Knee Pain

Knee Pain Overview


If you are suffering from knee pain, see a doctor / orthopedic surgeon who can determine the
cause and prescribe an appropriate treatment and pain management plan.
This site covers only the more common types of knee pain. It will familiarize you with
various causes, treatments, and prevention of knee pain, but please do not attempt to diagnose
yourself.
The knees are the most easily injured part of the body. The largest and most complicated
joint, the knee is used for everything from standing up, sitting, to walking, running, etc. It's a
weightbearing joint that straightens, bends, twists and rotates. !ll this motion increases your
risk of acute or overuse knee injuries.
Acute knee injuries "including torn ligaments and torn cartilage# are often caused by twisting
the knee or falling. $ports that involve running and jumping and sudden stopping and turning,
such as soccer, basketball, volleyball, tennis, and baseball, as well as contact sports such as
football, wrestling, and hockey increase the risk of an acute knee injury.
But more common than sudden knee injuries are injuries caused by overuse or overload.
Overuse knee injuries "including muscle strain, tendonitis and bursitis# may develop
gradually over days or weeks. %ain is often mild and intermittent in the beginning and
worsens over time. &hen muscles and tendons are stressed even slightly beyond their
capabilities, microscopic tears occur. "Inflammation, which is part of the healing process, is
what causes the pain#. These tears must be given a chance to heal before subjected to the same
activity to avoid overuse injury. Treat overuse injuries early to prevent chronic problems.
Knee pain is commonly caused by doing too much too soon when you haven't e'ercised for
a long period of time especially highimpact aerobics( walking, running or jumping on hard
surfaces or uneven ground( e'cessive running up and down stairs "&hen you walk upstairs
you are putting pressure on your knees that is e)uivalent to four times your body weight,
when running up the stairs it can be eight times your body weight#.
Knee osteoarthritis is a common cause of knee pain. The risk increases with age.
*steoarthritis is a form of arthritis involving degeneration of the cartilage. +'ercise is vital to
maintain strength and fle'ibility of muscles supporting the knee, which reduces the stress on
the knee joint.
%eople with knee osteoarthritis may also need to take pain medications and/or other
complementary pain treatments.
unners knee "also called patellofemoral pain or anterior knee pain# is a common cause of
knee pain in young people "not just in runners#. The pain is usually diffuse pain behind the
kneecap. $ymptoms often worsen after climbing stairs, jumping, running, or after a period of
sitting. ,aused by poor tracking of the kneecap, appropriate e'ercises prescribed by a doctor
or physical therapist is the main treatment in correcting runners knee. $tay away from high
impact activity if you have this condition.
Prevent knee pain by keeping the muscles that support your knees strong and fle'ible. $tart
out slowly. &alk before you run before you engage in a strenuous high impact activity such
as jogging or running, try walking for a week. If walking causes knee pain, you shouldn't be
running. &arm up and stretch before working out. -ive your body a chance to recover from
e'ercise. If you do high impact activities take every other day off. !void running up and down
stairs and full s)uats. !oing knee e"ercises to strengthen and stretch the muscles that support
the knee are vital for knee pain and injury prevention. %roper footwear is also important,
especially if walking or running on hard surfaces. .eep your weight under control. /educing
one's weight reduces stress upon the knee.
#ost knee pain is treated conservatively, but there are situations in which surgery is
re)uired. !thletes are at an elevated risk for sudden injuries that may re)uire surgery, such as
torn ligaments in the center of the knee or certain types of fractures. %eople with advanced
knee osteoarthritis may need knee replacement surgery if they are severely limited in dayto
day activities because of their condition. This is optional surgery and is a last resort.
0ost knee conditions respond to a combination of noninvasive treatments such as applying
heat or cold, temporarily restraining from activities that aggravate pain, and medications that
target pain and inflammation. +'ercises to strengthen the muscles that support the knee help
reduce stress on the knee joint and prevent reinjury.
K$%% %&%'()%)

%lease read the entire .nee +'ercises page before attempting the e'ercises further down the
page. If you are e'periencing knee pain, ask your doctor or physical therapist what e'ercises
are appropriate.
Exercises Can Prevent Injury
)trengthening the muscles that support the knee with knee e'ercises is most important in
protecting your knees from injury and knee pain.
&eak or fatigued muscles cannot ade)uately support the knee joint or absorb shock before it
gets to the knee and the e'tra stress placed upon the knee can cause injury to the structures of
the knee. $trengthening e'ercises can make the muscles tight, so follow strength e'ercises
with stretching e'ercises.
)tretching the muscles that support the knee with knee e'ercises is also important in
preventing injury. 1le'ible muscles are not as easily injured as tight muscles. Tightness of
muscles connected to the knee can also pull the knee out of alignment.
&hen doing stretching knee e'ercises, be careful to go slowly and not to overstretch. 2ou do
not want to tear a muscle.
You need to increase the duration of your knee exercises gradually to avoid overuse injuries
and knee pain. Be patient. You will see results.
)trength must be built up gradually. &hen muscles, tendons or ligaments are stressed
slightly beyond their limits, microscopic tears occur. This is normal, and as these tears heal
the muscles actually become bigger, firmer and stronger. These microscopic tears must be
given ade)uate time to heal or chronic problems can develop. Try not to e'ercise the same
muscle groups two days in a row to give your body a chance to recover. 3oing strengthening
knee e'ercises three or four times a week is enough. $tretching knee e'ercises can be done
more often.
The goal is to prevent injury and knee pain* not cause it.
3on4t ignore pain. %ain is your body4s way of protecting you from hurting yourself further. It
is not unusual to e'perience mild stiffness and aching of the muscles that lasts up to a day
after e'ercising. 5ut hardly being able to move for a few days after e'ercising means you
have overdone it. It4s difficult to know when to )uit when you doing knee e'ercises. *ften,
the pain doesn't4 set in until a day or two later. It happens. If it does, you will have a greater
understanding of your body4s limitations.
+hen you have overdone your knee e"ercises.
/est is important for inflamed muscles/tendons. !pplying ice wrapped in a cloth can help
reduce inflammation and pain and speed up healing. $ee Treatment for *veruse Injuries. .nee
pain should be completely gone before fully resuming your knee e'ercises program, however,
lightly e'ercising the sore muscle may help decrease muscle soreness.
(f you are currently e"periencing knee pain and/or have a very limited range of motion, or
are not sure which knee e'ercises are safe for you to do, see a physical therapist
"physiotherapist#. ! doctor or physical therapist can assess your condition and give you a
customized treatment / e'ercise plan.
0ain 0uscle -roups !ffecting .nee $tability
$everal muscle groups support the knee. The two main muscle groups that control knee
movement and stability are the )uadriceps and the hamstrings.
T,% -.A!('%P) is a fourpart powerful muscle that run along the front of the thigh and
attach to the front of the shinbone, just below the knee. The /uadriceps control the
straightening of the knees and movement of the kneecap. The )uadriceps is used to e'tend
the leg, and is essential for standing up, walking upstairs, walking uphill, and running.
T,% ,A#)T($0) are muscles that run make up the back of the thigh, and attach to the
back of the shinbone, just below the knee. The hamstrings are used to bend the knee and are
also needed when you are pushing against something.
Other #uscles Affecting Knee )tability
*ther muscles that affect knee stability, to a lesser degree than the )uadriceps and hamstrings
are the calf muscles, the hip abductors located on the outer thigh, and the hip adductors
located on the inner thigh. The body functions as a unit "remember the hip bone's connected
to the knee bone# and even muscles not near the knee can contribute to knee stability.
The iliotibial band "fibrous tissue on the outer thigh, e'tending front the hip to below the
knee# also affects knee stability. The glutes "back of hip muscles / buttocks# inserts into the
thigh bone and iliotibial band and also help stabilize the knee.
6It is important to do strengthening exercises for all the muscles that support the knee. or
example! if you concentrate on strengthening exercises for the "uads! and neglect
strengthening exercises for the hamstrings a muscle im#alance can #e created.
Im#alances in $uscles %upporting the &nee
(mbalances in #uscles )upporting the Knee
A physical therapist 1physiotherapist2 can help determine if you have a muscle imbalance in
the muscles supporting the knee and create a personalized e'ercise program.
Imbalance of the )uadriceps is common, especially in women The )uadriceps is divided into
7 divisions. If the inner division if weak, the stronger outer division tends to pull the kneecap
toward the outer side of the leg. Tightness of the )uads can also pull the knee towards one side
so stretching as well as strengthening of muscles that support the knee is important.
In some cases, the )uadriceps is significantly stronger than the hamstrings. "The )uadriceps
should only be about 89: stronger than the hamstrings#. This can cause weakness of the knee.
If this is the case, concentrating on strengthening e'ercises for the hamstrings, and stretching
e'ercises for the )uadriceps are very helpful.
Knee %"ercises
6;*T+< *nly do one e'ercise per muscle group on the same day. There are several e'ercises
to choose from for some muscles.
$trengthening .nee +'ercises
)trengthening Knee %"ercises
&arming up with 9 minutes of lowimpact aerobics, such as walking or riding a stationary
e'ercise bike, increases blood supply to the muscles to help prevent injury and stiffness.
-uadriceps )trengthening
-uad )trengthening 'ontractions3
$it in chair. +'tend legs, heels to floor. .eep knees straight "or as straight as possible if you
have arthritis.# Tighten thigh muscles. =old for count of >?. /ela' for count of @. 3o >?
repetitions. 2ou can do this several times throughout the day. 2ou can build up to 8 or @ sets
of >? repetitions at a time.
-uad )trengthening 4eg lifts3
Aie flat on back. 5end left knee at B?degree angle, keeping foot flat on floor. .eeping the
right leg straight, slowly lift it to the height of the left knee. =old for a count of @. /epeat >?
times. $witch sides. &ork up to >? sets of >? over several weeks.
%afety 'ip(
)eg lifts( )ifting #oth legs at the same time causes excessive stress on your lower #ack so
only lift one leg at a time* the opposite leg should #e kept slightly #ent with foot on floor.
-uad )trengthening )hort5Arc 4eg %"tensions<
$it or lie on floor. %lace a rolled up towel under your thigh for support. .eep you leg straight
and raise your foot about si' inches off the floor. =old for 9 seconds. $lowly lower your foot,
bending your knee. 3o >? repetitions. $witch sides.
-uad )trengthening Knee !ips3
$tand with knees slightly fle'ed. %oint your toes straight ahead.
0ake sure your kneecaps are also pointed straight ahead.
Aift one leg up and balance on the other leg. $lowly lower yourself up and down *;A2 a few
inches. .eep the knee of the leg you are balancing on slightly fle'ed. 2our knees must remain
pointing straight forward. 3o not let them turn inward. $tand straight, do not lean you body to
one side. 3o >? dips. $witch sides.
If you feel pain in your knees, start with fewer dips.
-uad )trengthening Partial )/uats3
3ouble leg partial s)uat< $tand. .eep 5ack Cpright. .nees pointing straight ahead inline
with feet and hips. $lowly lower yourself. 3on't bend your knees beyond a B?degree angle, if
B? degrees is too difficult bend even less.
%afety 'ip( $ake sure your knees do not extend #eyond your toes when doing partial s"uats.
&eeping your weight #ehind your knees reduces the pressure on the knee joint during the
s"uat. Bending the knees #eyond +, degrees -a right angle. places excessive strain on the
knee.
,amstring )trengthening
,amstring )trengthening 'ontractions3
$it in chair, heels on floor. 3on't move heels but pull back on them. 2ou will feel tension in
you hamstrings. =old for count of >?. /ela' for count of @. 3o >? repetitions.
=amstring $trengthening ,urls<
Aie on stomach. %lace left foot onto the back of the right heel. $lowly pull your right heel
toward your buttocks resisting with the left leg. This contracts the hamstrings. =old for a
count of >?. ".eep pressing your left foot and right heel against each other# =old for a count
of ten and rela' for count of @. 3o >? repetitions.
&alking backwards helps to develop the hamstrings. &hen walking backwards, your weight
is distributed more evenly, resulting in less strain on your knees.
Other )trengthening %"ercises for Knee )tability
,ip Adductors 1(nner Thigh2 6 groin muscle and inner /uad muscle 17#O2
)trengthening3
$it in chair, put fist between knees, s)ueeze together knees. =old for count of >?. /ela' for
count of @. 3o >? repetitions.
Aie on floor on your right side, shoulder and hips aligned. Cse your right hand to prop up your
head. %lace the left hand on floor in front of you to help balance yourself. 5end left leg and
bring it to the floor in front of you. $lowly raise your right leg about >? inches off the floor
then, hold for a second, then slowly lower leg to ground. Aift >? times on each side.
,ip Abductors 1Outer Thigh2 strengthening3
Aie on floor on your right side, shoulder and hips aligned.
5end right leg "leg on floor# to B? degrees.
$lowly raise you left leg about >D inches, hold for a second, then slowly lower leg.
3o >? repetitions. /epeat on other side.
0lutes )trengthening Backward leg swing3
=old onto back of chair for support. $wing leg back at a diagonal until you feel your buttocks
tighten. Tense muscles as much as you can and swing leg back a couple more inches. /eturn
leg to floor. /epeat >? times.
$witch sides.3o >? repetitions. /epeat on other side.
Balancing Knee %"ercises
1helps in knee stability2
=old onto back of chair or counter top for support. $tand on one leg for one minute. $witch
sides.
!s your balance improves, use one hand only for support. ;e't use one finger only for
support, then progress to letting go, but keeping your hands within a couple of inches above
chair in case you lose your balance. 3o not lean your trunk to one side.
To increase difficulty, shift weight onto the ball of the foot.
$tretching .nee +'ercises
;o bouncing, slow E controlled fashion, 9>? minutes aerobics warm up first "e.g. walking,
stationary bike# 0uscles warmed up are more responsive to stretches and less likely to tear.
'alf #uscles )tretch3
$tep back with left, forward with right, lean forward with hips. 3o not roll foot out to side.
.eep heel flat, foot forward. 5end knees for alternate stretch. =old @? F? seconds.
-uad #uscle )tretch3
5ring heel to hip with hand. .eep knees together. 3o not arch back. 3o not leg go to side.
=old for @? seconds. /epeat on other side.
,amstring )tretch3
$tanding position
.eep one leg on ground( put one foot on chair with leg straight. 5end forward at the hip. 3o
not attempt to touch your toes as this will stretch your back, and the goal of this e'ercise is to
isolate your hamstring muscles in the leg that is being supported by the chair.
$itting in chair hamstring< $traighten one leg, keeping heel on floor. Aean forward at hips,
keeping back straight. 3on't try to touch your toes. =old for @? seconds. /epeat on other side.
(liotibial Band )tretch3
$tanding position<
$tand up. ,ross right leg behind left leg moving crossing knee beyond the midline of the
body. Aean from the hips to the left, the stretch being felt on your right hip, side of the leg and
knee. =old for @? seconds. /epeat on other side.
$itting position< $it in chair< 5ring right foot to outside of left leg, bringing knee towards
opposite shoulder so that the knee crosses the midline of the body. =old for @? seconds.
/epeat on other side.
,ip Adductors 1(nner Thigh2 )tretch3
$tanding< $tep off to the side with the right leg. Then lean away from the leg "bending your
left knee#
$itting position< $it on floor, spread legs into a v position. $lowly lean forward from your
hips, keeping your back straight, until you feel the stretch. 3o not bounce. Then lean towards
the right, foot then left foot. =old each position for @? seconds.
,ip Abductors 1Outer Thigh2 )tretch3
$it on the floor,legs e'tended in front of you.
5end right leg and place right foot on floor on outside the left knee.
Twist upper body to right and use left elbow to gently push against outside of right nee until
you feel a gentle stretch in the right hips, buttocks, and lower back.
=old for @? seconds. /epeat on other side.
,ip fle"ors 1front of hips2 )tretch3
Tightness in these muscles can affect the alignment of the knee bones.
$tanding +'ercise< $tep forward with the right leg, bending right knee. .eep back upright.
This stretches the front of the hip on the left side. .eep left knee slightly bent also.
=old for @? seconds. /epeat on other side.
0luteal )tretch 1back of hips 6 buttocks23
$tand in front of chair, about two feet away from chair. %lace left foot on chair, leg bent. 5ring
your chest towards your knee, keeping back straight. =old for @? seconds. /epeat on other
side.
8Of all the above knee e"ercises, the )uadriceps strengthening contraction is probably the
easiest, safest and most important e'ercise you can do to prevent knee pain and injury. Those
who have trouble fitting in e'ercises into their schedule can always do this e'ercise while
watching television.
Knee5)afe Aerobics. Aowimpact e'ercises with minimal risk to the knee joint.
4ow5(mpact Aerobic %"ercises

!erobic e'ercise benefits those with knee problems by toning the muscles of the leg that
support the knee joint to absorb shock before it reaches the knee joint.
!erobic e'ercises also help in weight reduction. Aosing weight reduces stress on the knee
joint the impact placed upon on the knees is three times the body weight while walking.
!erobics also stimulate your the body to release endorphins natural painkillers produced by
one's own body.
!erobic e'ercise is important for the health of the heart, lungs, and overall function of the
body. =owever, highimpact e'ercises place e'treme stress on the weight bearing joints.
Those with knee problems should avoid high impact e'ercises. If you want to prevent future
knee problems and knee pain you may want to replace high impact activities with low impact.
&arm up before aerobic e'ercise to slowly increase your heart rate and breathing rate. 1ive
minutes of slow paced walking, and a few minutes of stretching are sufficient. ,ooling down
in the same manner is also important be sure to stretch your )uadriceps and hamstrings.
.now when to stop. *nce your muscles are fatigued, they can't absorb as much shock, and the
e'tra stress is offloaded to the joints, tendons, and ligaments. Taking every other day off will
give your body a chance to repair itself and prevent overuse injury.
3uring pregnancy, hormones that allow the pelvic bones to become more fle'ible also cause
the ligaments and tendons to loosen. This increases the chance of injury of a joint, especially
during highimpact e'ercises. ,heck with your doctor or physical therapist "physiotherapist#
as to the safety of an e'ercise
ecommended 4ow5(mpact Aerobic %"ercises
+alking3 5e sure to have proper shoes with ade)uate cushioning and support. &alk on even
surfaces. $tart with about 9 minutes of slower paced walking to warm up. &alk at a medium
pace for about another >? minutes per day and gradually build up to @? F? minutes by
adding a few minutes each time you walk. +nd your walk with 9 minutes of slower paced
walking. !fter you get into better shape you can start walking at a faster pace to increase the
intensity of your walks. 2ou can increase the intensity level even more by swinging your arms
as you walk. 2ou should be about to talk while you are walking, otherwise you may be
overe'erting yourself.
)wimming and +ater %"ercises3 If you have access to a swimming pool, swimming is an
e'cellent noimpact e'ercise. /egular 'land' e'ercises can also be done underwater. The
buoyancy of the water supports most of the body's weight while the resistance of the water
make your muscles work harder to perform movements. 2ou can use dumbbells and weights
strapped to the ankles to intensify the workout without stressing the knees and other weight
bearing joints.
*verweight people in particular may find that walking aggravates knee pain. &alking
underwater makes it possible for those with knee pain to get a good aerobic without stressing
the joints. 0ost public swimming pools offer water e'ercise classes.
0any public pools offer water e'ercise classes specifically geared to people with arthritis.
The water is usually between waistdeep to chestdeep so one doesn4t have to know how to
swim.
)tationary bikes< 0ake sure your seat is high enough so that your knees are not bent beyond
a B?degree angle. 2our knee should be slightly bent when your pedal is furthest away. !n
upright stationary bike "looks like a regular bike# gives you a higher intensity work out than a
recumbent bike. ! recumbent bike reclines and usually offers bucket seats and cushioned back
support. It may lesson the strain on your knees and lower back.
%lliptical Trainer3 +'ercising on an elliptical trainer Is as low impact as walking but can
provide a higher intensity cardio workout. The elliptical trainer is a cross between a stair
climber and stationary bicycle. It is designed to use all of the body's main muscle groups and
is a great way to get into shape and lose weight without sacrificing your knees.
Proper 1ootwear helps absorb shock and provides support. +ven with lowimpact e'ercises,
proper shoes are important.
Tip 3 3rink lots of water to prevent dehydration, drinking 8 cups of water before you start,
and > cup for each >9 minutes of aerobic e'ercise.
!cute and *veruse .nee Injuries

Acute knee injuries occur suddenly from falling awkwardly, a forced twisting of the knee, a
blow to the knee, etc.
!cute knee injuries include knee sprain "torn knee ligaments usually the acl#, torn knee
cartilage "torn meniscus#, ruptured knee tendon, and knee fracture.
Overuse knee injuries are usually caused by increasing the intensity or duration of an activity
increasing too )uickly.
*veruse knee injuries include knee tendonitis, knee bursitis, iliotibial band syndrome, and
muscle strains. *veruse also contributes to runners knee.
/ead on for more information on these common knee injuries / conditions..
A'.T% K$%% ($9.(%)
Torn A'4 1also called Knee )prain or Torn 4igament2
1our ligaments help stabilize the knee. Aigaments of the knee limit how far the bones of the
joint "the thighbone and shinbone# can move to prevent dislocation of the knee joint. The two
cruciate ligaments cross over each other on the inside the knee joint and limit fronttoback
motion. The two collateral ligaments are outside the knee joint and limit sidetoside motion.
Aigaments on the outside of kneecap usually heal by themselves. Aigaments in the center of
the knee rarely heal by themselves "because they are bathed in joint fluid and lack a blood
supply# and may re)uire reconstructive surgery. $urgery is not always necessary.
The A'4 "anterior cruciate ligament#, located in the center of the knee, is the most commonly
injured ligament in the knee. !,A injuries are most common in people who play sports and
women in sports are much more likely than men to tear this ligament. Twisting the knee is a
common cause of overstretched or torn ligaments of the knee.
)ymptoms of Torn A'43
The knee may give out suddenly when the !,A is torn and there may be a popping sound
upon injury. $ymptoms of a torn !,A include knee pain, swelling, stiffness, and bruising.
&alking is painful and the knee feels instable. The feeling of instability is caused by the bones
in knee joint sliding too far "this can result in damage cartilage#.
)eek (mmediate #edical Attention for Acute Knee (njuries. &hile waiting to see the
doctor, to reduce swelling and pain apply ice immediately and leave on >9 8? minutes per
hour. +levate the knee above heart level if possible. &rapping the knee in an !,+ bandage
"elastic bandage# provides compression and also helps limit swelling.
Treatment of Torn A'4
The !,A cannot heal because of lack of blood supply. If the tear is small, the knee may be
relatively stable and surgery may not be necessary. +'ercises to strengthen the muscles that
support the knee can help compensate for the lack of ligament stability.
&hether or not surgery is considered depends upon whether a person is active in sports. 5eing
able to function ade)uately in daily activities is often possible with a torn !,A. 5eing able to
safely perform the pivoting and sharp turning movements re)uired in many sports cannot be
safely performed with a torn !,A.
A'4 econstruction
If surgery is performed it is usually several weeks after the injury occurs to allow
inflammation to subside. The !,A is not actually repaired, but reconstructed. The !,A is
removed and reconstructed from a grafting a segment of a large tendon or ligament. !s in any
surgery, there are risks such as blood clots and infection.
,rutches are usually used for a couple of weeks following the surgery. 1ull recovery may take
several months and varies from patient to patient. =ighimpact activities must be avoided
until the knee has recovered sufficiently. ;ormal activities can be resumed before highimpact
activities. Aowimpact activities such as swimming help strengthen the muscles that support
the knee joint "to take some load off the ligaments# without straining the joint.
Torn #eniscus 1Torn 'artilage2
The meniscus "meniscal cartilage# is a spongy shock absorber that separates the thighbone
and shinbone. This is the cartilage referred to when you hear Gtorn cartilage.G There are two
menisci in the knee the medial "inner# meniscus and the lateral "outer# meniscus.
#eniscal tears may occur during participation in sports, often when the knee is twisted. These
types of tears are usually vertical. 3egenerative changes occur in the meniscus with aging,
and meniscal tears may occur as a result. These types of tears are often horizontal. The
degenerative tear may occur while kneeling or without any specific incident. $ometimes the
person may not recall any specific injury.
)ymptoms of #eniscus Tear
There may be a popping sound upon injury. 0ost people are able to walk immediately after a
meniscus tear but begin limping as swelling sets in. $ymptoms include pain along the inner or
outer side of the knee, stiffness, swelling, and sometimes HlockingI of the knee. ! piece of
torn cartilage may get caught between moving parts of the knee joint and limit motion or lock
the joint. ! clicking sound may be heard when moving the knee. The pain may be worse when
s)uatting.
)eek (mmediate #edical Attention for Acute Knee (njuries. &hile waiting to see the
doctor, to reduce swelling and pain apply ice immediately and leave on >9 8? minutes per
hour. +levate the knee above heart level if possible. &rapping the knee in an !,+ bandage
"elastic bandage# provides compression and also helps limit swelling.
Treatment of Torn #eniscus
Cnless it is a small tear on the outer edge, a torn meniscus will not heal on its own because of
its lack of blood supply in its center. ! meniscus tear sometimes can be repaired with sutures,
but more often the damaged area of the meniscus is trimmed. The torn piece of meniscus may
be surgically removed through arthroscopic surgery. !s in any surgery, risks include blood
clots and infection. 1ull recovery takes up to si' weeks.
;ot all meniscus tears re)uire surgery. $ome people can function with a torn meniscus. %ain
and swelling often resolve within F weeks, even though the meniscus hasn4t actually healed.
$urgery is often recommended. 3epending upon the nature of the tear, a torn piece of
cartilage may cause damage to the smooth cartilage that covers the ends of the knee bones. If
the knee becomes locked, normal functioning is not possible and the muscles that support the
knee weaken from lack of normal use.
The meniscus plays an important role in absorbing shock. If the entire meniscus or a large part
of the meniscus is removed, the knee usually develops degenerative arthritis "osteoarthritis#
within ten years. The articular cartilage that covers knee bones to help them glide over one
another breaks down. !voiding highimpact activities may slow down damage to the articular
cartilage. $trengthening the muscles that support the knee, especially the )uadriceps, help take
stress off the knee joint and may also slow down the development of osteoarthritis.
Knee :ractures
,aused by a forceful blow to knee as in contact sports or a fall. $ymptoms are knee pain,
moderate to severe swelling, there may be an inability to walk or to withstand weight on leg
and/or muscles going into spasms upon slightest movement of knee. Jray can confirm
fracture. $ometimes the knee being set in a splint or cast is enough. &hether or not surgery is
re)uired depends on the type of fracture.
)eek (mmediate #edical Attention for Acute Knee (njuries. &hile waiting to see the
doctor, to reduce swelling and pain apply ice immediately and leave on >9 8? minutes per
hour. +levate the knee above heart level if possible. &rapping the knee in an !,+ bandage
"elastic bandage# provides compression and also helps limit swelling.
uptured Tendon 1Torn Tendon2
Tendons attach muscle to bone. The )uadriceps tendon and patellar tendon connect to form
one continuous tendon that covers the patella "kneecap#. The )uadriceps tendon connects )uad
muscles to the patella( the patellar tendon connects the patella to the shinbone.
If the )uadriceps contract forcefully and suddenly "as when trying to break a fall#, the tendon
may tear where it attaches to the bone "either above or below the kneecap#.
If the tendon is completely torn, bending and e'tending the leg will be difficult "not just
because of the pain#.
! completely torn tendon can be surgically reattached. If the tendon is only partially torn,
surgery may not be necessary. ! cast is usually worn for several weeks. &hen the leg is
immobilized, muscles and tendons weaken. /ehabilitative e'ercises help restore strength and
fle'ibility to the knee/leg.
)eek (mmediate #edical Attention for Acute Knee (njuries. &hile waiting to see the
doctor, to reduce swelling and pain apply ice immediately and leave on >9 8? minutes per
hour. +levate the knee above heart level if possible. &rapping the knee in an !,+ bandage
"elastic bandage# provides compression and also helps limit swelling.
Tendonitis is inflammation of a tendon. Tendonitis of the knee may be caused an acute injury
but is more often caused by overuse. $ee overuse knee injuries below.
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*ften caused by the intensity or duration of an activity increasing too )uickly, common
overuse injuries include tendonitis, bursitis, muscle strains, and iliotibial band syndrome.
*veruse injuries may develop over days, weeks,or months.
)ee Treatment of Overuse Knee (njuries below . $ome injuries re)uire additional treatment,
e.g. stretching the iliotibial band is important in iliotibial band syndrome.
Tendonitis of the Knee
The )uadriceps tendon hooks )uad muscles "front thigh muscles# to the patella "kneecap#( the
patella tendon connects the patella to the shinbone. The )uadriceps tendon and patella tendon
actually connect to form one continuous tendon that covers the patella. 5oth tendons are
activated by the )uadriceps. The )uadriceps muscles are used to e'tend the leg. These tendons
are commonly irritated, especially the patellar tendon.
%atellar Tendonitis "also called jumper's knee# is generally caused by overuse of the
)uadriceps, especially jumping types of activities such as volleyball and basketball. The pain
is directly over the patellar tendon, just below the knee. Inflammation may develop.
Kuadriceps Tendonitis is also generally caused by overuse of the )uadriceps. The pain is over
the )uadriceps tendon, above the knee. There may be inflammation.
5eing less elastic have less blood supply than muscles, tendons are more easily injured and
take longer to heal than muscles.
It is important to give sufficient the knee time to heal before returning to the activity that led
to tendonitis. !ctivities that cause pain delay healing. Though inflammation is a part of the
healing process, chronic inflammation causes progressive damage to tissues.
Knee Bursitis
! bursa is a sac containing a small amount of fluid that is located between surfaces that need
to move to reduce friction. 5ursitis "Inflammation of a bursa# is usually caused by overuse.
The bursa in front of the kneecap "prepatellar bursa# is commonly irritated. +'cessive
kneeling often causes prepatellar bursitis "common in carpet layers, gardeners#. The
symptoms are knee pain and inflammation over the kneecap and sometimes a limited range of
motion. The inflammation is within the bursa, not the knee itself.
#uscle )trains
*verstretched "pulled# or torn muscles result in stiffness and pain. The main muscles
supporting the knee are the )uadriceps and hamstrings. Increasing the duration and intensity
of e'ercise or any activity too )uickly often cause muscle strain. 0ild muscle strains heal
)uickly.
(liotibial Band )yndrome 1(TB)2
The iliotibial band is a fibrous band of tissue that runs down the outer thigh, from the hip
"ilium# to just below the knee, inserting into the shinbone "tibia#. It helps provide stability to
the outer side of the knee joint, particularly during running.
(liotibial band syndrome is irritation / inflammation of the iliotibial band "the inflammation
is usually not visible# that causes lateral knee pain. This condition is most common in long
distance runners and cyclists.
)ymptoms of (liotibial Band )yndrome 1(TB)2
Though the pain usually occurs on the outer side of the knee just above the knee joint, it may
also occur over the entire iliotibial band or just below the knee, where the iliotibial band
inserts into the shinbone "tibia#. The pain usually sets in slowly, often after running for several
minutes. It is relieved by resting and aggravated by activity running, cycling, or walking.
'auses and 'ontributing :actors of (TB)
Overuse3 Increasing running or cycling distance too )uickly and/or not giving the body time
to recover between runs can lead to irritation and inflammation of the iliotibial band. /unning
uphill, downhill, on a slope, on hard surfaces, or on uneven ground increases the risk of IT5$.
Tightness of the (liotibial Band
! tight iliotibial band causes e'cess friction over the outside of the knee L over the lower end
of the thighbone L as the knee is bent and straightened. This leads to irritation and pain just
above the knee joint. "! tight iliotibial band may also cause runners knee.#
+eak hip abductors "muscles involved in moving leg to side#
The hip abductors help support the knee. $trengthening these muscles help to support the knee
and often helps improve IT5$.
0ait Problems
$ome e'perts believe that gait problems may increase the risk of IT5$. %roper footwear may
help.
Other #echanical %rrors.
=aving one leg shorter than the other or having bowed legs increases the risk of IT5$.
Treatment of (liotibial Band )yndrome
Treat pain and inflammation with /I,+.
If the condition is mild, temporarily reducing high impact activities, doing e'ercises that
stretch the iliotibial band, and shortterm use of antiinflammatory medications may be
sufficient.
1or persistent cases, physical therapy may be necessary. Though most cases improve with
conservative treatment, surgery is occasionally performed.
unners Knee
/unners are at an increased risk for this condition but it can affect anyone. The symptoms are
diffuse pain behind or around the kneecap. The knee may click or crack when straightened.
The knee may feel unstable. /unning, kneeling, climbing stairs, and sitting for long periods,
aggravates the symptoms.
%oor knee tracking appears to be the main cause of runners knee. The kneecap glides in a
groove in the thighbone. If the kneecap is pulled to one side, e'cessive friction on the back of
the cartilage of the kneecap during motion causes irritation. It may be caused by a simple
muscle imbalance that can be corrected with e'ercises. ,lick here for more information on
runners knee.
Osgood )chlatter !isease
*sgood $chlatter disease is a common overuse condition causing pain and inflammation just
below the knee, over the bump on the front upper part of the shinbone, which the patellar
tendon attaches to. This condition only occurs while a person is still growing.
Teens or preteens that develop this condition are usually highly active in sports that involve a
lot of running and jumping. ,ick here for more information on *sgood $chlatter disease.
Treatment of Overuse Knee (njuries
est* (ce* 'ompression* %levation 1('%2
6%ee a doctor immediately if your knee is giving out or if there is swelling or redness.
/therwise! see a doctor if the pain persists or is getting worse after 0 days
est3 ";ot total rest# /educe your activity until the swelling and pain subsides, usually @ or 7
days. !void activities that cause pain. 3o not return to the activity "kneeling, running,
jumping# that caused the problem until your physician advises you it is safe to so. It is usually
recommended you return to activities that caused the injury gradually and stop if pain occurs.
(ce3 !pply ice wrapped in cloth every >9 minutes per hour the first day then every @ to 7
hours for the second and third day. Aeaving the ice on for over 8? minutes can cause frostbite.
"0oist cold applying a wet towel between the skin and the ice pack penetrates more deeply
and )uickly than dry cold#
'ompression3 &rapping the knee in an !,+ bandage "elastic bandage# can limit swelling
and relieve pain. If the leg becomes colder than the other leg, the bandage is too tight.
/emove the wrap before bedtime. 5andages are also useful for holding on a bag of ice.
%levation3 +levate knee above the level of heart "place on pillow# while icing to further
reduce inflammation.
Applying ,eat
!fter four or five days, providing the swelling has subsided, applying heat to the knee may be
beneficial. =eat helps to increase the blood supply, which promotes healing and also helps to
rela' tight muscles. !pply heat for >9 minutes several times per day. "0oist heat penetrates
more )uickly and deeply than dry heat# &ait at least an hour between heat applications to
prevent the overheating of tissues.
8 $%7% apply heat to an inflamed joint. There already is increased blood supply with
inflammation. =eat will increase the inflammation.
#edications
2our doctor may prescribe medications for pain and inflammation.
Total healing may take two to si" weeks* depending upon the severity on the injury.
Prevention of Overuse Knee (njuries3
The best ways to prevent overuse knee injuries or to prevent reoccurrences are to<
$trengthen the muscles that support the knee with knee e'ercises.
• $lowly increase the duration and intensity of activities you are not accustomed to.
• &arm up before activities that involve running and jumping.
• Aimit highimpact activities to every second day to give your body a chance to
recover.
• .eep your weight under control. !s the knees are weightbearing joints, weighing less
decreases stress on the knees.
• %roper 1ootwear< !de)uate cushioning to help absorb shock, ade)uate support for
those who tend to overpronate to prevent e'cessive internal rotation of the lower leg
and knee.
unners Knee

/unners .nee is also called
%atellofemoral %ain $yndrome, %atellofemoral $tress $yndrome or !nterior .nee %ain
$yndrome.
/unners .nee is one of the most common causes of knee pain in all age groups, including
teens and young adults.
It can be chronic or intermittent. It is common in runners, hence the term Grunners kneeG, but
also occurs in inactive people.
/unners .nee is a condition characterized by pain behind or around the kneecap. %oor
kneecap tracking is believed to be the main cause this condition. The kneecap "patella# slides
over a groove on the thighbone "femur# as your knee bends and straightens. If, for e'ample,
the front thigh muscles ")uadriceps# are weak or imbalanced, the resulting muscle imbalance
can pull the kneecap to the left or right of the groove, causing pressure, friction, and irritation
to the cartilage on the undersurface of the kneecap when the knee is in motion.
*veruse/overload of the )uadriceps especially running, going up and down stairs can cause
this condition to flare up, as can poor e'ercise techni)ues, e.g. a poorly fitting bicycle,
improper footwear etc.
'auses of Knee #altracking
#uscle imbalances 6 weakness or infle'ibility in the muscles that support the knee, and
mechanical errors can cause poor knee tracking. There may be multiple factors involved.
#uscle imbalances in the lower body, especially the )uads are common. Tightness of the
muscles and tendons can also pull the kneecap toward one side. In females, the increased
inward slant of the thigh towards the knee is believed to the reason they are at higher risk of
developing /unners .nee / %atellofemoral %ain $yndrome
#echanical errors include misaligned joints in the foot or ankle( a kneecap that is located
too high in the joint( flat feet / over pronation. Pronation is the normal inward roll of the foot
as the arch collapses after heel contacts ground during walking or running. *ver pronation
causes e'cessive internal rotation of the lower leg and knee.
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TA'K($0 ($'4.!%3
+eak -uadriceps<
Kuadriceps "front thigh muscles# strengthening e'ercises are considered to the most important
e'ercise, in most cases, for correcting poor knee tracking. The )uadriceps controls the
movement of the kneecap. "They are attached to the kneecap and then to the top of the shine
bone by tendons#.
(mbalanced -uadriceps<
$ometimes the )uads "there are four divisions# are imbalanced. The inner )uad pulls the
kneecap inwards and the outer )uad pulls the kneecap outwards. If the inner )uad is weak, the
stronger outer )uad tends to pull the kneecap off center. In this case, e'ercises to strengthen
the muscles of the inner )uadriceps are particularly helpful
+eak ,amstrings3
!nother imbalance can occur when the muscles in the front of the thigh are significantly
stronger than the muscles in the back of the thigh "the hamstrings#. If your hamstrings are
weak, your )uads have to work harder. Tight hamstrings cause increased pressure between the
patella and femur.
Tight (liotibial Band3
The iliotibial band "a fibrous band of tissue on outer thigh that e'tends from the hip to below
the knee# also affects knee stability. If too tight, this muscle/tendon of the outer thigh can pull
the knee to one side. ! tight iliotibial band can also cause Iliotibial 5and $yndrome.
+eak ,ip Abductors3
The hip abductors "muscles on the outer thigh involved in moving leg to side# also help
support the knee. $trengthening these muscles may also improve runners knee.
unners Knee )ymptoms
%ain, typically diffuse pain, in front, around or beneath the kneecap. 0ore pain and/or feeling
of joint instability after climbing stairs, jumping rope, running, or after a period of sitting.
There is e'tra pressure between the kneecap and thighbone when the knee is bent at a right
angle as when sitting. The kneecap is pressed towards the femur. If there is already irritation
of the cartilage on the underside of the kneecap, discomfort or pain results. +ven sleeping in a
curled up position can cause pain when the condition has flared up. ,ontracting the
)uadriceps, as when going up or down stairs, also causes increased compression of the knee
joint.
$ometimes after activities that have activated the )uadriceps, it feels the knee is being pulled
to one side. $ometimes a clicking, cracking or crunching sound is heard when the knee is bent
or straightened. This is the kneecap slipping back into the groove.
!n Jray or 0/I of the knee can show if there is damage to the cartilage or if the patella is
displaced or tilted. ! tilted patella may be correctable with e'ercise if the tilt is caused by a
muscle imbalance.
unners Knee Treatment
est < "not total rest# Temporarily avoid activities that cause e'tra stress on the knees such as
s)uatting/kneeling or high impact activities like running until the pain subsides. $wimming or
lowimpact activities such as working out on an elliptical trainer are fine. !void
s)uatting/kneeling as a bent knee causes e'tra pressure between the patella and femur. !void
leg presses where you support your weight with a bent knee. $traight leg lifts are safer. !s you
get stronger, partial s)uats are ok
(cing3 !pplying Ice to the knee, especially after e'ercise may reduce pain and swelling. 3on't
ice for over 8? minutes at a time to prevent frostbite. +levating the knee above the level of the
heart while icing helps in reducing the inflammation.
$)A(!s 3 nonsteroidal antiinflammatory drugs such as !spirin or !dvil, as recommended
by your doctor. $ee 0edications.
%"ercise< +'ercises, particularly e'ercises to strengthen and stretch the )uadriceps "front
thigh muscles# and hamstrings "muscles of the back of thigh#. The e'ercises emphasized in
the majority of cases are those that strengthen the )uadriceps particularly the inner division of
the )uadriceps. This usually is very effective. $pending a few minutes, a couple of times a day
on these muscles and gradually working up to 8? minutes per day are sometimes all that is
needed. 5e patient. It can take several weeks to notice an improvement. $ee .nee +'ercises
page.
Knee Taping < Taping is used to realign the kneecap and hold the kneecap in place. !lthough
knee taping has not been scientifically proven to help stabilize the knee joint, it has been
shown to significantly reduce pain. The relief is usually immediate. There are different
techni)ues that a physical therapist "physiotherapist# can show you. The tape can be irritating
the skin.
Knee Brace< a %atellar $tabilizing 5race helps keep the kneecap in the middle of the
patellofemoral groove. This may be helpful when the muscles than support the knee are still
weak. ! knee brace can take some stress off the knee and help relieve pain. &earing a brace
does not replace the strengthening e'ercises that correct the root of the problem. 5races help
some people more than others. "&earing them during sports has not been shown to reduce
knee injuries# They are e'pensive, and some people find them hot and bulky. %atellar
stabilizing braces must be fitted properly to be effective. ;ot all knee braces are created
e)ually. !sk a doctor or physical therapist whether or not knee braces are appropriate for your
situation.
Proper :oot +ear< e.g. $hoes with an arch support to control over pronation, shoes with
ade)uate cushioning in sole to help absorb shock. *rthotics may be re)uired for those with
severe over pronation. $ee .nee %ain, *verpronation, and 1ootwear. =igh heels throw your
body forward and increase the pressure underneath your kneecap. Aimit the time spent
wearing high heels.
)urgery3
$urgery for /unners .nee should be a last resort, after an e'ercise program to correct muscle
imbalances has been given a fair trial. It may be necessary if there are significant structural
abnormalities.
!rthroscopy and Aateral /etinacular /elease< If the kneetracking problem is caused by
e'cessive lateral pull "kneecap pulls toward outer side of knee#, cutting the tight lateral
ligaments to reduce the amount of pull can rectify the problem.
%atellofemoral %ain $yndrome / /unners .nee may lead to ,hondromalacia %atellae.
unners Knee is usually easy to treat. 3oing the appropriate e'ercises, and avoiding
e'ercises and activities known to cause undue stress to the knees are usually enough.
'hondromalacia Patellae
,hondromalacia %atellae and %atellofemoral %ain $yndrome / /unners .nee are terms often
used interchangeably, catchall terms to describe anterior knee pain regardless of the cause of
the pain. They are not the same. =owever, %atellofemoral %ain $yndrome / /unners .nee
may lead to ,hondromalacia %atellae.
Cnlike ,hondromalacia, in %atellofemoral %ain $yndrome / /unners .nee there are no visible
changes in the articular cartilage on the under surface of the kneecap. !n 0/I can confirm
,hondromalacia %atellae.
,hondromalacia %atellae is a chronic degenerative condition affecting the articular cartilage
on the under surface of the kneecap. The cartilage softens, develops fissures, breaks down,
and begins to look like crabmeat. In e'treme cases the cartilage breaks down enough to
e'pose the undersurface of the kneecap. This results in pain and inflammation. The type of
damage to the cartilage is different than the degeneration in knee osteoarthritis.
! newer procedure that may be available soon for treating chondromalacia patella is the
,!/IA!-+ T/!;$%A!;T< small pieces of cartilage are taken from an area of the knee
where there is minimum weight bearing, grown outside the body and transplanted in back into
the damaged part. This procedure can repair 0I;*/ defects only.
The symptoms and the treatments of ,hondromalacia %atellae and %atellofemoral %ain
$yndrome / /unners .nee are essentially the same an e'ercise program to strengthen and
stretch the muscles around the knee, avoiding high impact activities, kneeling, and s)uatting.
$ee %atellofemoral %ain $yndrome / /unners .nee page.
$ometimes surgery is re)uired. $having/smoothing the cartilage on the underside of the
kneecap can be done by arthroscopy. /arely, in e'treme cases, the kneecap may have to be
replaced with polyethylene prosthesis.
Knee Osteoarthritis

.nee *steoarthritis, the most common type of osteoarthritis, is a chronic degeneration
of the articular cartilage around a joint.
.nee osteoarthritis most commonly affects people over 79 years of age but can occur at any
time.
The bones of the knees joint "the backside of the kneecap, bottom of thighbone, and top of
shinbone# are coated with smooth articular cartilage.
&hen knee osteoarthritis develops, the cartilage undergoes gradual changes loosing
elasticity, hardening, and cracking, becoming more easily damaged and eroded by use or
injury.
The bones can't move smoothly over roughened cartilage, causing irritation to the bone. The
end of the bones involved may thicken and bone spurs may form. $mall bits of cartilage may
break off and float around inside the knee. *ver half of knee osteoarthritis sufferers also have
mineral deposits in their cartilage. The joint fluid also changes in consistency, becoming
thinner and less tacky, decreasing its lubricating and cushioning properties.
There are many different levels of severity of damage, from mild cases without symptoms or
with mild symptoms to advanced cases where the cartilage is worn down to the point where
bone rubs on bone, damaging the bones and causing severe knee pain.
Though osteoarthritis is considered to be noninflammatory type of arthritis, minor
inflammation is involved. The inflammation is not nearly as severe as the inflammation
involved in inflammatory types of arthritis such as rheumatoid arthritis.
.nee osteoarthritis used to be considered a 'wear and tear' disease because it mainly affects
middleaged and elderly people and worsens over time. =owever, normal activity does not
cause knee osteoarthritis, and the cause of cartilage deteriorating and wearing away is not
known. +nzymes that damage the joint cartilage have been identified. 3o'ycycline, an
antibiotic that has been shown to inhibit these enzymes, was shown to slow down cartilage
deterioration in study led by Indiana Cniversity $chool *f 0edicine's arthritis and muscles
diseases center. ,od liver oil has also been shown to inhibit these enzymes.
0any people reduce their activity because of knee pain or because they believe it will worsen
knee osteoarthritis. !s a result, the muscles that support the knee become weaker and more
stress is placed on the knee joint.
);#PTO#) O: Knee Osteoarthritis
The deterioration of cartilage is gradual and there may be no symptoms in the early stages of
knee osteoarthritis. $ymptoms of knee osteoarthritis are stiffness "especially morning knee
stiffness#, knee pain that is aggravated by going up or down stairs, limitation in range of
motion, a crunching feeling in the knee, and weakness of knee. The knee may be swollen but
not red and hot.
"$ymptoms such as diffuse pain in knee joint and crunching sound in the knee can be caused
by Grunners kneeG, which is a common cause of knee pain in all age groups, including teens
and young adults.#
$welling of the knee may occur as a result of e'cess fluid accumulating within the knee joint.
3amaged cartilage in the joint triggers inflammation of the joint lining "the synovium# and
e'cess production of joint fluid "synovial fluid#.
!n accumulation of e'cess fluid within a joint is called joint effusion. In the knee, joint
effusion is sometimes referred to as water on the knee. .nee joint effusion sometimes results
in a 5aker's cyst.
In advanced cases, inflammation can also occur if bits of cartilage break off and float around
inside the knee joint and cause irritation and inflammation of the soft tissue in the joint.
In advanced cases, there may be deformity of the joint. ,artilage has a limited ability to repair
itself. The body compensates with the growth of e'tra bone, which results in visible
enlargement of the joint.
$ymptoms do not always correlate with the amount of damage to the joint. $ymptoms can
come and go for no apparent reason. This makes it difficult to assess whether or not a current
treatment is working. .eeping the muscles that support the knee strong, keeping your weight
down, and avoiding high impact activities can decrease the symptoms.
!(A0$O)($0 Knee Osteoarthritis
!n 'ray may be helpful in diagnosing knee osteoarthritis. In a conventional 'ray the
cartilage is invisible how much cartilage has been lost is judged by the gap between the
bones of the joint. ! conventional 'ray can easily miss the early stages of knee osteoarthritis.
!nd two radiologists may interpret the same 'rays differently. !n 0/I shows soft tissue "and
bones# can also show the joint in motion
3iffraction +nhanced J/ay Imaging "3+I# is a new type of 'ray that shows soft tissue as
well as bone. The application of 3+I to cartilage imaging was patented recently but is not yet
in clinical use.
:A'TO) increasing the risk of Knee Osteoarthritis
• !ging
• 0uscle weakness in the )uadriceps "muscles of the thigh that attach to the knee#
• Injury to the joint
• /epetitive movements "s)uatting, kneeling with heavy lifting#
• !ctivities re)uiring repetitive joint impact jogging
• -enetic susceptibility
• $kewed feet
• *besity
• Inappropriate footwear
T%AT#%$T) for Knee Osteoarthritis
%"ercise3
+'ercise is beneficial for knee osteoarthritis< $trong leg muscles support the knee and absorb
shock before it gets to the knee. +'ercising the )uad muscles increase circulation in the knee
joint and has been shown to stimulate beneficial biochemical changes in the joint fluid of the
knee, improving its lubricating properties. +'ercise also improves the range of motion of the
knee. =owever, in patients with knee osteoarthritis who have misaligned knees, over
strengthening of the )uads can sometimes make matters worse. ! doctor or physical therapist
"physiotherapist# can determine whether or not your knees are properly aligned and which
e'ercises would be most beneficial.
+'ercising in water, especially warm water, has may benefits for those with joint problems.
,eat and 'old3
,eat3
!pplying heat to the knee joint reduces stiffness and pain by increasing blood flow. The heat
is also a comforting distraction from the knee pain. 3* ;*T apply heat to an inflamed joint.
Csually, inflammation is not present in the early stages of knee osteoarthritis.
!pply heat for 8? @? minutes at a time, waiting at least an hour between each application to
prevent overheating of tissues. 3ry or moist heat is beneficial but moist heat penetrates the
tissues more )uickly, and penetrates more deeply than dry.
1or moist heat, you can use a towel soaked in warm water but it may cool off fairly )uickly.
!n alternative is to place a moistened towel between your knee and a hot water bottle. There
are also moist heating wraps available commercially.
12o not use ru#s and heat at the same time as a #urn may occur.
'old3
,old reduces knee inflammation and knee pain by constricting the blood vessels. !pply ice
wrapped in cloth to an inflamed joint for >9 8? minutes every @ or 7 hours. 3o not ice for
longer than 8? minutes at one time to avoid frostbite. 0oist cold "%lace a wet towel between
the skin and an ice pack for moist cold# penetrates more deeply and )uickly than dry cold.
6If you have circulation pro#lems or nerve damage do not use hot or cold therapies. -3nless
a physician says it is safe for you.
,ydrotherapy3
=ydrotherapy is the use of water "li)uid form or ice or in the form of steam# for therapeutic
purposes. It includes e'ercising in a pool, soaking in a whirlpool, saunas, and hot and cold
compresses. $oaking or doing e'ercises in warm water e'ercises are particularly beneficial for
those who suffer from knee osteoarthritis.
+eight 4oss3
5eing overweight places e'tra stress on the knee, a weightbearing joint. +ven >? pounds can
make a big difference in the symptoms of knee osteoarthritis.
Acupuncture3
! recent study on acupuncture and knee osteoarthritis has shown that e'tended acupuncture
treatment both reduces pain and increases function. ,lick here for more info on !cupuncture.
Knee Taping3
Though the reason it works is unclear, knee taping has been shown to significantly reduce
knee pain in patients with knee osteoarthritis. There are different taping techni)ues that a
physical therapist "physiotherapist# can teach a patient. $ometimes the skin can become
irritated from the tape.
Knee Braces3
Csed 1or ,ertain ,ases of .nee *steoarthritis< Cnloader braces are designed to provide knee
pain relief for those with knee osteoarthritis. They are very e'pensive but some health
insurance plans cover them. Kuite fre)uently, the cartilage is more worn out of one side of the
knee joint, causing the thighbone to sit on an angle and the thighbone to rub against the
shinbone on the worn out side. Cnloader braces take off the load "pressure# on a knee joint by
changing the angle of the knee joint. 5y changing the angle of the knee joint, a space between
the thighbone and shinbone is created, relieving knee pain and increasing range of motion. !n
'ray can determine if the space between the thighbone and shinbone is angled. ! doctor or
physical therapist "physiotherapist# can assess whether or not an unloaders knee brace would
be helpful in a particular case and recommend the appropriate knee brace.
Topical 'reams for Knee Osteoarthritis3
3eep =eating /ubs, e.g. ,reams applied directly to the knee joint give temporary pain relief
by creating surface heat. "3o not apply heating rubs to inflamed joints# The heat is mainly a
distraction from the knee pain.
Topical capsaicin3 ,apsaicin is an e'tract from red chili peppers. It can be purchased over the
counter. ,apsaicin reduces a substance in the nerve endings that transmit pain to the brain. It
does not work immediately( the effects are accumulative. It can take > to F weeks of regular
use to obtain the full effect. The benefits seem to add to the benefits of pain medications
and/or antiinflammatory medications.
T%$)3
This therapy involves stimulating nerve endings with low voltage electric impulses through
electrodes attached to the body at the site of the pain. It relieves pain in some patients. $ee
7iscosupplementation Treatment3
Moint fluid contains hyaluronic acid "hyaluronate#, which makes the fluid thick and sticky. In
osteoarthritis, the production of hyaluronic acid decreases and its concentration in the joint
fluid is reduced. This results in a thinner fluid, with reduced ability to lubricate the joint and
to absorb shock.
Niscosupplementation Treatment consists of a series of @ injections over @ weeks. ! fluid
"hyaluronates# similar to normal joint fluid is injected into your knee joint to lubricate and
cushion it. "In cases of knee osteoarthritis, the normal gellike joint fluid synovial fluid
becomes thinner# The knee pain relief usually lasts for F B months. If the symptoms recur,
the injections can be repeated. The success rate is very high in milder cases, and even in the
most severe cases the success rate is over half.
=yalgan -hyaluronate# is the first 13!approved hyaluronan therapy "viscosupplementation#
in the C$ for *steoarthritis of the knee. *ther 13!approved hyaluronates for hyaluronan
therapy includes $ynvisc "is a treatment option called a viscosupplement. It replaces
damaged synovial fluid with a su#stance similar to that found in healthy joints of 456 to 786
year6olds.#, $upartz "9oint luid 'herapy#, and *rthovisc.
Arthoscopic )urgery3
!rthoscopic surgery< ;oninvasive surgery, a camera attached to video monitor is inserted
through small incision. This is minor surgery, usually performed on an outpatient basis.
/ough damaged cartilage can be shaved( bone spurs can be removed, loose bits of cartilage
cleaned out.
Knee eplacement )urgery3
!lso called knee arthroplasty, this is major surgery and is a last resort option for e'treme
cases of knee osteoarthritis, when all else fails to relieve pain. ! knee replacement is not
perfect it has a limited life span of >? 8? years. This procedure makes it possible to carry
on everyday activities without pain and to do low impact aerobics, however, overuse will
accelerate wearing out the parts.
'artilage Transplant3
Cnfortunately, this is ;*T an option for those with knee osteoarthritis. This can only be done
only for small defects in the articular cartilage, not for the more common diffuse damage seen
in knee osteoarthritis. ! cartilage transplant is done by taking small pieces of cartilage from
an area of the knee where there is minimum weight bearing, growing cartilage outside the
body and transplanting in back into the damaged part can repair minor defects.
#edications3
0lucosamine A$! 'hondroitin and Other )upplements3
$tudies are ongoing to determine whether or not glucosamine and chondroitin can reduce or
halt the progression of knee osteoarthritis.
.nee osteoarthritis is a chronic, progressive condition. ,ombining several therapies may be
re)uired to ade)uately manage the symptoms of knee osteoarthritis e'ercise, 0edications,
knee taping, unloader knee braces in some cases, heat and cold, topical creams, and
complementary supplements such as cod liver oil, glucosamine, chondroitin. $ince the
symptoms can come and go it may take a while to know if treatment is effective. If
conservative treatments aren't enough, corticosteroids can be injected into the knee joint,
viscosupplementation injections, and when all else fails, knee replacement surgery.
Osgood )chlatter disease

Teens with pain and swelling below the knee may be suffering from *sgood $chlatter disease
"also called *sgood $chlatter condition#, a common overuse condition causing inflammation
of the tibial tuberosity.
The tibial tuberosity is the small bony bump on the front upper part of the shinbone "tibia#,
just below the knee, that the patellar tendon attaches to.
Teens or preteens that develop this condition are usually highly active in sports that
involve a lot of running and jumping "basketball, volleyball, soccer, gymnastics, etc.#.
&hen running and jumping the front thigh muscle pulls on the patellar tendon, which pulls on
the tibial tuberosity. /epeated pulling on the tuberosity causes it to become irritated, causing
pain and swelling. The patellar tendon may pull away from the shinbone, pulling fragments of
the tuberosity away with it. !s healing occurs, bone is eventually laid in the tendon. This
results in a permanent, small visible bump. This bump usually causes no problems.
There may also be inflammation of the patella tendon and surrounding soft tissue where it
attaches to the tuberosity. !s the injury heals, this swelling will go down.
*ne or both knees can be affected. *ften, only one knee is affected.
+hy does Osgood )chlatter disease only occur in growing teens6children< The tibial
tuberosity is on a growth plate near the upper end of the shinbone. 5efore skeletal maturity,
the growth plates near the ends of the bones are made of cartilage, which is softer and are
more vulnerable to injury than bone. -rowth plates are replaced by solid bone when growth is
finished.
In children the patellar tendon is stronger than the tibial tuberosity. In adults, the tibial
tuberosity has turned to bone and is stronger than the tendons. In adults, pain and swelling
below the knee may be caused by patellar tendonitis. "0ore information on tendonitis on
.nee Injuries page#
Tight )uadriceps may increase the risk of *sgood $chlatter disease. It is believed that during
growth spurts, the muscles and tendons may not always keep up with the growth of the long
bones and become tight. Tight )uadriceps "and to a lesser e'tent, tight hamstrings# causes
e'tra tension on the patellar tendon where it attaches to the tibial tuberosity. $tretching
e'ercises may help, especially before running and jumping.
!iagnosis is usually based upon the symptoms and a physical e'amination. !n 'ray is
sometimes taken. !lways get a proper diagnosis from a )ualified physician.
)ymptoms are pain and swelling over the tibial tuberosity "just below the knee#. There may
also be an enlargement of the tibial tuberosity itself. The pain increases with activities such as
running and jumping. The swelling is tender to the touch. .neeling on the area is painful. The
amount of swelling varies.
Treatment involves taking a break from or limiting activities that aggravate the symptoms(
usually this is all that is needed to allow the area to heal. =ow much time off is needed
depends on the severity of the condition. It may be a couple weeks or months, as
recommended by your physician. !pplying ice wrapped in a cloth to the area "for >9 to 8?
minutes every four hours# reduces pain and inflammation. 2our physician may recommend
antiinflammatory medications
*nce symptoms have subsided, it is usually recommended that the teen or child return to
activities involving jumping, running and s)uatting at a reduced level, increase them slowly
and cut back if symptoms recur. $tretching the )uadriceps helps reduce tension where the
patellar tendon attaches to the tibial tuberosity and may help the condition from reoccurring.
Osgood Schlatter is a common condition (with a big name) that goes away when the bones
have finished growing.
+ater on the Knee

&ater on the knee "or fluid on the knee# is a generic term for swelling in or around the knee
joint caused by an e'cessive accumulation of fluid.
The lining of the knee joint capsule, which encloses the knee joint, produces fluid that helps
lubricate the moving parts of the knee joint and nourishes the cartilage.
,ertain diseases and injuries cause e'cessive joint fluid to be produced.
.nee osteoarthritis and knee injuries "acute traumatic injury or overuse injury# are the most
common causes of water on the knee. Infection or inflammatory diseases may also cause fluid
on the knee.
Consult a physician to rule out infection and to receive a proper diagnosis. :n infection can
cause severe! permanent damage to the knee joint if not treated early.
!n accumulation of fluid within a joint cavity is also called a joint effusion. In the case of a
traumatic injury, joint fluid may contain blood. If infection is involved, the fluid may contain
pus. In gouty arthritis, there may be irritating uric acid crystals in the joint fluid. In
inflammatory conditions such as rheumatoid arthritis, the fluid contains elevated levels of
white blood cells.
.nee swelling is not always caused by e'cessive fluid within the joint capsule "joint effusion#.
$welling may also be on the outside of the knee joint. 5ursitis is a common condition that
causes swelling on the outside of the knee joint. $welling on the back of the knee may be a
5aker4s cyst.
Water on the knee may be an acute or chronic problem.
)ymptoms of +ater on the Knee
The swelling, which may or not be visible, causes a feeling of tenseness of the knee. There
may be an inability to completely straighten the knee. %ain is often, but not always, present.
*ther symptoms vary, depending upon the cause of the swelling. &hen water on the knee is
caused by osteoarthritis, walking or standing is particularly painful "when the knee bears the
weight of the body#. &hen inflammation is involved, the knee may be swollen, hot, red, and
painful. If inflammation and pain develop rapidly and there has not been an injury, there may
be a bacterial infection in the knee joint..
'ommon 'auses of +ater on the Knee
Knee (njuries
!cute or overuse knee injuries may result in water on the knee. $welling occurs as a result of
leakage of fluid from damaged tissue. 5leeding may also occur from ruptured capillaries,
resulting in swelling and discoloration "bruising#.
3amaged tissue releases chemicals that initiate inflammation. Inflammation involves the
dilation of capillaries "tiny blood vessels# and leakage of fluid from the capillaries, and the
stimulation of nerve endings causing heat, redness, swelling, and pain.
Acute injuries that often result in water on the knee include fractures, torn cartilage, or torn
ligaments. ! torn meniscus or torn !,A are the most common acute knee injuries resulting in
water on the knee.
Overuse injuries may also lead to water on the knee. .neecap bursitis "prepatellar bursitis# is
usually caused from overuse, especially e'cessive kneeling. The swelling is not inside the
knee joint itself but in the bursa in front of the kneecap. "! bursa may also become infected
and cause pus to form#.
Arthritis of the Knee
*steoarthritis is a degenerative disease involving the breakdown of joint cartilage.
*steoarthritis is the most common type of arthritis and the knee is the most common location
for osteoarthritis. Knee osteoarthritis is the most common cause of water on the knee. The
damage within the knee joint irritates the joint lining "the synovium# and causes e'cess
amounts of synovial fluid to be produced. "$ynovial fluid is a thick, sticky gellike fluid that
helps lubricate moving parts of a joint and nourish cartilage2.
0out is caused by a buildup of uric acid crystals in the joint, which fluid triggers
inflammation of the joint. -out occurs most commonly in the big toe, knee, wrist, or elbow.
The affected joints are hot and red and well as swollen and painful.
heumatoid arthritis* an inflammatory autoimmune disease* involves inflammation of the
joint lining. 0any joints are often involved. /heumatoid arthritis usually affects the joints of
the hands, wrists and feet but may occur in many other joints. The knees are affected in up to
onethird of people with this disease. /heumatoid arthritis usually involves the same joints on
both sides of the body.
$ymptoms of are pain and stiffness, which is worst in the morning, and swelling, warmth and
redness of the affected joints. /heumatoid arthritis affects the entire body and often causes
fatigue.
(nfectious arthritis
Infectious arthritis may be caused by bacteria, a virus, or fungi.
5acteria in the bloodstream can spread to a joint and cause infectious arthritis. 5acteria may
also enter from a wound. The knee is the most common location for bacterial arthritis.
,onditions that increase the risk of joint infection include diabetes, rheumatoid arthritis, and
other autoimmune disorders. %eople taking prednisone "corticosteroids# have an increased risk
of infection although prednisone can mask the symptoms of infection.
$ymptoms of a joint bacterial infection include acute onset of joint inflammation "pain,
swelling, warmth and redness of the knee#, fever, chills, general weakness, muscle aches,
dizziness, and headache. Infectious arthritis caused by bacteria "also called septic arthritis or
bacterial arthritis# re)uires prompt treatment with antibiotics. If not treated early, severe and
permanent damage to the joint can occur. The infection may also spread.
Niral infections usually resolve by themselves and usually do not damage the joint.
!ntibiotics are ineffective against viruses.
'hondromalacia, a condition affecting the cartilage on the under surface of the kneecap, may
also cause knee effusion.
Treatment of +ater on the Knee
Treatment of water on the knee depends upon the cause. Treatment involves treating the
underlying condition and the swelling.
If the swelling is particularly painful, the fluid may be aspirated from the knee for )uick
relief. =owever, depending on the situation, fluid may reaccumulate. !n injection of
corticosteroids "a powerful antiinflammatory# is sometimes given, depending upon the
underlying problem. If infection is suspected, aspirating the fluid can confirm infection and
identify bacteria involved to determine the appropriate antibiotic/s to be used in treatment.
%rompt treatment with antibiotics is necessary if infection is involved.
/educing activity that causes pain, applying ice wrapped in cloth for >9 to 8? minutes every
couple of hours, elevating the knee above the level of the heart "lying down with the knee on a
pillow#, and lightly wrapping the knee with an elastic bandage helps reduce pain and
inflammation. If wrapped too tight, circulation to the lower legs and feet could be cut off. If
the feet turn blue or cold, remove the bandage. The bandage should be removed before
bedtime.
;$!I3s "nonsteroidal antiinflammatories# reduce both pain and inflammation and are
usually welltolerated for shortterm use. Aongterm use can cause ulcers in some people.
!nalgesics, such as Tylenol, reduce pain but do not reduce inflammation.
Baker=s 'yst

! 5aker4s cyst is a membranelined sac of fluid that forms behind the knee.
! 5aker4s cyst is formed when synovial fluid "fluid that is produced by the joint lining to
lubricate and protect the joints# escapes from the knee joint capsule "also called the synovial
sac or synovium# and forms a new sac outside the joint at the back of the knee.
There may be a slight bulge or noticeable lump, most visible when standing.
5aker4s ,yst is named after the 5ritish physician, 3r. &illiam 5aker ">D@B>DBF#, who
published the first reports on synovial cysts of the knee joint. ! 5aker4s cyst is also called
popliteal cyst as it occurs in the popliteal space the area behind the knee joint.
'auses3
,onditions that cause an e'cessive amount of synovial fluid to be secreted, such as arthritis or
torn cartilage in the knee, may lead to a 5aker4s cyst. !dvanced osteoarthritis is the most
common cause of a 5aker4s cyst in older adults.
$ynovial fluid "a thick, sticky fluid that lubricates and protect the joints# is secreted by
membranes lining the knee joint and is contained in the knee joint capsule. +'cess synovial
fluid may accumulate and the pressure may cause the knee joint capsule to herniate into the
area in the back of the knee.
"+'cessive fluid within the knee joint is called knee effusion and is often referred to as water
on the knee#
+ven if the knee is healthy, a 5aker4s cyst may form if a normal bursa at the back of the knee
"bursae are sacs containing synovial fluid that reduce friction in moving parts of joints# forms
a tunnel that connects to the knee joint capsule and synovial fluid drains into the bursa at the
back of the knee and causes it to swell. This cause is more common in children.
)ymptoms3
In some cases there are no symptoms. The amount of swelling varies. Aarge cysts are
obviously more problematic. $ymptoms include discomfort or pain behind the knee and/or a
feeling of fullness or tightness that worsens when standing. There may be difficulty bending
the knee.
*ccasionally a 5aker4s cyst ruptures, causing acute pain behind the knee and pain, swelling,
and redness of the calf. $ince the symptoms of a ruptured 5aker4s cyst are similar to those of
a deep vein thrombosis "a blood clot in a deep vein# in the leg, immediate medical attention is
needed to rule the latter out.
Treatment3
Treating the cause of the 5aker4s cyst, e.g. arthritis or torn cartilage, usually reduces the
swelling. If the 5aker4s cyst is caused by torn cartilage, surgery to repair the cartilage may be
necessary.
/educing inflammation in the knee, whether from arthritis or an injury, may be achieved by
temporarily reducing activity, elevating the knee above heart level "placing the knee on a
pillow while lying down#, applying ice "wrap ice in cloth and apply 8? minutes at a time,
every three or four hours#, wrapping the knee in an !,+ bandage to provide compression, and
antiinflammatory medication..
If the 5aker4s cyst is not causing problems, no treatment is necessary. 5aker4s cysts often
eventually disappear without treatment. If the cyst is e'tremely large or painful it may be
drained or surgically removed.
Aspiration3 ! 5aker4s cyst can be drained using a needle/syringe but usually recurs if the
primary problem causing the 5aker4s cyst is still present.
(njection of corticosteroids< ,ortisone "a powerful antiinflammatory# may be injected to
reduce the amount of fluid being produced. !gain, this may only help temporarily.
)urgery< ! 5aker4s cyst can be surgically removed if problems persist despite treatment of
the condition that caused the 5aker4s cyst. $urgery is usually not necessary.
In rare cases, a lump behind the knee may be a tumor. !lways seek a proper diagnosis from a
)ualified physician.
#edications 1mainly for Knee Osteoarthritis2

Analgesics
!nalgesics are painkillers which relieve pain, but do not reduce inflammation. Tylenol falls
into this category. Tylenol "acetaminophen# is usually well tolerated but like every
medication, does not GagreeG with everyone. It can cause nausea in some people.
5ecause Tylenol does not erode the stomach lining as ;$!I3s can with long term use, it is
commonly prescribed for the pain of knee osteoarthritis and other chronic conditions.
It is usually safe to take Tylenol with most prescription medications but taking Tylenol with
alcohol can cause liver damage. +'ceeding the recommended daily limit also can damage
your liver.
'odeine Preparations
&hen Tylenol is not enough, more potent medications such as Tylenol with ,odeine may be
prescribed. ,odeine is a narcotic that helps reduce pain. It is rarely addictive when used for
pain relief. =owever, when codeine is used regularly for a long time, you develop a tolerance
to it you need larger amounts of the medication to relieve the pain. $ince knee osteoarthritis
is a chronic condition, save codeine preparations for your really bad days.
Tylenol > contains a low dose of codeine D mg . Tylenol 8 contains >9 mg of codeine E
Tylenol @ contains @? mg of codeine.
!cetylsalicylic acid "!spirin#, and Ibuprofen with codeine are also available
)ide effects of codeine are constipation, which can be counteracted with fiber, stool softeners,
prune juice, lots of fluids
$)A(!)
;$!I3$ ";onsteroidal antiinflammatory drugs# are medications used to treat pain and
inflammation.
$on5prescription $)A(!s3
!cetylsalicylic acid "!$!#, 5rand names< !spirin, !nacin
Ibuprofen, 5rand names< !dvil, 0otrin, ;uprin
;apro'en, 5rand names< !leve
Prescription $)A(!s3
3iclofenac "Noltaren, !rthrotec#, ,elebre', "Nio'' and 5e'tra have been recalled#
)ide effects of $)A(!s3
$ide effects are dose related<
$hort term use may cause upset stomach, nausea, heartburn.
Aong term use can cause erosion of the stomach lining and potentially lifethreatening
bleeding ulcers in some people. 0edications to reduce the risk of ulceration can be
prescribed. ;$!I3s should be taken with a meal to reduce the risk of stomach upset.
)low release $)A(!s dissolve mostly in the small intestine, past the stomach, decreasing the
chance of stomach upset however, the gastrointestinal effects of these medications are not
eliminated. ;$!I3s decrease inflammation by decreasing prostaglandins "natural substances
involved in inflammation# and certain prostaglandins are re)uired to protect the stomach
lining from stomach acid. $ome ;$!I3s have less severe gastrointestinal side effects than
others because they have less effect on the stomach prostaglandins "e.g. ,o'II $elective
Inhibitors#
'O&5> (nhibitors3
,*J8 inhibitors are a subset of ;$!I3s. The ,*J8 inhibitors are commonly prescribed
for osteoarthritis because they are less likely to cause stomach ulcers with longterm use than
the other ;$!I3s.
Vioxx and extra! two "O#$% inhibitors! are no longer on the market in the &nited States.
"elebrex is still on the market.
Nio'' was recalled $ept @?, 8??7 after a study showed an increased risk for heart attack and
stroke, beginning after >D months of taking Nio''. Nio'' had been on the market since >BBB.
Kuestions were raised as to the safety of 5e'tra and ,elebre', both of which are in the same
class of medications.
5e'tra was the ne't to go. The 1ood and 3rug !dministration re)uested %fizer to voluntarily
suspend sales of 5e'tra in the Cnited $tates in !pril, 8??9. The risks appeared to outweigh
the benefits. 5e'tra has a higher risk of rare but serious, lifethreatening skin reactions than
other ;$!I3s and offers no benefits over other ;$!I3s.
'elebre" remains on the market to date "summer 8??F#. In response to the re)uest of the
1ood and 3rug !dministration !pril O/8??9, ,elebre' has e'panded its risk information to
include a bo'ed warning highlighting the potential for increased risk of cardiovascular ",N#
events and gastrointestinal "-I# bleeding. The 13! concluded GThe benefits of ,elebre'
outweigh the potential risks in properly selected and informed patients.G
Based on currently available data :!A has concluded that the potential for increased
risk of serious cardiovascular adverse events may be a class effect of $)A(!s 1e"cluding
aspirin#.
T=+ 13! re)uires bo"ed warnings of potential cardiovascular risk for all prescription
;$!I3s both ,*J8 pain relievers and nonselective ;$!I3s#, including older nonspecific
drugs such as ibuprofen and napro'en. $ome drugs are available in both prescription and non
prescription form.
The 13! has asked manufacturers of non5prescription ;$!I3s to revise their labeling to
include more specific information about potential cardiovascular and gastrointestinal risks and
a warning about potential skin reactions. The new labeling is e'pected to be in place by the
end of 8??F.
;ote< &hile not riskfree, nonprescription ;$!I3s "including of ibuprofen and napro'en#
are of a lower dose and do not appear to significantly increase the risk of serious
cardiovascular events. Taking aspirin does not increase chance of heart attack but has the
other risks associated with ;$!I3s#.
Topical #edications
$ome prescription topical creams contain an ;$!I3 that is absorbed through your skin
directly to the area where it is needed. The amount of drug absorbed by the bloodstream is
minimal, eliminating or significantly reducing the side effects associated with oral ;$!I3s.
5ecause some medication still gets into the bloodstream, if you are taking oral ;$!I3s for
knee osteoarthritis you may have to reduce the dosage of your medication.
'orticosteroids
In severe cases of knee osteoarthritis, where mobility is severely restricted, corticosteroids
"steroids# can be injected into the knee joint for )uick relief that can last from weeks to
months to years. $teroid medications have powerful antiinflammatory properties but also can
have serious side effects. Csed too fre)uently, they can actually lead to more cartilage
degradation. In knee osteoarthritis, corticosteroids are not given orally because the side effects
outweigh the benefits.
)upplements for Knee Osteoarthritis

0lucosamine and 'hondroitin
'lucosamine and "hondroitin may slow down the progression of osteoarthritis! in addition
to relieving the symptoms.
-lucosamine and chondroitin are both manufactured by the body. They are substances found
in and around the cells of cartilage.
,artilage has a limited ability to regenerate "possibly because it has no blood supply.#
=owever, many researchers believe that -AC,*$!0I;+ supplements can help slowly
repair and rebuild some cartilage. ,=*;3/*ITI; is believed to promote water retention and
elasticity of the cartilage, and inhibit enzymes involved in cartilage breakdown.
-lucosamine and chondroitin are also believed to reduce inflammation. There have been
many studies that show glucosamine is as effective as antiinflammatory medications for knee
pain relief in the majority of knee osteoarthritis sufferers with fewer side effects.
$(, 0lucosamine6'hondroitin Arthritis (ntervention Trial 10A(T#
0any studies done so far on the effects of glucosamine and chondroitin are believed to be
inade)uate and incomplete. =owever, a large clinical trial funded by the ;I= ";ational
Institutes of =ealth#, the -lucosamine and ,hondroitin !rthritis Intervention Trial "-!IT#,
tested whether or not glucosamine and/or chondroitin have a beneficial effect for people with
knee osteoarthritis. This study ",linicalTrials.gov Identifier< ;,T???@8DB?# began in !pril
8??? and completed in ;ovember/8??9.
Key esults of )tudy3 G1or a subset of participants with moderatetosevere pain,
glucosamine combined with chondroitin sulfate provided statistically significant pain relief
compared to placeboabout OB percent had a 8? percent or greater reduction in pain versus
about 97 percent for placebo. !ccording to the researchers, because of the small size of this
subgroup these findings should be considered preliminary and need to be confirmed in further
studies.
1or participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone
did not provide statistically significant pain relief. G
G-!IT includes an ancillary study, which is still ongoing, that will assess whether
glucosamine and chondroitin sulfate can reduce or halt the progression of knee osteoarthritis
following additional treatment.G
0lucosamine and 'hondroitin Precautions
2ou should tell your doctor about supplements you are taking as even 'natural' supplements
may interact with medication you are on or affect other conditions you may have. If you are
diabetic, you should carefully monitor your blood sugar. There are concerns that glucosamine
may have some effect on insulin resistance, though no effect on glucose tolerance was seen
during the -!IT clinical trial. Though glucosamine is a sugar, your body can't convert
glucosamine into glucose. ,hondroitin may not be appropriate for patients on blood thinners.
If you wish to try glucosamine and chondroitin supplements, make sure you buy it from a
reputable manufacturer, as dietary supplements are not strictly regulated "contents are not
checked#. 2ou want to make sure you are getting what's on the label. -lucosamine is e'tracted
from the shells of shellfish. 3o not take it if you have an allergy to shellfish. ,hondroitin is
made from animal cartilage usually cow or shark. .
!lthough glucosamine is usually well tolerated, it can cause nausea, indigestion, heartburn,
flatulence, and diarrhea or constipation. ,hondroitin can also cause gastrointestinal
complaints.
)A#e 1)5Adenosylmethionine2
The body manufactures $!0e. It is not found in significant amounts in foods. $!0e
supplements appear to be as effective as antiinflammatory medication in relieving the pain of
osteoarthritis and increasing functional ability, although it takes longer to work. It is not yet
known if it actually slows down the progression of osteoarthritis.
$!0e was first being studied as a depression treatment when it was discovered that it reduced
the symptoms of osteoarthritis.
6$!0e has antidepressant effects and should not be taken with antidepressant medication
unless recommended by a physician. $!0e may cause a mild upset stomach.
(t can take up to a month to obtain full benefits of )A#e supplements.
$!0e is a very e'pensive supplement, which may be why is not used by as many people as
glucosamine and/or chondroitin. There also seems to be more public awareness of
glucosamine and chondroitin as a treatment for osteoarthritis. !dditionally, there have been
more studies on glucosamine and chondroitin than $!0e.
Other )upplements :or Knee Osteoarthritis
O#%0A5? fatty acids3 *mega@ has some antiinflammatory properties and in a study at
,ardiff Cniversity in &ales, people taking >??? mg cod liver oil capsules twice daily for @
months had significantly reduced levels of enzymes that cause cartilage break down.
-ood sources of omega@ are fish oil or fla'seed oil.
#)#3 0ethylsulfonylmethane !n organic sulfur compound that is found in most fresh foods
fruits, vegetables, grains, milk, and animal products. $ulfur is needed to form connective
tissue and is found in every cell in the body. Though scientific studies on the effects of 0$0
on osteoarthritis have been few, it is believed that 0$0 may reduce the pain and
inflammation of knee osteoarthritis. There are no known side effects. $ometimes
glucosamine, chondroitin, and 0$0 are combined in one supplement.
'alcium3 *ver half of knee osteoarthritis sufferers have mineral deposits in their cartilage.
3on't shy away from calcium supplements if you have calcium deposit in your joints Taking
calcium supplements 3*+$ ;*T cause calcium deposits. +very cell in your body needs
calcium. If you don't consume enough calcium, your body will withdraw it from your bones
to keep the amount in your blood stream constant. Though calcium is not a component of
cartilage, it is essential for healthy bones.
Knee eplacement )urgery

.nee replacement surgery is elective surgery. !ny surgery is considered elective if it is for a
condition that is not life threatening. .nee pain may not kill you but severe chronic pain is
difficult to live with.
In advanced cases of knee osteoarthritis the jointcushioning cartilage may be completely
destroyed and there may be severe chronic pain. =owever, the severity of damage does not
always correlate with the symptoms.
There are nonsurgical treatments for controlling the symptoms of knee osteoarthritis. 5efore
contemplating knee replacement surgery, the following treatments should be given a fair trial<
%"ercise< +'ercise strengthens the muscles around the knee so they can absorb shock before it
reaches the knee joint.
+eight 4oss3 &hen walking the force on the joints is up to five times the body weight. +ven
losing ten pounds can make a difference.
$)A(!s3 ;$!I3s reduce both pain and inflammation. Aongterm use may cause ulceration
of stomach lining and is not always a viable option. The ,*J8 inhibitors are a type of
;$!I3 that are less likely to cause stomach ulcers with longterm use than the other ;$!I3s,
however, there are potential cardiovascular risks involved with ,o'8 Inhibitors. There may
be an increased risk of serious cardiovascular events with all of the ;$!I3's "with the
e'ception of !spirin#, which is doserelated.
0lucosamine 6 'hondroitin )upplements3 5oth glucosamine and chondroitin occur
naturally in the body. They may be as effective as ;$!I3s without the gastrointestinal side
effects.
)A#e supplements may relieve the pain of osteoarthritis in some people but is very pricey
and many people cannot afford this supplement
+hat is Knee eplacement )urgery 1also called total knee arthroplasty2
3uring knee replacement surgery damaged bone and cartilage are shaved from the bones of
the knee joint "thighbone, shinbone, and kneecap# and replaced with metal and plastic
components.
The main parts of an artificial knee joint include metal caps for the thighbone and shinbone
and a highdensity plastic cushion that replaces lost cartilage.
%artial knee replacements can be done if the damage is limited to one area of the knee. 1ewer
compartments are replaced than in total knee replacements, which helps preserve bone
"implants may wear away bone around them# and the knee feels more Pnormal.'
&nee replacement surgery is gaining popularity! not only for seniors #ut also for middle6aged
people.
Knee replacements do not last forever. 1or this reason, many physicians recommend putting
a knee replacement off as long as possible. If a middleaged person gets one, they will
eventually need another replacement to replace the wornout implant. .nee replacement
implants usually last as least >? years, depending upon how active a person is. 2ounger
people tend to be more active than the elderly, so a knee implant may wear out more )uickly
in younger patients. Implants sometimes wear away bone, making it more difficult to anchor
the ne't replacement knee implant.
*'iniumQ is a relatively new material "from $mith E ;ephew Inc.# being used in some knee
implants. *'iniumQ knee implants are e'pected to last much longer than traditional implants
but whether or not they live up to e'pectations remains to be seen.
There are other factors involved in the success of a knee replacement besides the materials of
the implant the skill and e'perience of the surgeon may play the most important role. The
implant must be properly aligned to avoid early wear and loosening of the implant. The
patient, while encouraged to e'ercise, must avoid highimpact activities such as jogging,
running and jumping to avoid loosening of the implant. 5eing overweight can also accelerate
wear of the implant.
;I%&%( 'here are risks involve in any surgery. Blood clots are more likely to form after knee
replacement surgery than other surgeries. Precautions are taken to reduce the risk of #lood
clots forming.
The rate of postoperative complications is also lower when the knee replacement is performed
by a surgeon who has performed high volume of surgeries as well as performed in a hospital
that perform a high volume of procedures.
.nee replacement surgery is usually a last resort L considered only after all other methods of
pain relief have not provided ade)uate pain management.
,ydrotherapy :or Pain @ )tiffness

=ydrotherapy is the use of water for therapeutic purposes. 3ifferent methods and
temperatures may be used for different purposes.
=ydrotherapy includes the use of steam and ice as well as warm, tepid or cool water. 0ost
people with chronic stiffness and pain prefer warm water, although the use of cold can also be
very effective in relieving pain, and if applied immediately after e'ercise can significantly
reduce poste'ercise pain.
&arm water can relieve the pain and stiffness caused by knee osteoarthritis and knee injuries.
"3o not use heat in the acute stages of an injury use cold to reduce the inflammation# 0oist
heat penetrates more )uickly and more deeply into the tissues than dry heat.
)oaking in +arm +ater
! warm bath can ease pain and stiffness caused by osteoarthritis or an injury. "In the case of
an acute knee injury wait a few days until the inflammation subsides# $oaking in a regular
bathtub of warm water increases circulation, promotes healing, helps rela' tense muscles and
relieves stress. $tress can heighten one's perception of pain. !dding an essential oil such as
lavender or chamomile to the water or burning an aromatherapy candle contributes to a
soothing atmosphere. Aistening to recorded sounds such as sound of rain falling, or a
waterfall, or the sounds of the ocean can also by very calming. $oak for 8? to @? minutes.
*ver this can cause overheating of the tissues. $oaking may be done several times per day.
Benefits of +ater %"ercises 1warm or cool2
The properties of water that provide protection for the joints include buoyancy, hydrostatic
pressure, and resistance.
Buoyancy3 The buoyancy of the water supports the majority of the weight of the body, so
there is minimal stress placed upon the knee joints or any of the weightbearing joints. ;eck
deep water supports B?: of body weight( chestdeep water supports O9:( waistdeep water
supports 9?:.
,ydrostatic pressure3 The pressure that water e'erts on the body reduces swelling of joints
and also helps prevent or reduce post e'ercise pain.
esistance3 The muscles must work harder to perform any movement in water than on land
because of the resistant properties of the water. This allows one to increase the workload of
the muscles without adding stress to the joints. The harder the large muscles "legs and arms#
are worked, the harder the heart and lungs have to work to supply them with o'ygen.
+'ercising underwater allows for a highintensity aerobic workout that is easy on the knees
and other joints.
&hile water e'ercises can be performed in any swimming pool, the temperature of the water
is usually warmer for e'ercise classes for people with arthritis.
1<igh intensity aero#ic exercises should #e performed in cooler water to avoid overheating.
!dditional 5enefits of +'ercising in &arm &ater
+'ercise is essential for those with knee osteoarthritis for keeping the muscles that support the
knee strong and improving range of motion. =owever, the pain of osteoarthritis often makes it
difficult to begin e'ercising. +'ercising in warm water increases circulation, which helps ease
pain and loosens up stiff muscles and joints, making it easier to perform e'ercises.
*ften, water e'ercises to loosen up the muscles and improve range of motion are performed
in a warmer pool, and higher intensity aerobic e'ercises are performed in a cooler pool to
avoid overheating.
:ootwear* Pronation* and Knee Pain

+hat is Pronation
&hile walking, weight is transferred from the heel to the outer foot and and then to the inner
side of the foot "the ball of foot# before toeoff.
%ronation is the natural inward roll of the foot that occurs as the arch collapses "like a spring
to absorb shock# between the time the heel contacts the ground and toeoff. The lower leg also
rotates slightly inward during pronation. Pronation is normal and necessary for the foot to
ade)uately absorb shock.
+hat is Overpronation
Overpronation is an e"cessive inward roll of the foot while walking or running.
*verpronation causes e'cessive internal rotation of the lower leg and knee and can affect the
alignment of entire lower body. *verpronation places e'tra strain on the lower body and can
cause foot pain "pain in arches, heels and ankles#, knee pain, leg pain, and lower back pain.
*verpronation can cause or contribute to poor knee tracking and knee pain.
*verpronation can cause or contribute to poor knee tracking. The kneecap slides over a
groove on the thighbone as your knee bends and straightens. &hen the kneecap is pulled to
the left or right of the groove while walking or running, it causes friction and knee pain on the
underside of the kneecap. %oor knee tracking "runners knee# is most often caused by a
weakness or imbalance of the )uadriceps, but the e'cessive rotation of the lower leg and knee
from overpronating can also cause or contribute to poor knee tracking and knee pain.
*ften, mild overpronation is not the main cause of knee pain caused by poor knee tracking,
but a contributing factor
$evere overpronation often causes knee pain. &hile the lower leg is internally rotating
inwards, the upper leg is turning in the opposite direction, causing a slight twisting of the knee
joint that leads to irritation and knee pain.
)igns of Overpronation
%"cess wear on the inner sides of the shoes, often the inner sides of the heels, is a sign of
overpronation. &ith wear, the heels of the shoes may also tilt inwards towards each other.
*ther signs of overpronation are heels that lean inwards and kneecaps that turn inwards while
standing. .nee pain that develops gradually during activity and gradually dissipates with rest
is often a sign the kneecaps don't track properly. .nee pain caused by poor knee tracking can
be caused or aggravated by overpronation.
Arch height is a major factor in determining the amount of foot pronation. 1lat feet often
cause overpronation but not all overpronators have flat feet. Those who have feet with high,
infle'ible arches often underpronate.
#ortonAs foot, or 0orton4s toe can cause overpronation. 0orton4s foot "5ig toe shorter than
second# is common. If the big toe is shorter, the foot rolls inward further before toeoff.
:ootwear for Overpronation and Knee Pain
(otion control and stability shoes reduce overpronation to prevent knee pain.
0otion control shoes and stability shoes incorporate support features into the shoe. $hoes
with ade)uate medial / arch support and firm heel counters help control overpronation. $ome
shoes also have side posts for e'tra lateral support. 1irm midsoles reduce pronation and
protect the knees from lateral stress. The inner side of the midsole may be made of a denser
material "dual density midsoles# to reduce the amount of pronation. The shape of the shoe is
also important in controlling gait problems "overpronation or underpronation#. $traight shaped
shoes reduce overpronation.
$tability shoes are lighter and more fle'ible than motion control shoes. $tability shoes are
usually ade)uate for those who overpronate mildly. 0otion control shoes are for those who
overpronate severely. ! heavy person who overpronates will need a heavier, more supportive
shoe than a light person with the same degree of pronation.
!de)uate foot support for overpronators can relieve or prevent foot pain, knee pain and lower
back pain.
Shoes with )de*uate (edial + )rch Support "ontrols Overpronation to ,revent and -reat
.nee ,ain/
!de)uate medial "arch side# support is especially important for those with overpronation. This
prevents the foot from rolling inwards e'cessively as you walk or run.
0otion control shoes or stability shoes with good medial support are available. !rch
supports / orthotics can be inserted into most casual shoes. =owever, because reducing
pronation depends on proper heel support as well as arch support, arch supports should be
used in shoes with firm heel counters. The shoe should also have a firm midsole. The shoe
must also be deep enough to accommodate the arch support inserts. ,ustom shoe inserts
"orthotics# may be necessary for those with severe overpronation.
&hen knee pain around or under the kneecap is caused or partly caused by overpronation, an
arch support often provides more knee pain relief than a knee brace.
Shoes with 0irm 1eel "ounters "ontrol Overpronation to ,revent and -reat .nee ,ain/
! rigid heel counter "insert in back of heel of shoe to reinforce the heel cup that wraps around
heel# supports and stabilizes the heel to reduce overpronation. The heel cup should fit snugly
enough to prevent slippage and prevent twisted ankles.
Shape of the Shoe and ,ronation/
"Aook at the shape of the bottom of the shoe some are straight, some are curved, some semi
curved#
6$traight shaped shoes work best for controlling severe overpronation and for those with
flatter arches.
6$lightly curved shaped shoes accommodate an arch, and are good for people who have a
mild problem with overpronation.
6,urved shaped shoes work well for those who underpronate.
Knee Pain* .nderpronation* and :ootwear
Cnderpronation means the foot doesn't pronate enough to ade)uately absorb shock. This can
lead to pain in any area of the lower body from the feet "especially the heels# to the knees to
the lower back. Cnderpronators usually have high, infle'ible arches but not everyone with
high arches underpronates.
:ootwear for .nderpronators3
&ell cushioned shoes provide the e'tra shock absorption needed by underpronators. ,urved
shaped shoes "look at bottom of shoe# and fle'ible shoes help to encourage pronation.
Ade/uate 'ushioning 6 )hock Absorption and Knee Pain
:de"uate shock a#sorption not only prevents foot pain! #ut pain throughout the rest of the
#ody = foot pain! knee pain! and lower6#ack pain.
!de)uate cushioning is important for anyone who does a lot of walking. 1ootwear with
ade)uate cushioning is especially important when walking on pavement or any hard surface.
The impact of the feet hitting the ground is transmitted up the through the knees, legs, and
lower back. $hoes with cushioning help absorb the impact of the feet striking the ground
while walking, running or jumping. $hoes with shock absorbing soles not only prevent foot
pain, but prevent knee pain and lowerback pain
8(f you overpronate* highly cushioned shoes may not provide ade/uate support.
$hoes that are very padded can worsen overpronation. 1irm midsoles give more support,
reducing lateral stress on the knee and knee pain. There are motion control shoes that combine
high cushioning with ade)uate support but are often bulkier, heavier shoes.
,igh5heeled )hoes and Knee Pain
The damage and pain inflicted from wearing highheels is most often to the feet, but wearing
high heels is also a common cause of lower back pain and knee pain.
=igh heels throw the body forward and increase pressure underneath the kneecap. =igh
heeled shoes with wider heels are easier on the feet but cause just as much knee pain as
stilettos. $ome of the harmful effects of wearing high heels are immediate, but some problems
develop very gradually. *ver time, high heels may contribute to knee osteoarthritis.
=eels one half to three )uarter of an inch are ideal. =eels that are too low "under a halfinch#
may not provide ade)uate shock absorption.
<igh heels throw your entire #ody out of alignment and can cause foot pain! knee pain! and
lower #ack pain.
Acupuncture

!cupuncture treatment consists of very fine metallic needles inserted into specific points in
the body. 0any scientists believe acupuncture triggers the production of the body4s own
natural painkillers.
,istory of Acupuncture3
!cupuncture originated ancient ,hina. It is based on the belief that life energy flows through
the body along pathways called meridians and that health problems and pain result if the flow
of energy is blocked. $timulating specific points in the body through the insertion of fine
needles restores the flow of energy.
*nly a licensed professional should be performing acupuncture as improper needle placement
can cause pain "or injury#. There may be a mild discomfort upon insertion of the needles, but
they usually cannot be felt after this. %roper procedures must be followed, e.g. treatment site
swabbed with disinfectant, the use of disposable needles, to avoid infection.
A >B week study on acupuncture for knee osteoarthritis funded by $''A# ";ational
,enter for ,omplementary and !lternative 0edicine# and the ;ational Institute of !rthritis
and 0usculoskeletal and $kin 3iseases, both which are divisions of ;ational Institutes of
=ealth, found that an e"tended course of acupuncture to be beneficial in both relieving pain
and improving functioning in those with knee osteoarthritis.
In this study, 9O? people were divided into three groups. *ne received acupuncture, one sham
acupuncture, and one received education. %atients still received standard treatment from their
physicians, including medications.
The results were not immediate. !fter D weeks there was an improvement in function but
not pain. !fter >7 weeks, there was also an improvement in pain. The improvements in pain
and functioning at >7 weeks held throughout the rest of the trial.
Overall* the group receiving treatment with acupuncture resulted in about a CDE
reduction in pain and 7?: improvement in functioning, significantly higher than the two
other groups. This study is the longest and largest study of acupuncture for knee osteoarthritis
to date. %revious studies of acupuncture for osteoarthritis have had conflicting results,
possibly because they were too small.
0ore physicians are referring patients for acupuncture treatments than ever before for pain
relief, often as part of pain management program.
:s with any treatment! the results of acupuncture for the treatment of knee pain will vary from
person to person.
T+;$

Tens stands for Transcutaneous electrical nerve stimulation. "Transcutaneous simply means
through the skin#
! T+;$ unit is a small device that delivers low voltage electric impulses to the nerve endings,
through electrodes placed on the skin, to stimulate the nerves for the purpose of relieving
pain.
T+;$ may work by blocking pain signals to the brain and/or stimulating the production of
endorphins "naturally occurring painrelieving chemicals#.
! portable, batterypowered T+;$ unit can be worn all day if re)uired. It is small enough to
wear clip on a belt or wear inside clothing. Two electrodes are placed on the body at the site
of the pain or sometimes at a point that would be used in acupuncture "some T+;$ units have
two channels with four electrodes#. ! very mild electrical current stimulates nerve endings,
which may result in a reduction in pain.
T+;$ is often used to treat the pain of arthritis. +ven when T+;$ is being used for the same
type of pain, not everyone will have the same results. $ome people obtain immense relief,
while others find it ineffective. $ome report partial pain relief and use it along with other
treatments.
$tudies on T+;$ have had conflicting results. !s many have shown positive results as
negative results. There is greatest chance of success if a physician or physical therapist
instructs a patient on the proper use of the unit. ! onemonth trial period is usually
recommended to evaluate the effectiveness of this treatment.
8The current from a T%$) unit may interfere with a pacemaker.
T+;$ units are considered safe and are 13! approved. ! tens unit should be used under the
supervision of a physician or physical therapist.
4ow54evel 4aser Therapy 1444T2


Aowlevel lasers are also called cold lasers, soft lasers, biostimulation lasers, lowintensity
lasers, etc.
Aowlevel laser therapy "AAAT# is the use of a lowpowered laser that emits specific
wavelengths of light in the visible red and/or far infrared range for therapeutic purposes.
Aowlevel laser clinics are becoming more widespread in ;orth !merica.
These clinics treat musculoskeletal injuries/conditions "acute and chronic#, alone or in
conjunction with other treatments. AAAT is also commonly used in wound healing.
.nee injuries and conditions treated by lowlevel laser include tendonitis, bursitis, meniscus
tears, runners knee/chondromalacia patella, knee joint effusion, iliotibial band syndrome,
osgood schlatters disease, osteoarthritis and rheumatoid arthritis.
4ow5level powers use very low power and no heating of or damage to the tissue occurs.
Aowlevel laser treatment increases cell metabolism.
4ow5level lasers emit light in the red and infrared range. /ed and infrared light penetrate
deeply into human tissue, where the light energy is absorbed and turned into biochemical
energy. 5y increasing cellular energy in the treated area, lowlevel laser therapy is believed to
speed healing and reduce inflammation and pain. There are no known side effects.
4aser devices emit small concentrated beams of light. Aaser light is parallel "wavelengths
travel in the same direction#, coherent "highs and low point of light wave are lined up# and
monochromatic "one or more specific wavelengths of light#. In contrast, sunlight and common
light bulbs emits incoherent light in almost all directions over a wide range of wavelengths
The cost of one treatment is typically about R9? with an average of >? treatments given. The
number of AAAT treatments needed depends upon the condition being treated, the severity of
the condition and individual response. The effect of lowlevel laser therapy is accumulative.
Though some people have immediate results, improvements are often not noticed until after
@9 treatments.
#ost health care plans do not cover 444T because the 13! considers AAAT
investigational, e'perimental and unproven "though approved for use since 8??8 by the 13!#.
0ore large clinical trials that follow stringent scientific guidelines are needed. Though there
have been many trials they have been considered inade)uate. ">#
4ow5level laser therapy is becoming more popular with people seeking relief from chronic
conditions( sufferers may try AAAT when conventional treatments fail to provide sufficient
relief of symptoms or have undesirable side effects. 0any athletes use lowlevel laser therapy
to speed recovery from sports injuries.
Knee Anatomy
BO$%) O: T,% K$%%3
The femur "thigh bone#, tibia "shin bone#, patella "knee cap#, fibula "smaller bone ne't to shin
bone#.
0uscles, tendons and ligaments connect the knee bones. The kneecap glides in a groove in the
thighbone and adds leverage to the thigh muscles, which are used to e'tend the leg. The thigh
bone and shine bone come together at the knee joint and move on one another when bending
or straightening the leg.
K$%% 9O($T 'AP).4% "not shown#<
The knee joint capsule is a sac that encloses the knee joint cavity. It is attached to the bones of
the joint, and forms the joint cavity. The knee joint capsule has a tough, fibrous outer
membrane and an inner synovial membrane, which produces joint fluid "synovial fluid# that
lubricates the joint and nourishes the articular cartilage that coats the ends of the bones in the
joint.
4(0A#%$T) O: T,% K$%%3
1our main ligaments connect the bones of the knee<
Two ligaments are in the center of knee and are bathed in joint fluid the anterior cruciate
ligament "!,A# and the posterior cruciate ligament "%,A#
The other two ligaments are located on the outside of the knee joint the medial collateral
ligament "0,A# on the inner side and the lateral collateral ligament "A,A# on the outer side.
Aigaments on outside of kneecap usually heal by themselves. Aigaments in the center of the
knee rarely heal on their own because they are bathed in joint fluid and lack a blood supply.
'AT(4A0% O: T,% K$%%3
,onnective tissue that absorbs shock. The two types of cartilage are< !rticular E 0eniscular.
Articular 'artilage3
,oating on the end of all bones that make up the knee joint. The back surface of kneecap, end
of femur, and top of tibia are all covered with articular cartilage.
3amage to the articular cartilage is usually diffuse damage. This is usually gradual 'wear and
tear' damage caused by overuse, aging, and can be accelerated by poor knee tracking.
#eniscular 'artilage3
%rotects the articular cartilage and separates the bones of the knee. It is a spongy shock
absorber. This is the cartilage referred to when you hear Gtorn cartilage( meniscular cartilage is
commonly torn in twisting injuries.
#.)'4%) O: T,% K$%%3
-uadriceps3 0uscles on the front of the thigh. Csed to straighten the knee
,amstrings< 0uscles on the back of thigh attach to tibia "shin bone# at back of knee. Csed to
bend the knee.
T%$!O$) O: T,% K$%%3
Tendons join muscle to bone. The )uadriceps tendon hooks )uad muscles to the patella
"kneecap#( patella tendon connects the patella to the shinbone. The )uadriceps tendon and
patellar tendon actually connect to form one continuous tendon that covers the patella.
B.)A%< $mall sacs that provide a lubricating surface between surfaces that needs to move.
Knee 0lossary
AT,O)'OP%< a camera attached to a video monitor
AT,O)'OP;3 noninvasive way to do surgery. ! camera attached to video monitor is
inserted through small incision.
B.)A%< small fluid filled sacs providing lubricating surface between surfaces that need to
move
'AT(4A0%3 ,onnective tissue that cushions the ends of bones and is found between bones
absorbs shock. !rticular ,artilage is a smooth coating on the end of all bones that make up
the knee joint. 0eniscular ,artilage protects the articular cartilage and separates the bones of
the knee. It is a spongy shock absorber.
'hondromalacia Patellae 3 chronic deterioration of the cartilage coating the back surface of
the kneecap."also called Aateral patella compression syndrome, anterior knee pain#
+'tensor 0uscle< !ny muscle that causes the straightening of a limb.
:ascia < fibrous connective tissue covering, separating, or binding muscles and other soft
structures of the body.
:emur< Thigh 5one
,amstrings < 0uscles of the back of thigh
,ip Abductors< 0uscles of the outer hip, attached to the thighbone
,ip Adductors< 0uscles of the inner thigh.
(liotibial Band < ! connective tissue that runs from your hip to your outer knee.
Knee Tracking3 The kneecap "patella# slides over a groove "patellofemoral groove# on the
lower end of the thighbone "femur# as your knee bends and straightens.
4igament 3 1ibrous connective tissue that connects the bones and keeps joints stable and
controls their range of motion.
anterior cruciate ligament "!,A# in the center or the knee
posterior cruciate ligament "%,A# in the center or the knee
medial collateral ligament "0,A# outside the knee joint, inner side of leg
lateral collateral ligament "A,A# outside the knee joint, outer side of leg
#( 1#agnetic resonance imaging#< diagnostic techni)ue using magnetic fields, radio
fre)uency, and a computer to produce detailed images of structures within the body. shows
soft tissue "and bones# can also show the joint in motion
Patella3 kneecap
Patellofemoral3 The junction of the kneecap and thighbone
Patellofemoral groove 3 ! groove on the lower end or the thigh bone "femur#, which the
kneecap "patella# slides over
Patellofemoral Pain )yndrome 1P:)2 or unners Knee< Injury and pain caused by
incorrect knee tracking which results in the kneecap rubbing against the thighbone when
moving. ,an lead to ,hondromalacia %atellae
%ronation "the inward roll of the foot as the arch collapses after the heel contacts the ground#
-uadriceps < Aarge +'tensor 0uscle of the front of thigh divided into four parts ")uad means
four# that unite in a single tendon at the knee.
rectus femoris< middle front division of the )uadriceps
vastus lateralis< outer front division of the )uadriceps
vastus intermedius< front division of the )uadriceps
vastus medialis< inner front division of the )uadriceps
unners knee < see %atellofemoral %ain $yndrome
Tendon< fibrous connective tissue joining muscle to bone.
Tibia< shinbone
&5ay< electromagnetic radiation used to produce images of bones.
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