5 Tips to Improve Your Swollen Knee

Knee swelling is a major concern for athletes young and old.  Understanding their swollen knee is an important step to decreasing their pain and regaining their ability to be active & healthy.

When it comes to knee swelling and pain, many view it as the “chicken or the egg dilemma”: “Is my knee pain creating the swelling in my knee or is the swelling the source of my knee pain?”

That’s a great question and I’ll show you a whole new way of looking at your knees to help you quickly answer that question.  Understanding the swelling in your knee is the first step in taking control of your knees.

It’s time for you to stop handing over the responsibility for keeping your knees happy to your doctor, your personal trainer and/or your insurance company.  Those hinges halfway down your legs are YOUR knees.  Let me show you simple tips to determine the source of your knee swelling and what to do about reducing your knee pain.

It bothers me when I hear individuals say things such as;

“I have a swollen knee and no one can tell me why!”

“I can’t run any more because I have a bad knee.”

“My doctor told me to stop running because I have arthritis.  Now I’ve put on 20 lbs and my swollen knee pain is killing me!”

Tip #1 – Not All Swellings Are Created Equal

There are a different types of swelling and determining the source of the swelling is a key tool for sports medicine doctors and athletic trainers.

Knee Effusion – Swelling within the knee capsule or joint.  This is usually due to arthritis, chondromalacia or any injury within the knee joint. 

Bursitis – A bursa is small fluid-filled sac outside a joint that functions to decrease the friction between moving parts of the human body.  When a bursa become swollen, it will dramatically enlarged in a very defined area.  It usually looks much worse than they feel and, initially, an inflamed bursa is more of a nuisance than a source of significant pain.

General Inflammation – This is when the entire area around the knee is swollen but not within the knee joint (effusion).  The distal quads, the back of the knee, the upper shin and/or the sides of the knee are swollen from a source of tissue outside the knee joint. 

Tip #2 – Rule Out The Infection

Infections are BAD.  Recognizing an infection quickly can literally be the difference in simply taking some antibiotics for a week and being put into the hospital, spending thousands of $$ and having a terribly painful knee for months!

An infected knee usually starts with some form of a lesion, boil, spider bite-looking pimple or skin wound.  The wound becomes red, warm, swollen and enlarged over a period of hours to days.  Lastly, your knee becomes very stiff and your entire body responds with a fever and flu-like symptoms.  Recognizing this problem and seeking early medical care is the crucially important.  It’s important to note that not all joint infections originate from a skin wound and they can be the result of less obvious sources.

Tip #3 – Don’t Be Afraid of the “A Word”

Arthritis, often referred to as osteoarthritis (OA), is part of life and it can be managed well if done so properly.  Rheumatoid arthritis is very different.  Unless it’s advanced osteoarthritis and combined with other medical conditions, arthritis should not be the reason to become a couch potato and throw away your Athlete ID Card.  Maintaining knee joint range of motion (ROM), controlling your body weight, utilizing ice/compression, aggressive total body flexibility, cross training and proper footwear can easily reduce your symptoms and keep you “in the game”.  

Tip #4 – Reduce the Swelling Before You Increase the Strength

Always remember this: If your knee is swollen, your brain is telling your quad muscles to limit their strength.  It’s simplly a protective mechanism to reduce the stress on the knee joint.  Therefore, reducing your knee swelling will immediately increase your leg strength!  Conversely, anything that you do that increases your knee swelling will be reducing your quadriceps strength.

The goal for smart athletes:  Decrease knee effusion while increasing quad strength.

Tip #5 – Ice & Compression

I know I beat you with this point often but it’s worth repeating:  Ice and compression must be included in your fitness plan.  It controls swelling, decreases knee effusion, reduces knee pain, increases knee ROM and so many other positive factors related to your knee therapy.

I’m very excited about the articles and sports medicine tips I’m presently working on for MikeRyanFitness.com related to ice and compression, which will show you how to drastically decrease your joint and muscle pain!

Bonus Tip – Listen To Your Knees

Elite athletes do it.  World-class athletes depend upon it.  NFL athletic trainers and physical therapists include it in their therapy programs.  Why aren’t you doing it?

Let’s be honest, you’d have a hard time driving your car without the feedback from your dashboard.  Creating a Body Dashboard in your mind to listen to joints, body parts and such is exactly what the best athletes in the world do to stay healthy and to minimize little issues before they become big problems.

When it comes to your knees, they will tell you 80% of what you need to know to keep your knees healthy.  It’s time to improve your listening skills…as if we haven’t heard that line before?!

Playing it Smart with Pes Anserine Bursitis of the Knee

Pes Anserine Bursitis
Pes Anserine Bursitis

What is pes anserine bursitis? This ailment, while not extremely common, can be quite painful. It is the result of inflammation of the pes anserine bursa, which is located just below and to the inner side of the knee. A bursa is a fluid filled sac that acts as a cushion and is located close to most major joints of the human body.

This is a location vulnerable to repeated injury in athletes due to the fact that several ligaments, tendons, and muscles all meet in this same general knee area. This area of ‘high traffic’ can become aggravated with overuse. A typical mechanism of injury is a direct blow to the per anserine area at the upper inner tibia just below the knee. As you know, there is very little protection in this area with no muscle bellies or large fat stories to buffer the trauma.

The MCL, semitendinosus, sartorius muscle, and gracilis muscle all meet at the proximal tibia where this important bursa is located. They each provide support and alignment during body movement. The pes anserine bursa acts as a lubrication device, which minimizes the stress to the underlying tissue during interaction of the knee and all the surrounding tissue. This allows for proper body mechanics and weight distribution with all activities involving the lower extremity.

Sign and Symptoms of Pes Anserine Bursitis

Pes anserine bursitis is most common in long distance runners. Failing to properly stretch is a main cause but this condition also occurs in athletes who tend to contact the ground with their foot rotated outward. Even the slightest outward rotation of the lower limb during contact with the ground causes poor weight distribution and strains the inner thigh muscles and knee ligaments.

The following are symptoms of pes anserine bursitis:

  • Pain at the inside of the knee with repetitive knee movement (usually while extending the knee or climbing stairs).
  • Palpable swelling, warmth and tenderness on the inside of the knee 2-3 inches below the jointline. Often the pain associated with a bursitis can be minimal and the athlete reports that it “looks a lot worse than it feels”.
  • Redness over and around the area of the per anserine.
  • Pain located just below the inside joint line of the knee, which increases with resisted knee flexion and/or adduction (pulling the legs together).
  • Knee weakness associated with activities.

Professional Treatment for Pes Anserine Bursitis

Do not underestimate this injury. Take the necessary time off to allow for a full recovery prior to returning to your activities. One of the most common mistakes athletes make with this injury is not allowing for ample time to allow for sufficient healing before subjecting the tissue to high level stress. When this happens, the symptoms return much worse than previously experienced as you enter into the world of “chronic bursitis” and let’s just say that is not a fun place to be!

The following are my treatment recommendations for this condition:

  • Rest affected area by minimizing the activity associated with the cause the ailment.
  • Apply ice packs for 10-15 minutes 3-4 times daily.
  • Utilizing the necessary therapy modalities to decrease pain and reduce swelling.
  • Regularly stretch the knee, thigh muscles, and hips to promote relaxation of the area. Remember to breathe!
  • Proper diagnosis from your primary physician may require a referral for an x-ray an/or special test. Pain caused by pes anserine bursitis can mimic that of a stress fracture of the proximal tibia with endurance athletes.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Are you certain of your diagnosis of pes anserine bursitis or are there other injuries the source of these symptoms?
  2. Are all of the surrounding knee structures stable and intact?
  3. What activity do you believe is causing this pain and what can I do to prevent it in the future?
  4. Would you evaluate my lower extremity biomechanics to see if I have a leg length discrepancy, alignment problem or foot pathology that is a contributing factor to my injury?

Elite Sports Medicine Tips from Mike Ryan

  • Take a Timeout – In order to prevent any further aggravation to the knee take time off NOW so you can enjoy your sport next week.
  • Stretch It Out – Stretching works wonders for the body and proper healing of an injury such as this where muscles and tendons are involved.
  • Refill The Ice Tray – By now you may want to purchase additional ice trays after all of the icing that you will be doing! Ice is a great vasoconstrictor and it quickly reduces swelling. Apply the ice to the inside of the knee.
  • Baby Steps – After you feel you are healthy once again do not go out and run a half marathon! Start small and avoid obstacles such as hills and high intensity workouts while your leg strength and flexibility improves.