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Knee Pain - Doctor Q&A

 
  1st March - 31st March 2011  
     
 

Knee pain is a common illness that affects people of all ages. It may be the result of an injury or medical conditions such as gout and arthritis. Being overweight also increase your risk of knee problems.

Ask questions about your knee problems, injuries, including diseases, and conditions which can cause pain, and how knee pain can be treated from our Specialist.

DISCLAIMER
This discussion forum is intended for general information and is provided on the understanding that no surgical and medical advice or recommendation is being rendered. Please do not disregard the professional advice of your physician.

 
     
 
 

Dr. Chin Pak Lin (profile)
Consultant
Department of Orthopaedic Surgery
Singapore General Hospital
Appointment Tel: +65 6321 4377

     

More articles on Knee Pain
  Osteoarthritis
  It's in the bones
  Common knee injuries
  Foot and Knee pains

             
 
     
 
     
 

Posted by ashish.chichani

Hi,

Recently I had twisted my knee while playing squash. The doctors told me that its a minor case of Knee Effusion which is pretty common form of knee problem. Its been 15 days since and initially I wasn't able to walk though now I can walk quite freely but still feel the pain when I'm climbing/going down stairs.

I just wanted to know what kind of precautions should i take so that I can start playing again. Normally how many days does it take for the pain to completely go. Also are there any exercises which will help to build knee strength.

Thanks,
Ashish

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Knee effusion after a sports injury is a sinister sign. This is often associated with an intra-articular injury i.e. the meniscus, ligaments or cartilage injury.

Minor events can get better after 6-8 weeks with proper physical therapy and rest. Knee strengthening exercises can target the quadriceps or hamstrings, depending on the initial problem.

Difficulty in ascending and descending stairs can relate to a torn cruciate ligament or problems with the patella-femoral compartment.

If the pain persists, please seek consult with an Orthopaedic Specialist.

     
     
 

Posted by ender

After running the Marathon Singapore last Dec 5th, I thought I had recover after one week of rest. But during my regular training, I had this pain on my left leg after I reach about 8km. The location is behind the knee, just above the calf muscle. Pain would subside when I stop, and I would feel normal after a resting.

On 20th feb, I ran the marathon again, and as expected the same pain happen behind my knee after 10km.. I dragged on til completion by walking most the time. The day after I could walk properly especially climbing down the stairs. Pain location is the same, behind the left knee, somewhere near the upper calf muscle. This time a bit of pain of the side of the knee, but not as much as the one behind. 3 days of rest for the pain to be completely gone and I can walk normally. I tested running, again the 8km mark I felt the same pain, but I stopped immediately before it got worst.

I've been resting (no running) for more than a week, and have been pain free. I intend to rest till my two weeks mark before I starting training.

May I know what injury have I sustained? Is resting for two weeks enough for me to recover? Should I see a specialist?

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Your symptom seems to suggest that you have definite point tenderness over the medial head of the gastrocnemius muscle.

This is also known as a calf strain. You seem to have a Grade II tear which can persist for a week associated with swelling, pain and bruising. Definitive diagnosis will require an ultrasound or an MRI scan. Treatments involve rest, ice therapy and analgesics.

A sports therapist can help. If symptoms persist or worsen please seek a consult with a sports orthopaedic surgeon.

     
     
 

Posted by patricklth

Dear Dr Chin

I have a nagging left knee pain for more than 6 months already.

I had seen doctors at various clinics & they gave me painkillers & cream. Till now it's not ok. Its probably because of my weight, I think. What should I do?

I am quite a sporty person but due to work committments & I can only find time during weekend to do brisk walking.

Please advise

thank you
Patrick

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Knee pain is an extremely general complaint. We must exclude a referred pain from the spine and hip which can also present as an anterior knee pain.

Anterior knee pain i.e. pain that occurs especially on getting up from a chair, going down stairs and squatting are usually indicative of knee cap pathology. Pain that persist for more than 6 months will require an assessment by a specialist to rule out common sports knee injuries like a torn meniscus or a chondral ulcer.

     
     
 

Posted by luckyasharma

Dear Dr. Lin,

I am 31 years of age and since past 1yr have some knee problem. My right knee makes a clicking sound while climbing up the stairs. Prior to this problem i was doing Yoga and i stopped it thinking maybe i overstrained and should give some rest to the knee. But the clicking sound still persists. I have checked it with GP and also a Specialist. X-Ray is normal and there is no arthritis. I have been recommended to see a Physiotherapist or go for MRI.I have been advised not to squat, climb the stairs, running on hard surface etc. I have a 2 yr old daughter and some of these activities are unavoidable. I would like to have a healthy and active lifestyle to enjoy with my daughter. Kindly advise the cause/reason of this problem and how can I avoid it from aggravating.

Thanks and Regards,
Lucky

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

“Clicking Knee” is also known as Crepitus. This occurs when two rough surfaces rubs against each other. Considering the activities you have been advised not to do, I can assume that you have anterior knee pain aggravated by getting up from a chair, squatting and descending stairs, your problem probably lies with a mal-tracking knee cap (Chondromalacia Patellae).

Sometimes on special x-ray views, your pathology can be visualized. Rest assured that most atraumatic knee pain in healthy individuals can be addressed with proper physical therapy. Please seek consultation with an orthopedic specialist for a full assessment.

     
     
 

Posted by paul

Hi Dr Chin,

7 years ago, I fell down and slammed my right knee against the pavement while jogging and I was in pain for one week. I did not see a doctor. Now my front left side of right knee hurts, when I run long distance or squat down. I feel it is also affecting my posture standing as I tend to lean on left side now. Appreciate your advice.

Thanks a lot!!
Paul

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Anterior knee pain aggravated by getting up from a chair, squatting and descending stairs is usually caused a problem in patella-femoral compartment.

The injury made 7 years ago may have contributed to the problem and it is affecting your lifestyle now. You will need to have your knee assessed by an Orthopaedic Surgeon with the relevant x-rays.

     
     
 

Posted by angkb8

Dear Dr. Chin

Just one week ago, the left side of my left knee begin to feel painful. In bed I try to lift up my left leg I feel a sharp pain on my left knee area.

I had seen a doctor recently, the doctor given me Cataflam tablets and Voren Gel to apply. The pain seem to go away.

But recently the pain return.

Appreciate if you could tell me what wrong with my left knee. I have previous injury.

Thank you

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Sudden onset of a previously injured knee can represent an exacerbation of an old pathology. The pain on the outside of your knee (Lateral Compartment) can be attributed to structures around that area such as lateral compartment knee arthritis, lateral meniscus injury or a strain collateral ligament.

Analgesic as the first line remedy is often used to help patients through the inflammatory period. If the problem recurs, it is prudent to have imaging of the knee to assess the problem.

     
     
 

Posted by footy78

Dear Dr. Chin,

I am not a regular cyclist and seldom do I exercise as I have a torn left knee ligament. However, I did some fast cycling last August 2010. One or two days of cycling, my other knee (right) felt funny. There are no visible swelling, however, I do feel as though veins or something behind my knee are "sticking" together. This symptom lasted a few weeks, with occasional sharp pains on the outer side of my right knee. The occasional sharp pain went on for around 2-3 weeks before I do not feel the pain as often.

During the whole course of this, I wore a knee brace to support my knee everyday. It has been almost 5 months since it happened. Now, I am still wearing the knee brace and the knee still feels a bit weird. Sometimes when i walk up a step, I can feel a huge "crack" in the knee as if the knee went out of place... but I can still walk after that. Is my knee giving way? But I do not feel much pain upon using my fingers massage around my knee. Can you please advice if I have a tear or a torn ligament, cos it felt different from the last time i torn my left knee ligament as it was really painful back then compared to this time, or is it some other injury?

Thanks,
Ben

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

There are essentially 4 main ligaments in the knee that provide stability. The sensation of the knee giving way whilst climbing stairs raises the possibility of significant knee instability i.e. a torn ligament.

Symptoms persisting for more than 5 months would certainly warrant a review by an Orthopaedic Surgeon. Delaying treatment for an unstable knee can risk injuring other structures in your knee.

     
     
 

Posted by sikmunchan

Dear Dr Chin,

I've worned out the ligaments in both knees. Right now, the pain is manageable as it is intermittent. However, there are times when my knee will "click" and this weakens my balance. Why does it click? Anyway to stop the "clicking"?

Many thanks!
DSM

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Damaged ligaments cause the knee to be unstable. When this occurs there is a theoretical risk of injuring more structures in your knee leasing to an early onset of knee arthritis. Thus when arthritis has set in, the cartilage surface can be uneven and will lead to clicking sounds known as Crepitus.

     
     
 

Posted by sharschan

The radiographer report says both my knees show mild degenerative changes with small marginal osteophytes formation and tibial spiking. My BMI is 20.4. Please advise what can one do to stop or reverse the condition. I used to run and skip but have now stopped.

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Degenerative changes to your knees are permanent. No one or medicine can stop the ageing process. If your knees do not hurt, I strongly encourage you to continue with your exercises. However high impact exercises like jumping and running up stairs can hurt your knee more compared to swimming or stationery cycling.

     
     
 

Posted by chiangdon

Dear Dr Chin,

I am 46 years old. I have been having this knee problem for more than 10 years. When I walk up or down slopes and stairs, or after watching a movie in the cinema, the outside of my right knee becomes painful and it gets worse quickly with every downward step. I had to rest a while before it gets slightly better. However, after one night's sleep, it goes away completely until the next time I do a lot of walking up and down. As a result, when I play golf, I can hardly go beyond the 9th hole. When I do walking in the forest at the Tree-top walk at Thomson, upon the return leg down the long fleet of stairs, the outside of my right knee will hurt very badly. I have Cushing Disease and had Oesteoporosis before, currently being monitored by an SGH speecialist and taking Calcium with Vit D tablets daily.

Question : Would taking Glucosamine tablets help to prevent this pain from occurring? I heard that applying Glucosamine cream locally would be more effectively. Is it true?

Thanks in advance.
Don

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Anterior knee pain is often aggravated by getting up from a chair, squatting and descending stairs. This often attributed to mal-tracking of the knee cap with a chondral injury beneath the patella-femoral joint (Chondromalacia patellae). The problem lies with the cartilage and calcium supplements is of very little help.

The efficacy of oral glucosamine is debatable let alone topical creams. Glucosamine is not a painkiller and should not offer any immediate analgesic effect. However some topical glucosamine creams has capsaicin which may give some analgesic effect.

Physical therapy working on quadriceps strengthening often helps. Avoiding undulating terrain and stairs will reduce the pressure on the patello-femoral compartment.

     
     
 

Posted by dearhari

Hi doctor,

I jog almost 3 to 4 times a week. But often I get the knee pain. It is not terrible pain but its gives me an uncomfortable feeling while running. I consulted a doctor in GP and she informed that my ligament was insured and prescribed a pain killer and ointment. I would like to know what if there is a permanent solution for this pain? I like jogging and I don't want to stop jogging.

Thanks & Regards,
Hari

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

For endurance runners, we often see problems related to overuse. This can be from the cartilage, ligaments or meniscus. Thus most endurance training programs employ a cyclical training regime to avoid injuries. If you are a keen do look up some running clinics that can offer good advice to prevent injuries.

     
     
 

Posted by soonkee13

Hi Dr Chin

I am a 46yr/F. Occasionally I feel my knee hurts when I climb up/down the staircase, is there any cause of concern? On a separate note, is barley green leaves good for heatlh?

many thanks
sk

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Anterior knee pain is often aggravated by getting up from a chair, squatting and descending stairs. This often attributed to mal-tracking of the knee cap with a chondral injury beneath the patella-femoral joint (Chondromalacia patellae).

Physical therapy working on quadriceps strengthening often helps. Avoiding undulating terrain and stairs will reduce the pressure on the patello-femoral compartment.

The effect of barley green leaves on health has not been validated by any scientific studies.

     
     
 

Posted by th22

For a couple of years now, I have an on-off pain underneath my left kneecap. It usually occurs when I exert pressure on it, e.g, when I stand from sitting position, or climb steps. What could be the problem?

     
 

Answered by Dr. Chin Pak Lin Consultant Department of Orthopaedic Surgery Singapore General Hospital

Anterior knee pain is often aggravated by getting up from a chair, squatting and descending stairs. This often attributed to mal-tracking of the knee cap with a chondral injury beneath the patella-femoral joint (Chondromalacia Patellae). Physical therapy working on quadriceps strengthening often helps.

     
 
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