Anatomy of the Knee
The knee joint’s main function is to bend, straighten, and bear the weight of the body, along with the ankles and hips. The knee, more than just a simple hinged joint, however, also twists and rotates. In order to perform all of these actions and to support the entire body while doing so, the
knee relies on a number of structures including bones, ligaments, tendons, and cartilage.
The knee joint involves four bones.
The thighbone or femur comprises the top portion of the joint.
One of the bones in the lower leg (or calf area), the tibia, provides the bottom weight-bearing portion of the joint.
The kneecap or patella rides along the front of the femur.
The remaining bone in the calf, the fibula, is not involved in the weight-bearing portion of the knee joint but provides ligament attachments for stability.
Ligaments are dense fibrous bands that connect bones to each other.
The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide Front and back (anterior and posterior) and rotational stability to the knee.
The medial collateral ligament (MCL) and lateral collateral ligament (LCL) located along
the inner (medial) and outer (lateral) sides of the knee provide medial and lateral stability to
Tendons are fibrous bands similar to ligaments. Instead of connecting bones to other bones as ligaments do, tendons connect muscles to bones.
The two important tendons in the knee are (1) the quadriceps tendon connecting the quadriceps muscle, which lies on the front of the thigh, to the patella and (2) the patellar tendon connecting the patella to the tibia (technically, this is a ligament because it connects two bones).
The quadriceps and patellar tendons are sometimes called the extensor mechanism, and
together with the quadriceps muscle they facilitate leg extension (straightening).
Cartilaginous structures called menisci
The menisci’s primary job is to provide cushioning for the knee joint.
Bursae (one is a bursa) are fluid-filled sacs that help to cushion the knee. The knee contains 3 important groups of bursae:
The prepatellar bursae lie in front of the patella.
The Pes anserine bursae is located on the inner side of the knee about 2 inches below the joint.
The infrapatellar bursae are located underneath the patella.
Knee pain is the most common musculoskeletal complaint that brings people to their doctor. Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis,
gout and infections — also can cause knee pain. Many types of minor knee pain respond well to self-care measures. Physical therapy and knee
braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.
The location and severity of knee pain may vary, depending on the cause of the problem. Signs
and symptoms that sometimes accompany knee pain include:
Swelling and stiffness
Redness and warmth to the touch
Weakness or instability
Popping or crunching noises
Inability to fully straighten the knee
When to see a doctor
When you are deciding whether to call the doctor about your knee pain, a good rule of thumb exists for most long-term knee injuries. If your symptoms have not gone away after trying a week of PRICE
therapy and over-the-counter anti-inflammatory pain meds
Can’t bear weight on your knee or feel as if your knee is unstable (gives out)
Have marked knee swelling
Are unable to fully extend or flex your knee
See an obvious deformity in your leg or knee
Have a fever, in addition to redness, pain and swelling in your knee
Have severe knee pain that is associated with an injury
Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.
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. Some of
the more common knee injuries include:
ACL injury. An ACL injury is a tear of the anterior cruciate ligament. ACL are the most common type of knee injury, often resulting from a direct blow or a sudden change in direction or speed when running.
Posterior cruciate ligament injuries are uncommon and are generally caused by some sort of high-energy force to the knee Collateral Ligament Injury. Injury to the medial collateral ligament (MCL) often results from a direct blow to the outside of the knee, which causes pain on the inside of the knee. A blow to the inside of the knee may cause a lateral collateral ligament (LCL) injury, which causes pain to the outside of the knee.
Fractures. The bones of the knee, including the kneecap (patella), can be broken during motor vehicle collisions or falls.
The meniscus is formed of tough, rubbery cartilage and acts as a shock
absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it
Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Patellar tendonitis is most common in people who engage in sports or activities that require frequent running and jumping.
Some examples of mechanical problems that can cause knee pain include:
Iliotibial band syndrome.
Hip or foot pain In some cases, problems in the hip or foot can cause knee pain
Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee
Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is more common in people over the age of 50.
Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. In addition to pain, swelling, redness, and warmth over the kneecap may develop.
Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid.
Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. Septic arthritis often occurs with a fever, and there’s usually no trauma before the onset of pain.
Patellofemoral pain syndrome is a general term that refers to pain arising between the kneecap (patella) and the underlying thighbone (femur). It’s common in athletes; in young adults, especially those who have a slight maltracking of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
A number of factors can increase your risk of having knee problems, including:
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.
Lack of muscle flexibility or strength. A lack of strength and flexibility can increase the risk of knee injuries.
Certain sports or occupations. Some sports put greater stress on your knees than do
Previous injury. Having a previous knee injury makes it more likely that you’ll injure your knee again.
Knee Pain Diagnosis
The doctor will typically want to know the exact nature of the pain.
The doctor will be inspect the knee and press around the knee to see exactly where it is tender.
Depending on your particular history and exam, the doctor may suggest X-rays of the knee.
Rarely, the doctor may order a CT scan
Both X-rays and CT scans are excellent for diagnosing fractures. They both are also poor, however, at evaluating soft tissue structures of the knee, such as ligaments, tendons, and the menisci.
Magnetic resonance imaging (MRI) uses large magnets to create a 3-dimensional image of the knee.
In contrast to CT scans, MRIs do not image bones and fractures. However, they are excellent for evaluating ligaments and tendons.
Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.
Although it’s not always possible to prevent knee pain, the following suggestions may helpforestall injuries and joint deterioration:
Home Care for Knee Pain Some common home care techniques for knee pain that control inflammation and help to break the inflammatory cycle are protection, rest, ice, compression, and elevation (PRICE).
PROTECT the knee from further trauma. This can be done with knee padding or splinting.
REST the knee. Rest reduces the repetitive strain placed on the knee by activity.
ICE the knee. Icing the knee reduces swelling and can be used for both acute and chronic knee injuries, icing the knee 2 to 3 times a day for 20-30 minutes each time.
COMPRESS the knee with a knee brace or wrap. Compression reduces swelling.
ELEVATE the knee. Elevation also helps reduce swelling. Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.
Strengthen and stretch your quadriceps and hamstrings muscles
Keep extra pounds off. Maintain a healthy weight; it’s one of the best things you can do for your knees. Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning.
Practice perfectly. Make sure the technique and movement patterns you use in your sports or activity are the best they can be. Lessons from a professional can be very helpful. Get strong, stay flexible. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees.
Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise.
Medicine: Commonly used pain relievers, such as nonsteroidal anti-
inflammatory drugs (NSAIDs)
An example of a knee condition that may warrant a cortisone injection is knee
osteoarthritis. Cortisone is a powerful medication that can have side effects, therefore injections should be used sparingly.
Depending on your diagnosis, other medications, like a disease-modifying anti-rheumatic drug (DMARD) to treat rheumatoid arthritis, antibiotics to treat an infected knee joint, an oral steroid to treat a gout flare, may be warranted.
Surgery is generally reserved for specific diagnoses, such as:
Certain types of ligament injuries or knee dislocations
Certain knee fractures
Certain infected knee joints that require surgical drainage
Some advanced cases of knee osteoarthritis
Ayurveda describes knee pain or swelling of knee joint as ‘Sandhivata’ in which the vitiated
vata afflicts the joints which closely resembles the medical condition of Osteoarthritis.
Injury, ama dosha, excessive fasting, riding or standing aggravates vata dosha which leads
KNEE PAIN AYURVEDIC TREATMENT
Ayurveda describes a comprehensive approach towards managing chronic knee pain by practising a combination of corrective Ahar (diet), Vihar (exercise) and Aushadhi (Medicines).
DIET RECOMMENDATIONS (AAHAR)
Pulses: Black gram, green gram
Vegetables & spices: Onion, garlic, sesame seeds, ginger, radish, lady finger, pumpkin
Fruits: pomegranate, mango, grapes
LIFESTYLE CHANGES (VIHAR)
Ayurveda recommends regular, slow and gentle exercises with adequate rest to knee
joints. Regular Pranayama and Yoga Nidra is also recommended.
Avoid prolonged walking, standing, kneeling and squatting and crossed leg sitting.
Yoga asanas: Makarasana, Pavanamuktasana, Dhanurasana, Vakrasana
Home Remedies for Knee Pain
The Indian kitchen houses a variety of spices and herbs which can reduce knee pain. By taking these eatables in appropriate proportions, patients can make the knees stronger and more flexible.
Fenugreek Paste: Roast and crush a handful of fenugreek seeds. Take 2 tsp of this powder and add it to lukewarm water for making a thick paste. Apply on the affected area and remove after drying.
Sesame or Mustard Oil Massage: Fry 2 cloves of garlic in 2 tbsp of sesame oil or mustard oil until they turn black. Remove the vessel from heat and strain the oil. Once the oil has cooled to a comfortably warm temperature, massage it into the skin around affected area. Leave it on for about three hours before washing it off. Do this twice daily until you see improvement.
Sesame Seed Bites: Soak handful of sesame seeds in water overnight. Chew the seeds and drink the water early in the morning regularly. This remedy will reduce the frequency of joint pains.
Turmeric: A pinch of turmeric consumed with water and honey on a daily basis makes it an excellent remedy for knee pain. Or also take 1 tablespoon of turmeric glass of warm milk is a great idea and consuming on a daily basis increases your immunity system and also helps in easing the pain and swelling associated with knee pain.
Knee pain is also associated with people having lower levels of magnesium, using Epsom salt. It is helpful for reducing the inflammation and in using detoxification; the idea is to reduce the knee pain by soaking it in lukewarm Epsom salts for some time.
Moreover, some Ayurvedic measures or procedures work wonders to relieve the pain and
provide high level of comfort. These procedures include:
Hot & Cold Compress: This is an excellent Ayurvedic joint pain treatment with alternate hot and cold compression. The heat compression works to reduce pain and the cold compression reduces the inflammation of the joint.
Abhyangam: The full body massage technique using medicated herbal oil is one way to increase blood circulation within the body and in turn pacify vata. This further works to lubricate the joints and empowers easy movement of the knee.
Kizhi: The procedure using various herbs, sand, and rice tied all together in muslin cloth to make small herbal boluses (potlis). It works to reduce pain and reduce inflammation of the joints.
Janu basti: Janu Basti involves pouring of specially prepared warm herbal oil over the knee. The oil is retained inside a well created using black gram paste or whole wheat flour. The herbal oil used in the procedure restores the lubricating fluid in the joint and maintains integrity of the structures involved in the joint. It also improves the mobility of the knee joints.
Upnaha: The therapy using herbal paste applied on the affected knee area works to initiate healing, strengthen muscles, and improves blood circulation. Thin in turn reduces pain and inflammation at the applied area.
Sneha Basti: Sneha Basti involves enema using medicated oil. It helps in
colonic Detoxification as Colon is the main seat of Vata according to Ayurveda.
Ayurvedic Medicine (Aushdhi) for Knee Pain:
Since knee pain can occur due to many reasons like arthritis, wearing of the patella, and inflammation of the cartilage and bone, different kinds of treatment strategies are suggested to its patients. Thus, it is important to identify the root cause before beginning with an Ayurvedic treatment.
Maharasnadi Kashayam Tablets 2 tablets twice daily after meal
Dhanwantara Kashayam Tablets 1 tablet before food on empty stomach once to
twice a day
Trayodasang Guggulu Tablets 1-2 tablets twice daily after meal
Rsnadi Guggulu Tablets 1-2 tablets twice daily
Mahayograj Guggulu Tablets 2 tablets twice daily
Vatari Rasa Tablets 1 tablet twice daily
Vatganjakush Rasa Tablets 1 tablet twice daily
Bruhat Vata Chintamani Rasa 1 tablet twice daily
Rasnasaptak Kwath 25 ml twice daily with equal amount of water
Rasnaerandadi Kwath 25 ml twice daily with equal amount of water
Panchkol Churna 3-5 gm twice daily
Aswagandha Churna 5 gm at bed time
Maha Narayan Tail for L/A
Measures to Prevent Knee Pain
Increase Vitamin D Foods: Salmon, sardines, shrimp, egg yolk, fortified milk and yogurt, cereals, orange juice are good sources of Vitamin D.
High Supplementary Nutrient Diet: Knee pain patients must include almonds, apples, basil, spinach, fortified breakfast cereal, baked beans and carrots in their regular diet.
Enjoy Meals with Ghee: Ghee and oils in moderate amounts are necessary in daily diet, as they keep the normal joints properly lubricated and also provide lubrication to the dried- up joints.