Common Knee Problems

Article by grahem shane

For the knees to work properly, they are dependent on parts such as bones, cartilage, muscles, ligaments and tendons – all of which are subject to wear and tear, disease and injury.

What are some of the common knee problems?Osteoarthritis of the knee in various degrees and severity forms the bulk of the cases. Meniscus tears, either due to degeneration or trauma as a result of sports injuries, come next. Another common injury, especially among soccer players, is torn anterior cruciate ligament, one of the four major ligaments of the knee.

Why do knee problems occur?Degenerative conditions are more common in individuals with mal-aligned knee joint and patella, or the kneecap. They usually affect patients above 50 years.

If one has a varus knee (bow legged), excessive pressures will be subjected to the inner aspect of the knee. A valgus knee (knock kneed) or tilted patella (knee cap) will similarly be subjected to excessive stresses at certain parts of the joint. It does not help when one pounds the knee joint during activities such as playing basketball or soccer, or even prolonged running on hard surfaces.

Are there permanent cures for the various knee problems?

There is a solution for most of the degenerative conditions or injuries. We must accurately diagnose the condition in order to treat it effectively.

Physiotherapy, minor adjustments to lifestyle, knee braces, orthotics and anti-inflammatory medication or even local steroid injections usually bring permanent relief.

Joint injections with natural lubricants are useful for early osteoarthritis. PRP (platelet rich plasma) and even stem cell injections into the knee are newer developments in encouraging cartilage to regenerate.

An operation becomes necessary when the knee has a structural problem, such as a meniscus tear or torn ligament.

Can glucosamine cure knee problems?

Glucosamine is the building material needed to repair worn-out joint cartilage, just like calcium is needed to build strong bones. Crystalline glucosamine is generally more effective as it is better absorbed by the body.

A paper published in the medical journal Lancet in 2001 has proven that cartilage growth does occur with prolonged consumption of glucosamine.While many patients with knee problems have found glucosamine useful, some have been disappointed. This is because sometimes the knee joint is badly worn out and requires the consistent use of glucosamine for more than six months before any effect is noticeable.

When is surgery recommended for knee problems?

Many knee conditions can be treated more conservatively. Surgery will be advised only if all the conservative treatment measures fail.

What are the risks involved in knee surgery?

The risks depend on the age of the patient, any pre-existing medical conditions like diabetes or heart problems. These relate to the risk of anaesthesia and infection. Specific local risks include deep-vein thrombosis, post-surgery stiffness as well as risks of neuro-vascular injuries. These complications are rare and preventable.

Is a long period of convalescence needed before one can start walking again following a knee operation?It depends on the type of surgery. Patients with arthroscopic or key-hole surgery generally can walk the very next day. Even with total knee replacement, patients can start walking with the help of aid devices the next day.

What is total knee replacement? Who benefits from it?

In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.

Total knee replacement can be a life-transforming surgery. Patients who are in wheelchair can walk unaided after surgery.

If there are no medical contra-indications, this surgery will benefit everyone. However, we usually advise patients not to do the replacements yet if they are below 60 years of age as the implant generally lasts about 15 years.

How can you prevent knee problems that are associated with ageing?

Degeneration of the knee comes from overuse, abuse and from mal-alignment. If you have a mal-aligned knee, you will need foot orthotics to redistribute and even out the stress across the knee. It will be best to avoid pounding your knee with robust exercises. Glucosamine is essential.

Stretching of the muscles and ligaments around the knee will reduce stress across the joint. Quadricep-strengthening exercises, especially of the vastus medialis obliquus (a muscle of the quadriceps), will help realign forces across the patello-femoral joint (one of the knee joints).

What are the do’s and don’ts when it comes to knee-related exercises?

In general, any excessive pressure on the knee is not good for the knee. Climbing stairs is a good form of calorie-burning and cardio-exercise but it puts too much stress on the patella-femoral joint. Squatting or extension curls have the same effect.

Safe knee exercises include the stepper, leg press and cycling (with the seat as high as possible). If you have knee pain, swimming or aqua-aerobics is best.

Common knee problems in Singapore include Osteoarthritis of the knee & meniscus tears. Orthopaedic surgeon Dr Tho Kam San is based in Mount Alvernia Hospital and is an expert on common knee problems.










Knee Arthritis And How It Affects You

Article by Scott Michaels

Arthritis, any of more than 100 different diseases causing pain, stiffness, and in most cases, swelling in the joints.Arthritis affects people of both sexes and of all races, socioeconomic levels, and geographic areas.Osteoarthritis is the most common type of knee arthritis.

Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage is worn away by knee arthritis, bare bone is exposed within the joint. Knee arthritis symptoms tend to progress as the condition worsens. What is interesting about knee arthritis is that symptoms do not always progress steadily with time. Often patients report good months and bad months or symptom changes with weather changes.

This is important to understand because comparing the symptoms of arthritis on one particular day may not accurately represent the overall progression of the condition.The most common symptoms of knee arthritis are:pain with activities, limited range of motion, stiffness of the knee, swelling of the joint, tenderness along the joint, a feeling the joint may “give out”, deformity of the joint (knock-knees or bow-legs). Rheumatologists, physicians who diagnose and treat arthritis and related conditions, use a variety of diagnostic techniques. The first step is a thorough history and physical examination, during which the doctor questions the patient about symptoms and medical history to learn about potential exposure to infectious agents or a family history of arthritis.

The patient is examined to determine the pattern of joints affected. With this information, rheumatologists are usually able to make a diagnosis. Laboratory tests are used to help diagnose inflammatory arthritis.

For example, a blood test called erythrocyte sedimentation rate measures how quickly red blood cells cling together and fall to the bottom of a test tube. When there is inflammation in the body, red blood cells sink faster.

This test lets physicians evaluate how severe the inflammation is. Rheumatologists also test a patient’s blood or synovial fluid for the presence of specific antibodies–disease-fighting agents activated in the body by infections.

The presence of rheumatoid factor antibodies, for example, is an indication of rheumatoid arthritis, and antinuclear antibodies can be an indication of lupus. The presence of these antibodies along with clinical symptoms help establish the diagnosis. Physicians may also elect to test for the presence of specific genes, such as the HLA-B27 gene.The primary goal of treatment is to reduce joint pain and inflammation and to maximize joint mobility. To this end, rheumatologists work closely with patients and their families to develop a treatment regimen incorporating exercise and rest as well as pain-relieving and anti-inflammatory drugs, and in some types of arthritis, drugs that slow the progress of the disease. Low impact, regular exercise is very important in maintaining muscle strength and joint mobility. One of the best forms of exercise for people with arthritis is swimming, an activity that lets participants use muscles with minimal joint strain.

Arthritis sufferers benefit from physical therapy programs specially tailored to their age level and degree of mobility. Stretching and hot showers before exercise and applying ice packs to muscles and joints after exercise minimize discomfort related to exercise.

Rest is another crucial element of arthritis treatment. In addition to recommending at least eight hours of sleep a night, rheumatologists may also advise patients to use a cane, splint, sling, or special footwear to rest or stabilize affected joints periodically during the day.Almost all drugs used to treat arthritis can have side effects and may not work for all patients with arthritis. Researchers are investigating alternatives to traditional drug therapy and other treatment approaches.If joint damage is severe, patients with arthritis may need to have surgical treatment. Total hip and total knee replacements can significantly relieve pain and improve joint function. In some cases, surgeons replace damaged or deteriorating joints with artificial stainless steel or plastic components in a procedure called arthroplasty.

The latest facts and information about knee arthritis.










Alternative to Knee Replacement

Article by Francisco Mejias

For 25 years Robert Reid kept active by practicing karate, playing football, softball, and basketball. But, his love for sports took a toll on his body. Robert developed arthritis in his knees and would need surgery.

“The knee pain was tremendous, you always have that constant, constant ache that throbbing. I actually got to the point I was probably popping Advil’s like M&M’s,” recalls Robert.

To alleviate Robert’s pain doctors performed a partial knee resurfacing.“A knee has 3 separate compartments, and when only one part of the knee is diseased we have the opportunity to just replace that part of the knee; and instead of fully replacing it, I’m able to simply resurface the end of the bone with metal on one side and a high density medical plastic on the other side and leave the rest of the knee completely intact and leave all the ligaments and the rest of the person’s feeling of their knee as if it was their old knee,” explains orthopedic surgeon, Dr. Ira Kirschenbaum.

Because only the damaged surface of the knee is replaced during a partial knee resurfacing, trauma is minimized to healthy bone and tissue. “When you do a total knee replacement the whole knee gets chopped out and if it fails in 10 years, 12 years or whenever you have to put in another total knee, you’ve burnt every bridge,” reports Dr. Kirschenbaum.

According to Dr. Kirschenbaum, partial knee resurfacing would not be an effective treatment option for people suffering from severe arthritis and those patients battling rheumatoid arthritis. “Anyone with the osteoarthritis restricted primarily to one part of the joint is an excellent candidate and that represents probably 70% of all knee arthritis that’s out there.”

Dr. Kirschenbaum explains there are three phases of rehabilitation…first phase is healing of the wound, second, is achieving motion and third, is regaining the function you had prior to the surgery. By the end of the second week, most patients are 95% there with motion and function. And by 4 to 6 weeks most patients are resuming their usual activities.

Symptoms of knee arthritis include pain with activities, limited range of motion, stiffness of the knee, swelling of the joint, tenderness along the joint, a feeling the joint may “give out,” or deformity of the joint like knock-knees or bow-legs.

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Knee Replacement Facts, Symptoms & Treatment

Article by MediAngels

Knee replacement is surgery for people with severe knee damage. Knee replacement, or knee arthroplasty, is a surgical procedure in which the diseased surface of the knee is replaced by artificial materials.

The surgery can be performed for partial or a total joint replacement . The recovery period may last upto 6 weeks or longer and usually involves the use of aids (e.g. walking frames, canes, crutches) till recovery. There is substantial postoperative pain involved and includes vigorous physical rehabilitation.

When and Why do you need knee replacement?

Below mentioned diseases are some of the reasons you would need one. These hamper day to day activities:-

Severe osteoarthritis Advanced Rheumatoid arthritis Psoriatic arthritis Trauma Serious valgus or varus deformity (knock knees or bow legged)

What are the Pre-Operative preparations before surgery?

Knee replacement is major surgery. Before surgery, joints adjacent to the diseased knee are carefully evaluated. Routine blood tests, liver and kidney function tests and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism. Chest X-ray and ECG are performed to exclude significant heart and/or lung disease which may preclude surgery or anesthesia.

All the medications that the patient is taking is reviewed, especially blood thinners.

How is the surgery done?

There are majorly two types of surgery, depending on the disease process and degree of knee affected.

1. Total Knee Replacement (TKR)

The surgery involves exposure of the front of the knee, with detachment of part of the muscles of the thigh. The knee cap is displaced to one side of the joint allowing exposure of knee joint. The ends of these bones are then accurately cut to shape using cutting guides. Metal components are then impacted onto the bone or fixed using cement.

A round ended implant is used for the femur, mimicking the natural shape of the bone. On the tibia the component is flat, although it often has a stem which goes down inside the bone for further stability.

2. Partial knee replacement

Partial knee replacement or Unicompartmental arthroplasty (UKA) is an option for some patients. The knee is generally divided into three “compartments”: medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most patients with arthritis severe enough to consider knee replacement have significant wear in two or more of the above compartments and are best treated with total knee replacement. A minority of patients have wear confined primarily to one compartment, usually the medial, and may be candidates for unicompartmental replacement. Advantages over total joint replacement is that it includes smaller incisions, easier post-op rehabilitation, better range of knee movement and less complications. Patients suffering from Rheumatoid, Lupus, Psoriatic or marked deformity are not candidates for this procedure.

What are the complications of the surgery?

The most serious complication is infection of the joint, which occurs in <1% of patients. Deep vein thrombosis (blood clots in the leg veins) occurs in up to 15% of patients. Nerve injuries occur in 1-2% of patients. Persistent pain, failure to achieve full range of motion or stiffness occurs in 8-23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.

Who can do this surgery?

Knee replacement surgery is done by orthopaedic surgeon, generally those who are specialised or dedicated themselves to Joint replacement surgeries.

How can MediAngels help?

MediAngels is the world`s first global e-hospital catering to the needs of every patient and make available easy access, to the ever expanding super-specialty at your doorstep.

You can consult MediAngels Global Medical Experts in Orthopaedic – Joint Replacement for their opinion from the comfort of your home. You can even have your blood tests ordered, sample collected and reports delivered at your doorstep.

Visit MediAngels Experts to consult for joint replacement.

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MediAngels is the world`s first global e-hospital catering to the needs of every patient and make available easy access, to the ever expanding super-specialty at your doorstep. Orthopedics – Joint Replacement Surgery consists of replacing painful, arthritic or worn out parts of the Joint with artificial surfaces shaped in such a way as to allow joint movements. The Reconstructive / Joint Replacement Surgery is done to restore the anatomic alignment and balance the supportive ligaments to provide normal form and function of the joint to the patient.










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Arthritis Knee Surgery – The Professionals and Cons

Article by Steve Henderson

Arthritis could be a disease characterised by abnormal inflammations affecting the human body’s articulations or joints. The fingers, elbows, hips, and knees are the first targets of arthritis. Arthritis comes in varied forms. Osteoarthritis, the most common kind of arthritis, is caused predominantly by recent age, but might conjointly develop in response to certain lesions, infections, or malformations, of the knee. Different less common but equally debilitating sorts of arthritis are as follows: gouty arthritis, psoriatic arthritis, and rheumatoid arthritis.Treatment Choices for Arthritis In the KneeSeveral modes of treatment are obtainable for managing arthritis and its symptoms. These might vary from physical therapy, pharmacological remedies (medications), to arthritis-specific surgical procedures.The latter, a lot of commonly known collectively as arthritis knee surgery, incorporates a variety of a lot of specialized sorts – for example, knee osteotomy, arthroscopy, and knee replacement surgery. The precise kind of arthritis knee surgery can depend on a number of things, such as the extent and severity of the disease.What’s Knee Arthritis Surgery? Depending on the state of arthritis, the most recommended choice for treatment is often arthritis knee surgery.Arthritis usually develops in stages, gradually destroying the cartilaginous tissue present within the tissue joints. In its early stages, anti-inflammatory treatment and physical therapy are the first modes of treatment. But, because the disease progresses, arthritis knee surgery becomes an urgent and crucial necessity.Arthroscopy: A Less Invasive Option Arthroscopy may be a less invasive surgical possibility in arthritis treatment. This procedure involves the repair of ligament and cartilage tissue injuries within the knee and the opposite joints. During an arthroscopy, a little instrument resembling an endoscope can be inserted within the affected articulation via a very little incision.Though the effectiveness of this procedure remains an issue of debate, many proponents attest to the advantages of arthroscopy when applied in acceptable scenarios.Telltale signs that a patient needs knee arthroscopy are as follows: painful popping of the knee, knee joint instability or wobbling knees, a prickling sensation when using the knee joint, and inflammation or swelling of the affected body half(s).Knee Osteotomy: Higher Possibility for Younger Patients In cases of younger patients, these arthritics only usually have injury in solely one half of the knee joint. Consequently, they are not advised to bear complete knee replacement surgery.Generally, arthritis conjointly manifests through knock-legged or bow-legged cases, which are characterised by a joint reorientation, such that the joint’s weight center is transferred from its broken area to its healthy area. In such cases, knee osteotomy is usually the most effective course of action.Partial Knee Replacement Surgery: The Hybrid Considered a “hybrid” of each osteotomy and complete knee replacement surgery, partial knee replacement surgery is significantly less invasive than the latter. This procedure is finished by replacing the damaged portion of the affected articulation with a prosthetic one, whereas the healthy elements are left intact to heal. Partial knee replacement surgery is recommended for severe arthritis confined to bound parts of articulation. Compared to complete knee replacement surgery, this procedure requires smaller incisions and permits for a more fast recovery time.Complete Knee Replacement Surgery: A Practical Possibility For several arthritis cases, the foremost practical option is complete knee replacement surgery. This procedure entails the whole removal and replacement of the damaged joint tissue with plastic or metal prosthetic implants.Associated Risks: Arthritis Knee Surgery As in most sorts of major surgery, arthritis knee surgery patients are susceptible to thrombosis, infections, nerve damage, and bound anesthesia risks.In addition, arthritis knee surgery involves a number of post-surgery risks, together with instability of the affected joint, kneecap fracture or dislocation, and even decreased mobility or reduced vary of motion.Arthritis Knee Surgery: Execs and Cons In spite of the risks associated to the procedure, arthritis knee surgery comes with many benefits that can profit the inflicted patient. The first edges are, of course, considerable pain alleviation, enhanced mobility, with a considerable improvement in one’s quality of life. Most importantly, at intervals six months following the surgery, the previously affected joint has the potential to regain its full functionality.Conversely, arthritis knee surgery also comes with some perceptible disadvantages. As an example, post-operative patients could expertise discomfort and soreness in the period following the procedure. Additionally, the utilization of the prosthetic joint will be noisy and draw attention to its presence. In some cases, difficulties in movement might arise. And, relying on the sort of prosthetics used, the replacement knee could have limited usability, like only ten-15 years before a brand new replacement knee becomes necessary once more.All things considered, but, if we tend to weigh the pain and discomfort that are observed in some cases against the immense potential for successful post-surgery results, it is simple to conclude that the professionals of arthritis knee surgery unquestionably exceed its cons.

Steve Henderson has been writing articles online for nearly 2 years now. Not only does this author specialize in Arthritis ,you can also check out his latest website about:Modern Office Chairs Which reviews and lists the best Modern Home Office Furniture










www.doctorveklich.com – A video is done before bow legs correction treatment of a patient
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Reduce The Chance Of Knee Problems As You Age

Article by Robert Paul

As we get older the damage we do to our knees isn’t as easily noticed as the scrapes we used to get as kids. But the things we do as adults can cause worse knee damage that may have a long-term impact on the overall health of this important joint.

Our knees are subject to a lot of mechanical stress on a regular basis, and for the most part they are made to take it, although some bad habits can eventually lead to chronic pain or disability. To help avoid knee pain or reduced mobility later it is important to make some decisions now that can keep your knees healthier for a long time.

Maintain A Healthy Weight

Because your knees help support the weight of your body it is really important to maintain a healthy weight for your size and body structure. Every additional pound of weight adds additional pressure to these important joints.

Not only does it put extra pressure on your joints, but carrying around extra weight also causes cartilage to breakdown faster. Losing unhealthy body fat is one of the most important steps you can take to help protect your knees and decrease the change of developing a serious knee problem as you age.

Get Regular Exercise

Exercise goes hand in hand with maintaining a healthy weight so it may not be a surprise to hear that exercise is good for your knees. But beyond weight loss regular exercise is necessary for maintaining knee strength. Without exercise your joints will not have the protection they need from the muscles around the joint, which leaves your joints, ligaments and tendons vulnerable.

Choose a low-impact exercise to maintain the best knee health possible, something like weight lifting, yoga, walking, biking or swimming. These exercises are good for improving range of motion, building muscle and enhancing circulation. Focus on moderate daily exercise instead of occasional strenuous exercise for best results and to reduce the chance of injury.

Other Considerations

Good posture and proper body alignment are also important for joint health. Without proper alignment your joints, ligaments and muscles will be forced to absorb more strain than they were meant to. Don’t slump forward or lock your knees when standing. Make sure your weight is evenly distributed when standing and keep your abdominal muscles tight to help support your body.

Wearing the right shoes is important as well. Get shoes with a good arch support that help you keep your weight evenly distributed so you aren’t putting extra stress on your knee joints. If you have flat arches, bowed legs or an uneven length in your legs consider going to a store that specializes in shoes that help correct these issues.

Taking care of your knees now can mean you will reduce your risk of knee problems and likely save money on rehab down the road.

Using things like adjustable weight benches along with other basic weights can help improve your strength and enhance your joint health and muscle tone. Learn more at Robert’s comprehensive site: Weight Benches Guide










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Do you have knee pain? Genu Valgum may be the culprit.

Article by John Platero

A friend of mine went on a bicycle ride with me, and after about an hour started to experience severe knee pain. After checking her lower extremity I found she had “knock knees”. The clinical term for “knock knees” is Genu Valgum. The opposite would be “bowlegged” or Genu Varum. Since Genu Varum isn’t normally associated with pain or problems, we’ll concentrate on my friend with Genu Valgum. However, both of these conditions are the resultant of the Q-angle.

The Q-angle is determined in the frontal plane by drawing a line from the anterior superior spine of the ilium to the middle of the patella, and a second line from the middle of the patella down to the tibial tuberosity. A normal Q-angle for quadriceps femoris function is usually 10 -14 degrees for males and 15 -17 degrees for females

Anyway, back to my friend…

When assessing the lower extremity you have to “get out of the box” sort of speak, says Ruben Salinas PT, OCS. Ruben is the clinical director of the Fortansce and Associates Physical Therapy clinic in Arcadia, CA. “Don’t just focus where the pain lies look at the whole picture. Remember, the lower extremity is a closed chain, especially in cycling.”

Normally associated with Genu Valgum you’ll find pronation or flat feet, tight gastrocnemius and in some cases trochanteric bursitis.

Let’s look at one at a time:

At the ankle, the body will try and compensate for the valgus stress at the knee (tensile forces on the medial side of the knee; compressive forces on the lateral side) by pronating. In gait you have to dorsiflex one ankle in order to swing through with the other leg.

If your clients gastroc is tight, they won’t be able to dorsiflex, which will cause the foot to cave in. This will indeed affect the knee and then the hip. To lengthen the gastroc, have your client stretch. Be careful to insure their foot doesn’t cave in while stretching. If needed, support the inside of their foot with a wooden block so their foot won’t pronate.

For the tibialis posterior (which is an inverter and crosses the ankle) have your client perform “windshield wipers.” By strengthening the inverters, (see diagram) you’ll cause the foot to supinate which is the opposite of pronation.

Here’s how:

Lie a light weight on a towel. With their feet flat on the floor have the person slide the weighted towel inwards towards their other foot. There are other ways of helping the foot out, but that’s a whole other article.

My friend wasn’t complaining about her feet though, the pain was on the lateral or outside part of her knee.

So let’s examine the knee:

Because of the excessive Q-angle there will be more compressive forces on the lateral side and more tensile or distraction forces on the medial side of the knee. So how do you fix that?

“This is topic a large grey area in the physical therapy world,” says Ruben Salinas. He is an expert on knees. VMO weakness or the inability to fire has been suggested as the culprit for patella – femoral dysfunction. The experts still can’t agree. It’s definitely worth trying though. To increase VMO activity, try quad sets in all directions or have your client put a small ball or rolled up towel between their legs when the perform leg extensions. Have them squeeze tightly or adduct at the top of the extension.

Another method Ruben suggests is Bio-feedback. Have the client put their hands on both the Vastus lateralis and Vastus Medialis, then have them contract their leg. Through their fingers they should be able to feel which side contracts first. Try and get them to “fire” the inside (vastus medialis) first. It would be nice if you had some surface EMG’s, but hey, we’re just trainers!

At the hip, you’ll often find weak external rotators. It’s almost as if the head of the femur has rolled forward and inward. When this happens, the greater trochanter starts to smash up against a bursa which eventually could lead to bursitis.

The external rotators of your hip are the key here. Concentrate on the gluteus maxims and not the gluteus medius. Remember, the medius is an internal rotator. Don’t forget the deep external rotators either. By performing external rotation with a cable or tubing attached around the ankle, you will strengthen the piriformis, superior and inferior gemellus, obturator externus and internus as well as the quadratus femoris. This will help stabilize the hip so that smashing of bone against bone doesn’t occur.

Be aware, some clients may have an anteversion. This is the angle of the femoral neck in the frontal plane. (see diagram). Anteversion will turn the toe turn inwards, increase mechanical advantage of the gluteus maxims as an external rotator, increase the Q-angle and cause more pronation at the foot. Anteversion is structural, so you can’t repair that without a scalpel and a chain saw.

In conclusion, I hope you can see that in the case of the lower extremity you must take a holistic approach. Ask a lot of questions. How did they get this way? Is the condition acute or chronic? Is it congenital? Is it structural or muscular? Examine their gait.

If there is pain when performing these exercises, refer them out and get a medical release.

I hope this will help you and your clients, and I sincerely hope you’ll assess their posture before you load anyone with a weight.

By the way, after a little RICE, (rest, ice, compression, elevation) my friend was able to walk again. Now she just needs one of you to train her.

John Platero is a fitness expert, founder of Future Fit, Inc. multi-faceted fitness company that provides fitness products, services and education to fitness professionals and consumers and consults for Health and Fitness companies. He is the Director of the N.C.C.P.T. (The National Council of Certified Personal Trainers) which has certified thousands of trainers. www.nccpt.com










Knee pain due to knock knees as discussed by dr Farshchian

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Common Knee Problems

Article by Jhon

For the knees to work properly, they are dependent on parts such as bones, cartilage, muscles, ligaments and tendons – all of which are subject to wear and tear, disease and injury.

What are some of the common knee problems?

Osteoarthritis of the knee in various degrees and severity forms the bulk of the cases. Meniscus tears, either due to degeneration or trauma as a result of sports injuries, come next. Another common injury, especially among soccer players, is torn anterior cruciate ligament, one of the four major ligaments of the knee.

Why do knee problems occur?

Degenerative conditions are more common in individuals with mal-aligned knee joint and patella, or the kneecap. They usually affect patients above 50 years.

If one has a varus knee (bow legged), excessive pressures will be subjected to the inner aspect of the knee. A valgus knee (knock kneed) or tilted patella (knee cap) will similarly be subjected to excessive stresses at certain parts of the joint. It does not help when one pounds the knee joint during activities such as playing basketball or soccer, or even prolonged running on hard surfaces.

Are there permanent cures for the various knee problems?

There is a solution for most of the degenerative conditions or injuries. We must accurately diagnose the condition in order to treat it effectively.

Physiotherapy, minor adjustments to lifestyle, knee braces, orthotics and anti-inflammatory medication or even local steroid injections usually bring permanent relief.

Joint injections with natural lubricants are useful for early osteoarthritis. PRP (platelet rich plasma) and even stem cell injections into the knee are newer developments in encouraging cartilage to regenerate.

An operation becomes necessary when the knee has a structural problem, such as a meniscus tear or torn ligament.

Can glucosamine cure knee problems?

Glucosamine is the building material needed to repair worn-out joint cartilage, just like calcium is needed to build strong bones. Crystalline glucosamine is generally more effective as it is better absorbed by the body.

A paper published in the medical journal Lancet in 2001 has proven that cartilage growth does occur with prolonged consumption of glucosamine.

While many patients with knee problems have found glucosamine useful, some have been disappointed. This is because sometimes the knee joint is badly worn out and requires the consistent use of glucosamine for more than six months before any effect is noticeable.

When is surgery recommended for knee problems?

Many knee conditions can be treated more conservatively. Surgery will be advised only if all the conservative treatment measures fail.

What are the risks involved in knee surgery?

The risks depend on the age of the patient, any pre-existing medical conditions like diabetes or heart problems. These relate to the risk of anaesthesia and infection. Specific local risks include deep-vein thrombosis, post-surgery stiffness as well as risks of neuro-vascular injuries. These complications are rare and preventable.

Is a long period of convalescence needed before one can start walking again following a knee operation?

It depends on the type of surgery. Patients with arthroscopic or key-hole surgery generally can walk the very next day. Even with total knee replacement, patients can start walking with the help of aid devices the next day.

What is total knee replacement? Who benefits from it?

In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.

Total knee replacement can be a life-transforming surgery. Patients who are in wheelchair can walk unaided after surgery.

If there are no medical contra-indications, this surgery will benefit everyone. However, we usually advise patients not to do the replacements yet if they are below 60 years of age as the implant generally lasts about 15 years.

How can you prevent knee problems that are associated with ageing?

Degeneration of the knee comes from overuse, abuse and from mal-alignment. If you have a mal-aligned knee, you will need foot orthotics to redistribute and even out the stress across the knee. It will be best to avoid pounding your knee with robust exercises. Glucosamine is essential.

Stretching of the muscles and ligaments around the knee will reduce stress across the joint. Quadricep-strengthening exercises, especially of the vastus medialis obliquus (a muscle of the quadriceps), will help realign forces across the patello-femoral joint (one of the knee joints).

What are the do’s and don’ts when it comes to knee-related exercises?

In general, any excessive pressure on the knee is not good for the knee. Climbing stairs is a good form of calorie-burning and cardio-exercise but it puts too much stress on the patella-femoral joint. Squatting or extension curls have the same effect.

Safe knee exercises include the stepper, leg press and cycling (with the seat as high as possible). If you have knee pain, swimming or aqua-aerobics is best.

Common knee problems in Singapore include Osteoarthritis of the knee & meniscus tears. Orthopaedic surgeon Dr Tho Kam San is based in Mount Alvernia Hospital and is an expert on common knee problems.










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Why Pilates is Effective for Knee Pain Treatment?

Article by Joanna

Most of us suffer from some kind of knee pain, at one time or another. There are different reasons for the many kinds of knee pain that each individual has. You can suffer from knee pain as a result of a sports injury, an auto accident, or an overuse syndrome. It can also happen through an innocent knee knock or a slight tug when you missed your footing. Whatever the reason is, it is important to understand how it came about in order to be specific in knee pain treatment.

Major knee dislocations and fractures that required surgical intervention and professional medical help do not fall into this category until the rehabilitation phase. Other knee pain that comes about as a result of unbalanced patella due to tightness in the Iliotibial Band (IT Band), knock knees, bow legged individuals, knee tendinitis and more can be effectively solved with Pilates.

So how does Pilates play a part in the treatment of knee pain? Why Pilates?

Pilates For Knee Pain ReliefPilates, as a form of total body conditioning training program, is both functional and specific in knee pain treatment. Here are the reasons:

1.Alignment2.Articulation3.Form4.Muscular Strength5.Creating Space in Joint6.Improve Range of Motion7.Develop flexibility

When you’re looking at Pilates for knee pain relief, keep in mind there are several methods and exercises that you can perform, both at home and in a studio. These exercises will help strengthen and lengthen your muscles so that your knee becomes stronger and more agile. It will bend with ease, and without pain. At home, you can use your mat and combine it with a DVD if you wish. In the studio, you can use the reformer to get a greater benefit and heal your knee faster. Here are some specific exercises you can do at home and at the studio.

Pilates Knee Pain Relief Exercises (with a Mat)

Knee Folds: Lie on your back with your knees bent and your feet flat on the floor; using your abdominal muscles, lift one foot off the floor and bring it towards you; inhale as you lift in, exhale as you come back down; Repeat 8-10 times, then switch legs. It’s important to focus on your breathing as you do these. Keep your abdominal muscles tight and your spine to the floor.

Kneeling Side Kick: Kneel on your mat and pull your abdominals in while dropping your tailbone to the floor; extend your right leg directly out to the side, with your toe on the floor; drop your left hand to the floor directly under your shoulder, leaving your arm straight; place your right hand on your hip; lengthen your right leg away from you and lift up to hip height and then swing your leg to the front. Do 6-8 reps on each side.

Pilates Knee Pain Relief Exercises (with Machine)First Position: Lie on your back with your legs bent and your heels on the bar and your feet flexed; your knees should be squeezed together and your torso and arms are relaxed; as you inhale, fully extend your legs but be careful not to lock your knees; exhale as you come back down into first position.Knee Stretch: With your feet flat against the shoulder rests, kneel on the carriage; your hands should be on the foot bar. Using your hands, push away; this gives your legs and back a good stretch.

All of these pilates knee pain relief exercises will help to strengthen your knee and help you become pain-free. Pilates reformer exercises can give you a bigger benefit by adding some resistance, and giving you a broader range of motion. Remember the proper breathing technique, and concentrate on your knee as you perform each exercise. This will help you achieve a mind-body connection and allow you to listen to what your body is telling you.

Once your muscles and joints are strengthened and lengthened, you will be able to walk with ease. You would not hear any cracking or crackling in your joints. As you become more comfortable with your routine, you can add more advanced moves.

Singapore Pilates Central & Rehabilitation is an authentic Singapore Pilates Studio that specialises in using Pilates Pain Relief. Joanna uses various techniques like myofascial release, gyrotonic and pilates to nurse many of clients who has suffered from serious knee pain injuries. She uses these techniques as means to instant Pilates Pain Relief.










Victor discusses the leg extension, how it can help improve knock knees and how to properly execute it.

More Knock Knees Articles

What is Runner?s Knee?

Runner’s knee is a term used to describe a constellation of symptoms of knee pain that is frequently encountered in running athletes. Other terms that have been used to describe this condition are “anterior knee pain”, “chondromalacia patella”, or “patellofemoral pain syndrome (PFPS)” . Runner’s knee involves the kneecap, quadriceps tendon, patellar tendon, and the associated soft tissues that are critical to extension of the knee. Historically, “runner’s knee” was attributed to irritation and softening of the cartilage lining on the undersurface of the kneecap (“chondromalacia”). More recently, however, it has been recognized that overloading of the underlying (“subchondral”) bone can be a substantial source of pain, as it has a rich nerve supply. The soft tissues and fat pad in the front knee can be causes of pain as well.

While classically associated with long-distance running, any activity that places significant stresses on the front of the knee joint (“patellofemoral”) can result “runner’s knee”. This includes repetitive jumping sports like basketball or volleyball, as well as skiing, cycling, and soccer. The repetitive pressure and stress between the femur and patella in these sports can result in softening of the cartilage and abnormal loading of the underlying bone.

Runner’s knee presents as activity-related pain in the front of the knee and around the kneecap. While the pain develops during athletic activity, it can often be most pronounced afterwards during a period of rest. Pain is also felt after sitting for a long period of time with the knees bent – the bent position actually increases the pressure between the kneecap and femur. For the same reason, marathon runners will often paradoxically complain of greater difficulty running downhill rather than uphill. Kneeling, squatting, or direct pressure on the front of the knees may be uncomfortable as well.

The kneecap and its cartilage is subject to very high forces with daily activities, and any injury to the cartilage or factors which result in increased pressure between it and the thigh bone (“femur”) can increase the risk of “Runner’s Knee”. These include:

• Malalignment of the kneecap and/or leg
• Subluxation or dislocation of the kneecap
• Direct trauma to the kneecap
• Overuse with running and jumping activities
• Wide hips and/or “knock knees” (valgus) resulting in maltracking of the kneecap
• A weak quadriceps/vastus medialis muscle
• Flat feet (“pronated” feet)
• Direct trauma to the kneecap
• Overuse with running and jumping activities
• Wide hips and/or “knock knees” (valgus) resulting in maltracking of the kneecap
• A weak quadriceps/vastus medialis muscle
• Flat feet (“pronated” feet)

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In certain cases, runner’s knee results from irritation or injury to the soft tissue around the kneecap. For this reason, inadequate muscle strength and/or stretching of the thigh and calf muscles can predispose to “Runner’s Knee” as well.

While certain predisposing factors such as kneecap and leg alignment are not in the control of an athlete, other preventative measures can be taken to minimize the risk of “runner’s knee”. These include:

• Quadriceps and vastus medialis strengthening – a strong quadriceps and, specifically, the vastus medialis muscle will improve the tracking of the kneecap and help to minimize contact pressures between the kneecap and thigh bone.
• Keep your weight down – the patellofemoral joint experiences forces that are 8 to 10 times our body weight, such that even small reductions in weight can significantly reduce the forces on the kneecap. Ten pounds of weight loss can be as much as 80 to 100 pounds less force of the kneecap when climbing or descending stairs.
• Stretch before running or jumping activities – Strains of the patellar tendon, quadriceps tendon, or other soft tissues that stabilize the patella can cause significant anterior knee pain. Warming up and stretching both before and after exercise can help to prevent strain injuries to these structures.
• Wear proper shoes and orthotics – Flat feet (“pronated” feet) can predispose to maltracking problems and knee pain. Orthotics to reconstitute the arch of the foot can help to alleviate these symptoms. High heels can also worsen anterior knee pain and should be avoided if you have “runner’s knee” symptoms.
• Plan for a good running surface – Running on a flat surface without steep, downhill slopes can help to prevent significant stress on the knee cap. Even, padded surfaces and good running shoes can help as well.

Usually, the diagnosis of “runner’s knee” can be made in athletes based on the history and physical examination of the knee by your sports medicine specialist. The exam will evaluate the stability of the kneecap as well as alignment of the leg. Signs of tenderness under the kneecap and/or instability will be assessed. Strength and tone of the quadriceps and hamstrings will also be determined. Flexibility of the feet and loss of the arch should also be noted as this will predispose to kneecap problems. X-rays, MRI, and CT scans can all be useful adjuncts depending on the examination findings and symptoms. Special views can show the position and alignment of the patella in its groove on the thigh bone (“trochlea”). Tilting of the patella that leads to abnormal contact pressures can be appreciated. If instability of the kneecap is suspected, CT scan can help to determine abnormalities in alignment and position. MRI is useful to evaluate for softening or injury to the cartilage on the kneecap and femur.

The first line of treatment for “runner’s knee” is typically nonoperative. Recommendations include:

• Stop running, jumping, or any of the activities that cause pain in the knee. Even though it is difficult, the athlete must refrain from competition until he/she is pain-free. Fortunately, low-impact activities such as swimming or cycling can allow the athlete to maintain their aerobic fitness while protecting the patellofemoral joint.
• Avoid running down hills or down steep slopes or stairs that increase pressure on the kneecap.
• Ice and anti-inflammatory medications can certainly help to relieve the pain in the front of the knee.
• In certain cases, taping of the kneecap (“McConnell taping”) or use of stabilizing braces for the kneecap can help. These are particularly useful in the setting of instability of the kneecap.
• If the athlete has flat feet (“pronation”), orthotic inserts to reconstitute the arch can be extremely useful to alleviate symptoms.
• When the knee is pain-free, a course of rehabilitation for range-of-motion of the knee and strengthening of the quadriceps and vastus medialis muscle may be useful.

However, exercises that are performed with the knee bent should be avoided, as the pressure beneath the kneecap is increased in this position. Instruction on preventative stretching exercises for the quadriceps, hamstring, and calf muscles is very important as well. In rare circumstances, the knee will continue to be painful and refractory to all of the nonoperative measures described above. When the pain of “Runner’s Knee” prevents the athlete from returning to play, surgery may be considered. The specific treatment will depend on the underlying cause for the pain. Arthroscopic (“minimally invasive” camera-based) surgery can be pursued to manage softening or damage of the articular cartilage of the kneecap and thigh bone. If there is accompanying instability of the knee cap, soft tissue reconstructive procedures or re-alignment of the leg (“osteotomy”) may be performed to improve the tracking of the patella. These may also be performed to relieve abnormally high pressures between the kneecap and femur.

For more information on sports related injuries and issues, please visit www.sportsmd.com. SportsMD is the most trusted resource for sports health and fitness information for people engaged in sports everywhere. We have assembled the sports industry’s leading Doctors and health experts – each sharing valuable, practical advice to keep you playing injury-free.

 

 

Dr. Asheesh Bedi is an Assistant Professor of Sports Medicine and Shoulder Surgery at the University of Michigan and MedSport Program. He is a team physician for the University of Michigan Athletic Department and specializes in both arthroscopic and open surgery for athletic injuries of the shoulder, elbow, hip, and knee.

Dr. Bedi completed his undergraduate training at Northwestern University where he graduated Summa Cum Laude. He graduated from the University of Michigan Medical School with AOA recognition, and remained in Ann Arbor to pursue residency training in Orthopaedic Surgery at the University of Michigan. After completing his training, Dr. Bedi completed a two-year fellowship in sports medicine and shoulder surgery at the Hospital for Special Surgery and Weill Cornell Medical College in New York. He has also pursued additional dedicated training with Dr. Bryan Kelly in arthroscopic hip surgery for young athletes. While in New York, he was an assistant team physician for the New Jersey Nets professional basketball and New York Mets professional baseball organizations with Dr. Riley Williams, Struan Coleman, and David Altchek. He was also an orthopaedic consultant for the U.S. Open Tennis Tournament in 2007 and 2008 with Dr. David Dines and an assistant team physician for Iona College Athletic Programs.

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