Secrets That Experts Of Knee Pain Don't Want You To Know.

Simple Guidance For You In Knee Pain

People go to their doctor with the complaint of pain. This pain is activity-related in the beginning stages they may face problems while walking or while doing any particular activity.

But as the stage of Arthritis increases, this pain becomes persistent and it converts into rest pain and night pain as well. The patient doesn’t get relief even while sleeping and resting and that becomes a very painful situation.

There are few methods for diagnosis of Arthritis through which we can diagnose as well as find the type of it.

Osteoarthritis can be diagnosed with a very simple X-ray. In X-ray few changes occur through which we can make out that it is osteoarthritis.

In X-ray, very classical changes are seen such as joint space narrowing, which we call the gap between joints reduced in common language.

The reason for joint space narrowing is as I told you earlier, the articular cartilage, in between the bearing surface of the bone which acts as a shock absorber and makes the space get visible in X-Ray, wears out leading to narrowing of joint space. In a further stage, bones start growing known as  Osteophyte Formation.

Cyst formation happens under the joint surfaces. And if it reaches further stages, pathological fractures or deformity develop in joints or defects start occurring in bones.

In the majority of cases, there is no need to go for further tests, but in few cases, if some other type of arthritis is there or any other disease, then through some blood tests, we can detect the type of arthritis.

We can divide the treatment part into two ways.

• Operative treatment 

•  Nonoperative treatment.

In the initial stages, nonoperative treatment is indicated. We can further divide nonoperative treatment into two types

•  Pharmacological treatment.

•  Nonpharmacological treatment.

In Nonpharmacological Treatment.

 Medications are not given to the patients and they are told for some lifestyle modifications. They are educated about  The activity that they should adopt and neglect

The patient is asked to lose his weight and also do a few exercises and physiotherapy to build muscle strength. The exercise helps to strengthen the muscles around the joints which increases the binding capacity of joints. Increased binding capacity makes the joint stable. And if the joint stability is good further damage will slow down.

If the patient is not getting relief even after no pharmacological treatment then the orthopedic practitioner or your general practitioner prescribes some medicines.

These medicines contain

•  Pain killers as well
• Few pharmacological agents
• Such as glucosamine
• Diacerein

 For the pain they give you some local applications such as gels.

• Many times steroid injections are given,
• Hyaluronic acid injections are given.
• This is all fine for the initial stage and the patient gets a lot of benefits from this and they spends a long time on it.

If these treatments do not benefit and it goes to a stage that the modus operandi is not beneficial, then there are some small surgeries, which are beneficial.

Such as

• Arthroscopic debridement 
  
• In arthroscopic debridement,

With the help of a small microscope, the joint is washed completely to remove the debris which is built up inside the joint because of joint wear and damages. And small tears lying inside the joints those tears portions are removed, The patient becomes comfortable after this, and for a reasonable period, he remains pain-free.

 

The second option is Osteotomy

Osteotomy means changing the bone’s alignment by cutting it. In the initial stage when only one part of the joint is involved and not the entire joint is involved, the part which tolerates the maximum weight of the bone starts painting.

In an osteotomy, they cut the bone and remove the fixed amount of the wedge from it, and change the alignment of the bone.

The benefit of changing bone alignment is the line of weight-bearing, the disease which is going through bone where it is pain due to loading they shift that line of weight bearing towards the opposite part where the joint is not damaged.

Then the loading of the joint does not happen through that part.

•  Offloading from the damaged part.
• Started loading from the normal part.
• This stops joint pain and it is a very good operation.

Such as high tibial osteotomy, proximal fibular osteotomy makes the patient pain-free for a reasonable period of 10-15 years.

After that surgery, the patient has gone into an advanced stage and deformities have come in the joints, and all these models are failed then the option is a joint transplant or total knee replacement.

 Total knee replacement started from 1930 or 1940. Since then till now the stage we are in, there is big research, metal designing, and development in engineering, understanding of techniques many things have made this possible and brought joint replacement surgery at this stage.

Today we believe that among all the surgeries innovated in In the last 50 years in medical science, knee replacement is the most successful surgery.

In knee replacement cut 8 to 9 mm of damage bearing surface of the joint and give it a shape and on that shape, they fix capping of metal alloys.

There are three parts to it

•  Firstly  the femoral part which we fix in joint bone bearing,
• Secondly, a tibial part, which we fix at a bearing of the upper part of the leg bone,
• Thirdly  the patella, we fix plastic buttons.

 Between the femoral and tibial parts highly crosslink polyethylene pressure is formed which maintains the gap between them.

According to today’s metal design technique and approach, the outcome is very good and it is a kind of blessing for arthritis patients.

After doing this surgery patient gets complete relief from pain and becomes self-dependent.

With self-confidence and self-respect, he becomes capable of living his old age life. Now new techniques are being developed such as computer-assisted surgery, robotic assistant surgery, minimally invasive surgery, they are making new milestones for you day by day in the field of knee replacement.

Let's talk about knee pain.

 If you've been lifting for any length of time, likely you’ve had some sort of knee pain or might have knee pain in the future if you’re not doing the right things.

  Knee pain can debilitate your leg workouts  I’ve suffered from it, and I know what it can do to your legs when you’re trying to squat and especially squat heavy.

Reasons of knee pain it’s important to understand the difference, and the one that I think is really common especially for guys that train and lift weights.

 We’ve got our skeleton, what you'll see is that in the knee we’ve got a lot of different sources of pain.

Now you guys have probably heard about ACL pain and MCL pain and LCL.

 Well, we're talking about tears really because those are ligaments that get injured in sports most often.

The ACL and PCL are inside the knee. The LCL and MCL are going to be on the inside and outside of the knee, and basically, that’s just one source of injury but we’ve also got osteoarthritis changes that can happen where you actually get degenerative changes on the bone, the bone on bone area, or on the underside of the patella here that grinds up against the femur.

 Meniscus Issues.

 It's the cushion between the two bones, the tibia and the femur, that gives us that space between the joint that can wear down or tear. But I find that the most common injury that we get when we train, our inflammatory conditions from overuse of the patellar tendon.

The patellar tendon  runs over the patella, here it holds it in place, and you can get inflammation of this a lot of times causing patellofemoral issues, we’ve heard that before, and it impacts the tracking of the patella when your knee goes into flexion extension.

 As we flex the knee and extend the knee, you want normal mechanics of the patella so you get this glide. And it glides right into a  groove there, You can feel that it's supposed to glide right in the groove.

 It starts to get out of position This is not a knee issue. The knee is a train, with its track.

 What happens when the track gets twisted?

The knee in the train goes flying off the track.

When you start looking and focusing all your efforts on the knee pain and trying to cure the patellofemoral issues, or try to cure your patellar tendonitis and you're not paying any attention to the track, you're way off track.

You want to start looking for the source and the cause of your knee pain because most often, 99 percent of the time, the source of that is going to be somewhere else.

  It's either going to be the track at the bottom, which controls your ankle and foot, or, the track at the top which is going to be caused by, or controlled by the muscles in your hip.

 If you have flat feet, again, one of my biggest issues your foot will collapse down and in, There's no arch so the arch comes down and in. That takes the tibia here with it into internal rotation, that gets twisted and you've got a twisted track.

 

If this thing tries to move on this twisted track, it’s off the track already. It’s actually being pulled in, So, it's off the track. That's not going to move smoothly.

With every rep of your squat with a flat foot, that patella is banging up against the side of the track causing  Inflammation. You can get inflammation on the underside of the patella. You can get inflammation up through the tendon. We have issues though

  At the hip, more common because you could fix this. You could use an orthotic down here to try to boost up your arch so you can sort of fixing the mechanics and reestablish a straight track.

 Most guys have weak underdeveloped hips If your hip is underdeveloped and it can't control the internal or external rotation of your femur, the same things going to happen, that could be all aligned, but if this gets pulled down and in, you've got an issue.

If this gets pulled out too much because of tightness in through your hip, you've got an issue. But the biggest issue here is glute medius weakness, and that's something that we can actually address too. So, I wanted to show you one of the ways that you can address that and even test yourself and see.

The easiest test and I know lay on your side and do the Jane Fonda's leg raises up and down to the side. Do about 50 of them.

  If it burns like hell because you have weak glute medius, you're going to feel a real burn that might feel pretty damn intense, and you might be squatting 350, 400 pounds, it might still feel like it really burns, if that happens to you, you got to get that stronger.

 One of the ways that we do with a glute medius Hip Bump. And it's really pretty simple. What you're trying to do is, you're trying to allow your body to drop, right, in PT we call this Trendelenburg's Sign where you just drop down to the side, right. Because you're letting go of the muscles over here that keep you upright.

  In order to get it back, we have to contract our glute medius which is going to pull our pelvis back and over to the side. we're doing a closed chain hip abduction. Were doing a hip abduction if were looking at the right leg, and it's just lifting your leg out to the side.

If we try to do that in a closed chain with our foot connected to the ground,  I'm just going to let the leg go further away from my midline as I raise my midline to the right, just after doing this a little bit, I can really feel a burn in that left side glute medius.

Maybe it's not enough for you, all you've got to do is attach a band.

• Get inside of it,
•  Put it around your hips.
•  Do the same thing.
•  Get up on your left leg.
•  If you're trying to work the left hip,
•  You get up on the left leg,

You face the hip that you're working inside towards the source of the band

•  The points of attachment.
• You let yourself drop.
•  Just get really lazy.
• Let your hips drop.
•  From here, you squeeze it straight over to the side.

 Let it drop.

• Squeeze your hips straight over to the side.
• This is not an ankle move.
•  This is not a knee move.
•  This is a hip move.
• All your focus should be right here.

 Let it drop.

•  Squeeze your hip lateral, straight over to the side.

Hold it for a second, and then come down. I could already again feel this burning, and obviously working a weak area. We've had some top major league athletes that had extremely weak hips. And you would be surprised because they were strong everywhere else. This can cause knee pain.

 This can cause

•  Chronic knee pain,
•  Inflammation,
•  Everything else that it is you're feeling.

 So, just because it's small and it seems like kind of a girly exercise, it doesn't mean that it's not worthwhile, and something you should do. So, guys, again, knee pain.

 There's a lot of different kinds of knee pain.

•  I see guys working out a lot of times,
• They're dealing with a lot of the chronic inflammatory conditions,
• Most of the tendons,
•  Patellar tendon namely.

 

You can fix it, but you've got to look other places. You cant look right at the knee.

You've got to look up and down. Down at your ankle. Up at your hip. Find out what the cause is. If it persists and you are training with much more than knee pain, it might be time guys that you have to start looking into other solutions.  Like supplement for that very reason.

You know how important it is to keep inflammation under control. The foods you eat have an incredible impact on our bodies - some can fight inflammation, while others cause inflammation. Here are the top 5 foods you should avoid to prevent unnecessary pain and inflammation.

1. ANYTHING with Gluten Not everyone will have adverse reactions to gluten:

• Around 40% of the population carries the gene for celiac disease,
• Making them more susceptible to the inflammation gluten causes.
•  Even though only 1% of the population has celiac disease,
•  Gluten sensitivity is actually pretty common.
•  If you already have arthritis, it’s really best not to chance it.

2.  Nightshade vegetables

•  You’ve ever heard of New England Patriot’s quarterback Tom Brady,
•  Then you probably know about his super strict diet and how it’s kept him playing football for so long.
•  One of the food groups he avoids completely are nightshade vegetables,
• They are known to cause inflammation.
• Examples include eggplant, tomatoes, and peppers.

3. Processed Fast Food

• Fast foods joints love to cook and fry their foods in oils full of trans-fat oils,
• Which have an abundance of Omega-6 fatty acids.Omega-6 in low moderation is good for you,
•  But the amounts, you’d consume with just one serving of fast food Omega-6’s increase inflammation in the body by triggering fibrin build-up in your joints over time.
•  Normally, fibrin is a healing protein – partially by causing inflammation to bring in white blood cells.
•  When fibrin continues to build when it’s not needed (arthritis), pain is inevitable.

4. Barbecued and Blackened Foods

• Grilling alone doesn’t necessarily cause problems.
• It’s when you go for that pretty charred look on meats and vegetables that things start to go wrong.
• Cooking foods (meats in particular) at high temperatures over an open flame releases a by-product called Advanced Glycation End (AGEs).
• AGEs are well-known in the medical world to cause inflammation of not only the joints but of your entire vascular system.

5. Processed Sugar (Especially Soda)

• Full-sugar soda is laden with more sweeteners and artificial flavoring in one bottle that a person should ingest in a week.
•   Processed sugar triggers your body to release pro-inflammatory cytokines.
• Cytokines are released by the immune system to send healing cells to sites of injury, infection, or trauma.
• This is all well and good when you actually have something wrong,
•  But it will cause unnecessary inflammation and pain in your joints if the healing cells have nothing to heal.

Conclusion

To ensure a thorough assessment, it is best to perform the musculoskeletal exam of the knee in a systematic way.

The following is a suggested order of exams that incorporates many of the common techniques used for evaluating the injuries.

Begin the exam with the patient in the standing position.

Look for evidence of gross deformity, muscular atrophy, the symmetry of the patellar alignment, evidence of various or valgus positioning of the knee, or presence of pes planus and pes cavus of the foot.

From a posterior view, observe for more than two toes laterally also called the too many toes sign.

This can indicate an over-pronated foot or an abducted fore foot.

 Perform a toe raise and evaluate the heel position.

Normally the heel should change from a neutral to a varus position.

 Observe the gait, looking for an antalgic gate excessive pronation, or supination.

Evaluate an active range of motion. If pain or limitation exists, repeat the range of motion passively.

In a seated position, test for knee extension. In this position, also observe patellar tracking and internal and external rotation of the hip, which can help identify referred knee pain caused by hip pathology.

Also in this seated position, palpate anatomic landmarks for tenderness. Palpate the distal quadriceps, quadriceps tendon, the patella and patellar tendon, the tibial tuberosity, and the fat pads beneath the patella.

On the medial side, palpate the medial collateral ligament, the medial joint line, the pes anserine bursa, and on the lateral side, the lateral collateral ligament, the lateral joint line, and the fibular head. Posteriorly palpate the popliteal fossa and the distal hamstrings.