Do you hear a sudden click in your knee while bending down? Do your knees hurt while squatting? Well, your knees are trying to convey their ageing story. It may not be wise to ignore the click sound, minor pain or swelling once you have crossed your 50's.
Osteoarthritis (OA) is common among ageing population and one of the leading causes of disability. It is the second most common problem & the most frequent joint disease with a prevalence of 22% to 39% in India.
In Knee OA, the cartilage in the knee joint gradually wears away and it becomes frayed & rough and the space between the bones decreases. Arthritic knee usually begins with symptoms of joint click, pain and swelling that worsen in the morning. Knee arthritis can make it hard to do many activities such as walking and climbing stairs.
If unattended; the joint may become stiff & swollen, making it difficult to bend & straighten the knee. The knee may “lock” during the movement. It may creak, click, snap or make a grinding noise (crepitus). The pain can cause a feeling of weakness or buckling in the knee. Weather changes usually aggravate the symptoms - You may notice increased knee pain during rainy & cold weather.
Since OA is a degenerative condition; the damage occurred cannot be reversed. But timely intervention in the form of regular exercise and early Physiotherapy can arrest degeneration & maintain joint integrity.
Easy ways to manage OA knee :
Manage your Weight
Keep a check on your Calcium & Vitamin D levels
Avoid offending movements like squatting
Do not delay : Address the signs of pain in time
Specific knee exercises
We have some very easy and convenient tips to manage arthritis pain on our website. Read Here
You are about to have Knee Replacement Surgery (TKR). A lot of the long term results of knee replacements depend on how much work you put into it following your operation. Patients who prepare for surgery and actively take part in their care can recover in less time and with less pain. This guide has general information along with tips for things to do before and after surgery to help you make it a success.
You may get different instructions from your surgeon, doctor or physiotherapist. Always follow the directions of your care team. This guide is meant to be used under the direction of your physiotherapist.
Caution: If you have too much pain in your knee to exercise, or if any of the exercises cause more pain or swelling in your knee, stop. Tell your physiotherapist or doctor. If your whole leg becomes swollen or hot, tell your doctor right away!
General Guidelines: Before Surgery
If you exercise before surgery you can have a faster and easier recovery. Exercise helps to:
Maintain the range of movement of your knee
Make your muscles strong
Control your pain
Build your knowledge of how to exercise after surgery
Improve your sleep
Do activities that put less stress on your knee. Try cycling on a stationary bike (upright or seated) for 5-10 minutes, walking in water (water level should be atleast thigh deep). It is best to do specific knee movements and strengthening exercises (in guidance of physiotherapist).
Always warm up before exercising. Your physiotherapist may tell you to:
Apply moist heat to the front and back of your knee for 5-10 minutes OR Have a warm shower or bath
General Guidelines: After Surgery
Exercise after surgery will help you recover and regain the movement and strength of your knee. Exercise also helps to:
Prevent blood clots (Thrombosis)
Control your pain
Improve your sleep
Tips to help you make the most of your Knee (TKR) surgery
Take your recovery and rehab seriously. Exercise regularly as per the programme charted by your physiotherapist.
Continue with your knee replacement rehab programme for at least 3 weeks after surgery, probably 3 months of physiotherapy guided knee exercises to get the best result from your knee replacement.
Follow-up regularly with your surgeon, to monitor internal recovery.
Walker or crutches should be used until discontinued by Doctor or Physiotherapist.
Change knee position at least once an hour, while awake, to avoid stiffness.
Home exercises should be performed 3 times everyday unless advised differently by your Physiotherapist.
Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance after you leave hospital.
Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.
Swimming or walking inside swimming pool (where water level is at least till your thigh) is a very good strengthening exercise that prevents jerks and unnecessary strain on the knee.
Stay positive and committed. Don’t give up, and do what you can to keep a good attitude.
Don’ts : For 6-8 weeks after surgery, avoid:
Any pivoting (twisting) on your knee 2.Kneeling down 3.Squatting
Avoid high impact activities that cause jerk and stress on the knee joint, example running, jogging, rock climbing etc.
Avoid unnecessary stress on your knee by lifting very heavy objects. This can cause damage to your new knee.
Avoid using Indian traditional toilet, instead use a Western Commode (WC) or toilet chair.
Immediately after surgery, you can continue to do the following in bed :
1. Deep Breathing and Coughing Exercises :
Until you are up and moving well, take at least 10 deep breaths, followed by a cough, every hour that you are awake.
2. Pump Your Ankles :
When lying down, move feet up and down and in circles. Repeat 10 -15 times every hour you are awake.
3. Buttock Contractions
Tighten your buttock muscle and hold for a count of 5 seconds. Repeat five to ten times, three to four times each day
Moving your new knee :
It is important to move your knee soon after the operation unless your surgeon or physiotherapist tells you not to. This will minimize stiffness, pain and swelling, and reduce the formation of scar tissue. Check with your physiotherapist for guidance about the best way to warm up your new joint.
To Keep Pain and Swelling under control, once you are home:
1. Rest Your Joint
Change positions often (every 20 minutes) when you are awake. Try sitting, standing, and walking.
Pace yourself. Take things easy and slow.
Lie down 3 times a day for 30 minutes on your bed.
Put your leg up and support it with a rolled towel or with pillows (as shown).
2. Use Ice
Ice your knee when it is hot and red, painful and after exercises. (If your knee is very stiff and painful, check with your physiotherapist before icing
Follow these steps:
If your scar is not healed, cover it with a clean bandage and clean plastic wrap
Put a damp hand towel over your knee
Put a flexible gel pack, or plastic bag with crushed ice on your knee
Leave the ice ON for 10 minutes. Take it OFF for 10 minutes. Put it back ON for 10 minutes. Repeat 4-6 times a day
DO NOT use ice if your doctor has told you that the circulation to your legs is poor and that you should avoid using ice or heat
3. Use Pain Medicine
Use your pain medicines as prescribed by your doctor. Tell your doctor if the pain is too much or not improving.
4. Use Walking Aids
Use the walking aid that your physiotherapist has measured and recommended. Do not change or stop using the walking aid until your physiotherapist or surgeon tells you to. Walkers, crutches and canes help to:
Reduce the stress on your knee Reduce pain Improve your balance and reduce falls
Remember it is better to have a good walking pattern using two crutches than to limp and risk losing balance.
5. Sleep : It helps with rest and recovery. It is normal to have some sleepless nights up to 12 weeks after your knee surgery.
Consult an expert at ReLivaTM Physiotherapy & Rehab to learn more about rehab, Mobility Techniques and tips to make your Total Knee Replacement (TKR) Surgery a success.
Whether you are walking, running, cycling or exercising; you are likely to be using your knees a lot. While the common sense says that the more you use the joint the more mobile or lubricated it will remain. The better sense says that it will all be worthwhile only if you know how NOT to ruin them instead.
The knee joint is particularly vulnerable to damage and pain because it takes the full weight of your body and any extra force when you run or jump. You’re more likely to experience knee pain as you get older, and people who are overweight or do lots of sports have a higher risk of damaging their knees. And it’s not just athletes who suffer. Knee problems can happen to anyone.
“It’s difficult to strike the correct balance between mobility and stability. The knee needs to move back and forth, twist a little, and pivot too. The knee’s ligaments can tear, its tendons can swell up, one may get osteoarthritis, and even everyday wear and tear can ruin a perfectly good set of knees,” says Dr Shreya Sahasrabudhe, the Musculoskeletal specialist at ReLiva.
Ask yourself the following five questions and find out if you’re being nice to your knees.
How much weight are you carrying?
If you’ve ever loaded your car’s trunk with heavy objects or driven with four adult passengers, you may have noticed that the ride wasn’t as smooth. Your car’s shock absorbers probably didn’t soak up the jolts from the bumps and the potholes as well as they would have with a lighter load. Similarly, if you’re carrying too much weight on your body, your knees may also be in for a rough ride.
Every kg of excess weight exerts about 4 kg of extra pressure on the knees. So a person who is 10 kg overweight has 40 kg of extra pressure on his knees; if a person is 100kg overweight, that is 400kg of extra pressure on his knees. So if you think about all the steps you take in a day, you can see why it would lead to premature damage in weight-bearing joints.
Are you exercising?
In case your knee hurts, whether due to an injury or due to a chronic condition like Arthritis – Exercising the knee may seem counterintuitive, but regular exercise can actually lessen — and even relieve — arthritis pain and other symptoms, such as stiffness and swelling.
There are several reasons to exercise with knee arthritis. For example:
Exercise maintains the joint’s full range of motion.
Exercise strengthens the muscles that support the joint.
Strong muscles help the joint absorb shock.
“If all the benefits of exercise could be put into a single pill, it would be the most widely prescribed medicine in the world,” says Dr. Neelam Patel, a Physical therapist specializing in sports injury.
Are you overusing some muscles and joints?
The quadriceps muscles (front of the thigh) and the hamstring muscles (back of the thigh), which straighten and bend the knee respectively, are susceptible to strain (“pulled muscles”).
If your work requires you to frequently sit low or climb up and down stairs or stand, you are more prone to overuse. Initially your may feel fatigued. If this fatigue is not resolved prior to your return to work the next day, or shortly thereafter, microtrauma may occur. Microtrauma is when small soft tissue tearing occurs from overuse. Eventually your muscles and tissues become more traumatized, resulting in pain and loss of use.
Is your body properly aligned?
Anyone who’s ever driven and maintained a vehicle is likely to have dealt with an alignment problem. The effects of a minor collision may create a misalignment that’s not immediately obvious. Our bodies are very much like these vehicles, and we may not realize that our own alignment is off until an ankle sprain leads to knee trouble or certain random ache develops into a chronic pain. When we lose proper alignment, we see knee joints begin to break down or wear out. This is due to uneven weight distribution.
Are you wearing the right shoes?
Shoes with very high heels or those that lack the arch and heel support that your feet require, can place added pressure on your knees and throw them out of alignment. This, in turn, can cause pain under and around your knee. Wearing the right shoes when you exercise, go to work and for other daily activities, will help prevent knee discomfort.
Be Good to Your Knees Now
Arthritis of the knee is common, but it is not necessarily a compulsory consequence of aging. Taking care of your knees now will cost you a lot less time and effort than rehabilitating them down the road.
REMEMBER: When in doubt, rest and have your pain checked out. It’s better to spend a little time and money seeing a qualified physiotherapist than to be sidelined for months by an injury that you could have prevented or minimized.
Contributed by Dr Manali Jain (PT), consultant Physiotherapist at ReLiva Physiotherapy & Rehab. She has an avid interest in knee and knee conditions and looks forward to extend her knowledge to put to use for every common man.
According to the World Health Organization (WHO), obesity is one of the most common, yet among the most neglected, public health problems in both developed and developing countries . According to the WHO World Health Statistics Report 2012, globally one in six adults are obese and nearly 2.8 million individuals die each year due to overweight or obesity. Due to the increased risk of morbidity and mortality, obesity is now being recognized as a disease in its own right. Additionally, obesity is strongly associated with other metabolic disorders including diabetes, hypertension, muscular problems, dyslipidaemia, cardiovascular disease and even some cancers. The risk for these disorders appears to start from a body mass index (BMI) of about 21 kg/m. Obesity is generally classified as generalized obesity (GO) and abdominal obesity (AO). Individuals with obesity have higher rates of mortality and morbidity compared to non obese individuals.
India, with 1.2 billion people is the second most populous country in the world and is currently experiencing rapid epidemiological transition. Undernutrition due to poverty which dominated in the past is being rapidly replaced by obesity associated with affluence.
In a study done in India, the prevalence of obesity was 72.5% among women and 1.1% among men.Obesity is much more than a cosmetic problem, as its associated health problems is increasing.
Link between obesity and Knee OA:
Despite the multifactorial nature of musculoskeletal disease, obesity consistently emerges as a key and potentially modifiable risk factor in the onset and progression of musculoskeletal conditions of the hip, knee, ankle, foot and shoulder. A recent World Health Organization report on the global burden of disease indicates that knee OA is likely to become the fourth most important cause of disability in women, and the eighth most important cause in men. It suggests that primary prevention of knee OA should become a major aim of health care. Several investigations of risk factors for knee OA have been reported previously. Most common important risk factors include obesity, previous knee injury, selected physical activities, the presence of hand OA, and a family history of the disease.
Under normal conditions, articular cartilage provides a near frictionless surface, aiding in the distribution of pressure loads within the joint. OA has a logical link to obesity: The more weight that’s on a joint, the more stressed the joint becomes, and the more likely it will wear down and be damaged.
Weight plays an important role in joint stress, so when people are very overweight, it puts stress on their joints, especially their weight-bearing joints, like the knees and the hips. In OA, there is an imbalance of the anabolic and catabolic processes of the chondrocytes(cells which protect the surface of the joints), leading to damage of the structural and functional integrity of the cartilage and adjacent bone and other joint tissues. Excess weight has been identified as an important risk factor for OA of the knee. Obese individuals have 1.5-2 times the risk of developing knee OA than their leaner counterparts. While the link between excess weight and higher risk of knee OA is well accepted, the mechanism of association is debated.
Carrying extra body fat may also lead to the releases of a hormone called leptin, which some experts think may play a role in the development of osteoarthritis. In addition, body fat can release substances that promote inflammation in your body.
Ways to Recover from Knee pain:
Get a consultation.If you have knee pain, discuss types of activities with your physiotherapist that might be safe for you.
Exercise. Those who think they have no time for bodily exercise will sooner or later have to find time for illness. Good types of exercises for heavier people include walking – even for just a few minutes when you’re starting out – bicycling indoors or outside, and strength training to build stronger muscles under the supervision of the physiotherapist.
Diet modification.Plays an important role in reducing and achieving healthy lifestyle, thereby reducing the load on the knees. The “stoplight diet,” can be followed one does not forbid any foods but instead stresses an appropriate balance of high-, medium-, and low-calorie foods. In this diet, “green light” foods contain 20 fewer calories per average serving than standard food in that group, “yellow light” foods contain not > 20 calories above the standard for food in that group, and “red light” foods contain > 20 calories above the standard for food in that group and should be eaten infrequently.
As obesity and musculoskeletal problems are linked to each other, one must pay attention to their muscular flexibility, strength and weight parameters for longer healthy functioning of their knees. The fitter the body the better the life.
So appropriate weight and healthy knees go hand in hand.
The disorder commonly affecting the knee and other joints is called as Arthritis.
We commonly see our mothers or grandmothers groaning in pain when they try to do simple activities like getting up from the floor or climbing steps. Daily simple chores seem very difficult for them. They dread even the pleasant rains and winters as they are likely to experience increase in their aches and pains with the fall in temperature.
Arthritis is an inflammation of one or more joints. It is common in adults 65 and older, but it can affect people of all ages. There are many types of arthritis but most common types of arthritis are osteoarthritis and Rheumatoid Arthritis.
1. Rheumatoid Arthritis : It is an autoimmune disease in which the body immune system attacks the lining of the joint capsule, a tough membrane that encloses the joint parts known as synovial membrane. It is characterized by fluctuating course, with periods of flares and remission.
2. Osteoarthritis : It is a chronic degenerative disorder involves wear and tear damage to the joint’s cartilage. Enough damage results in bone grinding which causes pain and restricted movement and joint effusion.
Symptoms of Arthritis
The most common symptoms of Arthritis include pain, redness in the area, swelling, limited movement & stiffness in the joint.
Unpaid attention to these symptoms can lead you to be under the surgeon’s knife. But timely attention to the soft ringing of bells of your joints can help you deal effectively with your joint pain.
Physiotherapy is key to the treatment and management of arthritis. It can help you to maintain independence through improving your mobility, strength and flexibility.
Used along with medication it can also help to minimise pain.
Physiotherapy for arthritis focuses on the reduction of pain and stiffness as well as increasing the level of movement and range of motion for the individual.
Our experts at ReLivaTM use a combination of modalities, manual therapy techniques and exercise and movement programmes to suit your specific condition. They will aim to reduce the swelling in the affected area along with making a strategy to control pain and stiffness. They will also devise simple exercise programmes that you can practise at home to help you build your strength and flexibility.
Physiotherapy uses a mix of Modalities
Heat treatments : These treatments produce heat within your body tissues. The application can be directed towards superficial or deeper parts of the body. The most common types of treatment used are infra-red radiation (heat lamps) and hot packs for superficial treatments.
Electrotherapy : These treatments produce electrical stimulation of your body tissues. They may be extremely useful in the treatment of both acute and chronic arthritis, where pain, swelling and muscle spasms are present.
Exercise : A balanced programme of rest and exercise, and careful attention to joint posture is an important part of pain management, joint protection and maintenance of your joint function.
Manual therapy: Mobilisation and manipulation techniques are passive movements applied to a joint or soft tissue by the therapist in a specific manner to help restore full movement to a joint that is painful and restricted. Manual therapy is often useful in the chronic forms of arthritis and is often successful when other methods such as heat therapy and exercises have given little or no relief.
TENS : Transcutaneous electrical nerve stimulation (TENS) therapy is a commonly used electrostimulation method for relieving pain in rheumatoid arthritis.
Simple Tips to help avoid pain and stiffness:
Avoid staying in one position for long.
Avoid positions or movements that place extra stress on sore joints.
Avoid sitting on floor.
Modify your activities to make them easier.
Take proper rest when your symptoms are on a rise.
Try to lose weight if over-weight, as it reduces pressure on joints and alleviates pain.
Painful knees are a very common occurrence among the elderly and so was with Mr Narayanaswamy. He continued to live with painful knees which eventually hampered his everyday activity. There was chronic pain and despite medication his walking and general movement began to decline. He continued to console himself that the reduced activity and stamina was owing to his increasing age.
But after a prolonged period of about two years, by when he was bed-ridden and almost totally inactive – he underwent total knee replacement as advised by his doctor.
After an initial rehab of knee replacement, an average person usually reports significant improvement in walking and other movements. Unfortunately Mr Narayanaswamy was not showing any signs of recovery. Instead he consistently suffered from fever and weight loss. Eventually a TB infection was diagnosed that had affected the TKR implant too. So a revision surgery had to be performed on him shortly, thereafter.
It is at this stage that I got to meet Mr S. Narayanaswamy – who had gone through so much in the last two years. Not just being physically weak he was feeling mentally drained too. He recalls “After I came from the hospital, I was very low on physical as well as mental strength. I was depressed also. Even the slightest of movement made me breathless.”
I was to be his home visit Physiotherapist from ReLiva. On his initial assessment, I realized that it was not just his stamina, he was even having difficulty balancing himself while standing. He had been bed-ridden and completely inactive for more than a year.
As a physiotherapist, I identified that his immediate goal was to improve his balance, regain strength and thereafter build up his stamina. All of these eventually will help him regain self-confidence.
Together we worked hard day-in and day-out. I would visit him regularly at his place and work on his goals through a combination of therapy and exercises. Gradually he showed signs of recovery and began to stand properly on his own. We systematically progressed to the next set of exercises. Now I had prescribed him several movements to be done on his own during the rest of the day. The committed and sincere person that he was, he would do those home exercises diligently on most occasions. We were moving from one strength to another.
It was at the end of another session of physiotherapy when he broke the news with a beaming smile that he was thinking of visiting his daughter abroad!
We had come a long way. Here was a man who was completely bed-ridden for a year and a half and could not even speak on the telephone for more than a minute and NOW – he wanted to travel overseas! He was daring to dream and together we shall have to make his dream come true! We now worked towards a deadline when he could walk independently to take this long journey on his own.
After another bout of intense physiotherapy, he reported, “my energy level has gone up, I have regained my emotional strength, there is no depression, no breathlessness! I am walking properly and climbing stairs.”
Last, I saw him the day before he was to take his flight and he walked on his own with his walking stick. We did some strengthening exercises which he would continue doing on his own while he was away. He told me that “I am a happy individual now. I am back to life!” … what he didn’t realise was : What a happy and delighted therapist he was leaving behind in me watching his dream come true!
As shared by Dr Shrutika Parab (PT). Dr Shrutika is a home visit physiotherapist with ReLiva Physiotherapy. She is immensely popular among her clients for her enthusiastic and positive approach. You can contact her directly at ReLiva (+91 9920991584) or email to her at email@example.com.
For runners, taking on a run for the first time, the key is to have a solid training base and a detailed plan that allows
for a gradual increase in SPEED as well as DISTANCE.
Too Much. Too Soon. Too Fast
The most common issue that we see is the “Terrible Too’s”. You suddenly get up and start to train without a plan and end up doing “ Too much. Too soon, Too fast”
And that is the most common cause of Injury!
Chalk out a plan of training! Even better, if you do it along with a trained expert. The training plan should strike a balance between speed and strength. It would help you build up stamina, strength and endurance gradually, without causing any injury.
Prevention is better than Cure
Always remember to warm up, before you start running. Many injuries can be avoided by:
warming up and stretching regularly
Spending 10 minutes to warm up before each run will definitely cost you much lesser time than if you injure yourself and wait back to recover.
However if you do injure, it’s best to see a physiotherapy expert immediately to chalk out a quick recovery plan.
Mix Things Up
It is very easy to get into a habit of running the same route, at the same pace during your training. That begins to limit your muscles and their strength.
“Mix things up!”
Challenge your body with harder runs on certain days and recover at a slower pace another day. This will work-out many more muscles in a much more variety and keep them prepared against injuries.
Any good training plan needs no more than four days of running or walking every week. That’s not too much to do!
It is important that you don’t overdo it! And equally important, that you keep doing it sincerely! You can make the switch from run & Walk to only run if you
find it too easy. The day you feel, you’re not ready, continue to do walking! But ensure that you ‘Keep Moving’.
Look after your Body
While you train for your run, your body and muscles undergo a lot of wear and tear. Listen to your body! If you are tired, it’s a sign that the body needs rest! Overtraining immediately shows in form of decreased performance and injuries !
Look after your body. Swimming, Sauna or steam room can really help relax and stretch on a bit.
With these 5 things you can easily train for your run without worrying to injure yourself. Enjoy every step that you take to prepare yourself. Remember – “It only makes you stronger and better than what you were before!”
This article is an attempt to make the runners aware of the general thumb rules about running related injuries. These guidelines should not take the place of medical advice if attempting to return to sports following an injury. If an athlete requires assistance during or in the progression of a return to sport program they should consult with their medical expert, or physiotherapist