Knee pain? An exercise regime can help you

Do you have a knee pain? If you do, you are certainly not alone. Knee pain is incredibly common. It's responsible for about 1/3 of all doctor's visits for muscle and bone pain. While it is a special problem for athletes, (over half of all athletes endure knee pain every year, worldwide and in Sri Lanka), knee pain can also occur for reasons unrelated to sports.

While drugs are a common treatment for any kind of pain, they are by no means a lasting cure. The key to a permanent cure could in many instances lie with exercises that can strengthen the muscles and correct the cause for knee pain.

A few regular visits to a physical therapist who could put you on an exercise regime tailor-made for your specific condition may give you the elusive cure you all looking for, says an eminent physical therapist.

Chartered Therapist Dr GOPI KITNASAMY shares his hands-on experiences in the field and tells us why knee pain is so common, in this interview with the Sunday Observer.

Excerpts...

Q: Almost everyone has complained of a knee pain at some time or another irrespective of their age or gender. What is the cause?

A: The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Q: How do injuries affect the knee?

A: A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself.

During a twist or a fall, it’s often your ligaments that are damaged causing you pain and stiffness. Ligaments connect bone to bone and are designed to allow a limited range of movement from each joint. Any form of unexpected twist or rotation and the ligaments on either side can be torn.

During a game of football your knee can twist as your studs get stuck in the ground, or you jump and land awkwardly.

Or you can get injured from a block tackle. Injuries can also occur from something as simple as playing bowls or even gardening, where you might have been leaning over to attend to plants with your knee bent, then all of a sudden you try to turn sharply and lose your balance - this can also cause a knee ligament problem. All three of these examples could also cause a knee cartilage tear or damage.

Q: So, in summary the main reasons for knee pain are?

A: 1) Acute injury: such as a broken bone, torn ligament or cartilage. 2) Medical conditions: arthritis, infections. 3) Chronic use/overuse conditions: osteoarthritis, patellar syndromes, tendinitis, and bursitis.

Q: Elaborate, please.

A: Let's start with injuries. They can be categorised as:

1) Acute injuries

2) Fractures: Direct trauma to the bony structure can cause one of the bones in the knee to break.

3) Ligament injuries: The most common injury is the ACL (anterior cruciate ligament) injury. This is often a sports-related injury due to a sudden stop and change in directions.

4) Meniscus injuries: The menisci (medial and lateral) are made of cartilage and act as shock-absorbers between bones in the knee. Twisting the knee can injure the meniscus.

5) Dislocation: The knee joint or the knee-cap can be dislocated.

Then we come to Medical Conditions. These include:

1. Rheumatoid arthritis is an autoimmune condition that can affect any joint in the body. It can cause severe pain and disability.

2. Gout is a form of arthritis that is most commonly found in the big toe, though it can also affect the knee.

3. With septic arthritis (infectious arthritis), the knee joint can become infected; this leads to pain, swelling, and fever. This condition requires antibiotics and drainage treatments as soon as possible.

4. There are also medical causes called, ‘Chronic use/overuse conditions'. They include:

1. Patellar tendinitis - an inflammation of the tendons connecting the kneecap (patella) to the bone of the lower leg. Patellar tendinitis is a chronic condition often found in individuals repeating the same motion (such as runners and cyclists).

2. Osteoarthritis - A wearing down of cartilage of the joint due to use and age.

3. Bursitis: A bursa is a sac of fluid that cushions and protects your joints. Overuse, a fall, or repeated bending can irritate the bursa, causing pain and swelling. “Housemaid's knee” and “Baker'sare the most common.

Q: These conditions seem to apply to adults. What about children?

A: Children can develop inflammation of the point of bony insertion of the patellar tendon (Osgood-Schlatter disease).

Q: Who are more at risk to knee pain? What factors can increase risk of knee problems?

A: Excess weight

Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

Biomechanical problems

Certain structural abnormalities - such as having one leg shorter than the other, misaligned knees and even flat feet - can make you more prone to knee problems.

Lack of muscle flexibility or strength

A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on the joint.

Certain sports

Some sports put greater stress on your knees than do others. Rugby, football, basketball, tennis, running or jogging.

Previous injury

Having a previous knee injury makes it more likely that you'll injure your knee again.

Wrong footwear

Wearing high heels or flat shoe, wrong size, pointed shoes.

Q: What are the symptoms?

A: The location of the knee pain can vary depending on which structure is involved. With infection, the whole knee might be swollen and painful, while a torn meniscus or fracture of a bone gives symptoms only in one specific location.

The severity of the pain can vary as well from a minor ache to a severe and disabling pain.

Some of the other symptoms that accompany knee pain are:

. difficulty in walking due to instability of the knee,

. locking of the knee (unable to bend the knee),

. redness and swelling,

. inability to extend the knee.

Q: How do you diagnose the specific cause for a knee pain?

A: Knee pain can be diagnosed in the following ways:

Physical examination

This will include bending the knee through the full range of movement, checking for stability of the ligaments, and evaluating for any tenderness and swelling. It is often helpful to compare the results of the examination of the painful knee with the other knee.

Imaging tests

. X-ray can help detect bone fractures and degenerative joint disease.

. Computerised tomography (CT) scan can help diagnose bone problems and detect loose bodies.

. Ultrasound to see real-time images of the soft tissue structures within and around your knee, and how they are working.

. Magnetic resonance imaging will be useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

Lab tests - blood tests (infections, gout and arthritis) or sometimes arthrocentesis, a procedure in which a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.

Q: How do you treat knee pain?

A: Treatment for knee pain are as varied as the conditions that can cause the pain.

Medications

Medications might be prescribed to treat an underlying medical condition or for pain relief.

Physical therapy

Sometimes strengthening the muscles around the knee will make it more stable and help guarantee the best mechanical movements. This can help avoid injuries or further worsening of an injury.

Injections

Injecting medications directly into your knee might help in certain situations. The two most common injections are corticosteroids and lubricants.

Surgery

Knee surgeries range from arthroscopic knee surgery to partial/total knee replacement.

Other therapies

Acupuncture has shown some relief of knee pain, especially in patients with osteoarthritis. Glucosamine and chondroitin supplements have shown mixed results in research studies.

Q: How can you prevent knee pain? Give us some tips.

A: Maintain your weight. Because extra weight can increase your chances of developing osteoarthritis, maintain a weight that's appropriate for your size and age to decrease stress on your knees and to avoid increased chances for knee injuries.

1.Wear sensible shoes with a good fit. It will help you to maintain proper leg alignment and balance, ultimately preventing knee injuries.

2.Warm up. Before starting any exercise, warm up and then do stretches. If you stretch muscles in the front and back of your thighs, it decreases tension on your tendons, ultimately relieving pressure on the knees.

3. Do low-impact exercise. At the gym, opt for a rowing machine or a recumbent exercise bike. Both offer a strong workout with low impact to your knees.

4. Swim or walk. When exercising outside the gym, opt for swimming or walking/cycling

5.Weight train. Strengthen your leg muscles to better support your knees and avoid injuries by working out with weights. But be sure to consult with an expert first on the right way to life weights to prevent knee pain.

6. Don't decrease your activity. A decrease in activity will lead to weakness, increasing your chances of injuries.

7. Don't suddenly change the intensity of your exercise. Build up gradually to avoid knee pain.

8. Consider physical therapy. If you already have a knee injury, visit a physical therapist who can help to set up an appropriate exercise regime.

The ups and downs of the seemingly idle brain

Even in its quietest moments, the brain is never “off.” Instead, while under anaesthesia, during slow-wave sleep, or even amid calm wakefulness, the brain's cortex maintains a cycle of activity and quiet called “up” and “down” states.

A new study by Brown University neuroscientists probed deep into this somewhat mysterious cycle in mice, to learn more about how the mammalian brain accomplishes it.

In addition to an apparent role in maintaining a baseline of brain activity, the up and down cycling serves as a model for other ways in which activity across the cortex is modulated, said Garrett Neske, graduate student and lead author.

To study how the brain maintains this cycling, he found, is to learn how the brain walks a healthy line between excitement and inhibition as it strives to be idle but ready, a bit like a car at a stoplight. “It is very important to regulate that balance of excitation and inhibition,” said senior author Barry Connors, professor and chair of neuroscience at Brown. “Too much excitation relative to inhibition you get a seizure, too little you become comatose. So whether you are awake and active and processing information or whether you are in some kind of idling state of the brain, you need to maintain that balance.”

The cycling may seem simple, but what Neske and Connors found in their investigation, published in the Journal of Neuroscience, is that it involves a good deal of complexity. They focused on five different types of cells in a particular area of the mouse cortex and found that all five appear to contribute uniquely to the ups and downs.

Cells in a barrel

Specifically the researchers, including Saundra Patrick, neuroscience research associate and second author, looked at the activity of excitatory pyramidal cells and four kinds of inhibitory interneurons (PV, SOM, VIP and NPY) in different layers of the barrel cortex. That part of the cortex is responsible for processing sensations on the face, including the whiskers.

Neske induced up and down cycles in slices of tissue from the barrel cortex and recorded each cell type's electrical properties and behaviour, such as its firing rate and the amounts of excitation and inhibition they received from other neurons. The picture that emerged is that all types of interneurons were active. This included the most abundant interneuron subtype (the fast-spiking PV cell), and the various more slowly spiking subtypes (SOM, VIP, NPY).

In fact, Connors said, the latter cells were active at levels similar to or higher than neighbouring excitatory cells, contributing strong inhibition during the up state.

One way such findings are important is in how they complement recent ones by another research group at Yale University.

In that study scientists looked at a different part of the cortex called the entorhinal cortex.

- MNT

Flu vaccination likely to be more effective in future

An analysis of 10 years’ worth of data on human influenza B viruses has shed new light on the pathogen which can cause the seasonal flu. Findings from this study could help make flu immunisation programs more effective; by better targeting vaccines or by eventually eliminating one of the flu lineages completely.

What are Influenza B viruses?

Influenza epidemics seriously affect populations worldwide, with an estimated three to five million cases of severe illness and 250,000 to 500,000 deaths, yearly.

Four influenza virus lineages co-circulate in the human population to cause seasonal epidemics. Of the four, two are influenza A and two are influenza B virus lineages, named Victoria and Yamagata.

To date, most studies have focused on the influenza A virus lineages because they are the more commonly circulating lineages in humans which have also caused occasional pandemics.

A new study, led by Assistant Professor Vijay Dhanasekaran and Associate Professor Gavin Smith from Duke-NUS Graduate Medical School (Duke-NUS), has presented the largest comparative analysis of human influenza B viruses undertaken to date.

Results were achieved using advanced computational methodologies to analyse genomic data of the pathogen taken from human hosts.

Significantly, this study is also the first to integrate demographic information such as the host's age.

Findings offer new insight into the evolution and epidemiology of this highly infectious virus, and reveal how the two influenza B virus lineages fundamentally differ from each other and from the influenza A virus lineages.

Flu Vaccine Implications

“Our research shows that school aged children are more susceptible than adults to influenza B virus lineages, especially the Victoria lineage,” explained first author Asst Prof Dhanasekaran from the Emerging Infectious Diseases Program at Duke-NUS.

“This younger population should be targeted for the use of the quadrivalent influenza vaccines.”

Commonly administered influenza vaccines are generally composed of two influenza A lineage viruses - but only one influenza B lineage virus.

Recently, quadrivalent influenza vaccines, which target all four lineages, have been approved for use. However, they are significantly more difficult to prepare, more expensive and have limited availability.

This new study shows that it may be important to use these vaccines for a specific population.

Virus Eradication through Vaccination

The research team also ventures that a re-evaluation of influenza B vaccination strategies may have long term benefits in controlling the flu in the human population. Influenza B Yamagata viruses evolve at a much slower than influenza B Victoria viruses.

If the administration of the quadrivalent influenza vaccine was expanded sufficiently - it may be possible to eradicate the slower Yamagata lineage from humans.

- MNT

Paracetamol should come with warnings about possible long-term health risks

People taking paracetamol tablets for long-term pain relief should be warned about the possible health risks to their heart, intestines and kidneys, scientists said.

Paracetamol is widely considered to be a safe pain killer but taking it for long periods for certain illnesses may pose cardiovascular, gastrointestinal and renal problems for little benefit, they found.

A review of eight studies in the medical literature has found that long-term use of paracetamol, usually in people with multiple medical problems requiring pain relief, may cause an increase risk of other health issues.

Four studies found adverse cardiovascular events, one showed an increased risk of gastrointestinal problems such as bleeding, and four found that paracetamol users were more likely than non-users to have malfunctioning kidneys.

At the same time, the benefit of taking paracetamol to treat the chronic pain associated with the joint pain of osteoarthritis and acute lower back pain is questionable, said a team led by Prof Philip Conaghan of the Leeds Institute of Rheumatic and Musculoskeletal Medicine.

“We believe the true risk of paracetamol prescription to be higher than that currently perceived in the clinical community,” the researchers concluded in a study published in the British Medical Journal.

“Given its high usage and availability as an over-the-counter analgesic, a systematic review of paracetamol's efficacy and tolerability in individual conditions is warranted,” they said.

- The Independent