Knee pain elliptical machine

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Knee pain is one of the most common complaints seen in a rheumatology practice.

The most common cause of this knee pain is osteoarthritis. Osteoarthritis is sometimes referred to as "degenerative joint disease", or wear-and-tear arthritis. The main problem in osteoarthritis is degeneration of the articular cartilage that covers the ends of long bones. Bone spurs may form around the joint as the body's response. Osteoarthritis may result from an injury to the knee earlier in life. Fractures involving the joint surfaces, instability from ligament tears, and meniscal injuries can all lead to osteoarthritis.

Not all cases of osteoarthritis are related to prior injury, however. Research has shown that some people have a genetic tendency. Osteoarthritis develops slowly over several years. The symptoms of osteoarthritis are mainly pain, swelling, and stiffening of the knee. The pain of osteoarthritis is usually worse after activity. In the late stages, the pain can be continuous and even affect sleep patterns. This pain probably does not come from the articular cartilage because this tissue does not have a nerve supply. Sources of pain may be due to:

• Inflammation in the lining of the joint.
• Small fractures in the bone under the cartilage, the subchondral bone.
• Stretching of nerve endings over a bone spur (osteophyte).
• Degenerative tears in the meniscus cartilage.
• Loose bone chips in the joint.

The diagnosis of osteoarthritis can usually be made on the basis of the initial history and examination. X-Rays are helpful in the diagnosis and may be the only special test required in the majority of cases. Unfortunately, x-ray findings tend to occur late. In some cases of early osteoarthritis, the x-rays may not show changes typical of osteoarthritis. Evidence suggests magnetic resonance imaging is more suitable for detecting early disease.

Knee pain from osteoarthritis may be confused with other common causes of knee pain such as a torn menicus or kneecap problems. Sometimes, an MRI scan may be ordered to look at the knee more closely, particularly if structures other than the cartilage may be involved.

Anterior knee pain (pain in front of the knee) is the most common knee injury in athletes. Anterior knee pain usually develops gradually due to the repetitive motion of the patella (knee cap) sliding up and down, rather than due to a single, sudden injury. This occurs most often in sports requiring a great deal of running and jumping.

Keys to preventing anterior knee pain include wearing the proper shoes for the activity, warming up before exercise, maintaining the appropriate strength balance between the quadriceps and hamstring muscles, limiting the length and duration of activity, and maintaining flexibility.

Some long-term solutions to help manage knee pain include:

• Control pain and inflammation. Prescription strength anti-inflammatory medicine is available.
• Glucosamine and chondroitin are medications which may provide pain relief in osteoarthritis.
• Injections of glucocorticoid may afford temporary relief for acute flares of pain. These injections should not be given more often than three times per year.
• Viscosupplement (lubricant) injections such as Hyalgan or Supartz may also help.
• Reduce shock by using a walking aid (cane), wearing good shoes, choosing soft surfaces, and keeping the leg muscles conditioned for unexpected stresses.
• Exercise daily to maintain range of motion, strength, and cardiovascular fitness.
• Avoid activities in your fitness and recreational pursuits which cause high impact loads to the knee such as walking, jogging, hiking, stair-stepper machines.
• Substitute impact activities with low impact activities such as stationary cycle, swimming, cross-country ski machine, rowing machine, elliptical machine.
• Follow a regular exercise program 2 to 3 times a week to stretch and strengthen the muscles around the knee
For the athlete, maintaining cardiovascular fitness is very important. The use of a stationary bicycle, treadmill, elliptical machine, swimming, and walking may be beneficial.

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