Preventing Future Patellofemoral Pain

Article from UCSF Health

To decrease the risk of patellofemoral pain returning after surgical kneecap realignment, doctors generally recommend that you make the stretching and strengthening exercises you learned in rehabilitation part of your everyday routine.

Proper rehab will help your new kneecap attachments heal in a normal position and keep it moving smoothly in its track. To prevent rupturing your new kneecap attachments while they heal, avoid bending your knee more than 90 degrees. Try to be patient in rehab and do not rush to return to activities.

Many of the popular fitness exercises and activities put stress on your knees. To prevent patellofemoral pain it is important to learn knee-sparing exercise techniques. This can be done by dividing your activities into three components:

Daily Living

The average person takes between 12,000 and 15,000 steps a day, exerting a force between two and five times his or her body weight on the knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock rather than hard-soled shoes.

Muscle Strengthening and Conditioning

Activities themselves are not a substitute for conditioning, and your need for special conditioning to prepare for activities increases with age. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, which do not require the knees to absorb shock.

Recreation

Sports that require twisting and quick-direction changes put great strain on your knee. Any climbing or jumping activity where the knee is bent beyond 90 degrees puts undue pressure on the cartilage surfaces under the kneecap. To prevent injury, stick to light, non-impact activities for your recreation. If you decide to return to sports like football and basketball, a doctor should carefully examine your kneecap and test it for proper alignment.

If you plan on participating in sports, remember to take it easy during daily activities and to keep your kneecap tracking properly with stretching and strengthening exercises. Your doctor may prescribe a brace to wear during recreational activities, which will help keep your kneecap in track.

A small amount of pain is normal during physical activity, but if you feel so much pain in your knee to warrant taking a painkiller before an activity, you should consider cutting back or discontinuing that activity.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Do I Need Surgery for a Meniscus Tear?

Article on WebMD, medically reviewed by Tyler Wheeler, MD on May 16, 2019

You have two C-shaped discs of cartilage (soft tissue) that connect your thigh bone to your shinbone. These are called menisci. They’re like shock absorbers for your bones. They also help to keep your knee stable.Athletes who play contact sports like football and hockey are prone to meniscus tears. But you can also get this injury when you kneel, squat, or lift something heavy. The risk of injury increases as you get older, when bones and tissues around the knee begin to wear down.

If you tear your meniscus, your leg might swell and feel stiff. You might feel pain when twisting your knee, or be unable to straighten your leg fully.

What Are My Treatment Options?

Treatment for a meniscus tear will depend on its size, what kind it is, and where it’s located within the cartilage. Most likely, your doctor will recommend that you rest, use pain relievers, and apply ice to you knee to keep the swelling down. They may also suggest physical therapy. This will help to strengthen the muscles around your knee and keep it stable.

If these treatments don’t work — or if your injury is severe — they might recommend surgery. To be sure, your doctor will probably have an MRI done. And they might look at the tear with an arthroscope. That’s a thin tool that has a camera and light at the end. It allows doctors to see inside your joints.

If your doctor’s exam shows your meniscus tear is mild (Grade 1 or 2), you may not need surgery. If it’s Grade 3, you probably will. Your doctor might choose to do any of the following:

  • Arthroscopic repair. Your doctor will make small cuts in your knee. They’ll insert an arthroscope to get a good look at the tear. Then they’ll place small devices that look like darts along the tear to stitch it up. Your body will absorb these over time.
  • Arthroscopic partial meniscectomy. Your doctor will remove a piece of the torn meniscus so your knee can function normally.
  • Arthroscopic total meniscectomy. During this procedure, your doctor will remove the whole meniscus.

Meniscus repair is low-risk. Complications are rare. They may include injury to skin nerves, infections, and knee stiffness. Your doctor may prescribe antibiotics to help stave off infection. They may also recommend compression stockings to help prevent blood clots.

How Long Is Recovery?

You may have to wear a brace or cast to keep your knee stable. You’ll likely also have to use crutches for at least a month to keep weight off your knee.

Your doctor may recommend physical therapy as part of your recovery. It’ll help increase your range of motion and help your knee get stronger. They may also share some exercises you can do at home.

If you have a partial or total meniscectomy, you can expect your recovery to take about a month. If your meniscus was repaired, it may take as long as 3 months.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

12 Tips for Walking When You Have Sensitive Knees

Sensitive knees can be a challenge for walking, but it is a recommended way to maintain your function and reduce your symptoms. If you have knee pain due to osteoarthritis or other causes, you don’t have to let that keep you from starting a walking program.

A regular program of walking can reduce stiffness and inflammation and it won’t make most chronic knee conditions worse. Walking is the preferred exercise by people with arthritis, and can help you improve your arthritis symptoms, walking speed, and quality of life, according to the CDC.

Walking is part of a healthy lifestyle to keep your heart and bones strong and your joints functioning. Here are tips for walking when you have sensitive knees.

Why Walking Is Good for Your Knees

Your knee joint is composed of bone and cartilage. Cartilage doesn’t have a blood supply that is always nourishing it by the pumping action of the heart and so it relies on joint fluid for nutrition. Moving your joints is the way that you ensure the cartilage receives the nourishment it needs to stay healthy.

You may notice that your joints are stiff and sore in the morning or when you’ve been sitting and inactive during the day. By moving your joints, you help them maintain their function and you may help keep them functioning longer.

Regular exercise maintains and builds muscles, which you need to support your knee and maintain functioning. Weight-bearing exercise such as walking also helps maintain bone health.

Discuss your exercise options with your doctor and physical therapist when you have any condition that is causing knee pain. While walking is recommended for many people, it may not be appropriate for you.

Should You Walk When You Have Knee Pain?

If you have mild to moderate pain in your knees due to osteoarthritis, walking and other exercise helps mobilize your joint fluid and lubricate the joints. You should walk and do other exercises that move your knee joints. You are likely to find that the stiffness, pain, and fatigue improve with exercise.

If you have moderate to severe pain in your knees before you start walking, take it easy. Do a shorter walk at an easy pace or try an activity that doesn’t place much stress on the joint, such as water exercises in a pool. If joint pain remains severe, stop immediately as it is a sign of inflammation or joint damage that needs treatment.

If you have joint pain occasionally the day after a walk or run, you should take a day off and do a shorter workout or one that doesn’t put stress on the joint. If you always have joint pain after exercise, you may have to switch to a form of exercise that doesn’t put stress on the knees, such as cycling or swimming.

Tips for Walking With Sensitive Knees

Taking certain precautions can make it easier to continue your walking routine despite sensitive knees. Here are 12 ways to protect your knees when walking.

  • Add cycling: Incorporate cycling on a stationary bike, bicycle, or even an under-desk cycle to help keep your opposing muscles in shape for better support of the knee.
  • Aim for 6000 steps per day: A study found that people with osteoarthritis knee pain benefit most when they walk 6000 steps or more per day.2 If you wear a pedometer or use a phone app to track your steps, all of your steps during the day count. Make that your first goal. If you can eventually exceed that regularly without increasing pain, that is good.
  • Build your walking time: If you are new to walking, steadily build up your walking time following a plan for beginners. Walking can be broken up into 10-minute segments, with an ultimate goal of 30 minutes per day. Start at an easy or moderate pace as you build endurance. Eventually, aim to walk briskly at 2.5 to 3.5 mph or a pace that has you find challenging.
  • Choose softer walking surfaces: Walking on natural surface trails (dirt, bark dust, pea gravel) is easier on the joints. Although sometimes uneven, natural surfaces provide more balanced exercise. For even surfaces, choose a cinder track or asphalt rather than concrete. Note that flooring in malls and stores is primarily concrete.
  • Choose the right shoes: Shoes should be flat and flexible, bendable in the forefoot with a low heel-to-toe drop. Avoid high heels, pointy toes, and heavy shoes. Look for shoes with a wide toe box. Even a 1.5-inch higher heel can increase pressure on two common sites for knee osteoarthritis damage. Choose heels that are 3/4 inch or less.
  • Keep moving throughout the day: Get up and move around or stretch every 15 minutes. This will keep your joint fluid moving and nourish your knees. Even just a minute can help reduce the health risks of sitting and will be good for your joints.​
  • Lose excess weight: If you are overweight, losing even a few pounds can reduce stress on your knees. Diet is the most effective way to lose weight. You will be able to walk and exercise with less pain and discomfort after some of the excess weight has been lost.
  • Use cold packs after walking: You’ve done well by getting your joint fluid moving. You can apply cold packs afterward to help reduce inflammation.
  • Use inserts: When you have sensitive knees, avoid arch supports and shoes that have a high amount of arch support. You want your foot to move as naturally as possible. You can use over-the-counter orthotics that provide cushioning and support if you think that is helpful for you or they have been recommended by your doctor or podiatrist.
  • Use walking poles: Some people find that using trekking poles or Nordic walking poles helps them with stability and reducing joint fatigue when walking. Canes and other walking aids may be useful, depending on your condition.
  • Walk during low-pain times of the day: If you have a lot of pain or stiffness in the morning, simply try to get up and move around for a minute or two every half hour. You will better enjoy long walks at a time when you have fewer aches, and that will help you be consistent.
  • Warm up: You may benefit from applying heat to your joints before you walk, or walking after taking a warm shower or bath. Starting at an easy pace is recommended for everyone, but especially when you have stiff or sore joints. Start slow to get your joint fluid moving. Then you can pick up your pace after a few minutes.

A Word From New Mexico Orthopaedics

Walking is the most accessible form of physical activity and can help you maintain joint health. However, it’s not the only option. If your sensitive knees keep you from walking, you can get the physical activity you need by enjoying cycling, pool exercises, swimming, or water aerobics.

You should also include resistance exercise to build and maintain muscles, including any specific exercises recommended for your knees by your doctor or physical therapist. Balance exercises can also be beneficial. Once you are confident walking, you can even include them in your walking workouts. Just keep moving!

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What you need to know about sudden knee pain

What you need to know about sudden knee pain

Article Featured on Medical News Today

The complexity of the knee joint allows it to support a wide range of movements — but it also makes the area vulnerable to a variety of injuries and chronic conditions.

Each year in the United States, about 12 million people see doctors for knee pain. Researchers found that among all people seeking medical treatment in the country between 2007 and 2011, 1.5–7.3% sought care for pain in the front of the knee alone.

Below, we describe common causes of sudden knee pain and the symptoms that tend to accompany it. We also look into the options for diagnosis, treatment, and prevention.

Causes of sudden knee pain

Some of the more common causes of sudden knee pain are:

  • Anterior cruciate ligament, or ACL, injuries. These often occur during sports that involve jumping or other sudden changes in direction. They can cause instability or prevent the knee from bearing weight.
  • Posterior cruciate ligament, or PCL, injuries. These can develop after a blow to the front of the knee.
  • Collateral ligament injuries. These contact injuries often happen during sports.
  • Meniscus tears. Tackles, twisting, aging, and arthritis can each damage the knee’s meniscus, its shock-absorbing cartilage. A person may feel the knee “locking” or experience discomfort going down the stairs.
  • Fractures. The three bones of the knee joint can fracture or break. The patella, or kneecap, does so most frequently.
  • Patellofemoral pain syndrome. Sometimes called runner’s or jumper’s knee, this mainly causes pain at the front of the knee that gets worse with climbing the stairs, squatting, or bending. It sometimes causes popping sounds or swelling.
  • Dislocation. This can occur when the thighbone, shinbone, and patella are out of alignment, due to structural problems or injuries.
  • Tendinitis. This issue, inflammation of the tendons around the joint, stems from overuse and is more common among middle-aged athletes.
  • Bursitis. Repetitive motions, like running, can cause sacs of fluid around the knee to become irritated, painful, and swollen.
  • Osgood-Schlatter disease. This overuse injury is most common in teenage boys, particularly in athletes. The symptoms include soreness around the knee and pain when extending the leg.
  • Arthritis. This develops when the cartilage protecting the joints breaks down and leaves the bones rubbing against each other. It can cause swelling, stiffness, and a reduced range of movement.

Sometimes, physicians cannot identify what is causing knee pain. For about 30% of teenagers who seek treatment for pain at the front of the knee, a doctor cannot diagnose the cause.

Accompanying symptoms of sudden knee pain

In the list above, we describe specific symptoms of issues that commonly cause sudden knee pain. But in general, one or more of the following tend to accompany this pain:

  • swelling
  • stiffness
  • a clicking sound with the pain
  • pain when rising after sitting
  • pain climbing the stairs
  • pain descending the stairs
  • the knee “locking” or not bending
  • the knee giving way

The exact location of the pain can help identify the cause and the best way to treat it. For example, pain between the kneecap and the shin can be a sign of a repetitive use injury, such as from running.

Risk factors for sudden knee pain

Above, we list some risk factors for specific causes of sudden knee pain. Overall, the following tend to increase the chances of developing this pain:

  • increasing activity levels suddenly, which can put too much stress on the body too quickly
  • having poor alignment and a weak core, which can place stress on the knees
  • having weakness in one or both hips, which can lead to an uneven gait and eventual knee problems
  • having tight hamstrings and iliotibial bands, which can limit the body’s ability to recover from a workout
  • having an imbalance of strength and flexibility
  • wearing poorly fitting or worn out shoes
  • having overweight or obesity

Diagnosis and testing of sudden knee pain

Unless sudden knee pain clearly results from an injury or accident or the pain is severe, most people can safely wait for a few days before seeing a doctor. During this time, people should avoid or limit any activities that cause discomfort.

Resting, applying ice packs, and using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can provide relief. Symptoms may then start improving. However, this does not always happen.

A visit to a physician typically begins with a complete medical history and an overview of the person’s activity level. The doctor then manipulates the person’s leg, checking for pain, tenderness, and swelling. They also do this to assess the range of motion. To make a diagnosis, the doctor may need imaging, such as MRI scans or X-rays.

Treatment Options for Sudden Knee Pain

The treatment for sudden knee pain depends on its cause and severity. Some examples are below:

  • Arthritis. NSAIDs, physical therapy, yoga, and Pilates can help reduce pain, but if the condition is severe, a person may need knee replacement surgery.
  • Meniscus tears. When a tear is smaller, rest and over-the-counter pain relievers can help. More severe cases may require arthroscopic surgery to repair the tear or remove pieces of torn tissue.
  • Tendinitis. Thoroughly stretching the affected leg can increase blood flow, reduce inflammation, and help correct alignment shifts.

When a person is in too much pain to do physical therapy, the doctor may recommend cortisone shots. These provide a degree of relief that usually allows a person to start their rehabilitation exercises.

How to Prevent Sudden Knee Pain

Wear and tear on the body is inevitable, and injuries can be hard to avoid entirely. Still, the following can help people can maintain or improve their balance, strength, and flexibility, offering some protection from sudden knee pain:

  • strengthening the core and hips
  • maintaining flexibility in the joints
  • improving alignment
  • increasing levels of activity slowly
  • wearing shoes that fit well
  • stretching regularly

Summary

Sudden knee pain is a common issue — the complex structure of the knee means that it can be injured in various ways. Often, recovery from a knee problem just involves rest and self-care.

However, people with severe or persistent pain may require physical therapy or surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Frequently Asked Questions about Knee Pain

Frequently Asked Questions about Knee Pain

Article Featured on WebMD

Your knee hurts and you want to know why. Whether it’s an injury or arthritis, here are answers from an orthopedic surgeon who specializes in sports medicine and knee care.

Could my pain be from osteoarthritis?

Yes. Probably 95% of knee pain caused by arthritis is osteoarthritis, which is caused by “wear and tear” on the joints. Other types, like rheumatoid arthritis, are much less common causes of knee pain.

What kind of injuries can cause knee pain?

They’re usually twisting injuries to the knee: ACL, meniscus, or ligament injuries.

What’s the difference?

The main difference between arthritis and other kinds of knee pain is there’s no trauma associated with it. A person who tore their ACL or had a meniscus injury knows exactly when it happened. With arthritis, it’s more of a dull, aching pain. It gets worse as time goes on.

Will my pain go away on its own?

It depends. Arthritis pain tends to wax and wane over time. It may not completely go away, but sometimes it feels much better. Pain from an injury improves at first, but if you’re left with a sore joint, you may not be able to do certain activities.

When do I need to see a doctor?

Everyone has a different pain threshold. If you’ve an injury and your knee swells, you need to see your doctor. Even if the swelling goes away, you need to have your knee examined — you might have injured something inside the joint. If you have arthritis pain and the bad days outnumber the good, you should see your doctor.

How do I keep my knees healthy?

I think weight control is important. Flexibility helps as well. If you take part in a sport that requires a lot of physical exertion, like skiing or tennis or soccer, you need to get in shape.

Also, when you get tired, you need to stop. Look at the rate of knee injury: It goes up in the fourth quarter or final period of a game. Just a millisecond or two of delay of muscle function can cause injury. If the muscles that protect the ligament are tired, they don’t do a good job.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Roots of Post-Surgical Knee Nerve Damage Uncovered

Roots of Post-Surgical Knee Nerve Damage Uncovered

Article Featured on PPP

Two recent studies1,2 have uncovered tiny cutaneous nerves on the anterior and medial thigh and around the knee using high-resolution ultrasound imaging, which may explain the occurrence of chronic pain following knee operations. Previously, it has been deemed impossible to demonstrate that these tiny cutaneous nerves (less than 1-mm thick) exist around the knees.

In the first study,1 a team of researchers at the Medical University of Vienna, Austria located the entire course of ramus infrapatellaris (a sensitive nerve branch in front of and below the kneecap) with high-resolution ultrasound imaging. They showed that neuropathy of the intermediate and medial femoral cutaneous nerve can be reliably visualized throughout the course of the nerves, both in anatomical specimens and in patients.

The second study,2 also led by researchers at the Medical University of Vienna, Austria, highlighted the branched anterior cutaneous branches of the femoral nerve, nervus femoralis, confirming the reliability to visualize these branches using high-resolution ultrasound in anatomic specimens and in healthy volunteers, which could enhance the diagnostic and therapeutic management of patients with anteromedial knee pain. It was also found that the nerve pathways are highly variable for each patient.

To accurately isolate the nerve branches causing the pain, it is essential to carry out a “diagnostic blockade,” according to lead researcher Georg Riegler, MD, lead researcher from MedUni Vienna’s Department of Biomedical Imaging and Image-guided Therapy. “Since the nerve supply is so variable, it is essential to first make sure which of these tiny nerves [are] causing the pain,” he said in a press release.3 “This can only be done by selectively temporarily anesthetizing, or blockading, the suspected nerve, with a maximum of 1 mL of anesthetic. If the pain is significantly reduced immediately after a blockade has been done and returns once the anesthetic has worn off, then we have located the problem.”

One of the first options for treating nerve pain in the knee is to use localized pain patches or physiotherapy, followed by ultrasound-guided treatment. Other possibilities include cortisone injections, radiofrequency ablation, and surgical procedures. Dr. Riegler urged the importance of determining the exact position of the damaged nerve fibers before giving any targeted treatment to combat nerve pain.

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New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.