Transcription:
I Have Knee Pain, Do I Need To Worry?

Melanie Cole (Host):  At some point in your life, you’ve probably experienced knee pain. We all have. But how do you know when that pain is something that you should be worried about or see a doctor about? My guest today is Dr. Jamie Peters. He’s board certified family medicine and sports medicine physician with Allina Health. Welcome to the show, Dr. Peters. How common are knee pain and/or knee injuries?

Dr. Jamie Peters (Guest):  Well, knee pain is very common, something that I see every day in the clinic. And really, the cause varies you know with the mechanism or how people actually injure their knee, and also, it varies with age group.

Melanie:  So what generally happens as we age to our knees? They’re such an important joint, and they do so much for us. What happens as we age?

Dr. Peters:  Well, the one of the processes that occurs to knee is the lining of the knee can actually start to wear over time. And as people get into their fourth and fifth, sixth decade of life, you can actually get thinning of the cartilage. And that can vary from individual to individual. Some people have family predispositions or injured their knee in football earlier in life, and for those people, they may have that particular kind of problem occur earlier.

Melanie:  What parts of the knee, Dr. Peters, are most commonly injured?

Dr. Peters:  Well, I would say, again, it depends on the decade of life. I see a lot of teenagers with knee pain, and for those individuals, it often ends up being discomfort from the underside of the kneecap itself, where there’s some very delicate cartilage where it glides on the knee on the track. So that’s fairly common in younger individuals and can be addressed in a number of different ways depending on the cause. But often it’s something we can either have people do exercises or see a physical therapist, and that can be very helpful. As people age, certainly injury, twisting, turning, that can injure ligaments. So those are the structures that hold the knee from each side and in the middle. ACL is one of those ligaments that can be injured, and when that’s completely torn obviously that’s something that we would consider sending to a surgical colleague to repair. And then as people get older, as I mentioned already, wearing down of the lining of the knee, or it’s also called osteoarthritis or degenerative arthritis. It has different names. That tends to be more common in the older individual, the older athlete who’s trying to stay active.

Melanie:  Is there anything we can do to prevent or at least delay the onset of that natural wear and tear?

Dr. Peters:  Absolutely. And this is one of the really important points I think to get across to your listeners is that cartilages like to be used. So anywhere in the body, whether it’s a shoulder or ankles or elbows, and especially the knees, a healthy use of cartilage does keep it healthier than being more sedentary. At the same time, cartilage doesn’t like to be abused, so finding that sweet spot using the knee. Even if someone has arthritis already developed in the knee, regular use is important. The other part is appropriate use of the knee and the body. So as someone does develop some issues with wearing down or arthritis on the knee, having appropriate use means that you are keeping your whole body stronger. And a lot of people are familiar with the term “core strength,” and that’s strength around the glutes or the butt muscles and strength throughout the abdominal muscles. Keeping those stronger, doing various -- not real high impact but medium or lower impact activities and then cross training so that all those muscles around the mid part of your body stays strong, that can actually help the knee have less stress on the knee over time and can help people maintain their knee health and have less pain and can be more active.

Melanie:  And Dr. Peters, if people do experience knee pain, do you recommend ice? Do you recommend rest, stretching? Are things like lunges bad for the knees if you’re experiencing pain? Speak about a little bit about pain management for us.

Dr. Peters:  Sure. There’s different scenarios. So one scenario is someone’s out there, they’re doing a weekend warrior thing, they twist, they turn, they have a tweak in their knee or basically a sprained knee, that’s something you don’t need to go to the emergency room or you don’t need to -- as long as you can still weight bear, it may be a little uncomfortable, maybe some slight swelling, that’s something where, as you say, ice can be very helpful. And when we recommend ice, we usually recommend going with 50 minute duration, bag of frozen peas or a soft ice pack works just great, and repeating that every several hours. That’s something that you can watch that. Hopefully it improves in the next day or two. And certainly by three or four days, knee should be feeling good. Now, if it’s not, or if someone can’t actually weight bear on the knee after an injury like that or if the knee gets very swollen, those are indications that you need to seek some additional evaluation. That could be from someone like me, a sports med doc, or your primary care doctor as long as the primary care doctor is skilled and experienced in dealing with this kind of problem.

Melanie:  When does a cortisone shot come into play with knees?

Dr. Peters:  Well that gets more to the -- I just mentioned the injury type knee problem. But when you’re starting to get into that pattern where that knee cartilage is worn down, that’s actually something that can be seen on a regular x-ray. Usually weight bearing x-ray you can see the thinning of the lining of the cartilage. As that begins to wear down, there’s things that we can do to help. And I’ve already mentioned the core strengthening, which is really important, the regular use of a lower medium impact. So biking tends to be very helpful. But if these things aren’t enough and the pain is persistent, we have different kinds of injections that we can actually put medicine in the knee and help the knee feel better, allow people to stay more active. And one of the most common types of injection is use of steroids. So that tends to be relatively inexpensive as a medication, and it can be very helpful and last for four months to keep the knee swelling down and the knee -- you can be more active. When that is less effective, then we start to think about some of the other medications such as -- it’s called [visco] supplementation, or people know it as ground up [rooster cone] medicine there’s different names for them. Now it’s more commonly synthetic ground up -- well, it’s just like ground up [rooster cone] material. But that can also every effective for a period of time. It doesn’t last forever. And that does tend to be much more expensive, which is why we usually offer going with the steroid as a first step when we start to think about injections to help people be more comfortable with their knee and use it in healthier ways.

Melanie:  And what about bracing? The weekend warriors we were discussing or teenagers that’s been experiencing some knee pain has some weakness, does bracing contribute to that weakness and take the pressure off the knee, or does it help keep that knee secure?

Dr. Peters:  Well, my answer would have to be it depends. So if there is a knee sprain, which means that one of the ligaments was partially torn, then bracing to help prevent -- like a hinge brace, so something that’s stiffer, not just the neoprene. That can be helpful as people are getting back into sport. So I think that’s helpful. I mentioned that kneecap kind of pain I see with younger individuals, sometimes you can get a knee sleeve that actually can help guide the kneecap a little bit, and that can decrease pain and help people rehabilitate through kneecap discomfort. And then on the other end of the spectrum, when someone has wearing down on the inside or outside part of the knee compartment, we actually have some very nice bracing that’s called un-loader bracing, and that can help individuals with arthritis of the knee help keep the pressures away from the painful compartment, and that would be the inside or outside part of the knee and allow them to be active with less discomfort. So different kinds of braces for different kind of problems.

Melanie:  And how important are good shoes in helping our knees to stay stable, whether you are a runner or a walker or just your basic weekend warrior? How important is a good pair of shoes for that stable base?

Dr. Peters:  Melanie, that brings up a really good point. I see this all the time. So I see a lot of runners, a lot of marathon runners, and depending on their foot structure, that, as you just alluded to, that can cause discomfort and actually significant problems on the knees. So if someone has what we call hyperpronation, where their foot -- usually they have flat feet, and when they run, their foot goes way to the inside, that can then cause vibration back in the knee. And if you’re running long distances or even medium distances, that can create a problem for the knee. So having someone who has proper shoe wear that’s proper for their feet, appropriate arch support -- a lot of those can be over the counter now that they make very good over the counter shoe inserts or supports, that can be very helpful in alleviating that kind of pain. Someone with knee problems who’s wearing -- and this is something I don’t know if you personally are familiar with it, but people that sometimes wear high heels and they are always on high heels because they work in that kind of environment, if they had a knee problem, that can lead to problems both with the feet and in the knees. So we certainly advise sometimes trying to find something that’s still fashion reasonable but may not be so unhealthy for the feet or the knees. So, very good point. I’m glad you brought that up.

Melanie:  And in just the last minute, Dr. Peters, if you would, give your best advice for people suffering from knee pain or have knee injuries in preventing and keeping good strong knee joints.

Dr. Peters:  Well, I think using some [phrases] sometimes is helpful, and I actually type those out for patients and hand it to them as part of their summary of the visit. But the things I mentioned are use but don’t abuse. So listen to your body is number two, so use but don’t use abuse, listen to your body. If you’re getting persistent swelling, it’s getting worse, you need to get it evaluated before it gets worse so we can do some treatment and prevention. So those are probably the key things. And I think as part of listening to the body, if you are a runner and you are having persistent pain or swelling, a lot of these things, there are answers, and there’s great answers that can actually help you stay active. And in the end, in the bottom line is we want all of our patients to stay active over a lifetime that does create health over time. So there are usually answers, but sometimes it takes a professional opinion to get the right information so you can take care of your knees over time.

Melanie:  Thank you so much. You’re listening to the Well Cast with Allina Health. And for more information, you can get to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.