I saw a physical therapy patient this week with a chronic knee injury. His knee was swollen and stiff, much more than normal. I know his knee well and it typically has only mild swelling with good muscle tone. His diagnosis is Grade 1 chondromalacia or irritation behind his kneecap. It’s an issue which most of us, myself included, over 30 years old commonly have behind our patella or kneecaps.
Puzzled with how his knee looked, I asked: “What have you done to make your knee so cranky?” “Nothing different Doc,” the 42 year old cross-trainer said frustratingly, “Same damn workouts I’ve done for the past 6-7 weeks.”
Here comes my big question: “What did you do after your workouts in regards to cooling down, rollers, stretching and ice?”
There it is….the look of a cow looking at a new fence post!
The answer was clear even before he embarrassingly replied: “I didn’t do anything…I didn’t have time.” It’s a lame excuse and a common practice for athletes of all ages. It’s my mission with MikeRyanSportsMedicine.com to change that mindset and behavior.
The Truth about Joint Swelling
There are many sources of joint swelling or effusion. The extra fluid inside a joint can come from the inner lining of the joint, the bone itself or from an infection.
It’s much easier and less painful to keep swelling out of a joint than it is to get the swelling out of a swollen joint.
The important part to note here is to minimize the reason for the swelling instead of trying to convince your body to reabsorb the fluids after they have filled the joint. I think of process as similar to a flooded bathroom: fixing the leaky pipe under the sink is a much easier solution than mopping up 20 gallons of water covering the floor and soaked under the cabinets.
Tips to Control Joint Effusion
Roll – using a roller on your muscles before and after a workout is a simple relax muscles and to allow your joints to move normally and to do their job.
Stretch – Five minutes of lengthening muscles and fascia before and after a workout improves blood flow and promotes the drainage of waste products from your hard-working muscles.
Ice – Ice is your best friend so start spending more time with it. If a joint or soft tissue is either overly warm, red in color or sore after a workout, ice it for 10-15 minutes. Ice quickly decreases the metabolism or joint activity while also decreasing pain. Both are important.
Posture – As most of us do after our workouts, sitting in a car or at a desk for prolonged periods of time is not good for our spine or joints. Sitting shortens some of our major muscle groups like our hip flexors and chest muscles. If you have to sit after a workout, make a point to do some of the following:
Use perfect spine posture
Consistently engage your core muscles
Kneel on one knee every 20-30 minutes
Sit on a large therapy ball instead of a chair
Get up every 20-30 minutes to stretch hamstrings, hip flexors and chest muscles
These are simple steps which don’t require much time or effort. Keeping our bodies healthy is important for many reasons. Controlling inflammation and swelling should be a top priority for athletes with the common bumps & bruises and wear & tear that comes along with aging and the sports we love.
Patellofemoral pain syndrome (PFPS) typically presents with a dull pain just beneath the kneecap and lower front part of the thigh just above the knee joint. It is very common injury for runners. Hence, patellofemoral pain syndrome is sometimes referred to as “runner’s knee” or misalignment of the patella.
The patella pain can be elicited during walking, running, going up/down stairs, squatting and even during long periods of rest, without moving the joint. One or both knees can be affected simultaneously and it is more common with women than it is with men. The reason for the gender issue is based on the fact that women tend to have wider hips, which results in a significantly greater “Q angle” at the patellofemoral joint of the knee.
A number of risk factors for Runners knee have been identified and linked with the onset of patellofemoral pain syndrome in runners. Athletes who log excessive repetitive stress on their knee joint are the most predisposed population to develop patellofemoral pain with an overuse injury. Other factors include knocked knees, wide hips, flat feet and excessive foot pronation.
The perceived kneecap pain is a result of abnormal forces associated with the patellofemoral joint such as abnormal muscle pulling on the painful patella, weak quadriceps muscles, tight hamstrings, subluxations, dislocations, arthritis, stiff Achilles tendon, tendonitis, and degenerating knee cartilages losing their cushioning effects.
This results in an inflammatory response that unleashes a cascade of protective patella pain. Interestingly, this area is more often not swollen.
Signs & Symptoms of Patella Pain for Runners
Dull aching pain around the kneecap.
An increase in symptoms during and/or after lower extremity activities such as walking, running, squatting as well after long periods of rest with the joint in a fixed position.
Pain may also be perceived behind the knee.
Patella tenderness but not necessarily swelling around the knee.
Knee joint catching or locking.
Difficulties attaining full range of movement with popping or snapping sensations noted with active movement.
Professional Treatment for Runners Knee
Rest, elevate and ice the area for 15-30 minutes, up to 4 times a day.
Stretching of the quadriceps, hamstrings, hips, ankles and Achilles is a must.
Significantly limit or postpone your running for now.
Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
Avoid excessive weight bearing activities.
Utilize a self myofascial roller to be used regularly on the quads, lateral thigh, hamstrings and calves.
Utilize a knee compression sleeve or patella brace as needed. They can either decrease or increase the symptoms, depending upon the athlete.
Avoid making sharp movements on the knee joint, changing direction with the foot fixed to the ground, bending the knee back and forth.
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:
What type of tissue around my knee is the source of my pain?
Is there any arthritis in my knee and if so, where is it located?
What type of exercise or physical therapy can I do to minimize or eliminate this pain?
Do you recommend I take glucosamine?
Are there any long term complications I should be concerned about?
Do you recommend the use of orthotics for my injury?
Elite Sports Medicine Tips from Mike Ryan
Healthy Mind & Body – A healthy body and mind makes for a quicker recovery. Stay positive.
AM Stretches – Stretch the muscles around your knee joint before you begin your day. A proper warm up is always smart if reducing kneecap pain is your goal.
Keep Rollin – Lower extremity rolling to increase the blood flow and mobility of the muscles associated with the knee is a must.
Gear Up the Right Way – Make sure your equipment from your shoes to your exercise equipment is right for you and not contriputing to the problem.
Level Hipped & Level Head – Make sure you don’t have a leg length discrepancy or alignment problem. When it comes to eliminating kneecap pain, correcting this is priority #1.