoms of Tendinitis?

The symptoms of tendinitis include:

y Pain at the site of the tendon and surrounding area. Pain may gradually build up or be sudden and

severe, especially if calcium deposits are present.

y Loss of motion in the shoulder, called "adhesive capsulitis" or frozen shoulder.

How Can I Avoid Tendinitis?

To avoid tendinitis, try these tips when performing activities:

y Take it slow at first. Gradually build up your activity level.

y Use limited force and limited repetitions.

y Stop if unusual pain occurs. Do something else. Try again later and if pain recurs, stop that activity for theday.

How Is Tendinitis Treated?

Initial treatment of tendinitis includes:

y Avoiding activities that aggravate the problem

y Resting the injured area

y Icing the area the day of the injury

y Taking over-the-counter anti-inflammatory drugs

If the condition does not improve in a week, see your doctor. You may need more advanced treatments,

including:

y Corticosteroid injections. Corticosteroids (often called simply " steroids") are often used because they

work quickly to decrease the inflammation and pain.y Physical therapy. This can be very beneficial, especially for a "frozen shoulder." Physical therapy

includes range-of-motion exercises and splinting (thumb, forearm, bands).

y Surgery. This is only rarely needed for severe problems not responding to other treatments.



Arthritis and Tendinitis

(continued)

How Long Will Recovery From Tendinitis Take?

Tendinitis may take weeks to months to go away, depending on the severity of your injury.Warning

You should see your doctor if you experience any of the following:

y Fever (over 100 degrees Fahrenheit)

y Swelling, redness, and warmth

y General illness or multiple sites of pain

y Inability to move the affected area

These could be signs of another problem that needs more immediate attention.

Exercises for OA of the Knee

Slideshow: Tips to Keep Your Joints Healthy



Slideshow: Tips to Keep Your Joints Healthy

Move to Help Prevent Joint Pain

Keep joints healthy by keeping them moving. The more you move, the less stiffness you¶ll have. Whether you¶rereading, working, or watching TV, change positions often. Take breaks from your desk or your chair and movearound.



WebMD

Slideshows

View our slideshows to learn more about your health.



Food Frauds

y Sneaky little diet wreckers.

Are You at Risk for ED?

y Who gets it, how it's treated.

Keep Your Joints Healthy and Happy

y Take The Joint Juice®

Joint Health Assessment Now

y

Learn about Healthy Joints y Save 50% on Joint Juice Drink Mix

Learn About Your Joint Health

Pain

Keep joints healthy by keeping them moving. The more you move, the less stiffness you¶ll have. Whether you¶re

reading, working, or watching TV, change positions often. Take breaks from your desk or your chair and move

around.

Joint Pain and Arthritis

With overuse or injury, cartilage on the end of the joints can break down, causing a narrowing of the joint space and

the bones to rub together. Painful bony growths, or spurs, may form. This can lead to inflammation, swelling,

stiffness, and possibly osteoarthritis, the most common type of arthritis. Another type of arthritis is rheumatoid

arthritis, an autoimmune disease characterized by extreme inflammation.

Protect Your Body and Your Joints

Injury can damage joints. So protecting your joints your whole life is important. Wear protective gear like elbow and

knee pads when taking part in high-risk activities like skating. If your joints are already aching, consider wearing

braces when playing tennis or golf.

Healthy Weight for Healthy Joints

Joints hurting? Lose just a few pounds and you'll take some strain off your hips, knees, neck, and back. Extra pounds

add to the load placed on these joints, increasing the risk of cartilage breakdown. People with excess body fat may

also have higher levels of substances that cause inflammation. Even a little weight loss can help. Every pound you

lose takes four pounds of pressure off your knees.

Don't Stretch Before Exercise

Experts now say that stretching before exercise actually causes muscles to tighten, increasing the risk of muscle

pulls. Overstretched joints are more susceptible to injury, especially for people with arthritis. Instead, try sport-specific

exercise -- like slowly kicking before swimming. This warms up not only the muscles, but also loosens up the joints,

ligaments, and tendons around them.

Low-Impact Exercise for Joints



What exercise is good? To protect your joints, your best choices are low-impact options like bicycling and swimming.

That's because high-impact, pounding, and jarring exercise can increase your risk of joint injuries and may slowly

cause cartilage damage. Light weight-lifting exercises are another option. But if you already have arthritis, first speak

with your doctor.

Strengthen Muscles Around Joints

Stronger muscles around joints mean less stress on those joints. Research shows that having weak thigh muscles

increases your risk of knee osteoarthritis, for example. Even small increases in muscle strength can reduce that risk.

Avoid rapid and repetitive motions of affected joints.

Full Range of Motion is Key

Move joints through their full range of motion to reduce stiffness and keep them flexible. Range of motion refers to the

normal extent joints can be moved in certain directions. If you have arthritis, your doctor or physical therapist can

recommend daily range-of-motion exercises.

Strengthen Your Core

How can strong abs help protect joints? Stronger abs and back muscles help with balance. The more balanced you

are, the less likely you are to damage your joints with falls or other injuries. So include core (abdominal)

strengthening exercises in your routine.

Know Your Joints' LimitsIt's normal to have some aching muscles after exercising. But if your pain lasts longer than 48 hours, you may have

overstressed your joints. Don't exercise so hard next time. Working through the pain may lead to injury or damage.

Eat Fish to Reduce Inflammation

If you have joint pain from rheumatoid arthritis (RA), eat more fish. Fatty coldwater fish like salmon and mackerel are

good sources of omega-3 fatty acids. Omega-3s may help keep your joints healthy, as well as reduce inflammation, a

cause of joint pain and tenderness in people with RA. Don't like fish? Try fish oil capsules instead.

Drink Milk to Keep Bones Strong

Calcium and vitamin D help keep bones strong. Strong bones can keep you on your feet, and prevent falls that can

damage joints. Dairy products and green, leafy vegetables like broccoli and kale are good sources of calcium. If you

don't get enough calcium in your diet, ask your doctor about supplements.

Protect Joints With Good Posture

Stand and sit up straight. Good posture protects your joints all the way from your neck down to your knees. One easy

way to improve posture is by walking. The faster you walk, the harder your muscles work to keep you upright.

Swimming can also improve posture.

Be Careful Lifting and Carrying

Consider your joints when lifting and carrying. Carry bags on your arms instead of with your hands to let your bigger

muscles and joints support the weight.

Use Ice for Joint Pain

Ice is a natural -- and free -- pain reliever. It numbs pain and helps relieve swelling. If you have a sore joint, apply a

cold pack or ice wrapped in a towel. Leave it on for up to 20 minutes at a time. Don't have ice or a cold pack? Try a

bag of frozen vegetables wrapped in a towel. Never apply ice directly to the skin.

Glucosamine for Knee OA

Glucosamine is a natural chemical compound found in healthy joint cartilage. Some studies have shown glucosamine

-- combined with chondroitin -- may provide some relief for moderate to severe pain caused by knee OA. Yet the

results of other studies have been mixed.

For more WebMD tips to keep your joints healthy, click "Next".

Other Supplements for Joint Pain?



Health food stores are filled with supplements promising to relieve joint pain. Although some people have found relief

with methylsulfonylmethane (MSM) for OA pain, its safety and effectiveness hasn't been determined. Others have

tried Sam-E, ginger, or flaxseed. Many supplements used to treat OA pain and inflammation are not proven to be

effective. Talk to your doctor if you want to give supplements a try.

Treat Joint Injuries

Physical trauma can contribute to cartilage breakdown and OA. If you injure a joint, see your doctor right away for

treatment. Then take steps to avoid more damage. You may need to avoid activities that overstress the joint or use a

brace to stabilize it.

More Reading on Healthy Joints

y Nine Ways to Protect Your Joints

y All About Joint Pain

y Save Your Knees: 6 Things to Avoid

y How Weather Affects Health, Including Your Joints

y Newsletter: Healthy Bones, Arthritis, and More

6 Ways to Ruin Your Knees

Expert tips on how to avoid damaging your knees.

By ShahreenAbedin

WebMD Feature

Reviewed by Laura J. Martin, MD

Whether you're a seasoned athlete, a weekend warrior, or

totally laid-back when it comes to exercise, knowing how toprotect your knees from damage can mean the difference

between a fulfilling lifestyle and longterm, strained mobility.

Cruising on the track in the heat of a roller derby match, 27-year-

old Rachel Piplica was not at all prepared for the realization that

her knee could sideline her from competitive skating for months,

possibly years.

"Suddenly, I heard a pop and it felt like my knee bent

sideways. The pain was so bad I just fell and crawled away,"

Piplica tells WebMD.

The Los Angeles fashion designer who skates under the name

Iron Maiven tried to keep going. "I took one more stride and my

knee just let go again. The doctor immediately said, 'I think you

tore your ACL.'"

Piplica had experienced some warning signs during her previous

season of skating as captain of her team, but she ignored them

for the most part. "I had tremendous pain in my leg anytime I'd

squat down so I just kept my right leg straight. But I never saw a doctor for it. I just assumed, 'I'm in a

contact sport and this is what happens,'´ she tells WebMD.



Knee deep: A complex and vulnerable joint

Her torn ACL diagnosis confirmed,Piplica quickly learned how susceptible the knees can be to injury.

According to the American Academy of Orthopaedic Surgeons, these joints are responsible for sending

nearly 15 million Americans to the doctor every year.

And it's not just athletes who suffer. Knee problems can happen to anyone.

"Because they're the main hinge between the ground and the rest of your body, the knees serve as your 'wheels' that get you around and allow you to be active,´ says University of Pennsylvania orthopedic

surgeon and sports medicine specialist Nicholas DiNubile, MD. "Life can really go downhill when you

damage your knees,´ says DiNubile, who is a spokesman for the American Academy of OrthopaedicSurgeons and author of FrameWork - Your 7-Step Program for Healthy Muscles, Bones and Joints.

Bound by an intricate system of ligaments, tendons, cartilage, and muscle, the knee is highly prone to

injury. It's a complex hinge where the femur (thigh bone), tibia (shin bone), fibula (next to tibia) and

kneecap all come together.

"It's hard to find the right balance between mobility and stability; the knee needs to move back and forth,

twist a little, and pivot too,´ DiNubile says. The knee's ligaments can tear, its tendons can swell up,

osteoarthritis can take hold, and even everyday wear and tear can ruin a perfectly good set of knees.

Here are six pitfalls you can avoid to save your knees.

1. Ignoring knee pain.

An occasional ache here and there is common. "But knowing when you can and can't ignore pain is key,´

says sports medicine specialist Jordan Metzl, MD, from the Hospital for Special Surgery in New York

City.

Expert tips on how to avoid damaging your knees.(continued)

1. Ignoring knee pain. continued...

Metzl's rule of thumb: When the pain limits your ability to do what you normally do, you need to have itchecked out.

"If your body is sending you signals, you need to listen to them. If they persist, you need to have it

checked out,´ he tells WebMD.

For Piplica, exploratory surgery revealed a torn meniscus she had endured in the past -- unbeknownst to

her -- followed by the more recent ACL tear.

"In hindsight, maybe that first injury could have been repaired earlier, although I don't know if I could have

avoided this one altogether,´ she says. "At least I would have been more careful."

2. Being overweight.

Every pound of body weight yields five pounds of force on the knee, so even 10 extra pounds can put a

considerable load on those joints.

Being overweight also increases your chances of osteoarthritis in the knee, a common and often disabling

form of arthritis that wears away the knee's cushiony cartilage. Excess pounds also cause existing

arthritis to worsen more rapidly. According to the CDC, two out of three obese adults suffer from knee

osteoarthritis at some time in their life.

Although diet and exercise are critical for weight loss, it's a double-edged sword.



"If your knees hurt, it's harder to lose weight through exercise,´ says Metzl. So he recommends activities

that go easy on the knee.

For example, opt for a stationary bike over running on the treadmill, and walk on a flat surface instead of

hilly turf. If you're a die-hard treadmill fan, then go for longer sessions of walking punched with brief

intervals of brisk walking or running every three to five minutes, DiNubile says.

3. Not following through with rehab and rest.The rest and rehabilitation period after a knee injury is critical to avoiding future pain or reinjury.

Depending on the type of damage and treatment, recovery could last anywhere from a couple of weeks to

several months.

"During the rehab period, you need someone to help you tell the difference between something that just

hurts, and something that's going to do you harm,´ says DiNubile.

He tells WebMD that many of his young athlete patients are too eager to return to regular play as soon as

they stop limping. He advises patients to work with an orthopedic surgeon, a sports medicine physician,

a physical therapist, an athletic trainer, or some combination of these pros, in order to ensure proper

focus is placed on gradually strengthening the knees.

4. Neglecting your ACL.

One of the most commonly injured ligaments in the knee, the anterior cruciate ligament (ACL) is

responsible for about 150,000 injuries in the U.S. every year.

As Piplica learned firsthand, sports like roller derby that involve quick cuts, twists, and jumping, put the

ACL at higher risk for rupturing. More traditional high-risk sports include soccer, basketball, football, and

volleyball.


4. Neglecting your ACL. continued...

Women in particular have a two- to eight-times higher risk for ACL tears compared to men, mainlybecause the way women naturally jump, land, and turn puts greater strain on the ACL.

However, male and female athletes alike can be trained to "rewire´ themselves and thus lower risks of

knee injury. That's done through neuromuscular training, which involves supervised practice in improving

agility, leg strength, and jump-landing techniques for better knee joint stability.

These specialized techniques are effective in reducing risks of knee injury by almost one-half, according

to a 2010 review of seven neuromuscular training studies.

"Given what we know in how useful it can be in reducing ACL tears, it's irresponsible of coaches and

parents to not require athletes to undergo neuromuscular training,´ says DiNubile.

He recommends that athletes of any age who play ACL risk-prone sports should seek help from an

athletic trainer or other trained professional to help avoid this debilitating injury.

5. Overdoing it.

"You make gains in fitness when you work hard and then allow your body to recover. You can't do a hard

workout every day," Metzl says.

A sudden increase in intensity or duration of exercise can cause overuse injuries from repetitive strain.

Tendonitis and kneecap pain are common symptoms in the knee.



Pushing too hard is also related to overtraining syndrome, a physiological and psychological condition

among athletes in which they exceed their ability to perform and recover from physical exertion, often

leading to injury or lowered performance.

Be sure to include stretching exercises before and after working out. And follow hard training days with

easy ones so your body can recover.

6. Overlooking other muscles around the knees.Weak muscles and lack of flexibility are primary causes of knee injuries, according to the Mayo Clinic.

When the muscles around the kneecap, hip, and pelvis are strong, it keeps the knee stable and balanced,

providing support by absorbing some of the stress exerted on the joint.

DiNubile stresses the importance of building the quadriceps and hamstring muscles, as well as proper

strengthening of the body's core muscles, including the obliques, lower back muscles, and upper thigh.

His favorite tool to help accomplish this strengthening is a Swiss medicine ball. Other exercises to try are

knee extensions, hamstring curls, leg presses, and flexibility exercises.

Piplica recalls realizing just how weak some of her leg muscles were.

"Roller girls are striding out so much with their outer leg muscles, but we aren't necessarily working our

inner knees," she says. "I remember when I would run for exercise, my calves and shins would hurt sobad. That surprised me, because I thought if anything was strong, it was my legs.´

Piplica says she wishes she had been better educated about crosstraining activities for roller skaters, and

what muscle groups they need to focus on to keep their knees healthy.


6. Overlooking other muscles around the knees. continued...

As she awaits surgery to repair her torn ACL, Piplica tells WebMD that her perspective on long-term care

for her knees has definitely changed."Half of me is frustrated about not being able to skate sooner, but the other half knows how important it is

to get better so I don't do this again. I'm 27 years old with a serious knee injury preventing me from

moving around. So I need to look beyond just skating, skating, skating. I don't want to have knee

problems when I'm 40 or 50 because I'm not giving my body the kind of attention it needs right now."

Injection Therapy for Osteoarthritis

The content below was selected by the WebMD Editorial staff and is solely under WebMD's editorial control.




Hamstring Stretch

Warm up with a five-minute walk. Then, stretch. Lie down. Loop a bed sheet around your right foot. Use sheet to help

pull and stretch leg up. Hold for 20 seconds. Repeat twice, then switch legs. Stretching is one of three important

types of exercises for knee OA. Range of motion or stretching exercises keep you limber. Strengthening exercises

build muscle strength to stabilize weak joints. Aerobic exercises, like walking, help lung and heart fitness.

Exercises for OA of the KneeCalf Stretch

Stretching exercises loosen muscles, improve flexibility, and help prevent pain and injury.

Use a chair for balance. Bend your right leg. Step back with left leg, slowly straightening it behind you. Press left heel

towards the floor. Feel the stretch in your back leg.

For more of a stretch: Lean forward, bending the right knee deeper. Don't let the right knee go past your toes. Hold

for 20 seconds. Do twice, then switch legs.

Previous page Next page



Exercises for OA of the KneeStraight Leg Raise

To try this leg strengthening move, lie on the floor. Prop your back up on your elbows. Bend your left knee, keeping

foot on floor. Keep the right leg straight, toes pointed up. Tighten thigh muscles of your right leg. Slowly and smoothly

use your thigh muscles -- not your back -- to raise your leg.

Pause, as seen above, for five seconds. With thigh still tight, slowly lower leg to ground. Relax. Repeat 10 times.

Rest. Do another 10; then switch legs.




Exercises for OA of the KneeQuad Set

Is the straight leg raise too tough? Do quad sets instead. With these you don¶t raise your leg. Simply tighten the thigh

muscles, also called the quadriceps, of one leg at a time.

Start by lying on the floor. Keep both legs on ground, relaxed. Flex and hold left leg tense for five seconds, as seen in

right-hand photo. Relax. Do two sets of 10. Then, switch to other leg.




Exercises for OA of the KneeSeated Hip March

This move can strengthen hips and thigh muscles to help with daily activities, such as walking or rising from a chair.

Sit up straight in chair. Slightly kick back your left foot but keep toes on the floor. Lift your right foot off the floor,

keeping knee bent. Hold right leg in the air five seconds. Slowly lower your foot to the ground. Repeat 10 times. Rest

and do another 10, then switch legs. Too hard? Use your hands to help raise your leg.




Exercises for OA of the KneePillow Squeeze

This move helps strengthen the inside of your legs to help support your knee. Lie on your back, both knees bent.

Place a pillow between knees.

Squeeze knees together, squishing pillow between them. Hold for five seconds. Relax. Repeat 10 times. Rest, then

do another set of 10.

Too hard? You can also do this exercise while seated. See photo to right.




Exercises for OA of the KneeHeel Raise

Hold back of chair for support. Stand straight and tall. Lift heels off ground and rise up on toes of both feet. Hold for

five seconds. Slowly lower both heels to ground. Repeat 10 times. Rest. Do another 10.

Too hard? Do the same exercise, only sitting in a chair.Previous page Next page



Exercises for OA of the KneeSide Leg Raise

Hold back of chair for balance. Place your weight on left leg. Lift right leg out to the side. Keep right leg straight and

outer leg muscles tensed. Don't slouch. Lower right leg and relax. Repeat 10 times. Rest. Do another 10, then repeat

with left leg.

Too hard? Increase leg height over time. After a few workouts, you¶ll be able to raise your leg higher.




Exercises for OA of the KneeSit to Stand

Practice this move to make standing easier. Place two pillows on chair. Sit on top, with your back straight, feet flat on

floor (see left). Use your leg muscles to slowly and smoothly stand up tall. Then, slowly lower yourself back down to

sitting. Be sure your bent knees don¶t move forward of your toes. Try with arms crossed (see left) or loose to your

side.

Too hard? Add pillows or use a chair with armrests and help push up with your arms.




Exercises for OA of the KneeOne Leg Balance

Your goal is to do this hands-free. Steady yourself on a chair, if needed. First, shift your body weight to one leg but do

not lock your knee straight. Slowly raise the other foot off the ground, balancing on your standing leg. Hold for 20

seconds. Lower raised foot to the ground. Do twice, then switch legs. This move helps when getting out of cars or

bending.

Too easy? Balance for a longer time. Or try with your eyes closed.




Exercises for OA of the KneeStep Ups

This move helps strengthen your legs for climbing stairs. Face a stable step, both feet on the ground. Step up with

your left foot. Follow with your right foot. Stand on top, tall and with both feet flat. Climb down in reverse: right foot

down first, then left. Do 10 times. Rest, then repeat another 10 times. Then repeat, starting with right leg first.Too

hard? Use a railing, wall, or lamppost for balance. Or try a lower step.




Exercises for OA of the KneeWalking

With stiff or sore knees, walking may not seem like a great idea. But it's one of the best exercises for knee arthritis. It

can reduce joint pain, strengthen leg muscles, and improve flexibility -- and it's good for your heart. The best part --

no gym membership needed.

Good form is key: Look forward, walk tall. Keep arms and legs moving, relaxed. Always ask your doctor before

starting exercise when you have osteoarthritis.




Exercises for OA of the KneeLow-Impact Activities

Being active may also help you lose weight, which takes pressure off joints. Other exercises that are easy on the

knees: biking, swimming, and water aerobics. Water exercise takes weight off painful joints. Many community and

hospital wellness centers, YMCAs, and pools offer classes for people with arthritis.

Don't give up favorite activities, like golf. Talk to your doctor or physical therapist about modifying painful moves.





HowMuch Exercise?

Start with a little. If you can do it without pain, do more next time. Aim for 30 minutes a day.

Over time you¶ll build your leg muscles to support your knee and increase flexibility.

Some muscle soreness is normal, but hurting or swollen joints need rest. Take a break and ask your doctor¶s advice.

Ice painful joints and take acetaminophen or an anti-inflammatory pain reliever, like ibuprofen or naproxen, if your

doctor says it's OK.


Caring for Your Joints

Here are nine tips to help you guard your joints against injury and diseases such as arthritis. It

is information you can use daily to maintain healthy and strong joints.

You and Your Joints



A joint is the connection between two bones. Joints and their surrounding structures allow you to bend

your elbows and knees, wiggle your hips, bend your back, turn your head, and wave your fingers to say

bye-bye.

Smooth tissue called cartilage and synovium and a lubricant called synovial fluid cushion the joints so

bones do not rub together. But increasing age, injury -- even sitting the wrong way or carrying too much

weight -- can wear and tear your cartilage. This can lead to a reaction in your joint that can damage your

joints and lead to arthritis.

The best way to care for your joints is to keep them and your muscles, ligaments, and bones strong and

stable. Here are some tips for good joint health.

Watch Your Weight for Healthy Joints

Keeping your weight within a healthy range is the best thing you can do for your joints. Weight-bearing

joints, such as your knees, hips, and back, have to support some, if not all, of your body weight. That's

why so many overweight people have problems with these areas of the body.

The higher the number on your bathroom scale, the more wear and tear you put on your joints. Losing

weight reduces pressure on your knees, hips, and back and helps prevent joint injury. Research has

shown that with every pound gained, a person puts four times more stress on the knees. Women who

lose about 11 pounds reduce their risk of developing arthritis of the knees.

Exercise for Healthy Joints

Exercise can help you lose extra pounds and maintain a healthy weight. Some research suggests that

aerobic exercise -- activities that get your heart rate up -- can reduce joint swelling. Opt for exercises that

won't give your joints a pounding. Instead of step aerobics, try low-impact exercises such as swimming or

bicycling.

Another healthy idea: Don't sit still! Couch potatoes, computer addicts, and anyone else who remains

glued to a chair all day long have a high risk for joint pain. Less movement means more stiffness in your

joints. So get up and get moving. Change positions frequently. Take frequent breaks at work and stretch

or go for a short walk. If you can't leave the office, try taking phone calls while standing.

BuildMuscles to Support Joints

Strong muscles support your joints. If you don't have enough muscle, your joints take a pounding,especially those in your knees, which must support your entire body weight. Weight training exercises

help build muscle and keep existing muscle and surrounding ligaments strong. That way, your joints don't

have to do all the work. Make sure you talk to your doctor before starting any type of exercise routine,

including weight lifting. You don't want to strain the joint that you're trying to strengthen

Caring for Your Joints

(continued)

Help Joints With a Strong Core

Make sure your exercise routine includes activities that strengthen your abdominal (core) muscles.

Stronger abs and back muscles help you keep your balance and prevent falls that can damage your

joints.

Know Your Limits for Your Joints' Sake

Certain exercises and activities might just be too tough for your joints to handle. Avoid exercises that

cause joint pain. You will likely feel some muscle pain after working out. But any soreness that lasts



longer than 48 hours means you need to take it easier next time. Such pain could mean you've

overstressed your joints, and working through it may lead to injury or damage.

Don't be afraid to ask if you need help with a specific task or chore. A second pair of hands always comes

in -- well, handy!

Perfect Your Posture for Good Joints

Slouching is not good for your joints. Standing and sitting up straight protects your joints from your neckto your knees. Good posture also helps guard your hip joints and back muscles.

Posture is also important when lifting and carrying. For example, if you use a backpack, be sure to put it

over both shoulders instead of slinging it over one. Being lopsided puts more stress on your joints. When

lifting, use the biggest muscles in your body by bending at your knees instead of bending your back.

Protecting Your Body Protects Joints

Make sure you always wear a helmet, knee pads, and elbow and wrist pads when taking part in high-risk

activities, including work-related ones such as repetitive kneeling or squatting. Even if you think you're a

pro on a bicycle or on a pair of Rollerblades, you should never go without safety gear. Hit the wrong bump

in the road and you could be headed for a lifetime of joint pain. Serious injuries or several minor injuries

can damage cartilage.

Preventing injuries can help ward off early onset arthritis. Elbow and wrist braces, or guards, also help

reduce stress on your joints during activities.

Add Ice for Healthy Joints

Ice is a great drug-free pain reliever. It helps relieve joint swelling and numbs pain. If you have a sore

joint, apply ice wrapped in a towel or a cold pack to the painful area for no more than 20 minutes. Don't

have ice or a cold pack? Try wrapping a bag of frozen vegetables (peas work best!) in a light towel. Never

apply ice directly to the skin.

Eating Right Nourishes Joints

A healthy, balanced diet helps build strong bones. Strong bones can keep you on your feet, and prevent

falls that may lead to joint damage. Make sure you get plenty of calcium every day. You can do this by

drinking plenty of milk and eating foods such as yogurt, broccoli, kale, and figs. If those foods don't tempt

your taste buds, ask your doctor if calcium supplements are right for you.

Recent research indicates that a diet that contains the proper amount of vitamin D is important for good

bone and joint health. You should ask your doctor about the proper amount of vitamin D and ways you

can get it.

Oranges may also give your joints a healthy boost. Some studies suggest that vitamin C and other

antioxidants can help reduce the risk of osteoarthritis.

Salmon is particularly beneficial for your joints. Not only is it a good source of calcium, it also contains

omega-3 fatty acids. Omega-3s promote healthy joints and reduce joint pain and swelling in people with

arthritis. Mackerel is another source of omega-3s. You can also get omega-3s by taking fish oil capsules.

Knee Pain Overview



Introduction to Knee Pain

Knee pain is the most common musculoskeletal complaint that brings people to their doctor. With today¶s

increasingly active society, the number of knee problems is increasing. Knee pain has a wide variety of

specific causes and treatments.

Anatomy of the Knee

The knee joint¶s main function is to bend, straighten, and bear the weight of the body along with the

ankles and hips. The knee, more than just a simple hinged joint, however, also twists and rotates. In order

to perform all of these actions and to support the entire body while doing so, the knee relies on a number

of structures including bones, ligaments, tendons, and cartilage.

Bones

y

o The knee joint involves four bones.

o The thighbone or femur comprises the top portion of the joint.

o One of the bones in the lower leg (or calf area), the tibia, provides the bottom weight-bearing portion of

the joint.

o The kneecap or patella rides along the front of the femur.

o The remaining bone in the calf, the fibula, is not involved in the weight-bearing portion of the knee joint. Itonly provides ligament attachments for stability.

Ligaments

y

o Ligaments are dense fibrous bands that connect bones to each other.

o The knee includes four important ligaments, all of which connect the femur to the tibia:

o The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide front and back

(anterior and posterior) and rotational stability to the knee.

o The medial collateral ligament (MCL) and lateral collateral ligament (LCL) located along the inner (medial)

and outer (lateral) sides of the knee provide medial and lateral stability to the knee.

Tendons

y

o Tendons are fibrous bands similar to ligaments.

o Instead of connecting bones to other bones as ligaments do, tendons connect muscles to bones.

o The two important tendons in the knee are (1) the quadriceps tendon connecting the quadriceps muscle,

which lies on the front of the thigh, to the patella and (2) the patellar tendon connecting the patella to the

tibia (technically this is a ligament because it connects two bones).

o The quadriceps and patellar tendons are sometimes called the extensor mechanism, and together with

the quadriceps muscle they facilitate leg extension (straightening).

Cartilage

y o Cartilaginous structures called menisci (one is a meniscus) line the top of the tibia and lie between the

tibia and the 2 knuckles at the bottom of the femur (called the femoral condyles).

o The menisci's primary job is to provide cushioning for the knee joint.

Bursae

y



o Bursae (one is a bursa) are fluid-filled sacs that help to cushion the knee. The knee contains three

important groups of bursae.

o The prepatellarbursae lie in front of the patella.

o The anserine bursae is located on the inner side of the knee about two inches below the joint.

o The infrapatellarbursae are located underneath the patella.

Knee Pain Overview

(continued)

Home Care for Knee Pain

Inflammation is the body¶s physiologic response to an injury. In treating many types of knee pain, a

common goal is to break the inflammatory cycle. The inflammatory cycle starts with an injury. After aninjury, substances that cause inflammation invade the knee, which causes further injury, which leads to

further inflammation, and so on. This cycle of inflammation leads to continued or progressive knee pain.

The cycle can be broken by controlling the substances that cause inflammation, and by limiting further

injury to tissue.

Some common home care techniques for knee pain that control inflammation and help to break the

inflammatory cycle are protection, rest, ice, compression, and elevation. This regimen is summarized by

the memory device PRICE.

y PROTECT the knee from further trauma.

o This can be done with knee padding or splinting.

o A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example isa form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the

prepatellarbursae.

y REST the knee.

o Rest reduces the repetitive strain placed on the knee by activity.

o Rest both gives the knee time to heal and helps to prevent further injury.

y ICE the knee.

o Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.

o Most authorities recommend icing the knee two to three times a day for 20-30 minutes each time.

o Use an ice bag or a bag of frozen vegetables placed on the knee.

y COMPRESS the knee with a knee brace or wrap.

o Compression helps accomplish two goals:

o First, compression is another way to reduce swelling.

o Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint

mechanics intact.



y ELEVATE the knee.

o Elevation also helps reduce swelling.

o Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the

central circulation.

o Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs. Elevation works

best when the knee -- or any other injured body part -- is higher than the level of the heart.

y Over-the-counter pain medicine: Commonly used pain relievers such as nonsteroidal anti-inflammatory

drugs (NSAIDs) like naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in the

treatment of knee pain.

o These drugs directly control pain and, at higher doses, act as anti-inflammatory agents, helping to break

the inflammatory cycle. Like all medications, however, these drugs have side effects.

o You should not use NSAIDs if you have a problem with bleeding or stomach ulcers or some types of

kidney disease.

o Acetaminophen (Tylenol) can also be used to control knee pain but does not have the anti-inflammatory

properties of the NSAIDs. Still, this treatment is remarkably useful in many types of knee pain such as

osteoarthritis.

Knee Pain Overview

(continued)

When to Call the Doctor for Knee Pain

When you are deciding whether to call the doctor about your knee pain, a good rule of thumb exists for

most long-term knee injuries. If your symptoms have not gone away after trying a week of PRICE therapy

and over-the-counter anti-inflammatory pain meds, you should set up an appointment with your doctor or

a sports medicine or orthopedic (bone and muscle) specialist to further evaluate the pain. This rule can

also be applied to new knee injuries that are not disabling. Remember, however, that this rule should only

serve as a guide. If you are concerned about the pain, you should call the doctor.

When to Go to the Hospital for Knee Pain

y If you cannot put weight on your knee, you should consider going to the ER to be evaluated by a doctor

because of the possibility of a fracture.

o

Many fractures may require immobilization in a specific position or surgery.o Putting off seeing a doctor may hinder healing.

y Other signs and symptoms that demand emergency evaluation:

o Fever (which may indicate infection)

o Unbearable pain

o Drainage

o Large wounds

o Puncture wounds



o Swelling, if you are on a blood thinner (warfarin or Coumadin) or have a bleeding disorder (such as

hemophilia)

Getting a Knee Pain Diagnosis

History: Even in today¶s world of technology, doctors rely on a detailed history and physical exam morethan any single test.

y

o The doctor will typically want to know the exact nature of the pain.

Where in the knee is your pain?

What does the pain feel like?

How long has the pain been present?

Has it happened before?

Describe any injuries to the knee.

What makes it better or worse?

Does the knee pain wake you up at night?

Does the knee feel unstable? Have you been limping?

o The doctor will also want to know a bit about you.

Do you have any major medical problems?

How active is your lifestyle?

What are the names of the medications you are taking?

o The doctor will want to know about any related symptoms.

Do you still have normal sensation in your foot and lower leg?

Have you been having fevers?

Physical exam

y

o The doctor will likely have you disrobe to completely expose the knee. If possible, wear shorts to your

appointment.

o The doctor will then inspect the knee and press around the knee to see exactly where it is tender.

o In addition, the doctor may perform a number of maneuvers to stress the ligaments, tendons, and menisci

of the knee and evaluate the integrity of each of these.

X-rays, CT scans, and other tests

y

o Depending on your particular history and exam, the doctor may suggest X-rays of the knee. X-rays showfractures (broken bones) and dislocations of bones in the knee as well as arthritis and abnormally large or

small joint spaces.

o Rarely, the doctor may order a CT scan (a 3-dimensional X-ray) of the knee to precisely define a fracture

or deformity.

o Both X-rays and CT scans are excellent for diagnosing fractures. They both are also poor, however, at

evaluating soft tissue structures of the knee such as ligaments, tendons, and the menisci.

y MRI



o Magnetic resonance imaging (MRI) uses large magnets to create a 3-dimensional image of the knee.

o In contrast to CT scans, MRIs do not image bones and fractures as well.

o Also in contrast to CT scans, MRIs are excellent for evaluating ligaments and tendons for injuries.

y Fluid removal

o The knee and all bursae of the knee are filled with fluid.o If your symptoms suggest infection or crystalline arthritis, such as gout, your physician may remove fluid,

with a needle, from the knee.

o This fluid will then be analyzed to better clarify the diagnosis.

o Crystals, which suggest crystalline arthritis, often can be seen under the microscope. Infection may also

be detected under a microscope by finding bacteria and pus in the fluid.

y Blood tests: The doctor may also elect to perform certain blood tests to evaluate for signs of infection or

diseases such as rheumatoid arthritis, lupus, and diabetes.

y Arthroscopy

o The orthopedic surgeon may elect to perform arthroscopy if you have chronic knee pain.

o This is a surgical procedure where the doctor will place a fiber optic telescope within the knee joint. Thearthroscope is attached to a camera that relays real-time images to a video monitor.

o By doing so, the surgeon may be able to see small particles in the knee or to look more closely at

damaged menisci or cartilage.

o The doctor may also be able to repair damage by shaving down torn cartilage or removing particles from

the knee while looking at the inside of your knee on a video monitor.

Knee Pain Overview

(continued)

Types of Knee Pain

The nerves that provide sensation to the knee come from the lower back and also provide hip, leg, and

ankle sensation. Pain from a deeper injury (called referred pain) can be passed along the nerve to be felt

on the surface. Knee pain, therefore, can arise from the knee itself or be referred from conditions of the

hip, ankle, or lower back. All of the following sources of knee pain arise from the knee joint itself.

In general, knee pain is either immediate (acute) or long-term (chronic). Acute knee pains can be caused

by an acute injury or infection. Chronic knee pain is often from injuries or inflammation (such as arthritis)

but can also be caused by infection.

Acute Knee PainFractures (broken bones)

y

o Description: Fractures of any of the bones of the knee are traumatic injuries typically caused by moderate

to high forces (such as car accidents, contact sports, or falls).

o Symptoms: Fractures may be accompanied by swelling or bruising but are almost always extremely

painful and tender. The pain is typically so severe that people are often unable to walk or even put their

full weight on the knee.



o Evaluation: Fractures are an emergency and should be checked by a doctor. This evaluation will

generally include x-rays and other relevant studies. A delay in evaluation can result in fracture fragments

being moved and associated injuries.

o Treatment: Depending on the particular fracture, the doctor may either recommend immobilization (with a

cast or splint) or surgery to repair it.

o Prognosis: Fractures often heal with no long-term problems. Some fractures, however, are complicated

by arthritis or by injuries to arteries or nerves that can be serious.

Sprained and torn collateral ligaments

y

o Description: The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Like

all ligaments, this ligament may be sprained or torn. A sprained ligament may be partially ruptured. A torn

ligament is completely ruptured.

o Symptoms: Severe MCL sprains or tears often produce a tearing or ripping sensation along the inner joint

line of the knee. You may also notice knee instability and swelling. A force from the outer (lateral) knee to

the inner (medial) knee is typically responsible for this injury in contrast to the more rarely injured LCL,

which is typically a result of an inner to outer force. In general, bruises occur at the point of impact.

Sprained and torn ligaments occur opposite the point of impact. Both MCL and LCL injuries are common

in contact sports but can also result from twisting the knee with a planted foot such as in skiing.o Evaluation: After a relevant history is taken and physical examination is performed and conservative

treatment, the doctor may suggest MRI or arthroscopy to further evaluate a torn ligament. The doctor may

also recommend x-rays. The x-ray does not help in diagnosing ligament injuries but may help detect any

bone injuries or arthritis prior to arthroscopy.

o Treatment: For a mild sprain, early rehabilitation with compression, ice, elevation, anti-inflammatories,

and pain control medications along with an exercise regimen including a stationary bike and leg-

strengthening exercises may be all you need. Such an exercise regimen should be under the supervision

of a doctor or physical therapist because certain exercises are to be avoided. In contrast to mild sprains,

complex tears often require surgical repair for best results.

Knee Pain Overview

(continued)

Acute Knee Pain continued...

Sprained and torn cruciate ligaments

y

o Description: An anterior cruciate ligament (ACL) injury is a common sports injury generally caused by a

hard stop or a violent twisting of the knee. The posterior cruciate ligament (PCL) is stronger than the ACL

and much less commonly torn. The PCL requires strong forces, such as those produced when the

dashboard strikes the knee in a car accident, to tear. Due to these severe forces, PCL injury is often

associated with other ligament and bone injuries.o Symptoms: If you tear your ACL, you may hear a pop. You will also notice your knee give way or become

unstable and feel pain that is bad enough that you might feel like vomiting. This will, almost always, be

followed by marked knee swelling over the next couple of hours because the ACL bleeds briskly when

torn.

o Treatment: Surgical repair is recommended for high-level athletes who demand optimal outcomes.

Conservative treatment and knee braces may prove sufficient for those who do not demand quite so

much from their knees.



Tendon ruptures

y

o Description: Both the quadriceps and patellar tendons may rupture partially or completely. A quadriceps

tendon rupture typically occurs in recreational athletes older than 40 years (this is the injury former

President Clinton suffered while jogging), and a patellar tendon rupture typically occurs in younger people

who have had previous tendonitis or steroid injections to the knee.

o Symptoms: Rupture of either the quadriceps or patellar tendon causes pain (especially when trying to kick

or extend the knee). Those people with complete ruptures are unable to extend the knee. The patella is

also often out of place either upward (with patellar tendon rupture) or downward (with quadriceps tendon

rupture).

o Treatment: Tendon ruptures should be evaluated urgently. Tendon ruptures generally require surgical

repair. A partial rupture may be treated with splinting alone.

Meniscal injuries

y

o Description: Injuries to the meniscus are typically traumatic injuries but can also be due to overuse. Often,

a piece of the meniscus will tear off and float in the knee joint.

o Symptoms: Meniscal injuries may cause the knee to lock in a particular position, or either click or grind

through its range of motion. Meniscal injuries may also cause the knee to give way. Swelling typically

accompanies these symptoms although the swelling is much less severe than with an ACL injury.

o Treatment: Meniscal injuries often require arthroscopic surgical repair. A locking knee or a knee that

"gives" should be evaluated for arthroscopic repair.

Knee dislocation

y

o Description: Knee dislocation is a true limb-threatening emergency. This is also a rare injury. Dislocation

of the knee is caused by a particularly powerful blow to the knee. The lower leg becomes completely

displaced with relation to the upper leg. This displacement stretches and frequently tears not only the

ligaments of the knee but also arteries and nerves. Untreated arterial injuries leave the lower leg without a

blood supply. If circulation is not restored, amputation may be required. Nerve injuries, on the other hand,may leave the lower leg viable but without strength or sensation.

o Symptoms: Knee dislocations are severely painful and produce an obvious deformity of the knee. Many

dislocations are reduced -- or put back into alignment -- on their own. As this occurs, many will report

feeling a dull clunk.

o Treatment: If the knee dislocation has not been put back into place on its own, the doctor will immediately

reduce the dislocation. Medical treatment, however, does not stop here. Whether a dislocation reduces by

itself or is put back into place in the hospital, it requires further evaluation and care. After reduction,

people with these injuries are observed in the hospital where they usually do a number of tests to ensure

that no arterial or nerve injury has occurred. If such an injury is found, it must be repaired immediately in

the operating room.

Knee Pain Overview(continued)

Acute Knee Pain continued...

Dislocated kneecap (patella)

y



o Description: A common injury caused by direct trauma or forceful

straightening of the leg, such as an injury that happens when serving in

volleyball or tennis. Kneecap dislocation is more common in women, the

obese, knock-kneed people, and in those with high-riding kneecaps.

o Symptoms: If you have this injury, you will notice the patella being out of

place and may have difficulty flexing or extending your knee.

o Treatment: The doctor will move the patella back into place (reduce thedislocation). Even if the patella goes back into place by itself, however, it

needs to be x-rayed for a fracture. After reducing the patella and ensuring

the absence of a fracture, the doctors will treat these injuries by splinting

the knee for 3 weeks to allow the soft tissues around the patella to heal

followed by strengthening exercises to keep the patella in line. This injury

often causes damage to the cartilage on the back of the patella.

Chronic Knee Pain

Arthritis: Arthritis of the knee is an inflammatory disorder of the knee joint that is often painful. Arthritis

has many causes.

y

o Knee Osteoarthritis

Description: Osteoarthritis (OA) is caused by degeneration of cartilage in

the knee. In its extreme form, the menisci (cartilage) will be completely

eroded, and the femur will rub on the tibia, bone on bone.

Symptoms: Osteoarthritis causes a chronically painful knee that is often

more painful with activity.

Treatment: Treatment is aimed at pain control with over-the-counter pain

relievers. Anti-inflammatory medications, either over-the-counter, or by your

doctor's prescription, are also quite helpful. More severe OA can be treated

with narcotic pain medicines or a knee joint replacement in which a

synthetic joint replaces your knee joint.

o Rheumatoid arthritis of the knee

Description: Rheumatoid arthritis (RA) is a connective tissue disease of the

whole body that affects many joints often including the knee. People who

have this disease often have family members who suffer from it as well.

Symptoms: In addition to knee pain, rheumatoid arthritis may produce

morning stiffness and pain in other joints.

Treatment: Treatment includes pain medications, anti-inflammatory

medications, and prescription drugs (such as methotrexate [Rheumatrex])aimed at slowing disease progression.

o Crystalline arthritis (gout and pseudogout)

Description: These severely painful forms of arthritis are caused by sharp

crystals that form in the knee and other joints. These crystals can form as a



result of defects in the absorption or metabolism of various natural

substances such as uric acid (which produces gout) and calcium

pyrophosphate (pseudogout).

Treatment: Treatment is aimed at controlling inflammation with anti-

inflammatory medications, and at aiding the metabolism of the various

chemicals that may lead to crystal formation.

Bursitis

y

o Description: As a result of trauma, infection, or crystalline deposits, the

various bursae of the knee may become inflamed.

o Symptoms: Acute or chronic trauma causes a painful and often swollen

knee from the inflammation of the bursae. A particularly common bursitis is

prepatellar bursitis. This type of bursitis occurs in people who work on their

knees. It is often referred to as housemaid¶s knee or carpet layer¶s knee.

Another type of bursitis is anserine bursitis. The anserine bursa is located

about two inches below the knee along the medial side of the knee. More

commonly occurring in the overweight and in women, but also affecting

athletes and others, anserine bursitis often causes pain in the region of thebursa and is often worse with bending the knee or at night with sleep.

o Treatment: Treatment will usually include home care with PRICE therapy

and NSAIDs. Severe forms, however, can be treated with periodic steroid

injections to the bursae.

Knee Pain Overview(continued)

Chronic Knee Pain continued...

Infection (or infectious arthritis) y

o Description: Many organisms may infect the knee. Gonorrhea, a common

sexually transmitted disease, can infect the knee, as can common

organisms residing on normal skin.

o Symptoms: Infection of the knee causes painful knee swelling. In addition,

people who develop such infection typically complain of fevers and chills.

Less severe infections may not have associated fevers or cause this ill

feeling.

o Treatment: New swelling and pain in the knee must be evaluated for

infection based on your doctor¶s opinion. Treatment usually includes

intensive antibiotic therapy and may include aspiration of the joint, or

surgical drainage of the infection.

Patellofemoral syndrome and chondromalacia patella

y

o Description: These 2 conditions represent a spectrum of disease caused by

patellar mistracking.

o Symptoms: The condition typically occurs in young women and also in

athletes of both sexes and elderly people. In patellofemoral syndrome, the

patella rubs against the inner or outer femur rather than tracking straight



down the middle. As a result the patellofemoral joint on either the inner or

outer side may become inflamed causing pain that is worse with activity or

prolonged sitting. As the condition progresses, softening and roughening of

the articular cartilage on the underside of the patella occurs, and the

syndrome is referred to as chondromalacia patella.

o Treatment: Home care with PRICE therapy, NSAIDs, and exercises (such

as straight leg raises) that balance the muscles around the patella work for most people. Others may benefit from bracing or taping of the patella,

commercial arch supports (for the arch of the foot), or orthotic supports that

correct foot mechanics and may reduce abnormal forces on the knee.

Severe cases of patellofemoral syndrome or chondromalacia may be

treated surgically through a variety of procedures.

Jumper¶s knee

y

o Description: Tendonitis (inflammation of the tendon) of the quadriceps

tendon at the upper point of the patella, where it inserts, or tendonitis of the

patellar tendon either at the lower point of the patella, or at the place where

it inserts on the tibia (called the tibial tuberosity, the bump about two inchesbelow the knee on the front side), is termed jumper¶s knee. Jumper¶s knee

is so named because it is typically seen in basketball players, volleyball

players, and people doing other jumping sports.

o Symptoms: Jumper¶s knee causes localized pain that is worse with activity.

It usually hurts more as you jump up than when you land because jumping

puts more stress on tendons of the knee.

o Treatment: Home therapy with the PRICE regimen together with anti-

inflammatory drugs is the basis of treatment. Particularly important are rest,

ice, and NSAID drugs, which will help stop the pain and break the cycle of

inflammation. After controlling the pain, you should slowly start an exercise

regimen to strengthen the quadriceps and hamstring muscles and resume

your sport of choice a few weeks down the line. Also, bracing of the

extensor mechanism may help remove stress from the tendons

Knee Pain Overview

(continued)

Chronic Knee Pain continued...

Osgood-Schlatter disease

y

o Description: Osgood-Schlatter disease occurs in adolescent athletes where repetitive extension of theknee causes inflammation and injury of the tibial tubercle (the bony protrusion at the top of the shin, just

below the kneecap).

o Symptoms: Children suffering from this syndrome report pain at the tibial tubercle. This pain is typically

worse when extending the leg. The tibial tubercle is tender to touch and over time begins to protrude

more because the chronic inflammation stimulates the bone to grow.

o Treatment: Osgood-Schlatter disease is a self-limited condition that usually resolves as the thetibial

tubercle stops growing with the end of adolescence (at about age 17 years in males and age 15 years in



females). Treatment includes PRICE and NSAID therapy. In severe cases, splinting the knee for a few

weeks may help reduce the pain and halt the inflammation cycle.

Iliotibial band syndrome

y

o

Description: A fibrous ligament, called the iliotibial band, extends from the outside of the pelvic bone tothe outside of the tibia. When this band is tight it may rub against the bottom outer portion of the femur

(the lateral femoral condyle).

o Symptoms: Distance runners typically suffer from this condition. These runners complain of outside knee

pain usually at the lateral femoral condyle. Early on, the pain will typically come on 10-15 minutes into a

run and improve with rest.

o Treatment: The most important aspect of treating iliotibial band syndrome is to stretch the iliotibial band.

One way to do this is to place the right leg behind the left while standing with your left side about two to

three feet from a wall. Then, lean toward your left for 20-30 seconds using the wall to help you support

yourself. In addition to stretching the iliotibial band, PRICE therapy and NSAIDs may be of some help.

Knee Pain Prevention

Knee pain has a host of causes. Many types of pain are difficult to prevent, but you can do some general

things to reduce the likelihood of sustaining a knee injury.

Stay slim

y

o Staying slim reduces the forces placed on the knee during both athletics and everyday walking and may,

according to some medical research, reduce osteoarthritis.

o Keeping your weight down may also reduce the number of ligament and tendon injuries for similar

reasons.

Keep limber, keep fit

y o Many knee problems are due to tight or imbalanced musculature. Stretching and strengthening, therefore,

also help to prevent knee pain.

o Stretching keeps your knee from being too tight and aids in preventing both patellofemoral syndrome and

iliotibial band syndrome.

o Strengthening exercises particularly of the quadriceps (straight leg raises and leg extensions are two

excellent exercises, but please see a book on exercise and training for more) can help prevent knee

injury.

Knee Pain Overview

(continued)

Knee Pain Prevention continued...

Exercise wisely

y

o If you have chronic knee pain, consider swimming or water exercises.

o In water, the force of buoyancy supports some of our weight so our knees

do not have to.



o If you don¶t have access to a pool or do not enjoy water activities, at least

try to limit hard pounding and twisting activities such as basketball, tennis,

or jogging.

o You may find that your aching knees will act up if you play basketball or

tennis every day but will not if you limit your pounding sports to twice a

week.

o Whatever you do, respect and listen to your body. If it hurts, change whatyou are doing.

o If you are fatigued, consider stopping - many injuries occur when people

are tired.

Protect the knee

y

o Wearing proper protection for the activity at hand can help avoid knee

injuries.

o When playing volleyball or when laying carpet, protecting your knees may

include kneepads.

o When driving, knee protection may include wearing a seatbelt to avoid the

knee-versus-dashboard injuries as well as injuries to other parts of your body.

Good and Bad Exercises for Low Back Pain

Lower Back Pain:H

ow ExerciseH

elps

You may feel like resting, but moving is good for your back. Exercises for lower back pain can strengthen back,

stomach, and leg muscles. They help support your spine, relieving back pain. See which exercises can help low back

pain and which you should avoid. Always ask your doctor before doing any exercises for back pain.




Good and Bad Exercises for Low Back PainTry: Crunches

Lie with knees bent and feet flat on the floor. Cross arms over your chest or put hands behind your neck. Tighten

stomach muscles and raise your shoulders off the floor. Breathe out as you raise your shoulders. Don't lead with your

elbows or use arms to pull your neck off the floor. Hold for a second, then slowly lower back down. Repeat 8 to 12

times.




Good and Bad Exercises for Low Back PainAvoid: Toe Touches

Exercise is good for low back pain ² but not all exercises are beneficial. Some may aggravate pain. Standing toe

touches, for example, put greater stress on the disks and ligaments in your spine. They can also overstretch lower

back muscles and hamstrings.





Avoid: Sit-ups

Although you might think sit-ups can strengthen your core or abdominal muscles, most people tend to use muscles in

the hips when doing sit-ups. Sit-ups may also put a lot of pressure on the discs in your spine.


Good and Bad Exercises for Low Back PainTry: Hamstring Stretches

Lie on your back and bend one knee. Loop a towel under the ball of your foot. Straighten your knee and slowly pull

back on the towel. You should feel a gentle stretch down the back of your leg. Hold for at least 15 to 30 seconds. Do

2 to 4 times for each leg.




Good and Bad Exercises for Low Back PainAvoid: Leg Lifts

Leg lifts are sometimes suggested as an exercise to "strengthen your core" or abdominal muscles. But lifting both

legs together while lying on your back can make back pain worse. Instead, try lying on your back with your right leg

straight and left leg bent at the knee. Slowly lift right leg up about 6 inches and hold briefly. Lower leg slowly. Repeat

10 times, then switch legs.




Good and Bad Exercises for Low Back PainTry: Wall Sits

Stand 10 to 12 inches from the wall, then lean back until your back is flat against the wall. Slowly slide down until your

knees are slightly bent, pressing your lower back into the wall. Hold for a count of 10, then carefully slide back up the

wall. Repeat 8 to 12 times.





Try: Press-up Back Extensions

Lie on your stomach with your hands under your shoulders. Push with your hands so your shoulders begin to lift off

the floor. If it's comfortable for you, put your elbows on the floor directly under your shoulders and hold this position

for several seconds.


Good and Bad Exercises for Low Back PainTry: Bird Dog

Start on your hands and knees, and tighten your stomach muscles. Lift and extend one leg behind you. Keep hips

level. Hold for 5 seconds, and then switch to the other leg. Repeat 8 to 12 times for each leg, and try to lengthen the

time you hold each lift. Try lifting and extending your opposite arm for each repetition.




Good and Bad Exercises for Low Back PainTry: Knee to Chest

Lie on your back with knees bent and feet flat on the floor. Bring one knee to your chest, keeping the other foot flat on

the floor. Keep your lower back pressed to the floor, and hold for 15 to 30 seconds. Then lower your knee and repeat

with the other leg. Do this 2 to 4 times for each leg.




Good and Bad Exercises for Low Back PainTry: Pelvic Tilts

Lie on your back with knees bent, feet flat on floor. Tighten your stomach by pulling in and imagining your belly button

moving toward your spine. You¶ll feel your back pressing into the floor, and your hips and pelvis rocking back. Hold

for 10 seconds while breathing in and out smoothly. Repeat 8 to 12 times.Previous page Next page

Good and Bad Exercises for Low Back PainTry: Bridging

Lie on your back with knees bent and just your heels on the floor. Push your heels into the floor, squeeze your

buttocks, and lift your hips off the floor until shoulders, hips, and knees are in a straight line. Hold about 6 seconds,

and then slowly lower hips to the floor and rest for 10 seconds. Repeat 8 to 12 times.




Good and Bad Exercises for Low Back PainLifting WeightsMay Help

Done properly, lifting weights doesn't usually hurt your back. In fact, it may help relieve chronic back pain. But when

you have acute (sudden) back pain, putting extra stress on back muscles and ligaments could raise risk of further

injury. Ask your doctor whether you should lift weights, and which exercises to avoid.




Good and Bad Exercises for Low Back PainTry: Aerobic Exercise

Aerobic exercise strengthens your lungs, heart, and blood vessels and can help you lose weight. Walking, swimming,

and biking may all help reduce back pain. Start with short sessions and build up over time. If your back is hurting, try

swimming, where the water supports your body. Avoid any strokes that twist your body.Previous page Next page

Good and Bad Exercises for Low Back PainTry: Some Pilates Moves

Pilates combines stretching, strengthening, and core abdominal exercises. Under the instruction of an experienced

teacher, it may help some people with back pain. Be sure to tell your teacher about your back pain, because you may

need to skip some moves.




Low Back Pain: What Can You Do?


NEXT ARTICLE:

y Low Back Pain: What Can You Do?11 Tips for Back Pain ReliefBack Pain Medications Which drugs are used to relievelower back pain?

y Back Pain CausesBack Pain and Narcotic Painkiller AddictionAlternative Treatments for Back Pain11 Ways toAvoid Back Pain

WebMD Medical Reference

Reviewed By BrunildaNazario, MD

If you¶ve been sidelined by a sore back, you¶re not alone. Four out of five people experience back pain at some point,

making it the fifth most common reason for visiting the doctor.

Back pain takes various forms, from a persistent dull ache to sudden sharp pain, and has many causes. Sometimes it

results from a sprain, fracture, or other accidental injury. It can stem from a disease or medical condition, such as

arthritis, fibromyalgia, or spinal stenosis (a narrowing of the spinal canal through which the spinal cord runs). Many

people develop back pain simply because they¶re overweight or sedentary.



The good news is that most lower back pain usually gets better within a few days or weeks, and surgery is rarely

necessary. What¶s more, simple self-help strategies such as these can be surprisingly effective at preventing back

pain and keeping it from returning:

1. Get more exercise. If your back is hurting, you may think the best way to get relief is to limit exercise and to rest.

A day or two of rest may help, but more than that may actually increase your pain. Experts now know that physical

activity helps ease inflammation and muscle tension by keeping blood and nutrients flowing to the affected area.

When you exercise, always start and end with stretches.

2. Watch your weight. Extra pounds, especially in your midsection, can make back pain worse by shifting your

center of gravity and putting strain on your lower back. Staying within 10 pounds of your ideal weight will help control

back pain.

3. If you smoke, stop. Because nicotine restricts the flow of nutrient-containing blood to spinal discs, smokers are

especially vulnerable to back pain.

4. Sleep on your side. If you¶re prone to back pain, sleep on your side with your knees pulled up slightly toward your

chest. Prefer to sleep on your back? Put one pillow under your knees and another under your lower back. Sleeping

on your stomach can be especially hard on your back. If you can¶t sleep any other way, place a pillow under your

hips. No matter how you sleep, a firm mattress is probably best. To firm up a soft mattress, you can place a half-inch-

thick plywood board underneath.

5. Pay attention to your posture. The best chair for preventing back pain is one with a straight back or low-back

support. Keep your knees a bit higher than your hips while seated. Prop your feet on a stool if you need to. If you

must stand for a prolonged period, keep your head up and your stomach pulled in. If possible, rest one foot on a stool

-- and switch feet every five to 15 minutes.

11 Ways to Avoid Back Pain(continued)

continued...

6. Be careful how you lift. Don¶t bend over to lift heavy objects. Bend your knees and squat, pulling in your stomach

muscles and holding the object close to your body as you stand up. Don't twist your body while lifting. If you can,

push rather than pull heavy objects. Pushing is easier on the back.

7. Avoid high heels. They can shift your center of gravity and strain your lower back. Stick to a one-inch heel. If you

have to go higher, bring along a pair of low-heeled shoes and slip into them if you become uncomfortable.

8. Stash the skinny jeans. Clothing so tight that it interferes with bending, sitting, or walking can aggravate back

pain by causing poor posture and misalignment of the spine.

9. Lighten your wallet. Sitting on an overstuffed wallet may cause discomfort and back pain. If you¶re going to be

sitting for a prolonged period -- while driving, for example, take your wallet out of your back pocket.

10. Pick the right handbag or briefcase. Buy a bag or briefcase with a wide, adjustable strap that¶s long enough to

reach over your head. A messenger bag (like the ones bike messengers wear) is made to wear this way. Having the



strap on the opposite shoulder of the bag distributes the weight more evenly and helps keep your shoulders even and

your back pain-free. When carrying a heavy bag or case without straps, switch hands frequently to avoid putting all

the stress on one side of the body. To lighten the load, periodically purge bags, cases, backpacks, and other carriers

of things you don't need.

11. Forget about back braces. Various back supports are available, from elastic bands to special corsets. They can

be helpful after certain kinds of surgery, but there is not much evidence that they help treat chronic back pain. By

immobilizing and thus weakening back muscles, back braces may actually aggravate back pain.

Low Back Pain: What Can You Do?


NEXT ARTICLE:

y Low Back Pain: What Can You Do?

y 11 Tips for Back Pain ReliefBack Pain MedicationsBack Pain CausesBack Pain and Narcotic Painkiller

AddictionAlternative Treatments for Back PainAlternative Treatments for Low Back PainFrom acupuncture to biofeedback, natural ways to relieve lower back pain.

WebMD Feature

By David Freeman

Reviewed By BrunildaNazario, MD

From acupuncture to yoga, many different alternative treatments purport to relieve chronic back pain. Which are

worth trying?

³As long as you¶ve had your back pain problem checked out by a doctor to rule out a serious disease, it would be

reasonable to try any of a number of alternative treatments,´ says Daniel C. Cherkin, PhD, a senior investigator at

Group Health Research Institute in Seattle who has conducted research on alternative medical techniques for back

pain.

Of course, experts say it¶s best to stick with the alternative treatments that are proven to be safe and potentially

effective. Here are seven:

Acupuncture. Can inserting needles in your body really relieve lower back pain? Recent studies, including a

randomized trial of acupuncture published in the Archives of Internal Medicine, suggest that it may. The only question

seems to be why this ancient healing tradition works.

Practitioners of traditional Chinese medicine maintain that the needles affect the flow of a ³vital energy´ known as qi

(pronounced chee) within the body. Some scientists suggest that it works by triggering the release of natural

painkillers known as endorphins.



Donald B. Levy, MD, medical director of Brigham and Women¶s Hospital¶s Osher Clinical Center for Complementary

and Integrative Medical Therapies in Chestnut Hill, Mass., says that how acupuncture works may not matter, at least

from the patient¶s perspective. ³I can¶t explain how my car works,´ says Levy, who is also an assistant clinical

professor of medicine at Harvard Medical School in Boston. ³I just know that if I turn the key properly in the ignition, it

starts.´

Acupuncture needles typically stay in place for 20 to 30 minutes, and several sessions may be required.

Alexander technique. This type of physical therapy uses hands-on training to teach people to avoid specific

postures and ways of moving that cause pain by placing undue strain on the musculoskeletal system. It pays

particular attention to releasing tension in the neck, back, and spine. Its name comes from an Australian actor named

F. M. Alexander, who developed the technique.

There isn't a lot of research on the Alexander technique, but one study published in the journal BMJ showed that

people given one-on-one training in the technique reduced their back pain. "This is an effective technique to improve

pain and function in the long term," one of the study's authors, Paul Little, PhD, professor of primary care research at

the University of Southampton in England, told WebMD in an email. But "it's not a magic bullet. It requires time and

application."

Biofeedback. This high-tech treatment can help you learn to loosen tight muscles by using your mind to control your

body. To learn biofeedback, sensors are applied to your body that give continuous feedback about body functions

such as heart rate, breathing, blood pressure, muscle tension, and brain wave activity. A biofeedback therapist

teaches you relaxation techniques so you can see how to control a specific body function. As you become aware of

the connection between the mind and the body, you may be able to reduce muscle tension and relieve pain.

Alternative Treatments for Low Back PainFrom acupuncture to biofeedback, natural ways to relieve lower back pain.

(continued)

continued...

Although there¶s no compelling evidence to show that biofeedback works specifically for chronic back pain, there is

evidence that it can ease chronic pain generally. It¶s worth a try, Cherkin says.

Chiropractic. Chiropractic¶s signature treatment, spinal manipulation, may help relieve back pain. The National

Center for Complementary and Alternative Medicine reports that spinal manipulation ³appears to be as effective as

conventional treatments.´

³We don¶t know what¶s going on in the body [during spinal manipulation],´ says William C. Meeker, DC, president of Palmer College of Chiropractic in San Jose, Calif. ³But we know that it alleviates sensations of pain and soreness and

increases joint mobility.´

During your first visit, the chiropractor will usually take a medical history and do a physical exam that focuses closely

on the spine. In subsequent visits, the chiropractor will use twisting, pulling, or pushing movements to adjust the

bones and joints in your spine. The chiropractor may also use heat, electrical stimulation, or ultrasound to relax your

muscles.



Physical therapists, osteopaths, and even some conventional medical doctors use spinal manipulation, too. Health

insurance plans often cover the cost of chiropractic care.

Massage. It feels good to get a massage, and massage does ease the muscle tension that often accompanies back

pain. Though few studies have looked at massage as a remedy for chronic back pain, Cherkin says all showed

positive results. Cherkin's own study, the largest of its kind, showed that back pain sufferers treated with 10 weekly

massage visits got long-lasting pain relief.

Meditation. A kind of meditation known as mindfulness may help ease chronic back pain, possibly by changing

emotions that tend to make pain worse. ³The emotional component of pain cannot be overestimated,´ says Natalia E.

Morone, MD, assistant professor of medicine at the University of Pittsburgh School of Medicine.

³Mindfulness helps people become aware of thoughts, emotions, and sensations without judging them,´ Morone says.

She says that the overall pain-relieving effect of mindfulness appears small, though some people who participated in

her studies experienced dramatic pain relief. Others said that, although they continued to have back pain, it didn¶t

bother them as much.

Yoga. For anyone with a bad back, learning yoga might sound like the ultimate bad dream. Why would anyone

wracked with pain want to try poses (asanas) with names like "Cobra Posture" and "Supine Butterfly?" But research

suggests that this ancient movement-and-meditation technique can ease chronic back pain. In one study, people with

back pain who took 12 classes learning a gentle, easy-to-do form of yoga known as viniyoga had pain relief that

lasted at least several months.

"Yoga was clearly better than self-care," says one of the study¶s authors, Karen J. Sherman, PhD, senior investigator

at Group Health Research Institute. "It's certainly worth trying, but only if you're willing to practice." She recommends

finding a yoga instructor who has experience working with people who have back pain, and cautions that physically

demanding forms of yoga could actually make back pain worse.

arthritis and tendinitis

Documents