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Bursitis

A bursa is a fluid filled sac that sits around joints to help prevent tendons rubbing against bone and cushions the surrounding structures.  They can become irritated and inflamed from repetitive movements or tightness through the muscles or tendons above them.  They can also in rare cases become infected.  When a bursa becomes irritated the body produces an increased amount of fluid and causes the sac to swell and become painful.  The medical name given to different bursae become swollen is often linked to jobs that put increased strain upon that one particular bursa; for example ‘Baker’s Cyst’, ‘Clergyman’s Knee’ and ‘Housemaid’s Knee’.

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Iliotibial band syndrome

The iliotibial band or ITB is a tendon that runs down the side of the thigh and attaches onto the outside of the knee and blends into the fascial (connective tissue) covering of the lateral (outermost) tibia and fibula.  Tightness through the ITB can cause the pain at the side of the knee where it attaches on to the bone, but can also cause pain and discomfort at the hip where the tendon originates.  It is often caused by an overuse of one muscle group or an imbalance of muscle tension through the hip, knee or thigh.  If it becomes inflamed and swollen one of the best treatments is ice and gentle stretching as well as temporarily stopping the activity that causes the problem in the first place.

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Knee ligament injuries

Your knee ligaments help to keep your knee stable, but up to 80% of the total knee strength comes from the quadriceps muscles.

The medial collateral and lateral collateral ligaments are located on the inside and outside respectively of your knee joint, and limit the amount of sideways movement that occurs. You can strain your medial collateral ligament if you twist your leg while it’s straightened or from an impact from the side. These movements often occur during sporting activity, for example, when running in a straight line suddenly changing direction and twisting through the knee or being impacted on the outside of the knee when you are weight bearing on the leg.  Usually damage to the lateral collateral ligament isn’t isolated; there is often injury to other structures at the same time from the injury.

Your anterior cruciate ligament and posterior cruciate ligament form a cross inside your knee and help prevent backwards and forwards motions of the upper leg in the knee joint.  Anterior cruciate ligament injuries are one of the most serious types of knee injury as they can leave the knee painful and unstable and as such more prone to resulting osteoarthritis.  They can heal but normally require considerable rehabilitation or even surgery in those who have greater athletic demands.

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Osgood-Schlatter Disease

This is a developmental problem that mainly initially occurs in teenager boys and sometimes in girls, where a painful lump appears at the front of the knee where the patella tendon inserts onto the bone of the shin.  The pain usually comes and goes with activity and so is more common in those who are active in sports. It is usually a self-limiting condition  so apart from a residual lump on the front of the knee is most likely to resolve itself over time.

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Osteoarthritis

This commonly occurs in those over the age of 60 but can also occur with someone who has had a serious previous injury or a very active lifestyle.  Osteoarthritis is also more common in those who are overweight, as the increased weight causes more damage to the menisci upon movement.  The cartilage in the joint is not pain sensitive but as it wears away it can cause irritation to the surrounding structures or from loose bits of cartilage floating around in the joint.  Eventually if left untreated the cartilage can wear away completely and then you get bone rubbing on bone which is very painful, can cause cysts in the bone and will more than likely require surgical intervention and a knee replacement.

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Patella mal-tracking

In this condition the knee cap moves in and out of its normal alignment on movement of the knee.  This is because of an increase or decrease in strength through the muscles of the thigh pulling the knee cap.  This deviation can cause swelling and pain at the front of the knee, but can also if left untreated results in pain under the knee cap itself as the cartilage gets irritated and worn.  This condition is often more common in teenage girls but can be seen in any athletic population where a training imbalance has occurred.

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Meniscal injuries

The menisci themselves can be prone to injury as they are only partially attached within the knee. You can damage them if you play a sport that involves twisting your upper leg while your foot is planted on the floor. As you get older your meniscus may degenerate and become slightly thinner or develop micro tears which will increase the chance of damage following a minor injury.  Following a meniscal injury, depending upon its severity, you may require surgery to help the healing process.

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Your knee is forcefully moved beyond its usual range of movement, for example if you have a fall or land awkwardly

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You play a sport that combines running, jumping and stopping with quick changes of direction, such as football

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You have a condition such as arthritis or gout, which can affect your joints

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You are very overweight, which can put pressure on your knees

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You are involved in an accident and the front of your knees hit something pushing them backwards – this can cause damage to the posterior cruciate ligament damage

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You wear unsuitable footwear that doesn’t match the shape of your feet or have poor training methods and flexibility; these factors can lead to overuse injuries of your knee

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Pain

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Clicking

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Locking of the Joint

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Swelling

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Instability – you may feel like your knee is giving way.

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Protection

    Protect your injury from further harm.

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Rest.

    Rest the injury for the first two to three days and only then reintroduce movement so you don’t lose too much muscle strength.

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Ice.

    Apply a cold compress such as ice wrapped in a thin cloth to help reduce swelling and bruising. Do this for 10 minutes every one to two hours. Don’t apply ice directly to your skin as it can burn your skin.

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Compression

    Compress the joint by bandaging it to support the injury and help decrease swelling. A tubigrip stocking is best and can be bought from most pharmacies.  However remember to NOT leave this on while you sleep as it can lead to the formation of DVT’s (deep vein thrombosis – blood clots that can block blood vessels.)

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Elevation

    Elevate your knee by resting it on cushions and keeping it above your heart if you can.  When supporting the knee provide support along the whole length of the leg as it will be more comfortable.

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Heat.

    This includes having a hot bath or using a heat pack as the heat will increase the amount of inflammation with the joint and relax the muscles that are supporting the joint, so when you come to move again the knee may be more unstable. The way to remember this is to think of inflammation as a source of heat in your body, so if you put heat on something inflammed, it will just become more inflammed.

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Alcohol.

    Drinking alcohol can increase bleeding and swelling in the affected area as well as reduce your awareness of the amount of pain you are in, and so allow you to cause more harm without releasing it

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Running or other forms of exercise.

    Exercising on an injury only increases the amount of damage that has already occurred and will prevent the overall healing process

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Massaging the injured knee.

    This can increase the amount of swelling or bleeding in the knee as massage causes a small degree of damage to the muscles when performed, which also causes inflammation

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Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.

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Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury.  We also advise stretching your muscles after cooling down in order to return the muscles to their resting length and to prevent muscle shortening over a period of time.

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Wear correct footwear. There are many different models of trainers available, but the best is one that matches the shape of your feet. If you’re not sure, it’s a good idea to go to a specialist sports shop and ask for advice.