Hip & Knee
Hip and Knee Pain Management West Palm Beach
The knee is a weight-bearing joint that functions to allow movement of the leg and is critical to walking normally. The knee joint has three compartments: the inner (medial) compartment, the outer (lateral) compartment and the patellofemoral, where the kneecap joins the femur. The thigh bone (femur) meets the large shinbone (tibia) forming the main knee joint. It is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint as well as crossing within the joint. The fact that the knee is such an intricate structure and that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.
The hip joint is made up of two bones: the pelvis and the femur (the thighbone). It is the largest ball-and-socket joint in your body and allows for a lot of movement such as walking, running, and climbing. The joint is also composed of several powerful muscles that attach to these bones. These muscles play an important role in the health of your hip. They work together to provide you with a full range of motion while keeping your body stable and upright. Pain in the hip can be a result from a number of factors including abnormalities of the skin, nerves, joints, soft tissue, arthritis, and many more. Hip pain may also occur after a back or spine injury. To properly diagnose the cause of your hip pain, see an orthopedic physician.
A Groin pull or groin strain results from putting too much stress on muscles in your groin and thigh. If these muscles are tensed too forcefully or too suddenly, they can get overstretched or torn. This injury usually occurs in sports where cutting, side-stepping, or pivoting are required. Often, there is forceful separation of the legs or twisting of the toe outward. Signs and symptoms include pain and tenderness in the inner thigh region. Physical therapy and rest may help speed up recovery of a groin strain. Some people find that modalities used in physical therapy such as ultrasound, therapeutic massage, and specific exercises can be very helpful in the recovery process.
Arthritis means “joint inflammation.” Arthritis causes pain and swelling in the body’s joints such as the knees or hips. There are many types of arthritis but osteoarthritis is the most common. Osteoarthritis is often referred to as degenerative joint disease or age related arthritis because it develops as people get older. Osteoarthritis of the hip occurs when the cartilage coverings on the ball (the head of the femur) and the socket (the acetabulum) wear out. This cartilage serves as a cushion or shock absorber between the bones and joints. This breakdown in cartilage causes pain, swelling and deformity. Pain is often worse when you bear weight on the affected limb. Range of motion is often limited especially internal rotation and hip flexion. Among over 100 different types of arthritis conditions, osteoarthritis is the most common affecting over 20 million people in the United States. Patients who have osteoarthritis of the hip or knee sometimes have problems walking. They often have joint stiffness, pain and swelling. While you cannot reverse the effects of osteoarthritis, early nonsurgical treatment may help avoid a lot of pain and slow the progression of the disease. Following a physical therapy program of gentle-regular exercise can help improve strength and range of motion to the affected joint.
A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci (plural of meniscus)-one at the outer edge of the knee and one at the inner edge. The menisci keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right.
A meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. These tears can occur when you lift something heavy or play sports. As you get older, your meniscus gets worn. This can make it tear more easily.
Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
Older people are more likely to have degenerative meniscal tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.
You might feel a “pop” when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscal tear are:
- Stiffness and swelling
- Catching or locking of your knee
- The sensation of your knee “giving way”
- You are not able to move your knee through its full range of motion
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.
Bursitis & Tendinitis
Bursitis and Tendinitis are both common conditions that cause swelling around muscles and bones. They occur most often in the shoulder, elbow, wrist, hip, knee or ankle. Bursitis occurs when the small, fluid filled sacs that act as a cushion between a bone and other moving body parts such as muscles, tendons or skin become swollen. People get bursitis from overusing a joint. Hip bursitis is a common problem that causes pain over the outside of the upper thigh. When the bursa sac becomes inflamed it can be very painful as patients with hip bursitis move this tendon with each step. Another form of Bursitis often found in the knee is Prepatellar bursitis, also known as housemaid’s knee. This is pain and swelling on the top of the kneecap, which causes limited and painful movement of the knee.
Tendinitis occurs when a tendon; which is a flexible band of tissue connecting muscle to bone becomes swollen. Tendinitis usually occurs after repeated injury to a certain area. Tendinitis causes pain and soreness around a joint. Doing the same kinds of movements every day or putting stress on joints can increase the risk for both of these conditions. The most frequently encountered tendinitis around the hip is iliotibial band (IT band) tendonitis. The IT band begins at the hip and extends to the outer side of the shinbone just below the knee. This band functions to coordinate with several of the thigh muscles to provide stability to the knee. The most common tendinitis to occur in the knee is patellar tendinitis. Jumping sports (such as basketball and volleyball) put a huge load on the kneecap and attached tendons. Signs and symptoms of patellar tendonitis include pain to touch directly on the patellar tendon and occasionally, swelling. Treatment includes activity modification, and physical therapy.
Iliotibial Band Friction Syndrome
Iliotibial band friction syndrome is a common cause of knee and hip pain in athletes. This is the inflammation and painful irritation of the iliotibial band where it passes over the lateral epicondyle of the femur, an area just above the outside of the knee. ITBS is considered an overuse syndrome usually common among runners, cyclists and military personnel. The cause of this painful syndrome is usually due to a combination of stresses on the ITB such as; poor flexibility, training on uneven surfaces, worn out shoes, repetitive overuse, and abnormal hip, knee, and foot mechanics. This syndrome can often be treated with a conservative approach. A physical therapist may use ultrasound and other modalities to help the injured tissues heal more quickly. A skilled physical therapist can also help correct any biomechanical or training errors and teach you how to perform them the right way.
An anterior cruciate ligament, or ACL, injury is a tear in one of the knee ligaments that joins the upper leg bone with the lower leg bone. The ACL functions to keep the knee stable. An ACL injury often occurs during sports. This type of injury is common in soccer, skiing, football and other sports with lots of stop –and- go movements. ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes. Some common signs and symptoms of an ACL injury include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery.
The medial collateral ligament (MCL) is one of the four ligaments that are critical to the stability of the knee joint. The MCL spans the distance from the end of the femur to the top of the tibia and is on the inside of the knee joint. The MCL is usually injured when the outside of the knee joint is struck. The MCL on the inside of the knee becomes stretched and if the force is great enough, some or even all of the fibres will tear. MCL tears generally occur during sporting activities that require contact or rapid change in direction. There are two main movements that will place stress on the MCL and that is twisting of the knee and outside forces or impact to the knee. Patients with this condition may notice a pop or tearing sound at the time of injury. Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Severe tears may require surgery.
The Lateral collateral ligament (LCL) is one of the four major knee ligaments. The LCL connects the end of the thigh bone (the femur) to the top of the smaller shin bone (fibula), on the outside of the knee. When the LCL is torn the knee joint may bend too far inwards when stressed. Lateral collateral ligament tears are less common. Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Surgery is uncommon on this type of injury.
The posterior cruciate ligament is stronger and often less likely to be injured. The most common injury to the PCL is the so-called “dashboard injury.” This occurs when the knee is bent and an object forcefully strikes the shin backwards. This has been seen in car collisions with a forceful strike of the shin to the dashboard. Injury to the PCL can also occur when someone falls on the front of their knee. The symptoms of this tear are very similar to an ACL Tear. There will be swelling, knee pain and decreased motion. In making the diagnosis for this type of tear knowing how the injury happened and the position of the leg during the action is very important. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. Surgery is not typically required.
Chondromalacia Patella is the abnormal softening of the cartilage under the kneecap (patella). This is the most common cause of chronic knee pain. This is a result of the degeneration of cartilage due to poor alignment of the kneecap as it slides over the lower end of the thigh bone. This process is sometimes referred to as patellofemoral syndrome. The pain is located in front of the knee. It is caused by the wearing down, roughening, or softening of the cartilage under the kneecap. Often pain in the front of the kneecap is experienced when sitting with bent knees, squatting, jumping or using the stairs. Treatment includes pain relief with rest, ice, compression, and elevation. Swelling must be controlled. Progressive strengthening of the quadriceps is essential. Rarely, surgery is required to assist in realigning the kneecap. Anti-inflammatory medications, bracing, and physical therapy are often helpful.