For most people, healthy knees are an important part of a happy existence. Imagine having a knee that cannot bend, or lacks the stability to lock and support your body. Without functioning knees, living an active life is much more difficult, therefore it pays to take care of these vital joints and get appropriate treatment if you are unfortunate enough to be injured.
Knees are like big, complicated hinges that are also subject to wear and tear, and preventative measures during some activities and sports can be helpful in protecting your knees. Taking measures to reduce the stress on knees is much easier than recuperating from an accident as some knee injuries can take a long time to heal and cause a great deal of pain, not to mention the potential long term effects of sustaining an injury.
Typical knee injuries
Sports, such as skiing, football or squash are a frequent cause of injury. Any pursuit that requires quick changes of direction or the weight of the body being rapidly transferred from one limb to another can result in a tear, a sprain or even breakage.
Falls are another source of trauma to the knee, and any large impact, such as being hit by a car, can also cause knee injuries. Even when hiking or biking, a rock could give way resulting in a fall that could have a negative impact on your knees.
There are many moving parts in the knee, from bones to tendons, ligaments, and cartilage, including the discs known as the menisci, which act as a kind of shock absorber between the surfaces of the leg bones. The four main bones of the knee are the femur (thigh bone), the tibia (large shin bone), the fibula (or smaller shin bone), and the patella, the small bone that forms the kneecap.
When it comes to breaking bones in the knee, fracturing the patella is the most common. Falling on this small bone, or a blow to the leg, can easily fracture it. As the patella acts much like a shield to protect the knee, breaking it can make it difficult to walk. Breaks can range from splitting the bone into two, to crushing it into small fragments. Treatment could include surgery, a splint or a cast, and having to be on crutches for up to eight weeks.
Twisting the knee while the foot is on the ground and supporting the body can often be a recipe for tearing the menisci. Wear and tear can also cause many small injuries to the menisci, and these injuries can sometimes suddenly aggregate and result in a large tear. The menisci do not have a great blood supply and healing can be slow and difficult. Symptoms can include pain, swelling and an inability to straighten the knee completely. If a piece of a meniscus comes loose and then gets caught between the femur and the tibia, it may be difficult to walk without being in severe pain.
The ends of the leg bones are also covered with strong connective tissue called articular cartilage, which assists with smooth movement of the knee. Violently twisting the knee can tear this. If this does happen there may be swelling and pain in the joint and an injury of this type may also be accompanied by damage to other parts of the knee.
Tearing or spraining the ligaments are among the most common knee injuries. The knee has four important ligaments that need to be strong and healthy for it to function well. These ligaments are the medial collateral ligament, the lateral collateral ligament, the posterior cruciate ligament, and the anterior cruciate ligament.
The medial ligament is one of the most commonly injured. Tripping over while wearing a pair of skis can be enough to twist the knee sufficiently to damage the ligament. Tearing the tendons, which attach the muscles of the leg to the joint, is another commonly seen type of knee injury.
In professional football we are seeing more and more ligament based injuries (just look at what happened to both Zlatan Ibrahimovic and Macrus Rojo last week in both sustaining acl injuries). This is due to the technology of both the grass and footwear and when a player plants their foot in the turf and turns their foot remains static (due to the grip of the boots and the lack of mud in the turf) but their knee doesn’t, resulting in a ligament injury. In Ibrahimovic’s case he landed awkwardly from a jumped and jarred his knee.
Treating knee damage
The first thing to do is protect your knee from further injury, then apply ice.
Make an ice pack and apply it to the injury as soon as you can, for between 10 and 30 minutes. An easy way to make an ice pack is to place some ice cubes in a plastic bag and then wrap this in a towel. Be careful, as applying too much ice can cause damage to the skin. The cold should lessen inflammation and pain but do not leave the ice on for extended periods as it can burn. Some physicians say the ice should be reapplied every couple of hours (when awake) for the first two or three days.
Compression bandages on the knee can help to reduce swelling, support the joint and make it more comfortable. The pressure should not be excessive, cause pain or restrict blood flowing to the knee.
Find a stool or a chair and place a cushion on it so you can put your foot up and elevate the affected knee. This should help to minimise the swelling. Aim to keep your knee above your heart. It may be easier to do this lying on a sofa. When in bed, you can put your foot on a pillow.
When a knee injury occurs, try not to apply heat for the first three days, when inflammation is most likely to develop. Also avoid alcohol, which could impede healing and encourage you to underestimate the severity of the damage. Avoid exercise that could cause more damage or aggravate the injury, and do not massage it straight away. After the first three days, some light massage may have a soothing effect.
In severe injuries, surgery may be necessary, to stitch together a torn ligament or tendon, for example. Constant or severe pain could be a sign, along with the knee giving way or locking, that some kind of surgical treatment is required. Many surgical procedures are carried out with an arthroscope, which is a kind of tube with a camera on the end of it that allows a surgeon to look inside the knee and carry out repairs through a small incision.
Getting strong again
Minor tears may heal on their own, given appropriate rest. A knee that has been operated on will need a longer recuperation period. It is likely that after a knee injury, some physiotherapy will be needed, which can help with healing the injury, recovering movement, getting rid of stiffness and developing strength in structures that support the knee, such as the leg muscles.
Physiotherapy can help with keeping the knee active, which is sometimes a vital element of the recovery process. For some injuries, moving the joint without involving the surrounding muscles can be beneficial. A good physiotherapist or sports doctor will assess what your knee needs and will most likely give you exercises to do at home.
Ignoring the need for treatment
The occasional ache or pain may be nothing to worry about, but failing to pay attention to strong pain may end up causing you a lot of problems in the future. If knee pain is reducing your ability to take part in the activities your normally do, then it is time to get it looked at. In general, chronic knee pain that is affecting your life is a sign that something is wrong. A serious problem will not correct itself, and left untreated, can result in more pain and irreversible damage.
As we get older, knee joints become more vulnerable too and we do not bounce back from injury as easily. Even a relatively minor injury could develop into something more serious, if ignored. If your knee is very swollen, or you cannot put weight on it, it is probably a good idea to seek professional help, as this could be a sign of tendon or ligament damage.
If you can feel something moving around in your knee, it could be that a piece of bone or cartilage has come loose. An arthroscopy may be required to get it out of there, as it could cause further damage to your cartilage, or wedge itself into a position where the pain is severe and the knee may not lock or unlock successfully.
Pain in the knee can also be a sign of osteoarthritis, which is a degenerative disease of the joint. Osteoarthritis can be extremely debilitating, and it needs to be managed. Catching it early, before the knee is greatly affected, is always a good idea. If you are suffering from osteoarthritis, then a plan can be put in place to manage the pain and help to protect the knee from getting worse.
If your knee has been injured, then accept that it could several months before it improves. Rushing back to action may delay healing and cause further problems.