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KNEE PAIN / INJURY
Think about the kneecap as a puppet controlled by "strings" -- muscles, tendons, and ligaments. As long as all of the strings pull in just the right way, the kneecap moves back and forth smoothly in its track. But if any string pulls too strongly or not hard enough, the kneecap is pulled out of its track and can no longer glide easily against the thighbone, which can cause pain and may even damage the kneecap. Because women have wider hips, the upper-leg bone of a woman enters the knee at a greater angle, which twists the knee. This makes women more vulnerable to certain types of kneecap injuries, such as chondromalacia (in which the smooth layer of cartilage that coats the end of the thighbone becomes roughened or cracked), as well as problems with the anterior cruciate ligament (ACL).
If the large muscles in the thigh (quadriceps) are inflexible due to disuse or lack of stretching before exercise or if these muscles are overused, they can cause inflammation of the knee tendons (patellar tendinitis), or "jumper's knee." Muscle imbalances, in which one group of muscles is stronger than another and pulls harder, can cause knee problems, too.
While knee problems can result from injuries such as falls, automobile accidents, and athletic injuries or diseases like arthritis, the vast majority of knee problems are caused from overstressing the knee during running, climbing, or other repetitive, high-impact exercise. Poorly conditioned leg muscles also stress the knees.
However, if your knee problems are the result of overuse, lack of use (or "weekend warrior syndrome"), or improper training rather than injury, you can use the strategies and home remedies in the next section to improve and maintain the health of your knees and, if you do develop pain, to help ease the hurt and speed healing.
Recognising the symptoms of Knee Injuries
1. Experience discomfort and pain while walking or running.
2. Inability to straighten the leg.
3. Tenderness, swelling, pain and/or discomfort in the knee.
4. Cracking sound when you bend your knee and moving knee-joint becomes difficult.
Causes of Knee injuries: The causes of different types of knee injuries are-
1. Arthritis – Degeneration of cartilage at the joint and inflammation.
2. Torn Cartilage – When you twist the joint while putting weight on it, the cartilage is injured.
3. Tendonitis – Overuse of the tendons above or below the kneecap can become inflamed.
4 Runners Knee – Overuse of the shock absorbing cartilage, under the kneecap can cause degeneration.
5. Sprain – The thighbone is connected to the skin bone by 4 strong ligaments that are not very flexible. If they are overstretched, one or more of the ligaments can be sprained.
Knee Injuries healed naturally
1. Swelling and pain can be reduced, by taking painkillers.
2. Take rest, apply ice directly to the injured area, compress it and then elevate.
How to prevent Knee Injuries?
1. If you have knee problems avoid hills and stairs as it exerts pressure.
2. Attain flexibility by stretching your legs before and after exercise.
3. Foot abnormalities put great stress on the foot get them corrected.
4. Lengthening and intensifying your workouts will cause friction in the joint and increase risk of overuse injury.
5. Strengthen leg muscles by walking upstairs or hills.
6. Cycle in low gears and set the seat to a proper height to minimize knee stress.
7. Don’t wear worn out and shoes that don’t fit well.
Know when to fold them. If you get a sudden twinge in your knee that makes it "lock up," restricting full motion, get off your feet, says Clary. You may be able to move again cautiously after a few minutes. But begin gently: Don't resume heavy or strenuous activity, Clary advises.
Press on some ice. For any knee pain, applying ice will help force your body to flush the knee with blood and oxygen, elements vital for repair. Ice also acts as an anesthetic to soothe the ache, says Patrice Morency, a sports injury management specialist in Portland, Oregon, who works with Olympic hopefuls.
Use an ice pack or ice cubes inside a plastic bag. Just make sure the ice pack is wrapped in a towel, so it doesn't come in direct contact with your skin. Apply ice to the sore knee no longer than 20 minutes every hour, says Morency.
Try an anti-inflammatory. You can calm inflammation and soreness with over-the-counter remedies that contain the anti-inflammatory ingredient ibuprofen, according to Paul Raether, M.D., a marathoner who is a physical medicine specialist at the Kaiser Permanente Medical Center in Portland, Oregon. Nuprin, Advil and Motrin are among the brands of over-the-counter anti-inflammatories. (You can also find low-priced versions marked "ibuprofen" in most pharmacies.)
Taken as directed, ibuprofen is also a painkiller, so it's important not to be lulled into a false sense of security when the pain eases. When you resume your activity, try it when you're not taking an anti-inflammatory, so you can feel the pain if your knee sends out warning signals.
Make a beeline to bromelain. Made from pineapple, bromelain is touted as a natural anti-inflammatory that is thought to speed healing, according to Morency. It is sold in tablet form in some health food stores. "I've used it personally and know that it works," says Morency. According to the directions, you can take up to three tablets a day until the knee pain subsides. Then start to resume your activities with caution. (The only drawback is that bromelain can cause dermatitis in some people, so you should stop taking it if your skin begins to feel itchy.)
Unbrace yourself. Wearing a knee brace may be a short-term solution after a particularly painful bout of knee pain. But try to go without that brace as soon as possible to prevent becoming psychologically attached, suggests Dr. Raether.
Avoid the knee bashers. Some activities, such as running and hiking over hilly terrain, put a greater demand on the kneecap than others. "These force the kneecap strongly against the end of the thigh bone," says Dr. Raether. If you're having knee pain, minimize those activities until you've had time to strengthen your leg muscles, he says.
Check out new workouts. Knee problems often occur when someone starts a workout program without first understanding how to properly perform exercises or an activity. "You need to know the precautions before you launch into a new exercise routine," says Mike Nishihara, director of athletic development for the National Institute for Fitness and Sports in Indianapolis.
Runners and walkers, check your soles. If you're a frequent runner or walker, you need stable shoes if you want to avoid knee injury. Examine the shoes you have been wearing to see whether it's time for a new pair, suggests Dr. Raether. One way to check is to place them on a table at eye level to see whether the shoes stand straight up. (If the soles have worn down unevenly, the shoes will tip out or in.) Also examine around the midsole and sides to spot excessive wear. "Many shoes will begin to severely break down after 300 miles," says Dr. Raether.
Buy shoes with your knees in mind. If you have kneecap-related pain, there's a good chance that you're a pronator--someone whose foot turns toward the inside with every step. When you examine your shoes, notice whether your right shoe is caved to the left or your left shoe is caved to the right, suggests Dr. Raether.
When shoes are worn down this way, it's a sure sign that you are a pronator Ask for a stable shoe when you're buying running or walking shoes.
Muscle up your leg muscles. To strengthen the quadriceps, the thigh muscles that hold your knees in place, start with straight leg raises, says Dr. Raether. Lie on your back with your right knee straight and your right foot angled about 20 degrees toward the outside. (To keep your spine in a neutral position, you can place a rolled-up towel under the small of your back.) Keeping the foot angled, slowly lift your leg a few inches off the floor. Hold your leg in place for a count of three and then lower it. Repeat with the left leg.
This exercise should be repeated about 50 times. "It's one of the best quadriceps strengtheners around," says Dr. Raether.
Work your hamstrings. To rehabilitate an injured knee, it's essential to build up strength in the hamstring muscles on the back side of the thighs. Dr. Raether recommends the following exercise to work the hamstrings.
Strap on some ankle weights and lie on your stomach with your legs outstretched. Bend your knees slowly to lift the ankle weights. Lift both legs to a 90-degree angle (your feet are over your knees), then slowly lower your feet to the floor again. Repeat 12 times.
Note: Begin with very light ankle weights. You can gradually increase the weight as long as it doesn't cause a flare-up of knee pain.
Lose some weight. Every time you run or walk, the force of your feet hitting the ground is felt in your knees. "For someone who's 20 pounds overweight, that's a tremendous blow," says Clary. Less weight on your frame simply means less damage with each step, he says.
Master the stair-climber If you use a stair-climbing machine, reduce stress on your kneecap by taking short steps and maintaining good posture. "By taking shorter steps, you will prevent the knee from going out over the ankle," says Clary. "This reduces the stress on the knee joints."
Home Remedy Treatments for Knee-Saving Strategies
Since your knees take so much of the impact of exercise and everyday living, it's important to keep them healthy. Take note of the following home remedies to do just that.
Stay trim. Being overweight stresses all the joints of the body, but carrying around those extra pounds is particularly tough on the knees, because with every step, you exert on your knees a force equal to one-and-a-half times your body weight. When you run, the force is five times your weight. An extra 20, 30, 40, or more pounds of body weight (usually from body fat) can really stress the knees.
For example, if you're only 20 pounds overweight and you jog, you're putting 100 pounds extra force on each knee with every step. So work on getting and keeping your weight within a healthy range (ask your doctor what that range is for you) by adopting a low-fat, lower-calorie diet, and getting regular exercise.
Look at your feet. A common cause of knee problems is overpronation, or rolling inward of the foot. A certain amount of pronation is normal, but too much can cause knee problems because it throws the knee out of alignment.
You can correct overpronation with supportive shoes designed to prevent pronation or with orthotics, which are special shoe inserts. You can buy ready-made, over-the-counter (OTC) orthotics, or you can get custom-made ones from a podiatrist, orthopedist, chiropractor, or sports-medicine specialist.
Buy the right shoes. Wear the lowest heel possible. The body can tolerate a heel of about one inch; higher heels throw the body forward and stress the knees. If you tend to pronate, buy a shoe that has antipronation devices or high-density material on the inner side and cushioning material on the inner side of the sole. Also, seek out shoes that have a stiff heel counter, the part of the shoe that cups the heel, because it helps stabilize the heel.
For sports, buy shoes designed for the activity -- walking shoes for walking, running shoes for running, and so on. Wearing running shoes for walking can cause pain in the shins and, in some cases, knee pain.
Then replace them. Often, knee problems are simply the result of walking or running in shoes that are worn out. Replace your athletic shoes every six months or every 400 to 600 miles.
Check your alignment. If you're bowlegged or knock-kneed, you may be at greater risk for knee problems. To check your alignment, stand with your ankles touching. If you're in alignment, both your ankle bones and your knees should touch. If your knees touch but there's a large space between your ankles, you're knock-kneed. If your ankles touch but there's space between your knees, you're bowlegged.
If you are not in alignment, activities such as swimming or cycling, in which the knees don't take quite such a pounding, might be less likely than running to cause you pain. (If you choose cycling, be sure the seat is set high enough so that your leg is almost fully extended on the downward stroke to prevent knee strain.)
Don't rely on OTC braces. Often, you see people wearing knee braces or bandages they've purchased at the pharmacy. An OTC knee brace may make you aware of the knee and remind you to avoid overtraining, but it doesn't really correct or prevent problems -- in fact, it can give you a false sense of security and might tempt you to be less cautious than you should be.
If you do use an OTC knee brace, opt for the one-piece neoprene or elastic braces rather than the elastic wraps, which make it difficult to apply pressure evenly to the knee. But keep in mind that if your knee hurts enough to brace it, you should see your doctor.
Avoid "knee-busting" activities. Deep knee bends and squats may feel like great fitness boosters, but they're too hard on the knees. So is kneeling, especially on hard surfaces.
If you lift weights, never fully flex the knee, don't "lock" your knees when you're in the standing position, and keep the amount of weight you ask your knees to lift to a minimum.
If you're gardening, washing a floor, or doing some other activity that requires kneeling, use a foam kneeling cushion or knee pads and give your knees frequent rest periods.
Don't "run through" knee pain. Many people, especially athletes, believe that it's best to "run through" knee pain -- that if they keep going, the pain will disappear. However, they are likely doing more harm than good. Pain is a sign that something is wrong, and if you push through it, even more damage may occur.
Change surfaces. If you walk or jog on a road, do so on the flattest part -- roads slant downward toward the edges so that water will drain off. If the side of the road is your only option, switch sides of the road frequently.
Hard surfaces such as concrete or asphalt can increase the beating the knees take, too. If possible, run or walk on a softer surface, such as a forest pathway, grass, or a running track. Bypass soft, shifting sand, however, which can stress the knees.
Running or walking downhill can cause knee problems, as well. The natural tendency is to "brake" with the knees downhill, which can overstress them. Slow down and, whenever possible, traverse (that means zig-zag) rather than going straight down hills. If you're already having knee problems, you should probably avoid training downhill.
Mix it up. Repetitive movements strengthen some muscles while they allow others to grow week with disuse. That's why cross-training is such a good idea. When you cross-train, you do a variety of physical activities rather than just one or two. Combine running or walking with biking, swimming, dancing, aerobics, weight training, or any other activities you enjoy.
Stretch and strengthen. For strong, flexible knees, try performing these exercises regularly:
• Hamstring stretch. Lie on your back, raise your right leg, and hold the thigh up with your hands. Gently and slowly straighten the knee until you feel a stretch in the back of the thigh. Don't bounce. Hold the stretch for 10 to 20 seconds. Repeat three to five times on each leg.
• Quadriceps stretch. Stand with your right hand on the back of a chair. With your left hand, reach back, pull your left heel toward your left buttock, and point your left knee to the floor until you feel a stretch in the front of the thigh. Hold for 10 to 20 seconds. Repeat using the right hand and right leg. (If you can't reach your ankle, loop a towel around your foot to pull the leg up, or do the stretch lying on your stomach on a bed or the floor.)
• Calf stretch. Stand two to three feet from a wall and lunge your right foot forward. Keep your left leg straight, with your heel on the floor and your toes pointed forward, and keep your right leg slightly bent. Lean into the wall, with both hands on the wall supporting you, until you feel a stretch in the left calf. Hold for 10 to 20 seconds. Repeat with your left leg bent and your right leg straight.
• Hip-extensor strengthener. This exercise strengthens the muscles in the back of the hip. Lie on your stomach, tighten the muscle at the front of your right thigh, then lift your right leg eight to ten inches off the floor, keeping the knee loosely locked. Hold for five to ten seconds. Do ten repetitions. Repeat with the left leg.
• Hip-abductor strengthener. This exercise strengthens the muscles at the outside of the thigh. Lie on your left side with your head resting on your left arm, tighten the muscle at the front of your right thigh, then lift your right leg eight to ten inches off the floor. Hold for five to ten seconds. Do ten repetitions. Repeat on opposite side.
• Hip-adductor strengthener. This exercise strengthens the muscles on the inside of the thigh. Lie on your left side with your head supported by your left hand, your right knee bent slightly and resting on the floor in front of you; keep your left leg straight. Tighten the muscle at the front of the left thigh, then lift the left leg eight to ten inches off the floor. Hold for five to ten seconds. Repeat ten times. Switch legs, and repeat ten times.
• Quadriceps strengthener. Lie on your back with your right leg straight and your left leg bent at the knee to keep your back straight. Tighten the muscle at the front of your right thigh, and lift your right leg five to ten inches from the floor, keeping the knee loosely locked. Hold for 10 to 20 seconds. Repeat ten times. Switch legs, and repeat ten times.
R.I.C.E. it. Okay, despite all the good advice, you've overdone it and your knee hurts. Give it R.I.C.E. -- rest, ice, compression, and elevation. Take the weight off the knee. During the first 24 to 48 hours, use an ice pack wrapped in a thin towel (20 minutes on, 20 minutes off) to keep the swelling down. Then wrap the knee (not too tightly) in an elastic bandage to reduce swelling, and keep the knee elevated.
Take an anti-inflammatory. Aspirin or ibuprofen can reduce the pain, inflammation, and swelling (acetaminophen eases pain but does nothing for inflammation). Don't use anti-inflammatories, however, if you have an ulcer, a bleeding condition, or a sensitive stomach.
Avoid heat. Ice prevents fluid buildup, but heat can promote it. For the first 48 to 72 hours after a knee injury, when the knee is probably still somewhat swollen, avoid hot tubs or hot packs.
Massage it. While massage won't affect the bony structures of the knee, it does increase circulation and can loosen tight hamstrings and other tissues that may be pulling on the knee. If you've already developed knee pain, see a massage therapist or physical therapist, not just a friend, for a professional massage.
Strong Muscles, Strong Knees
Often, a muscle imbalance, in which one muscle or muscle group is stronger than another, causes knee problems. In other cases, lack of flexibility can contribute to knee pain or injury. In order for knees to function well, the muscles around them need to be both strong and flexible. You can do this by strengthening and stretching both the quadriceps (the muscles in the front of the thigh) and the hamstrings (the muscles at the back of the thigh).
While rest is important when you injure your knee, too much rest can contribute to knee problems. Lack of use can cause muscles to weaken. Gentle exercise such as swimming can help keep muscles toned even when knees are a bit sore. And regular exercise can correct imbalances, increase flexibility, and prevent many injuries.
However, not all exercises are healthy for the knees. Avoid loading the knee with weight when it's in a 90-degree position (that's the same angle it's in when you're sitting in a chair) or bent even more than that (such as in a baseball catcher's position), especially if you have kneecap pain. Unless you are getting up from sitting, avoid this position.
When to See the Doctor
Anytime you notice that there is pain or weakness or that your knee is swelling (especially after an injury), you should see the doctor, according to Paul Raether, M.D., a marathoner who is a physical medicine specialist at the Kaiser Permanente Medical Center in Portland, Oregon. Swelling could be a sign of serious internal knee damage, including bleeding or torn cartilage.
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