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Turn on the television any given Sunday during the fall and you will
invariably witness a football player writhing on the field in pain
clutching his knee. While we are not all elite 250 pound
super-athletes, many can relate to pain at the knee joint. There
are many different structures surrounding the knee joint including
muscles and tendons, ligaments, and articular cartilage which
provide support and stability for activity, however, all these
tissues are candidates for injury given the abnormal stresses we put
our knees through. The knees can experience many different types of
injuries and pain, and there are several common mechanisms for
damage. OVERUSE
Well known to you marathoners, knee pain may result from a
chronic pounding your knees endure as you hit the pavement
repeatedly to get your mileage in. Overuse stresses can occur at
the underside of the patella (kneecap) creating a dull, aching pain
caused by wearing away of the articular cartilage. This condition
is called Patellofemoral Syndrome (or chondromalacia). Other
repeated stresses may occur at the patellar tendon causing a tender
point just below the kneecap. Burning or sharp pain at the outside
of the knee with activity may indicate inflammation of the IT Band.
Treatment varies for each of these conditions. Many of these
overuse injuries can be temporarily treated by simply remembering
the acronym R.I.C.E. (Rest, Ice, Compression, and Elevation).
Long-term rehabilitation may involve assessing a muscular imbalance
which may be contributing to faulty alignment and abnormal stresses
on the structures. Such treatment would involve strengthening and
stretching of the appropriate musculature. Also, bracing or taping
procedures may be warranted to assist the patella to maintain proper
alignment with activity.
TRAUMATIC
All skiers are probably familiar with the structure known as the
ACL (Anterior Cruciate Ligament). This ligament, as well as others
surrounding the knee, can be strained or torn as a result of impact
or a sudden twisting motion. If severe, these injuries may need to
be treated with surgery. Sometimes rehabilitation involving
strengthening of the muscles and using modalities such as electrical
stimulation or ultrasound to decrease pain and swelling may be
adequate to return the knee to normal. Other preventative exercises
can be done to decrease the likelihood of a traumatic injury such as
these. More intensive therapy is required to rehab a knee after
surgery to restore strength, range of motion, and flexibility.
PATHOLOGIC
Osteoarthritis, Rheumatoid Arthritis, and Osgood-Schlatter’s
Disease would all be included in this category. These conditions may
be treated with prescription anti-inflammatory medication in
conjunction with exercise, stretching, and/or bracing and
modalities.
As previously mentioned, many injuries can be prevented with a
comprehensive exercise protocol including gaining good muscular
balance between the quadriceps and hamstrings, strengthening of the
calves and hips, balance training, and stretching of the entire
lower body and back.
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