Knee injuries - “It happens with a twist”
Knee injuries - “It happens with a twist”
Tommy Conway, Director and Lead Physiotherapist at OneHEALTH
Have you started to get a stiff knee all of a sudden? Or have you twisted suddenly and now your knee hasn't been right since?. It’s the age old story, we all know someone with a bad knee. The pain and stiffness Starts slowly and eventually you see they have a full limp. The knee can be of some mythical importance, most think it’s an unsolvable problem. The reason for this is history. How many times have you heard about a great sports person that had to retire because they had “Bad knees”. The story hasn’t moved on but science has. If you take a knee surgery now, you can barely see the stitches post op whilst 20 years ago the scar would be the length of your knee cap. The knowledge about how the joint works has also improved so now more than ever we have the potential to help your sore and stiff knee.
The biggest problem with knees is most people leave them on the long finger and hope they will get better overtime, but they don't. So,Do you feel a pain “deep inside your knee”? Does it feel “Right on the bone”? Does your knee pinch when you bend it, or does it get very stiff and catch when you are trying to straighten it?. Are you struggling to get going in the morning, sore walking or sore getting from a sit to stand. Maybe you are at the top of the stairs fearing that your knee will “give way” on the way down. Slowly making your way down step by step, holding onto the banister for dear life whilst avoiding using the “bad knee”. These are all signs of possible knee meniscus damage, but also can be signs of you nearing meniscus damage. The warning shots AGAIN are firing, let’s discuss what is the elusive knee meniscus.
What is a knee meniscus?
There are two menisci in the knee joint. Each meniscus is a roughly ‘moon-shaped’ pad that lies beside each other on the top surface of the tibia (shin bone). The Meniscus sits on cartilage and the cartilage sits on the bone. Think of the knee as a sponge cake with 5 layers. The base layer is the sponge, your shin bone. Then comes the jam, your knee cartilage that sits on top of the shin bone. In the middle is the cream, your meniscus. The next layer is the jam again, more articular cartilage that props up the final layer of sponge, your major leg bone. So now you can visualise what way the knee looks like, let's talk about the function of the middle layer, the meniscus.
The menisci have several functions:
- Shock absorber within the knee
- Provide nutrition for articular cartilage
- Reduce friction during movement
- Increase stability & keeps the joint balanced
- Limit’s extreme bending and straightening
How is the meniscus damaged?
There are two ways your meniscus can get damaged. It can happen through consistent wear and tear of the specific part of the joint or a sudden twisting motion. It commonly occurs acutely when the foot is planted on the ground and the knee is twisted at the same time, intentionally or maybe due to a tackle in sport. This injury does not have to occur at speed as the mechanism of twisting while the joint is weight bearing can cause the meniscus to get trapped between the bones and pinched. If there is not enough space left in the joint a meniscus tear may result. After this sudden episode the knee will be sore and that’s when most people will book in to see me. So this type of meniscus injury gets great results as the person knows that in that incident of twisting the knee got injured. But what if you're someone that doesn't have an incident but still has pain. What if you are someone that doesn't want to have “ “bad knees”? How do you stop the meniscus being damaged?. The truth is, it’s all about the space.
What do I need to do to get better?
Take the cake example I have used above. Let's split the cake into four quadrants, Slice the cake down the middle (vertical) and then slice it across(Horizontal). This will give you four quadrants. Two on the left, Left front and left back. Two on the right, right front and right back. When I put pressure on the top of the cake I will make the space narrower for the meniscus in the middle. The meniscus will have less space to move, it can get pinched. If I put pressure on the right hand side of the cake, I will narrow the space for the right meniscus, but creates more space for the left meniscus. If I put pressure on the right back side of the cake, I will make the space narrower for the back right meniscus. When this happens, your knee joint will run out of space and pinch, that’s why over a period of years the pinch will get more severe and so will the pain and ache. This pinch will happen with a twisting motion and what most people don’t understand about the knee is “IT’S NOT A HINGE JOINT”. It’s a joint just like the elbow, It has to have the ability to twist and turn. The ability to bend the elbow and straighten requires the bones to rotate, this also happens at the knee. Why have so many great Irish sports players careers ended with “Bad knees” is because the sports of hurling and football are all about twisting and turning. If your knee is unable to twist you won’t be able to play pain free and that’s why you will have to retire. You have a twisted knee or as I like to call it “Stuck in a twist”. Just like the elbow, if you lose the ability to bend and straighten the joint I would be worried, It’s a warning shot. The reason you are in pain is because you can’t sit on your heels or you can’t fully straighten your knee. You do not have enough space for the meniscus to move, over time it will pinch and cause damage to the joint. You need to get the full movement back in your knee to get pain free, that is the first step. Even if you are someone who is after having a clean out of the knee, your knee is still “stuck in a twist”. What happened in the surgery is they gave you more space to move, that’s all. They did not resolve the mechanism that caused your knee injury, the twist is still there. In summary you need to understand why you're losing movement, you need to understand why you are now in pain and maybe you need to understand why you are still in pain. Most don’t answer the why but If you can answer the why? Then knee rehabilitation can be a piece of cake. I hope this helps.
