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Knee pain demands attention  

Knee pain can affect the quality of your life - challenging your sleep, shaping your mood or limiting your activity. Taking some smart steps now could help prevent knee pain from gnawing away at your daily life later.

Chrissy Horve-Willoughby, a physical therapist in Clinton, said there are a number of structures around the knee that must be in good health to maintain function. There are also a number of places we can get into trouble, she said at the Clinton Community YMCA last month.

The bone, cartilage, ligaments, muscles and tendons control how the knee functions in relation to the feet, ankles and hips. None is a solo player. A problem with one could affect another.

For instance, a foot problem could cause the muscles or bone to rub unevenly, Horve-Willoughby said. Or a balance problem may cause weight to come down harder on the foot, also affecting the knee.

There are two types of pain: pain at rest and pain during activity.

If a person feels pain while at rest, the ache might be rooted in a structural problem with the knee, she said. If pain strikes during activity, the distress may be related to muscles surrounding the kneecap, or patella.

Arthritis is when the cartilage in the joint wears away, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health. Arthritis also can affect the muscles, tendons and ligaments. Some possible causes include excess weight, a joint deformity or repeated injury. Morning stiffness and swelling is sometimes a sign the pain is related to arthritis.



There are some lines of defense.

 

- The stronger the surrounding muscle, the healthier and more stable the knee. Leg strengthening exercises, such as biking, water walking or anything else that does not pick up the foot, can help, Horve-Willoughby said. An exercise done in the pool can work the inner thigh. Raise your leg to the side and pull down through the water resistance. On land, put an exercise ball between your knees and squeeze.

- Stretch. Stretching the muscles on the front of the thigh (the quadriceps) and the back of the thigh (the hamstrings) can relieve pressure, said the National Institute of Arthritis and Musculoskeletal and Skin Diseases. If a hamstring or calf were too tight, Horve-Willoughby said, that could affect the mechanics of the knee and cause things to rub or wear differently.

- Wear appropriate shoes with plenty of cushion. Inserts could help absorb the shock and stress on the knee. According to Consumer Reports November 2003 issue, orthotic inserts could ease moderate foot pain and may be worth trying an over-the-counter product for a couple of weeks.

If the pain doesn't improve, Horve-Willoughby said, it's worth getting your knee checked. Questions the doctor will ask include: Do you feel pain all the time? Where does it hurt? Does the pain change as activities change? The answers will help identify the problem and form the solution, such as prescribing a shoe insert or medication, recommending physical therapy or, as a last resort, considering surgery.

Horve-Willoughby said undergoing physical therapy could prevent the need for surgery. If surgery is needed, the therapy could improve the outcome and recovery time.

Younger patients, especially, should take steps to save the knee. She said the golden rule is RICE: rest, ice, compression and elevation. If that's not enough, get a screening and ask your family physician if you can talk to a physical therapist.

To help deal with your health insurance company or Medicare plan, she said to be sure to obtain documentation of the medical necessity and whether you're improving in a reasonable amount of time