Pains from Knee Sprains 

Some common local causes of knee pain are; trauma and overuse, dysfunction of the lower limb and referred pain from low back, pelvis and hip. When pain is perceived as coming from the knee all the anatomical components need to be examined in addition to the joints that contribute to the biomechanics of the knee, i.e. low back, pelvis, hip and ankle and the foot.

One of the most common types of injury of the knee is damage to the ligaments. Ligaments are usually injured due to direct trauma to the knee and the amount of ligament injury caused is described as 1st, 2nd or 3rd degree sprain;
1st Degree Sprain – some tearing/over stretch of the fibres, no joint instability, mild pain, minimal swelling – treatable in approximately 1 week.
2nd Degree Sprain – Separation/tearing of fibres causing moderate instability and moderate to sever pain, swelling and stiffness – treatable in approximately 3-6 weeks.
3rd Degree Sprain – total rupture, gross instability, pain usually severe, profuse swelling, usually requires lengthy immobilisation and/or surgery.

Ligament injury will usually involve a certain amount of swelling directly over the location of the ligament.
Treatment of 1st and 2nd degree sprains usually involves, rest, ice, compression/elevation, ultrasound, soft tissue work, nutritional support of vitamin C and zinc. Once the ligament begins to heal gradual introduction of mobilisation and strengthening exercises can help and finally, proprioceptive training once ligament has healed. 3rd degree sprains are more serious and often require surgical repair.

If your a runner – one thing you may want to look at is – shoe drop. essentially the difference between the height/​thickness of the midsole under the heel compared to the same measure under the ball of the foot. Human tissues can be sensitive to sudden changes in the way they are loaded, Differing shoe drops may load certain tissues differently. As such, if you are currently uninjured there is no justification for changing the drop of your shoe, but should you want to, then be mindful of allowing the body time to adapt to such changes. In the context of current pain/​injury then it could be that a certain drop may be beneficial in reducing sensitivity and complementing your overall management strategy.

 

 

Lockdown Run and Runners Knees

Have you got pain on the outside of your knee?

Then you might have Ilitiotibial Band Syndrome (ITB). It is one of the leading causes of lateral knee pain in runners.

It is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee and inserts just below the knee.

Causes:

Running too much too soon

Bowing knees

Foot pronation

Flat feet Fall on to the hip

Running downhill

Symptoms

Pain around the outside of the knee may limit activity.

Pain can radiate.

Pain comes on when running distance.

Climbing stairs can be painful.

 

Treatment:

Apply heat before training, ice after training.

Massage / Acupunture and Chiropractic / Physical Therapy. A lot of people with ITB problems see your Sports Therapist or Chiropractor for help!

Stretch – static, foam roller

Exercising the Glutes with Side steps and resistance bands/ hip abduction exercises – Glutes (3 types – Medius {if you look it up} are key players in knee pain).

 

 

 

Osteoarthritis

Knee Pain can also be due to Osteoarthritis (OA)— especially in older adults.

If you’ve been diagnosed with OA, there are many safe and effective supplements/ herbal products that have been advocated for treating osteoarthritis (OA):

these are:

Avocado-soybean unsaponifiables (ASU) – OA

• ASU consists of 1/3 avocado oil and 2/3 soybean oil. Lab tests have found it can reduce the damaging effects of the inflammation response on joint cartilage and stimulates the production of collagen (important for building health tendons, ligaments, muscles and joints) and repair of damaged cartilage.
• Randomised controlled trial (RCT) evidence supports it use in improving symptoms of people with OA – reducing pain and making walking easier.
• Effective dose: 300mg/ day for 3 months
• Safety:
  • Allergic reactions:
    • Particularly if there is known allergy to banana or chestnut.
• Interactions:
  • Increased risk of bleeding – if taken with aspirin, heparin or warfarin.
  • Increased risk of blood pressure – if taking an MAOI antidepressant medication.

Capsaicin Gel – OA

• This extract of chilli, affects substance P, involved in pain signals and activating joint inflammation.
• RCT trials show it can be effective in reducing pain and tenderness.
• Effective dose: 0.025% – 0.075% gel applied 4 times a day
• Safety:
  • Must be kept away from eyes, mouth and open wounds.

Ginger – OA

• Thought to work by reducing chemicals that increase joint inflammation. It also contains salicylates which can relieve pain.
• RCT evidence shows that ginger can reduce pain and disability in people with OA.
• Effective dose: 510mg/day to 1,000mg/day.
• Safety:
  • Symptoms:
    • May cause digestive problems such as relatively mild heartburn
• Interaction:
  • Increased risk of bleeding – if taken with aspirin, heparin or warfarin.

Glucosamine Sulphate – OA

• A supplement derived from shellfish, shown to reduce damage in and repair cartilage.
• The weight of evidence from RCT trials have shown it can reduce pain and improve walking.
  • The evidence for Glucosamine Hydrochloride is however weak.
  • Effective dose: 1,500 mg/day
  • Safety:
    • Adverse effects:
      • Allergy:
        • Shouldn’t be taken by people who are allergic to shellfish
  • Occasional mild stomach upsets.

Green-lipped mussels – OA

• Shellfish derived supplement, containing omega 3 fatty acids, minerals, amino acids and carbohydrates,
• RCT evidence suggests that they can help reduce pain, improve function and quality of life of people with OA, when taken with painkillers.
• Effective dose: Not established
• Safety:
  • Interaction: not established but possible interactions with aspirin, warfarin etc could occur.

Indian Frankinsense – OA

• Plant extract, thought to prevent the production of pro-inflammatory substances.
• RCT research evidence found supplementation can improve OA knee pain, knee flexion and walking distance.
• Effective dose: trials have used 1g daily
• Safety:
  • Not much research

Phytodolor – OA

• Is  a mixture of herb extracts that have painkilling, ant-inflammatory and anti-oxidant properties.
• RCT evidence shows that it is effective in improving joint mobility, reducing pain and painkiller use. Appears to be as effective in reducing pain, swelling and stiffness as medications such as diclofenac and piroxicam.
• Effective dose: usually given as 30-40 drops, 3 times a day
• Safety:
  • Adverse effects reported include stomach upset, diarrhoea and skin allergies.

Pine bark extract – OA

• Rich in bioflavonoids, which have anti-inflammatory and antioxidant actions. Can reduce chemicals that breakdown cartilage.
• RCT evidence shows significant reduction in pain and use of painkillers and improved function in people with OA.
• Dosage: typical treatment of 2 50mg of Pycnogenol®
• Safety:
  • Reported adverse side effects have been headache and stomach upset

Rosehip – OA

• Contains chemicals thought to relieve joint inflammation and prevent joint damage.
• RCT evidence of people complaining of hip and knee OA found increased hip flexion and reduced pain, though no improvement with hip rotation. Other trials of people with multiple sites of OA showed a significant reduction in pain and use of painkillers and reduced severity of disability symptoms.
• Dosage: typically 5g/ day have been used in trials
• Safety:
  • Adverse effects may include allergy, constipation, diarrhoea and heartburn

SAMe – OA

• SAMe is found naturally in the body and lab studies suggest it has painkilling ability and helps stimulate the synthesis of collagen and proteoglycans.
• RCT evidence shows that SAMe is similarly effective as NSAIDs in reducing pain and the limitations reported by people with OA, though with half the reported side effects of NSAIDs.
• Dosage: most studies have used doses between 400-1,600mg/day.
• Safety:
  • Infrequent, mild adverse effects:
    •  include nausea, restlessness, headache, dry mouth and stomach upset.
• Severe adverse effects:
  • In people with depression, reactions of anxiety and mania have also been reported.

SKI 306X – OA

• Mixture of herbs, shown to have a protective effect on joint cartilage.
• RCT trials show that SKI 306X significantly reduces OA pain, and has been shown to be similar in effectiveness as diclofenac  for pain reduction and patient satisfaction.
• Dosage: 200mg 3 times per day
• Safety:
  • Some heartburn and stomach upsets have been reported (5.6% similar proportion to diclofenac) .

 

Reference:

“Complmentary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia. A report by the Arthritis Research Campaign.”