Injury Prevention: Advice from Singapore’s Knee Pain Doctors for Active Lifestyles

With increasing life expectancy and demand to maintain an active and independent quality of life, many individuals are in search of effective and credible means to care for their knees to prevent injury and arthritis and to modify activities to keep their knees safe.

Anterior Cruciate Ligament (ACL) injuries and meniscus tears are commonly occurring injuries and are known to affect individuals across a broad age spectrum due to sports participation or simple overexertion. Data obtained from the National University of Singapore-Singapore General Hospital (NUS-SGH) Academic Medicine Research Institute (AMRI) has shown that between 2000-2010, the incidence of ACL injuries alone numbered nearly 13,000, with conservative estimates indicating an increase of 7% occurring over the next 5 years due to increasing sports participation and a more active lifestyle.

With an emphasis on high-quality education, a world-class transportation infrastructure, and exciting recreational facilities, it is no surprise that the young and old alike are taking to more active lifestyles to enjoy the myriad of activities available in our society. Unfortunately, this surge in activity also brings about an increase in the incidence of knee injuries and degenerative knee conditions.

Singapore ranks among the top 20 countries in the world for the incidence of knee replacement surgeries. The cost incurred is estimated at nearly $30,000 per operation and is projected to weigh heavily on our healthcare system, which is straining to provide world-class service to an aging population for a smaller percentage of foreign workers.

Understanding Knee Pain

When attempting to identify the cause of one’s knee pain, the physician will perform a thorough examination. This includes a medical history and physical examination of the knee. In some cases, additional diagnostic tests such as x-ray, MRI, or CT scans may be necessary to confirm the diagnosis. It is important to go through this process to accurately identify the source of one’s knee pain, as effective treatment will be directed at the cause.

There are many causes of knee pain. It may originate from the knee itself, but it can also come from other direct sources. Inflammation from an injury to the structure of the knee can be the source of pain. Some knee injuries cause swelling, which can also be painful. Overuse of the knee often inflames the tendons, resulting in pain. A tear in the cartilage will also be a source of pain. Injuries to other parts of the body can also cause pain in the knee. These include hip or foot injuries. If the mechanics of walking are altered, it can add stress to the knee and cause pain. An injury to the nerves that supply sensation to the knee or the spinal cord can also be a source of knee pain.

Causes of Knee Pain

Muscle imbalances are a prominent contributor to knee pain. For example, if the quadriceps muscles on the front of your thigh are stronger than your hamstring muscles on the back of your thigh, this could lead to excess force and load being put through your patella (knee cap) during movement. Muscle weakness and poor flexibility, particularly in the muscles of the thigh and leg that surround and support the knee, are also common causes of knee pain. This often occurs in the muscle groups above and below the knee. For example, the quadriceps may be too weak to support the knee during movement, or the muscles in the calf may be too tight, which can cause excess force to be transmitted through the knee joint. This can have a direct effect on the knee joint or cause altered movement in the knee, which can cause pain and discomfort.

Risk Factors for Knee Pain

This explains why knee osteoarthritis is more prevalent in obese individuals compared to those of normal weight, and why knee symptoms in those who already have knee osteoarthritis tend to worsen with weight gain. The effects of obesity on knee joint replaced the sac with Firestorms One of the and so ofostreestress are the quickarising outtaline. The replaced begins to also be more prevalent in obese individuals.

Obesity increases the risk for knee osteoarthritis in several ways. Overloading of the knee joint and increases in joint compressive forces occur with weight gain. It is estimated that for every pound of body weight gained, there is a 2-3 pound increase in knee joint load. Obesity also has systemic effects on the metabolic and endocrine systems, causing chronic, low-grade inflammation and metabolic changes that have deleterious effects on knee joint health.

Over the years, studies have shown that several factors increase the risk of developing knee osteoarthritis. Modifiable factors include obesity, quadriceps muscle weakness, and certain occupational tasks. Non-modifiable risk factors include age, sex, and anatomical abnormalities.

Preventing Knee Pain

Use of appropriate footwear can reduce the risk of knee injury in physically active individuals by a large degree. Studies suggest that shoes can reduce knee joint load during walking and thus reduce the risk of knee osteoarthritis. It is believed that shoe design and construction can influence the distribution of pressure through the knee joint mainly by affecting the position of the foot in stance and thus the movement of the tibia (shin bone) during gait. For example, in a study on adults with knee osteoarthritis, shoes with specially designed insoles were shown to significantly reduce the knee adduction moment (the force at the knee that causes it to turn inwards) during walking.

Maintaining an ideal body weight is an important factor in preventing knee pain as the knees support the upper body. For example, every pound of extra body weight exerts about 4 pounds of extra pressure on the knees. Evidence shows that being just 10 pounds overweight increases the force on the knee by 30-60 pounds with each step. Weight loss has been found to be associated with slowing of cartilage degeneration in the knee and is beneficial for those with symptomatic knee osteoarthritis.

Strengthening the muscles that support your knee with exercises, particularly the quadriceps and hamstrings, has been proven to reduce the risk of knee injury for both males and females. Strengthening the hip and core muscles will be a great help too, as they are very influential on knee mechanics. Seeking guidance from a physiotherapist or relevant healthcare professional on what exercises are most appropriate for you in particular is recommended.

Strengthening Exercises for Knee Health

Hamstring muscles are also crucial to knee stability. Studies have shown that anterior cruciate ligament tears often occur when an external force is applied to the front of the tibia while the leg is in an extended position (e.g., a football tackle). Since the primary action of the hamstring muscles is to flex the knee and posteriorly tilt the pelvis, strong hamstrings will act as an antagonist to the aforementioned tibial force by pulling the tibia backwards into a more flexed and stable position. Hamstring strengthening exercises include the use of gym equipment such as the leg curl machine, or simple home exercises such as the supine bridge. It is important to maintain a good balance between the strength of the quadriceps and hamstring muscles, as an imbalance (often having strong quadriceps and weak hamstrings) has been shown to have deleterious effects on knee joint health.

Quadriceps and hamstring muscles have been well documented to have a direct influence on knee health. In particular, clinical studies have shown the vastus medialis obliquus (VMO), a quadriceps muscle, to play a significant role in patella tracking. Weakness in the VMO is often associated with patella maltracking, a common source of anterior knee pain. Techniques to isolate the VMO include straight leg raises and short arc extensions. Electrode biofeedback has also been suggested as a means to enhance VMO recruitment.

Knee pain doctor Singapore strongly encourage the implementation of strengthening exercises, as these have been suggested to be the most effective form of non-operative, non-pharmacological treatment for maintaining knee health. Strengthening muscles provide better support and a more stable load to the joint, in turn lessening the likelihood for the joint to sustain injuries.

Maintaining a Healthy Weight

Conversely, maintaining a healthy weight can prevent the occurrence of knee pain. One pound of body weight is equal to 3500 calories, so to prevent weight gain, an average adult only needs to consume about 100 extra calories per day. By following a regimen of regular strengthening exercises and maintaining a consistent healthy diet, individuals with healthy body weights can prevent the development of knee pain. For individuals who have excess weight, even a small reduction in weight can help reduce the risk of developing knee OA. An analysis of the First National Health and Nutrition Examination Survey (HANES I) showed that weight loss over a 10-year period reduces the risk of knee OA by 50%. Given the potential harmful effects of weight gain, it’s clear that weight management is an essential factor in preventing the occurrence of knee pain.

It’s a well-established fact that every pound of body weight accumulated throughout one’s lifetime results in about five extra pounds of pressure on the knee joint. In other words, a five-pound weight gain increases the amount of pressure on the knee by 25-75 pounds with each step. This additional pressure explains why, over time, weight gain can be a significant factor in the development of knee pain, and why losing weight can help reduce knee pain. Simulation studies have predicted that a decrease in body weight by 11 pounds may reduce the risk of OA in women by 50%.

Proper Footwear for Active Lifestyles

The level of activity and the type of activities that you do will determine what kind of shoe you should wear. When you’re participating in a given sport, you may be at higher risk for specific types of knee pain. For example, pain in the front of your knee can be a result of overuse during running, frequently bending your knee, or jumping activities. This is common in runners, jumpers, skiers, cyclists, and soccer players. All the time you are involved in these activities, you are loading the patellofemoral joint. The stress on your joint is increased with certain footwear. It’s a good idea for you to find out which type of shoe is best for your sport. When you are walking or running, a normal gait cycle occurs moving from the shock absorption phase (when your foot makes contact with the ground) to the propulsion phase (when your foot pushes off of the ground). An important study measured the effects of athletic shoes on the patellofemoral joint. It found that shoes with a reinforced heel and insole lessen patellofemoral force to normal walking levels as compared to going barefoot or wearing flat thin-soled shoes. So if you are involved in activities requiring a lot of running or jumping, you should consider using these types of shoes to minimize knee joint stress. Flat thin-soled shoes should be reserved for activities that don’t involve much stress coming from the ground. An example would be using them for the trip to the courts to switch into your basketball shoes.

Seeking Professional Help

When your knee discomfort or pain begins to disrupt your everyday lifestyle or if you’ve suffered an injury, it is vital to seek professional help from a knee pain doctor. When complications have moved past slang terms, the R.I.C.E. approach (rest, ice, compression, elevation), and self-diagnosis, there’s a list of tool conditions and symptoms that will determine whether or not you should seek medical treatment from a knee pain doctor. If you are having problems from a past knee injury, a clear sign to consult a physician is whether or not there is prolonged swelling in the knee a day or more after the harm has taken place. Another sign can be if there is chronic or severely debilitating pain accompanied by a feeling of instability in the knee. If any of these symptoms persist for an extended period of time, it is advised to seek medical attention. Other symptoms that require seeing a knee pain doctor are if there is recurring pain that is not provoked by any activity or pain that prevents you from participating in activities that you normally could do. If there are any signs of an injury, i.e. popping or crunching noises, inability to straighten the knee, or if the knee gives out unpredictably, it is then recommended to consult a physician. These signs can be crucial in catching an injury early and can determine a quick recovery through an acute injury program.

When to Consult a Knee Pain Doctor

The decision on whether to consult a knee pain doctor or a knee surgeon can vary depending on the severity and nature of the knee pain. In cases of trauma or acute onset of symptoms that are severe, persistent, and greatly limiting your normal activity, the primary assessment of the injury by a knee pain doctor is more appropriate. With a suspected serious injury, the knee pain doctor can organize appropriate investigations to rule out certain diagnoses and/or refer to a knee surgeon if required. Without previous investigations of the problem, a knee surgeon may potentially perform surgery that is deemed unnecessary or inappropriate. However, in cases where there are obvious mechanical symptoms and an MRI-confirmed diagnosis of a significant lesion, direct assessment by a knee surgeon would be the preferred option.

In the early and acute phases of most knee pain injuries, the first point of call is often to a physiotherapist. At this stage, the physiotherapist should conduct a thorough subjective and objective examination of your knee. From here, they should be able to give you a more informed diagnosis of your condition. If your condition is outside of the physiotherapist’s scope of practice, or if he/she is not achieving the expected results with their treatment, they should then refer you to a knee pain doctor. In some health systems, it is possible to directly consult a knee pain doctor without a referral. This can help speed up the process to obtain a clear diagnosis and appropriate management plan for the injury.

When knee pain comes on, there are a number of different areas to seek help, ranging from seeing a knee pain doctor to self-help. Knowing which area to go to for help can be a task in itself. By consulting this section, at least you will be in a more informed position to make your decision.

Treatment Options for Knee Pain

Recent research has shown that dietary supplements can be useful in the treatment of knee pain. Supplements of vitamin D, E, and K have been shown to be helpful in preventing the progression of knee osteoarthritis. Vitamin K is needed to form a protein that is necessary for bone health, whereas Vitamin D helps the body to absorb calcium and E has been shown to prevent the release of enzymes that break down cartilage in the joints. Finally, a randomized controlled trial involving the dietary supplement of glucosamine has shown that it has moderate to large effects in the treatment of knee osteoarthritis.

Simple analgesics such as aspirin and paracetamol are helpful when the pain is mild or moderate. Other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and specific COX-2 inhibitors may be prescribed to relieve pain and reduce inflammation in the joint. These are often used in the treatment of arthritis, for example. Tablets such as glucosamine may also be useful. A short course of stronger pain relievers, such as codeine or tramadol, may be used when the pain is more severe.

Several different types of medication can be useful in the treatment of knee pain. Because individual responses to medications vary and because medications can have side effects, the doctor will often want to supervise your use of medications.


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