Common Knee Injuries

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OVERUSE KNEE INJURIES

Often caused by increasing the intensity or duration of an activity too quickly, common overuse injuries include tendonitis, bursitis, muscle strains, and iliotibial band syndrome. Overuse injuries may develop over days, weeks, or months.

See Treatment of Overuse Knee Injuries further down the page. Some injuries require additional treatment, e.g. stretching the iliotibial band is important in iliotibial band syndrome.

Tendonitis of the Knee

The quadriceps tendon hooks quad muscles (front thigh muscles) to the patella (kneecap); the patella tendon connects the patella to the shinbone. The quadriceps tendon and patella tendon actually connect to form one continuous tendon that covers the patella. Both tendons are activated by the quadriceps. The quadriceps muscles are used to extend the leg. These tendons are commonly irritated, especially the patellar tendon.

Patellar Tendonitis (also called jumper's knee) is generally caused by overuse of the quadriceps, especially jumping types of activities such as volleyball and basketball. The pain is directly over the patellar tendon, just below the knee. Inflammation may develop.
(In adolescents, pain below the knee is often due to an overuse injury called Osgood-Schlatter disease).

Quadriceps Tendonitis is also generally caused by overuse of the quadriceps. The pain is over the quadriceps tendon, above the knee. There may be inflammation.

Being less elastic have less blood supply than muscles, tendons are more easily injured and take longer to heal than muscles.

It is important to give sufficient the knee time to heal before returning to the activity that led to tendonitis. Activities that cause pain delay healing. Though inflammation is a part of the healing process, chronic inflammation causes progressive damage to tissues.

Knee Bursitis

A bursa is a sac containing a small amount of fluid that is located between surfaces that need to move to reduce friction. Bursitis (Inflammation of a bursa) is usually caused by overuse.

The bursa in front of the kneecap (prepatellar bursa) is commonly irritated. Excessive kneeling often causes prepatellar bursitis (common in carpet layers, gardeners). The symptoms are knee pain and inflammation over the kneecap and sometimes a limited range of motion. The inflammation is within the bursa, not the knee itself.

Muscle Strains

Overstretched (pulled) or torn muscles result in stiffness and pain. The main muscles supporting the knee are the quadriceps and hamstrings. Increasing the duration and intensity of exercise or any activity too quickly often cause muscle strain. Mild muscle strains heal quickly.

Iliotibial Band Syndrome (ITBS)

The iliotibial band is a fibrous band of tissue that runs down the outer thigh, from the hip (ilium) to just below the knee, inserting into the shinbone (tibia). It helps provide stability to the outer side of the knee joint, particularly during running.

Iliotibial band syndrome is irritation / inflammation of the iliotibial band (the inflammation is usually not visible) that causes lateral knee pain. This condition is most common in long-distance runners and cyclists.

Symptoms of Iliotibial Band Syndrome (ITBS)

Though the pain usually occurs on the outer side of the knee just above the knee joint, it may also occur over the entire iliotibial band or just below the knee, where the iliotibial band inserts into the shinbone (tibia). The pain usually sets in slowly, often after running for several minutes. It is relieved by resting and aggravated by activity - running, cycling, or walking.

Causes and Contributing Factors of ITBS

Overuse:
Increasing running or cycling distance too quickly and/or not giving the body time to recover between runs can lead to irritation and inflammation of the iliotibial band. Running uphill, downhill, on a slope, on hard surfaces, or on uneven ground increases the risk of ITBS.

Tightness of the Iliotibial Band:
A tight iliotibial band causes excess friction over the outside of the knee  over the lower end of the thighbone  as the knee is bent and straightened. This leads to irritation and pain just above the knee joint. (A tight iliotibial band may also cause runners knee.)

Weak hip abductors (muscles involved in moving leg to side)
The hip abductors help support the knee. Strengthening these muscles help to support the knee and often helps improve ITBS.

Gait Problems:
Some experts believe that gait problems may increase the risk of ITBS. Proper footwear may help.

Other Mechanical Errors:
Having one leg shorter than the other or having bowed legs increases the risk of ITBS.

Treatment of Iliotibial Band Syndrome

Treat pain and inflammation with Rest, Ice, Compression, and Elevation (RICE). See RICE under Treatment for Overuse Injuries further down page. If the condition is mild, temporarily reducing high impact activities, doing exercises that stretch the iliotibial band and short-term use of anti-inflammatory medications may be sufficient.

For persistent cases, physical therapy may be necessary. Though most cases improve with conservative treatment, surgery is occasionally performed.

*Always get a proper diagnosis from a qualified medical professional.

Runners Knee

Runners are at an increased risk for this condition but it can affect anyone. The symptoms are diffuse pain behind or around the kneecap. The knee may click or crack when straightened. The knee may feel unstable. Running, kneeling, climbing stairs, and sitting for long periods, aggravates the symptoms.

Poor knee tracking appears to be the main cause of runners knee. The kneecap glides in a groove in the thighbone. If the kneecap is pulled to one side, excessive friction on the back of the cartilage of the kneecap during motion causes irritation. It may be caused by a simple muscle imbalance that can be corrected with exercises. Click here for more information on runners knee.

Osgood-Schlatter Disease

Osgood-Schlatter disease is a common overuse condition causing pain and inflammation just below the knee, over the bump on the front upper part of the shinbone, which the patellar tendon attaches to. This condition only occurs while a person is still growing.

Teens or preteens that develop this condition are usually highly active in sports that involve a lot of running and jumping. Cick here for more information on Osgood-Schlatter disease.


Treatment of Overuse Knee Injuries

Rest, Ice, Compression, Elevation (RICE)

*See a doctor immediately if your knee is giving out or if there is swelling or redness. Otherwise, see a doctor if the pain persists or is getting worse after 3 days

Rest: (Not total rest) Reduce your activity until the swelling and pain subsides, usually 3 or 4 days. Avoid activities that cause pain. Do not return to the activity (kneeling, running, jumping) that caused the problem until your physician advises you it is safe to so. It is usually recommended you return to activities that caused the injury gradually and stop if pain occurs.

Ice: Apply ice wrapped in cloth every 15 minutes per hour the first day then every 3 to 4 hours for the second and third day. Leaving the ice on for over 20 minutes can cause frostbite. (Moist cold - applying a wet towel between the skin and the ice pack - penetrates more deeply and quickly than dry cold)

Compression: Wrapping the knee in an ACE bandage (elastic bandage) can limit swelling and relieve pain. If the leg becomes colder than the other leg, the bandage is too tight. Remove the wrap before bedtime. Bandages are also useful for holding on a bag of ice.

Elevation: Elevate knee above the level of heart (place on pillow) while icing to further reduce inflammation.

Applying Heat

After four or five days, providing the swelling has subsided, applying heat to the knee may be beneficial. Heat helps to increase the blood supply, which promotes healing and also helps to relax tight muscles. Apply heat for 15 minutes several times per day. (Moist heat penetrates more quickly and deeply than dry heat) Wait at least an hour between heat applications to prevent the overheating of tissues.

* NEVER apply heat to an inflamed joint. There already is increased blood supply with inflammation. Heat will increase the inflammation.

Medications

Your doctor may prescribe medications for pain and inflammation.

Total healing may take two to six weeks, depending upon the severity on the injury.


Prevention of Overuse Knee Injuries

The best ways to prevent overuse knee injuries or to prevent reoccurrences are to:
  • Strengthen the muscles that support the knee with knee exercises. Click here for knee exercises.
  • Slowly increase the duration and intensity of activities you are not accustomed to.
  • Warm up before activities that involve running and jumping.
  • Limit high-impact activities to every second day to give your body a chance to recover.
  • Keep your weight under control. As the knees are weight-bearing joints, weighing less decreases stress on the knees.
  • Proper Footwear: Adequate cushioning to help absorb shock, adequate support for those who tend to overpronate to prevent excessive internal rotation of the lower leg and knee. Click here for info on footwear, pronation, and knee pain.
*Always get a proper diagnosis from a qualified medical professional.