Our knees are very important to us. At the most important moments in our lives, we go down on a knee. When our hearts flutter, we go weak in the knees. At all other times, our knees act as our shock absorbers and help us walk, run, jump, stand, carry weights, play and squat. We aren't conscious about them, but life without them would be hard.
For people who play a lot of sports, the knees are a matter of crucial concern because they are prone to many injuries. It is not uncommon to hear of sportsmen cooling it off on the bench because of a hamstring or ligament tear. While some of these injuries are temporary and heal with time, others can be lifelong problems, cruelly ending careers and dreams. And while most of us do not play a lot of sports, there are chances that we might injure our knees during any of our daily activities or whenever we play that occasional game.
Types of knee injury
The knee is a joint between the leg bone and the thigh bone. It is a pivotal joint which means that while we can't take circles around our knees as we can do with the shoulder joint, we can pivot and swivel our bodies around them. A knee injury can occur to any of the parts that make up the knee namely, the bones, cartilage, ligaments and tendons, muscles and the menisci.
Bones: The knee consists of three bones: the lower end of the thigh bone (femur), the upper end of the shinbone (tibia) and an outer knee cap that shields the joint. Most injuries to the bones come in the form of fractures where the bone gets broken or chipped. These occur due to some forceful impact, either a fall or collision. The knee cap can get dislocated (patellar dislocation) because of twisting or on impact.
Most fractures heal with time. They are diagnosed with an X-ray and the knee is usually put in a cast and the person advised ample rest.
Cartilage: The cartilage at the end of each bones sometimes weaken or wear off, either over time or due to overuse. This condition is called Osteochondritis Dessicans (OCD) and can cause long-term pain, preventing normal activity. Treatment for OCD includes putting the knee in a cast, rest or surgery.
Muscles and tendons: The knee functions by the action of two sets of muscles namely, the quadriceps muscles on the front of the thigh and the hamstring at the back of the thigh. These muscles are attached to the knee bones with tendons. They are prone to stretching and tearing due to sudden, extreme stretching actions or by overuse. Muscle tears and stretching are more commonly called strains and can be very painful. Treatment usually requires long periods of rest and gentle exercising followed by strengthening of the muscles.
Sudden movement of the quadriceps muscles can cause the tendons to rupture, causing pain and inability to strengthen the leg. Ruptured tendons can be surgically reattached or may not require surgery in some cases. Tendons also tend to get inflamed or irritated when overused, a condition known as tendonitis. Tendonitis of the knee (patellar tendonitis) is characterized by pain during walking, bending or stretching and is treated through rest and anti-inflammatory medication.
Of tears and tears
The most common knee injuries, however, are ligament tears (sprains) and meniscal tears.
Sprains are characterized by a snapping sound during injury, pain and swelling of the area. It also becomes harder to put the weight on that leg and one experiences difficulty in walking or any other form of activity. There are three grades of sprains. First grade injuries imply that the ligament has been stretched but not torn, second grade injury indicates slight tearing of the ligament and a third degree injury means that the ligament has been torn entirely.
The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate ligament in the center of the knee are the most prone to injury. These are the ligaments that form an "x" inside the joint, preventing forward movement of the knee. They are bathed in joint fluid and there is almost no blood flow in the area, which means the ligament cannot be repaired. Very often, cruciate ligament tears can end someone's sporting career and limit daily activities. Surgical reconstruction is the only viable option if one wishes to continue with sports. Because the surgery involves reconstruction of the ligament rather than repairing, the process is slow and it takes months before the knee can be operational again.
A meniscal tear is equally common. The menisci (singular: meniscus) are shock absorbing cartilage sitting on top of the tibia. The cartilage can be torn during physical activity. Like an ACL injury, a torn miniscus does not heal because of lack of blood flow to the region, unless it is a small tear on the outside surface. Meniscal tears are characterized by pain in the knee while climbing, inability to fully strengthen the knee (locking) and inflammation of the knee for a few weeks after the injury. Meniscus treatment includes trimming of the torn part. A torn meniscus that is left untreated can cause damage to the cartilage at the end of the bones and locking of the knee weakens the muscles that support the knee. On the other hand, surgically removing a large part or the entire meniscus, too can cause arthritis to set in very early. Most people are able to function well with a slightly torn meniscus and surgery is not always necessary. Physiotherapy helps strengthen the muscles around the knee thereby helping in shock absorption. Because the menisci work to absorb shock, meniscal tears can bring an end to sports and heavy exercise or weight-lifting.
Permanent damages to the knee such as these can be very disheartening, specially in people who are physically active and wish to remain so. However, knee injuries can be prevented and if certain precautions are taken, it saves on a lot of pain, both physical and emotional.
Preventing knee injuries
While there is no sure-shot method to make our knees accident-proof, taking the following precautions during sports and exercise regimen could prevent a lifetime of knee problems.
- Wear protective gear while playing. Knee caps prevent sudden twisting of the knee and can prevent ligament and meniscal injuries as well as muscular tears. Shin guards can effectively protect your bone during forceful impact and prevent fractures.
- Always warm up before you play. Stretching exercises, yoga, jogging and running get the knee muscles warmed up and active enough to play. Taking them straight from a period of inactivity to one of high activity can cause sudden stretching and twisting and turning, increasing the risk of damage in almost every part of the knee.
- Use the muscles on your leg and other parts of your body to support the knee joint while jumping and landing, sudden turning and pivoting. This is crucial in not allowing all the weight to fall on the knee joints and prevents the most common injuries.
The knees are a crucial part of the body and these pivotal joints play a pivotal role in our daily activities. To ensure that they continue to serve our bodies for the rest of our lives, do not risk losing them to a moment of high impact or sudden movement.
Best Regards
Prakash Nair
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