How do you prevent knee injuries?

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[iokuyama]

I see a lot of people train with knee braces/pads. It seems knee injuries are very common among Aikido practitioners. My knees are not doing so well these days either. Not much pain, but they don't feel right.

Do you have any suggestions on how to prevent knee injuries, how to protect them, and how to heal them without taking any time off from training?

[Janet Rosen]

to take your last question first :-)
you cannot "heal' an injury without resting it. a soft tissue injury likestrain or sprain etc (NOT talking about a bruise or minor pulled muscle) NEEDS 6 to 8 wks to heal.
re your knees "not feeling right" well there is no such thing as a "knee" really--so anything we would tell you is sort of guessing and anecdotal--is it your quadriceps, your patella, a ligament, etc? we don't know and maybe you don't either.
in GENERAL good posture and body mechanics is the key: toes, knee, hip should face the same direction, you should aim to not bend a knee past the point where it obscures your view of your toes, don't lock or hyperextend your knees, etc. Make sure not to go knockkneed when dropping center. Warm up before class and stretch a little after warming up and a lot after training. Learn a good standing quads stretch that includes engaging all 4 parts of the quads. Keep hamstrings strong--stronger than quads. PAY ATTENTION TO WHAT HURTS AND WHAT HELPS and don't 'tough it out'--listen to your body and learn.

[Steve Mullen]

Glucosamine Sulphate tablets and cod liver oil can help regenerate soft tissue and promote healthy joints etc, but start finding ways to train which protect your knees now rather than when it is too late.

Try and stay conscious of twisting on your knee or over stretching, just generally look after yourself when training and don't go too all out. Having said that, I am a member of the screwed knees group myself.

[Hanna B]

Different lines of aikido have different amount of knee pads among their practitioners. In part it reflects the amoung of suwariwaza done, but there are ofter factors as well.

[SeiserL]

IMHO, keep proper alignment and don't overdo it.

[Brian Vickery]

IMHO, keep proper alignment and don't overdo it.

...I second this response! ...if you're looking to PREVENT knee injuries, this is the best way to do it!

[Janet Rosen]

Glucosamine Sulphate tablets and cod liver oil can help regenerate soft tissue
actually the one double blind research done w/ glucosamine showed that it was as effective as nsaids in relieving pain of osteoarthritis in the knee. it did not address the issue of regeneration of articular cartilage, which is the tissue posing a problem in osteoarthritis.
i would like to see links to studies for 'regeneration of soft tissue', as i've never seen any.

[James Kelly]

I’m not so sure we really have any way to prevent knee injuries.

I have one really, really bad knee and one knee that has never felt a day of pain its whole life (knock on wood). Both knees have done the same number of rolls, walked the same distance in suari-waza, felt the impact of the same number of breakfalls, thrown the same number of techniques with the same alignment (both good and bad), been through exactly the same warm-ups, ingested the same amount of glucosamine, over done it the same number of times, rested the same number of days, ... the list goes on. About the only thing I can think of that we do that isn’t symmetrical are sword cuts and I have a hard time believing that all my knee problems come from suburi (my right knee, aka the front one, is the bad one).

So I wonder how much of my knee problems are just random. A tiny injury way back when caused something else to go out of whack which in turn pulled on this or wore down that... if there really was something I did to cause my knee to go bad, why didn’t it do the same damage to the other one...? If all my precautions helped save my good knee, why didn’t it save the bad one...?

These are the things I think about when I’m off the mat due to my bum knee.

ps – I highly recommend a light yoga. It’s the only thing that has been able to help.

[Saw Y. C. Naw]

Some people tend to hit their knees on the mat when doing backward rolls, and if that is not corrected over time, it could become a problem for the knees.

Other than that, maybe more calcium and vitamin D? Excess calcium does not improve bone strength without sufficient vitamin D, as this article suggests. (http://www.nutraingredients.com/news/ng.asp?n=63782&m=1NIEN09&c=vwgtrjufjlqzoms)

[Hanna B]

IMHO, keep proper alignment and don't overdo it.

...I second this response! ...if you're looking to PREVENT knee injuries, this is the best way to do it!

Are you thinking about doing this as nage, as uke, or both?

[Janet Rosen]

Other than that, maybe more calcium and vitamin D?
there is no reason to think that osteoporosis is in any way linked to knee problems in/out of aikido.

[heyoka]

I'm frequently plagued by leg problems of a variety of sorts, including painful knees, and I've found relief from many of these issues by taking a glucosamine chondroitin supplement every few days.

Also I take it easy with anything involving seiza and don't try to force myself to stay in those positions longer than I have to. I've heard from more than one person that a lot of suwari-waza can be damaging to the knees if you haven't been acclimated to it from a young age, and frankly I'm not open to testing the theory.

[Josh Reyer]

So I wonder how much of my knee problems are just random. A tiny injury way back when caused something else to go out of whack which in turn pulled on this or wore down that... if there really was something I did to cause my knee to go bad, why didn't it do the same damage to the other one...? If all my precautions helped save my good knee, why didn't it save the bad one...?



One thing is that as children we don't necessarily learn the most body-efficient way of walking, and small bad habits picked up in youth can lead to problems down the road.

For example with me, I'm ever so slightly pigeon toed on my right side. I daresay it's not even noticable by other people when I'm walking, but I've been aware of it for some time. It's something, I believe, I've done since I was walking. I fear that if I'm not careful, it could lead to problems later on. Occasionally I'll get a feeling in that knee like I need to crack it, but it just won't crack. I try to correct the foot's alignment when I walk, but most of the time I'm not paying enough attention to it, and I wonder if trying now wouldn't do more harm than good...

[Richard Langridge]

Funny, your description of "a feeling in that knee like I need to crack it" is exactly the feeling I often get in my knees after doing lots of ushiro ukemi. But that's just because I suck at ukemi!

[Ivan Sekularac]

Great Post! :)

I also expirience pain in my knee if I overdo it... best is too rest if you feel any pain or pressure in your knees.

Try is to get ankle weights, 5 pounds (2.27 kg) should be OK, sit in the chair and slowly raise (straighten) one leg, keep it up for 10 sec and slowly lower it down on the floor... do 3 sets of 20 (or more if you can) and you should be strengthening muscles around you knee... that will help.

[Janet Rosen]

Great Post! :)
Try is to get ankle weights, 5 pounds (2.27 kg) should be OK, sit in the chair and slowly raise .
Weight training is not necessarily the first/best place for a person w/ knee pain to start! Yes it is true that strong quads are important, but not ou tof balance w/ strong hamstrings....
Also, a person w/ chronically TIGHT quads or trigger points in the quads will NOT benefit by strength training as muscles in that condition need to be relaxed and stretched/balanced in order to contract efficiently....
Also a person with knee pain due to misaligned patella may have an imbalance between lateral and medial quads, which means that weight training needs to be focussed more on one aspect....
Also a person w/ meniscus problems may need to approach weight trainining somewhat differently....
these are a few examples of why it is important to differentiate 'things that are in general good to maintain still healthy knees' and 'things that are appropriate for xyz condition.'

[ikkitosennomusha]

The anterior cruciate ligament (ACL) is the most common ligament in the knee to be a problem for athletes. If there are stresses or small tears it can cause pain and require rehabilitation. If it snaps, a surgical procedure is required to stitch the ligament back together.

It would be a rare thing for your posterior cruciate ligament to snap because if it did, your femur would slide right off of your tibia toward the front detaching your patella. Besides, your ACL is more flexible while being durable and your PCL is more firm and stiff. The word "cruciate" was coined because the ACL and PCL intersect in a "cross" type fashion.

My advice to anyone having a problem is to quite training temporarily and pay a visit to your local doctor for an x-ray. From there, the proper therapy can be determined by your physician. Remember, if you act early, you might can do something about it so don't wait too late. We all get minor aches and pains so if it is something that a little rest, ibuprophen, and sports cream cannot cure in a few days, see a doctor.

Dr. Medling

[Ivan Sekularac]

Weight training is not necessarily the first/best place for a person w/ knee pain to start! Yes it is true that strong quads are important, but not ou tof balance w/ strong hamstrings....
Also, a person w/ chronically TIGHT quads or trigger points in the quads will NOT benefit by strength training as muscles in that condition need to be relaxed and stretched/balanced in order to contract efficiently....
Also a person with knee pain due to misaligned patella may have an imbalance between lateral and medial quads, which means that weight training needs to be focussed more on one aspect....
Also a person w/ meniscus problems may need to approach weight trainining somewhat differently....
these are a few examples of why it is important to differentiate 'things that are in general good to maintain still healthy knees' and 'things that are appropriate for xyz condition.'

I agree with you, my advice for weight training was for people who are starting aikido and do not have any problems yet but are afraid they might develop one.

[Janet Rosen]

brad, statistically wouldn't you say that, in terms of knee pain as oposed to outright disability, unbalanced quads, mistracking patellas and minor patella injury are all more common than acl injuries?

[ikkitosennomusha]

brad, statistically wouldn't you say that, in terms of knee pain as oposed to outright disability, unbalanced quads, mistracking patellas and minor patella injury are all more common than acl injuries?

I am referring to the more severe injuries that are quired when treatment for minor illnesses that you described are not sought after. ACL damage can occur as direct neglect to a minor issue or it can occur without warning. In aikido, the necessary elements for such twisting, hyper-flexion movements etc. while being nage or uke are prevalent under demanding elements.

Age, weight, the type of activity, being in the right place at the wrong time, etc. are factors. I have seen alot of atheletes come in from the field or off the court from a physical activing having had no prior knee injury tear an ACL. I have also seen people with reacurring issues and more drastic, invasive measures need to be taken.

Like I said, I cannot determing the condition of the the progenitor of this thread without performing a physical and certain tests so whether you view a particular injury as common or not, they can all happen with relative probability. This is not about statistics, this is about what can happen in the worst case scenario and finding preventative measures to avoiding any kind of injury.

Practice as safely as you can with what you have been taught. Sometimes accidents are going to happen but being aware of the situation you are in and how to protect yourself is the key to staying healthy.

The quadriceps are 4 heads comprised of striated skeletal tissue and is not the only group that holds the patella in place and stabilizes the knee. You don't have to have quads like mine to walk. Mine very muscular, defined, striated, and lope over my knee a little due to my bodybuilding. However, the way humans were desinged, one typically wouldn't have that issue. Since most injuries occur while doing some sort of antagonist lifting or during some sort of demanding sport, sometimes strength training can be an asset that can work in synergy with your training regimen.

It is not at all uncommon for atheletes to weight train to strengthn tendons and joints to perform their duty on the field such as football players, baseball players, basketball players, and even golfers!

So the answer to an earler post, is yes, weight training under the correct supervision to assist your dynamics in your particular sport is a good thing but should only be done when healthy and when prior injuries are fully healed. For each sport, the athelete has different needs and since each individual is genetically different, a customized program is necessary. I hope this helps.

[David Mullin]

Poor biomechanics = PAIN. there are three main muscle groups involved with knee pain. Quads, Adductors, and ITB/TFL.
First Quads, a lot of stances and foot work over work the vastus lats ( the outside muscle of the quads) the vastus Med is inhibited and becomes weaker compaired to the lat. On that line the Adductors on the inside of the leg, become inhibited relative to the Iliotilbial band and Tensor Facia laita on the very outside of the thigh. The upshot is all of this imbalance between muscle groups puts undo torsion on the knee = pain. Isometric exercise to correct these imbalanced conditions will usually correct knee problems.
Now all of this is without any torn ligaments or meniscus. Even so once a real tear has healed up these imbalances will happen from limping and compensating during the healing process. Neuromuscular reeducation is the way to restore the balance around the knee.

[Jory Boling]

In regards to "preventing" knee injuries (or at least minimizing chances of), a sempai of mine recently showed me a different way to do a backward roll. Instead of going down to one knee first he showed me how to turn a back fall (back breakfall?) into a back roll by kicking out and rolling on over.

Also, in my dojo, they prefer regular back falls to be done by squatting and then kicking out. Your weight never goes down on your knee (in a perfect world).

That has taken some of my kneepain anxiety out of the equation. Now I only worry about it during abuse in suwari waza.

[ksy]

hi, came across this article on knee injury survey etc. maybe some of you would like to check this out
http://www.zanshinart.com/Aikido/AikiKnee.html

[Abasan]

Does anyone else suffer pain on the other joint of the knee? Something like a twisted ligament or similar. Mostly its not painful, unless you sit seiza.

Getting up feels like a wire is pulled short at the knee and remains painful to straighten the leg for a few minutes or until you kick it out.

Just wondering what injury this is.

[Janet Rosen]

Does anyone else suffer pain on the other joint of the knee?
this makes no anatomical sense. try again? :-)
if you can describe via landmarks on the outside of the body exactly where it is, then some of us MAY be able to identify the most likely structures to be involved and some of the common problems associated with them...none of us will be able to make a diagnosis.

[billybob]

Do you have any suggestions on how to prevent knee injuries, how to protect them, and how to heal them without taking any time off from training?

Let them bend.

"The knee joint will never fail by itself" - my physical theapist. Our knee joint is massive and strong. It is rugged enough to support a full grown cow. Look for knee trouble in your lower back and find tension in your lower abdomen and groin. He mentioned that many female athletes have a 'cultural' tension in their abdomens that causes ACL problems especially for them - he hadn't worked out the details.

If you are training on a crowded mat - be flexible. If someone falls on you, fall also. Force is the enemy of healthy joints. Good smooth gentle training is the best cure.

I yelled at some of the 'weight training is THE cure all for joint injuries' crowd and let myself get shouted down. If you are in pain. ease up.

Knees are strong. Let them bend

dave

[Janet Rosen]

He mentioned that many female athletes have a 'cultural' tension in their abdomens that causes ACL problems especially for them - he hadn't worked out the details.
hmmm
maybe because the research shows the problem is elsewhere (and what the heck is a cultural tension???) specifically gender difference in use of quads and hamstrings. extensive studies have been done on college basketballers, becuase there was literally an epidemic of acl ruptures in women players WAY out of proportion to men players.
it was discovered that 3 main theories (estrogen levels, pelvic wideness in women, which DOES make us more prone to collapse knees inward, and different angles within the knee structure btwn men and women) were of minor importance compared to biomechanics: women tend to use quads for jumping and men tend to use hamstrings.
bear in mind hamstrings are quite wonderful in being both extensors and flexors depending on whether you look at the hip or the knee. so there are certain gross movements that can be done relying more on them or more on quads. and jumping with quads is way less knee-friendly (engaged quads tighten knee--feel how they immobilize kneecap, which is a GOOD thing--and that includes making the acl taut). when women basketballers are given plyometrics that include re-education on jumping, their acl damage rates go way down. i've also spoken w/ a coach for womens volleyball team who has incorporated this kind of regimen for his team and seen huge improvements in safety.
i used this info for some self-reeducation during gmy last bout or knee rehab and found that yes, i was able to experiment w/ feeling quads use vs feeling hamstrings use--quite interesting.
so there is such a thing as "jumpink like a girl" and it ain't good -- dunno bout the "throw like a girl" thing though :-)

[billybob]

Janet,

I perceive superior training to my own from you so I'll answer in lay terms. By 'cultural tension' he was referring to how different peoples inhabit their bodies differently. He says Americans 'drive' their bodies as though they were automobiles, etc. Some men expresss 'chestiness' or 'upper bodiness',
some people express collapse, or hunch over as though they were about to be clubbed on the head. He observed that we 'dress up' our bodies, in the mirror, rather than letting them be the gravitic walking engines they are meant to be. He showed me pictures of myself from the rear to prove this point. Women, he said, accentuate their sexually attractive features (maybe that is what men are doing above).

Have you noticed that people in business attire walk differently than people dressed for outdoor work?
Drunks move differently etc. I think what I'm saying actually supports what you said, and what the relevant research found.

I'm glad the reeducation is helping. I'm also hoping to lose my self imposed moniker 'Gimpy Dave'

dave

[Janet Rosen]

thanks for clarification, dave; yes, overall makes sense in terms of larger culture/gender issues as they relate to somatics/body movement.

[mriehle]

It would be a rare thing for your posterior cruciate ligament to snap because if it did, your femur would slide right off of your tibia toward the front detaching your patella.

Really? I guess I'm a pretty luck guy. Actually, now that I think about it I guess I know why.

Both my knees are pretty much trashed.

I have a repaired tibial plateau fracture in my right knee and a repaired PCL in my left knee. I remember it was the PCL as opposed to the ACL because my orthopedic surgeon was actually quite surprised.

But my patella is right where it belongs, thank you. I suspect this is because I didn't really get to put any weight on it. I wasn't allowed to move around much after the repair surgery for my right knee.

I remember one of the diagnostic procedures was a bit, um, creepy. I'm pretty sure a knee is not supposed to move like that.

Besides, your ACL is more flexible while being durable and your PCL is more firm and stiff. The word "cruciate" was coined because the ACL and PCL intersect in a "cross" type fashion.

Well, this explains some things. My knee is still a little unstable. Not badly, but I can feel when things get out of alignment and it's uncomfortable.

[musashipug]

I'd suggest you get a referral to a local Orthopedic certified Physical Therapist who also is an Aikidoka. Most orthopedic Dr.'s and P.T.'s don't know the specific demands we put our knees through in training.

Stay Safe,

Roger

[Lyle Bogin]

Sometimes you just have to refuse to do certain things on the mat that hurt you.

[aikispike]

All these smart answers... the only think i can think of is "less suwari waza"

Spike

I'd suggest you get a referral to a local Orthopedic certified Physical Therapist who also is an Aikidoka. Most orthopedic Dr.'s and P.T.'s don't know the specific demands we put our knees through in training.

Stay Safe,

Roger

[Amendes]

Some people tend to hit their knees on the mat when doing backward rolls, and if that is not corrected over time, it could become a problem for the knees.

Other than that, maybe more calcium and vitamin D? Excess calcium does not improve bone strength without sufficient vitamin D, as this article suggests. (http://www.nutraingredients.com/news/ng.asp?n=63782&m=1NIEN09&c=vwgtrjufjlqzoms)

LOL I was doing backrolls last night, and I relly must admit my left knee is very sore right now. Also my left knee is a very bad knee to begin with. I know it is from impacting on my back roll for 100% sure this time, as I felt it when I was doing it.

So now I need to adjust so that I do not land on that back knee.

The other thing that has been taking my left knee by surprise is the pivoting involed on it when doing any kneeling techniques or knew walking.

I am now at the point where I do not knee walk anymore. However I am visiting another school in a week and I hear it is very traditional, and I relly do not want to be rude by not knee walking or sitting in Seiza.

Anyway I believe I have a cartilage tear from a sports injury in the past and it will never get better, and I will never quit doing what I love to do, so basically I have to live with the pain and adjust.

I'd say it's wroth it.

[Robert Rumpf]

LOL I was doing backrolls last night, and I relly must admit my left knee is very sore right now. Also my left knee is a very bad knee to begin with. I know it is from impacting on my back roll for 100% sure this time, as I felt it when I was doing it.

When I do back rolls in the best way that I've learned how, my knees don't touch the ground. Perhaps you should reconsider how you roll.

This video is a good random example that I found online:
http://www.youtube.com/watch?v=iehmiFpfVVg

If you look at the 0:38 second mark, you'll see what I mean. It happens really fast - the support structure allows for the first connection beyond the shoulder to be the balls of the toes instead of the knee.

Of course, it takes a considerable amount of effort and focus to do backrolls in this way consistently, and so I typically cop out and plant my knee when I am actually forced to take backrolls, even though I know this to be incorrect. I see this copping out with many people (senior and junior), and it makes a lot of practical sense to plant the knee when you're on a mat since it takes less energy and focus, and the mat cushions the knee.

At the first place I trained, we had the option of rolls on hardwood floors, so the potential pain of planting became more obvious. Because of this, the point was made explicitly clear there, as it has been at seminars, etc. Still, it is hard to get yourself to act to an ideal when the sub-par suffices.

In general, I try to avoid backrolls and instead do backfalls, since I'm lazy and space tends to be at a premium. The alternatives are to become better disciplined (working on it), better conditioned (should work on it), and/or to choke on the roll and do a plant. If I can't get myself to do it correctly, I'm probably better off not reinforcing a bad habit.

Rob

[DonMagee]

I'm a big believer in proper strength training and stretching. Most people tend to not keep their body's in shape, thus they tend to get more knee and back injurys.

[Brion Toss]

I'm a big believer in proper strength training and stretching. Most people tend to not keep their body's in shape, thus they tend to get more knee and back injurys.
Yup. And stretching too hard at the beginning of class,when the muscles are cold, and not enough at the end, when the muscles are warm. And doing exercises that, done correctly, strengthen the knees (like squats), and avoiding exercises that put too much shear on them (like leg extension machine lifts).
I have a former knee, due for replacement, on starboard side, and a similarly former ankle, also about ready for replacement, on port. So I limp symmetrically; it kind of looks like a normal walk. But the proper training and stretching that Dan is talking about has played a huge part in extending my Aikido career. Oh, and Zebra mats on a sprung floor!

[robert weatherall]

My only advice. Never carry anyone on your back while running.

[Gernot Hassenpflug]

I heartily agree with Mr. Knowlton in post #26. The problem is most likely elsewhere, where he points out one ought to look. Sadly, without the sensitivity, capacity to investigate this, and the knowledge of what to do about it, the cure is not forthcoming. Here is advice I received from my ballet teacher last night. I got a slight twinge in the tendon/muscle just above the patella while bending the knee. I thought it was owing to the fact that I probably did not concentrate enough on keeping the buttocks together so that the upper leg is connected well to the base of the spine and not drifting away outwards (and rotating inwards from the front). He said not to concentrate so much on squeezing the buttocks together, but much much more on pulling up in/under the chest (this connects front and back of body so that spine takes "down" force through legs into ground, while front of body controls the springiness of this spinal connection).

[Amendes]

Apparently there is something out there called
Prolotheraphy. (I think thats how its spelled.)

It is apparently does wonders for knees that are doing symptoms like mine, and thosse that alot of Martial Artists seem to be getting.

I want to know if someone else has tried this before I shell out the kind of money it costs, because I don't want to pay for snake oil.

I also do Taekwondo as well as Aikido and I relly don't want to stop competing in Taekwondo but this knee thing has relly been making me start to think I am too old or something.

[Don]

I think, in order of importance, and considering a long aikido career:

1. Be in shape, which includes not being too overweight, flexibility and strength training

2. Be lucky

3. Have good genes for your knees

3. Be young (statistically speaking I at 51 having practiced aikido for 14 years am more likely to incure a knee injury even if I have 1, 2, and 3 than a young person who has 1,2, and 3 - more exposure hours if nothing else. On the other hand I am probably smarter now than when I was younger....)

[Walter Martindale]

Yup. And stretching too hard at the beginning of class,when the muscles are cold, and not enough at the end, when the muscles are warm. And doing exercises that, done correctly, strengthen the knees (like squats), and avoiding exercises that put too much shear on them (like leg extension machine lifts).
I have a former knee, due for replacement, on starboard side, and a similarly former ankle, also about ready for replacement, on port. So I limp symmetrically; it kind of looks like a normal walk. But the proper training and stretching that Dan is talking about has played a huge part in extending my Aikido career. Oh, and Zebra mats on a sprung floor!

What we're learning in the coaching world is that warm-ups should involve movement and loosening, with stretching being a separate session aimed at flexibility, after warm-up. A flexibility session should be separated from a "training" session by more than an hour to let the nervous system recover from the stretching. Apparently static stretching aimed at increasing range of motion prior to a training session turns off many reflexes that the body/muscles/nervous system (all part of the whole being) uses to protect itself and to "be athletic".
Sorry, I can't cite the journals, but at coaching conferences and seminars, that's the current thought.
W

[Matthew White]

best advice I can think of is find a dojo that has few knee injuries due to training, and train there... I know that should be obvious but some of the injury statistics I've seen for aikido would suggest otherwise.

[Carlos Rivera]

Let them bend.

"The knee joint will never fail by itself" - my physical theapist. Our knee joint is massive and strong. It is rugged enough to support a full grown cow. Look for knee trouble in your lower back and find tension in your lower abdomen and groin.

If you are in pain. ease up.

Knees are strong. Let them bend

dave

Good advice Dave, I just went through arthroscopic surgery for my rt. knee; torn meniscus, pinched ligaments, and a bit of chicken jambalaya that got jammed in there. :D

From my recent experience, you have to let them bend, go light for the first few weeks and analyze how your knees should bend. Just don't put any excessive weight on them while recuperating.

As far as how to avoid a knee injury, you should learn the techniques well (especially koshinage) so you don't actually bear a person's full weight, but only a temporary bearing of weight. In addition, listen to your best training partner- your body.

Sometimes we feel a twitch or pull and tend to ignore it; that was my mistake. If it's a twisted knee, rest, ice, compress and elevate.

Here's a good article from WebMD:
http://firstaid.webmd.com/knee_pain_overview_treatment_firstaid.htm

Knee Pain Overview Treatment

Self-Care at Home

In treating many types of knee pain, a common goal is to break the inflammatory cycle. The inflammatory cycle starts with an injury. After an injury, substances that cause inflammation invade the knee, which causes further injury, which leads to further inflammation, and so on. This cycle of inflammation leads to continued or progressive knee pain. The cycle can be broken by controlling the substances that cause inflammation, and by limiting further injury to tissue.
Some common home care techniques that control inflammation and help to break the inflammatory cycle are protection, rest, ice, compression, and elevation. This regimen is summarized by the memory device PRICE.

PROTECT the knee from further trauma.

This can be done with knee padding.

A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example is a form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the prepatellar bursae.

REST the knee.

Rest reduces the repetitive strain placed on the knee by activity.

Rest both gives the knee time to heal and helps to prevent further injury.

ICE the knee.

Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.

Most authorities recommend icing the knee 2-3 times a day for 20-30 minutes each time.

Use an ice bag or a bag of frozen vegetables placed on the knee.

COMPRESS the knee with a knee brace or wrap.

Compression helps accomplish 2 goals:

First, compression is another way to reduce swelling.

Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint mechanics intact.

ELEVATE the knee.

Elevation also helps reduce swelling.

Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.

Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs.

Over-the-counter pain control medications: Commonly used pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in the treatment of knee pain.

These drugs directly control pain and, at higher doses, act as anti-inflammatory agents, helping to break the inflammatory cycle. Like all medications, however, these drugs have side effects.

You should not use NSAIDs if you have a problem with bleeding or stomach ulcers or some types of kidney disease.

Acetaminophen (Tylenol) can also be used to control knee pain but does not have the anti-inflammatory properties of the NSAIDs. Still, this treatment is remarkably useful in many types of knee pain such as osteoarthritis.

When to Call the Doctor

When you are deciding whether to call the doctor, a good rule of thumb exists for most long-term knee injuries. If your symptoms have not gone away after trying 3-7 days of PRICE therapy and over-the-counter anti-inflammatory pain medications, you should set up an appointment with your doctor or a sports medicine or orthopedic (bone and muscle) specialist to further evaluate the pain. This rule can also be applied to new knee injuries that are not disabling. Remember, however, that this rule should only serve as a guide. If you are concerned about the pain, you should call the doctor.

When to Go to the Hospital

If you cannot walk on your knee, you should immediately go to the hospital's emergency department to be evaluated by a doctor because of the possibility of a fracture.

Many fractures may require immobilization in a specific position or surgery.

Putting off seeing a doctor may hinder healing.

Other signs and symptoms that demand emergency evaluation:

Fever (which may indicate infection)

Unbearable pain

Drainage

Large wounds

Puncture wounds

Swelling, if you are on a blood thinner (warfarin or Coumadin) or have a bleeding disorder (such as hemophilia)