Whether they creak, throb, lock or swell up there's a fix for every type of faulty knee
One in three people over the age of 40 experiences knee pain at some stage
We are a nation of creaky knees.
One in three people over the age of 40 experiences knee pain at some stage, and recent research suggests more Britons under the age of 50 are undergoing knee replacements.
The study, published in the journal Arthritis & Rheumatism, also showed a 5.7 per cent increase in the number of knee replacements in Britain last year— knee replacements now outnumber hip replacements.
Experts say obesity is partly to blame, combined with increasingly sedentary lifestyles.
‘Research shows the obese are up to
four times as likely to develop knee osteoarthritis as they are high
blood pressure or type 2 diabetes,’ says Professor Alan Silman, medical
director of Arthritis Research UK.
good news is that weight loss and exercise combined have been shown to
achieve the same level of symptom relief as joint replacement surgery.’
But arthritis isn’t the only cause.
Here, we look at common knee problems — and what you can do about them.
SYMPTOMS: Pain and swelling on the front and sides of the knee. Stiffness in the morning that can last up to 30 minutes; pain after repetitive use; discomfort usually worse in the evening. In severe cases, walking or even standing is painful. Sometimes the knees become permanently bent and bowed.
PROBABLE CAUSE: Osteoarthritis. Around one in five adults over 45 have osteoarthritis pain in the knee — the average age of onset is 47 and women are more likely to suffer from it.
Osteoarthritis is caused when the shock-absorbing cartilage in the joint becomes rougher and thinner through wear and tear. This triggers inflammation in the joint.
To compensate for this loss of cartilage, bones in the knee thicken, making the joint appear knobbly.
TREATMENT: There is no cure, but there are a vast range of treatments to help manage the symptoms. These include regular exercise to strengthen the supportive muscles around the joint.
‘Following an attack of inflammation, it’s important that you get the affected joint and muscles moving through their normal range of motion as soon as possible to prevent weakening of surrounding muscles and to reduce inflammation,’ says Jane Tadman of Arthritis Research UK.
Another low-tech option is shock-absorber shoes, a knee brace or an insole, as well as physiotherapy.
‘Physical exercises to strengthen the muscle that supports the knee joint, weight loss and pain relief are the most effective ways of treating osteoarthritis of the knee, other than replacement surgery for severe cases,’ says Tadman.
In a new ‘halfway’ surgical technique — microfracture — a drill or pick is used to make holes in the surface of the bone to encourage new cartilage to grow.
Housemaid's Knee is painful to the touch, feels warm and may be swollen
SYMPTOMS: Discomfort on the inside of the knee or shinbone.
The pain increases with physical activity, such as climbing stairs.
The knee is painful to the touch, feels warm and may be swollen.
PROBABLE CAUSE: Bursitis or housemaid’s knee. This occurs as a result of pressure on the bursa, small fluid-filled sacs that act as cushions and reduce friction between bone and other moving parts of the joint, such as tendons and ligaments. They are found throughout the body, and each knee has 11.
The bursa over the knee cap or on the inner side of the knee can become inflamed and swollen as a result of overuse or direct trauma.
As a consequence, people who do a lot of kneeling, such as carpet fitters and gardeners (and in days gone by, housemaids), have a high risk of bursitis in their knees. Frequent falls, infections and complications with arthritis or gout may also be linked.
TREATMENT: Steroid injections into the bursa can help reduce inflammation, and excess fluid can also be drained out of the affected areas with a syringe. Severe, chronic bursitis can be surgically removed.
SYMPTOMS: Sharp pain in the centre of the knee. Pain worse with twisting movements. The knee can also become locked and won’t bend or straighten.
PROBABLE CAUSE: Torn meniscus. The menisci are one of the two different types of cartilage found in the knee. They are discs of tough tissue that act as shock absorbers between the ends of the two bones.
Over time these can become torn, with tiny pieces breaking away and becoming jammed in the joint.
It’s a common result of twisting injuries or can even arise from something as innocuous as simply getting out of the car.
TREATMENT: For mild cases, painkillers such as ibuprofen can help, but in more severe cases surgery may be needed to remove or repair the torn part of the meniscus.
A damaged meniscus can cause the knee to produce more lubricating fluid, and removing some of this can bring some relief from pain. However, the fluid and swelling will usually come back.
SYMPTOMS: Throbbing knee, accompanied by pain in the fingers and toes.
Swelling in the joints; morning stiffness that typically lasts more than an hour; both knees are affected (rather than one, as with osteoarthritis).
First symptoms usually show up in fingers and toes, but knees can be affected at an early stage, too (knuckles and the wrists may become affected). In severe cases, the joint slowly changes shape and can be completely destroyed.
PROBABLE CAUSE: Rheumatoid arthritis. Considered to be the most debilitating form of arthritis, this is caused by the body’s immune system attacking and destroying tissue in the joint, causing inflammation and pain.
The condition is thought to be caused by a combination of factors, including genetic susceptibility and environmental or biological triggers, such as viral infections or hormonal changes.
TREATMENT: Painkillers, anti-inflammatory drugs and corticosteroids tackle symptoms, while so-called disease-modifying anti-rheumatic drugs, such as methotrexate, are designed to slow disease progression by blocking the damaging effects of the chemicals released when antibodies attack the joint.
Biological treatments, such as TNF-alpha inhibitors, are designed to work by interfering with the mechanisms that trigger the immune system attack in the first place and have revolutionised treatment since they became available a decade or so ago.
Consultant rheumatologist Dr Karim Raza, of Birmingham University, says: ‘Rheumatoid arthritis is a serious disease and we need to take it as seriously as heart disease, diabetes and cancer.’
SYMPTOMS: Swelling at the back of the knee, like a partly inflated balloon. Skin is red, with pain in the knee and lower leg; the knee clicks or locks.
In rare cases the swelling can burst causing acute pain, with fluid leaking into the calf, causing swelling and inflammation.
PROBABLE CAUSE: Baker’s cyst. The initial swelling in the knee is caused by a build-up of joint fluid, also caused synovial fluid, which is needed to lubricate moving parts.
Levels rise in response to injury or a condition such as arthritis, which can cause a bulge of fluid.
TREATMENT: Tackling the under-lying problem, such as arthritis or injury, may be enough in some cases. The cyst, which is not usually removed because it often returns, can be drained. Ice packs may help reduce the swelling.
SYMPTOMS: Severe pain that comes on within hours. Skin is red and shiny with white lumps beneath the surface. The joint will be hot to touch and accompanied by stiffness. Attacks usually last three to ten days, and symptoms often develop during the night. Big toe may also be affected.
PROBABLE CAUSE: Gout. The most common type of inflammatory arthritis, it affects almost one in 60 men at some time, usually later in life.
The condition occurs when the body’s waste product, uric acid, is deposited as needle-like crystals in the joints, where they cause inflammation.
In a significant number of cases there is a family history, but being overweight also increases the risk, as does drinking too much alcohol, which can hinder the body’s ability to get rid of uric acid.
Some foods, including sardines and dried beans, which are rich in purines can aggravate gout as these increase the levels of uric acid.
TREATMENT: Painkillers are usually recommended as a first treatment. Colchicines, which work by interfering with the uric acid crystals to reduce inflammation, may be prescribed, but are not widely used because of potential side-effects, including nausea and stomach pain.
A drug called allopurinol is designed to stop future flare-ups by lowering uric acid levels by interfering with the conversion of purines into uric acid.
It usually has to be taken for two to three months before effects kick-in, and sufferers may have to take it indefinitely.
SYMPTOMS: Sharp pain behind or below the knee cap while running or walking. It can also develop into a dull, ever-present ache that can make sleep difficult.
PROBABLE CAUSE: Tendinitis. Also called Jumper’s knee, the condition arises from damage to the tendon that attaches the bottom of the knee cap to the top of the shinbone, called the patellar tendon.
Older people are most at risk because with advancing age, tendons become weaker.
It is also linked to overuse and is often found in sports people and dancers — constant twisting can trigger it. Aggravating factors include being overweight, having tight leg muscles and poor alignment of leg bones.
TREATMENT: Special exercises can help strengthen the tendon and supporting muscles, and a patellar tendon strap takes away some of the stress from the tendon by supporting the knee below the knee cap.
The condition can be avoided by allowing adequate time for recovery between periods of exercise.
For more information, visit arthritisresearchuk.org