Swelling and cracking of the knee could be related to underlying problems in the knee,
such as arthritis, wear and tear, or it could be related to injuries such as sports injuries
sustained while playing football, rugby, tennis, running. These could all contribute to swelling and cracking.
The most important thing is whether the cracking is painful or painless.
Pain and swelling associated with arthritis are usually of a gradual progression.
It happens over time and it gets worse over time and it's made worse by activities such as excessive
walking, going up and down the stairs or running for example or sports activities.
The other side are the sports injuries such as football, rugby and tennis. They could lead to injuries
to either the ligaments or the cartilage inside the knee which can be associated with swelling
and cracking of the knee.
The term "bad knees" is a general term which could point to the fact that there is a problem
with the knees. The way to know if there is a problem with the knees are the symptoms
which include pain, swelling, instability, difficulty with walking made worse by activities,
inability to run, inability or difficulty going up or down the stairs. These are all
symptoms that would signify that there is a problem with the knee. There's no medical
term that is called bad knees but there is a problem with the knee which could be either
related to wear and tear or could be due related to an injury sustained in the knee. The most
important factor to note is pain: how bad is it, what brings it on, what makes it worse,
are there any aggravating factors, relieving factors, and if there is any history of trauma
associated with this and obviously following that the examination and the imaging findings
such as x-rays or MRI scans of the knee.
The common causes of knee pain can be divided into mainly two groups. The acute injuries:
ligament injuries or cartilage injuries, or arthritis which is wear and tear. The acute
injuries or the injuries to the knee could be divided into two groups either ligament
injuries or cartilage injuries like a torn cartilage. If you look at the knee, there
are ligaments that wrap the knee from the outside, so the collateral ligaments which
surround the knee on either side, so the medial collateral and the lateral collateral ligament,
then you have the ligaments on the inside of the knee which are the cruciate: the anterior
cruciate and the posterior cruciate ligament at the back of the knee itself and they all
have to function in synergy to preserve function of the knee and to allow us to play sports.
The other structures that are important on the knee are the meniscus or the cartilage
which act as cushions to the knee when you run, walk on them and they can be injured
and cause mechanical symptoms with the knee. The second group is the arthritic group or
the wear and tear group of the knee. This is when the knee starts to wear out and the
cartilage becomes thinner to the point that it may reach the point where there is no space
at all between the two surfaces and then you start to erode the bone and that's sort of
an indication to proceed with surgery such as knee replacement surgery. Other issues
associated with a knee and sports for example are runner's knee where there is friction
as you run between the bones and the soft tissues and they may lead to painful clicking,
Iliotibial band syndrome. Iliotibial band is a band of tissue that runs across the knee
towards the tibia and it can also be injured or damaged or irritated by certain activities
such as squatting or lunges. Other conditions for example, gout, prepatellar bursitis,
or inflammation or swelling of the front of the knee which is common in carpenters, in
gardeners, people who kneel for a living, and then finally fractures or trauma caused
to the knee such as fracture of the femur, patella, the kneecap or the tibia; which can
happen due to traumatic injuries such as falls, it can happen in car accidents, and it can
happen and also simple twisting while you're walking down the road, for example.
To help relieve knee pain at home, it is important to start by resting the knee. So, stop activities
as much as possible to try and allow the knee to recover and give it room to breathe. Second
thing is if it's swollen, then you might want to use ice to reduce the swelling especially
after an injury while playing football or rugby, for example, and using an ice pack
at home can help reduce pain and swelling at the same time. Sometimes we use what we
call a compression bandage just to compress the knee and reduce the swelling as well.
Elevating the knee on a stool or a couple of pillows to relieve swelling as well helps
in reducing pain. Taking painkillers, simple painkillers such as paracetamol or anti-inflammatories
such as ibuprofen if you're allowed to take it, helps relieve the pain as well and reduce
the inflammation. Avoid the activities that might trigger the onset of pain. For example,
if the pain gets worse while squatting or doing lunges, then you might want to avoid
those certain movements. Some people find that going down the stairs can be a bit tricky.
Go one step at a time. Avoid any activities where you might need to do a sudden change
of direction on the knee and try and do linear exercises. Physiotherapy helps and it helps
to strengthen the muscles and the envelope around the knee to try and provide strength
to the knee to be able to cope with stresses. So, it's important to start physiotherapy
whenever you're able to do so. Wearing the right shoe wear is very important especially
if you run quite a lot. I would encourage you to get a fitted running shoe to allow
you to run if you do a lot of running. Sometimes taping, patellar taping can help and also
stretching of the tendons using either dynamic or static taping can help reduce some of the
swelling or pain around the knee. You might have seen this on football players, the blue
tape or black tape that's applied which is also used on the shoulders as well as the knee.
You need to seek medical advice when you have a problem with your knee that is not getting
better or a problem with your knee that's associated with instability, knee giving way,
problems with going down or up the stairs, general reduced mobility, pain especially
at nighttime, or pain on certain movements. If you're getting sharp pain and clicking
at the same time, if you're getting pain and recurrent episodes of swelling in the knee,
then it's important also to seek help. These are all symptoms that could delineate that
there is a problem which could be either due to either an injury such as an acute injury
or a chronic injury which has become worse over time. The pain associated with arthritis
or wear and tear is usually of a gradual onset which becomes worse over time and can reach
a point where you have pain at rest or pain at night. If you notice that your walking
distance is decreasing, if you have problems going up inclines or going down hills, if
your knee is starting to give way regularly, if it's not holding your weight and associated
centres of instability, if the patella or the kneecap is dislocated and moving sideways
more than normal and it's associated with painful clicking, if there is associated swelling,
mechanical symptoms in the knee, then it is important to seek help.
Knee pain is treated by conservative options and surgical options. The conservative options
include the easy options include rest, elevation, allowing the knee to settle down, compression
using a soft bandage and using ice in an acute injury or what we call the RICE regime: rest,
ice, compression, elevation - followed by painkillers which include paracetamol, anti-inflammatories.
These reduce the inflammation and reduce the swelling and also help to control pain symptoms
followed by injections. Injections do help. Especially if the underlying pathology is
wear and tear. There are various types of injections. The commonest injections that
we have are local anaesthetic plus steroid injections, but there are other forms of injections
that are being more commonly used with varying levels of evidence including platelet-rich
plasma or PRP; which is an extract from your blood that's injected into the knee to allow
to reduce the inflammation and reduce pain. There is varying evidence. Some people are
for it, some people are against it. In certain pathologies, it does help such as patellar
tendinopathy, for example, or the quadriceps tendinopathy which is where there is inflammation
of the tendons around the knee. There is some evidence that it might help in arthritis as
well. Now, if the pain is sharp and intermittent and it's associated with mechanical symptoms
such as the knee giving way, collapsing on you, or instability, then it might need further
imaging such as X-ray or an MRI scan of the knee to see if there is any evidence of cartilage
damage or ligament damage which might require surgical intervention. There are other types
of injuries such as sports injuries, such as a runner's knee, friction syndrome, Iliotibial
band. These are repetitive injuries associated with certain sports which if you rest and
avoid certain activities and do some exercises to help stretch the muscles and tendons do
get better. What doesn't get better obviously are cartilage tears and the ligament injuries
especially ACL injury or a torn medial meniscus or torn cartilage. These may require surgery
in the form of arthroscopic or keyhole minimally invasive surgery. When you develop arthritis,
it can be either mild, moderate or severe. When it reaches the severe point especially
when you have pain at rest or pain at night or your exercise tolerance decreases to less
than 100 or 200 yards, then it becomes important to treat the problem and if there's severe
arthritis both clinically and on the X-ray and the symptoms are fairly suggestive of
this, then surgery in the form of either a partial or a total knee replacement is indicated in
those cases. According to the latest paper publication by The Lancet, knee replacements
do reasonably well and if you have a knee replacement in this day and age, your chances
of surviving for 20 to 25 years are eight out of ten which is a good statistic to have.