Knee Pains

Why we get so much knee pains?

There have been an ever increasing incidence of knee joint pains, osteoarthritis and knee joint replacement surgeries in the last two decades. Historically Indians are a hard working population and our forefathers never had such big issue with their knees as present generation have. Ever wonder, what has brought this change? Why are we put down to the knees by our knees, itself! 


Human knee joints are indeed a complex joint that is made up of four bones, two discs, four major ligaments, cartilage covering the bone ends & over 15 muscles and tendons crossing the knee joint. Humans are the only species that are blessed to stand and walk upright; thanks to our knee joints and other changes in our body during evolution. We can run, dance, play, work and do lots of other activities that are unique to humans. But all these unique activities are possible due to complex but excellent structure of the knee joint that is gifted to humans by nature. Unfortunately, present generation has abused this marvellous gift instead of making a good use of it. The knee abuse and the knee neglect is the root cause of increased incidences of knee joint pains in the present generation.


There are various reasons that can damage our knee joints; on some reasons we don't have any control, some requires preventive steps from us and other reasons require timely treatment to stop progression. These reasons are listed below.


1. Aging

With increasing age, the wear and tear increases. As we grow old, our body also does. Some changes develop in the knee joints also; and practicality speaking we don't have any control on age. However with increasing age, we should take more care of our knee joints. One should realise that an ageing joint is not only ageing but is also amenable to even minor injuries. Aging knee joint requires special care and some sort of maintenance therapy that can be in the form of mild physiotherapy or rehabilitation. A regular yearly visit to the doctor and checking health of the knee joints, is not a bad idea. This will allow us to know if something is brewing up inside and we will be able to take care of the knees in time. 


2. Lifestyle

Modern lifestyle is the biggest killer of the knee joints. India has fast adopted western lifestyle but selectively. We adopted all the luxuries but left the physical work out that westerners do regularly. Long back, we also stopped the hard work that our ancestors used to do. In total, we selected the best of two worlds and that has resulted in ever increasing obesity and resultant knee joint damage at an early age.


3. Competitive World

The high level of competition in India and extra-long hours of working put undue stresses on our body. We just forget to take care of our body in the zeal of achieving better than others, but end up losing ourselves in that zeal. The knees take the biggest burnt since we sit for long hours in an odd posture in front of computer or in meeting and then run around to meet the targets with an overweight body; both puts extra load on the knee joints. 


4. Improper Training

Unguided hard-work or training is again a culprit. Many players and professionals practice their discipline without a proper coach or a guide. Sometimes the coach or the guide himself is not properly trained or qualified. Playing or working under half trained guide or without a guide puts our knees at a great risk. A well trained coach is always aware what type of body movements can lead to what type of injury and what to do in case of any injury to the knee, on field and after the field. Same is the scenario for well trained guides in different professions who have good knowledge of protective gears and ways to avoid injuries. 


5. Stressful Working Environment

Working under stress is not good either. It does not allow your body to relax or breathe in between the hard work loads. Cooling down with a relaxed mind is necessary for self healing of small injuries. 


6. Injuries

Even though we take all the precautions, still injuries can happen. Sometimes the injuries are minor and sometimes major. But we must understand that all the injuries are different from each other. We should not compare Mr X’s injury with Mr Y’s injury and start treating ourselves. We shouldn’t also compare treatment and recovery of Mr X with Mr Y. Best thing is to go to the doctor who can only identify the injury and the best treatment for it. Nothing can replace a good detailed history that is revealed by patient to doctor and a good clinical examination done by patient. As there are four bones, four major ligaments, two discs and a whole cartilage covering in the knee joint; it is important to identify the exact tissue that is injured. X-rays are good to diagnose only bony injuries and not soft tissue injuries. Ligaments, discs and cartilage require a good quality MRI for proper diagnosis. Family physicians and fracture surgeons are generally not trained to diagnose soft tissue injuries like ligament injuries, cartilage injuries or disc (meniscus) injuries. An orthopaedic surgeon with special interest in knee injuries, an arthroscopy surgeon or a sports surgeon are the doctors who are trained for diagnosis of such injuries.


7. Limb Alignment

The relationship between thigh bone and leg bone keep on changing from birth till old age. Generally, a child has some amount of bow legs when he is born and gradually these bowing decreased and legs become straight. Throughout the adolescence till end of the middle age, legs remain straight and then again some bowing starts. This is a usual physiological pattern. However some has different bony configuration like knock knees, excessive bow legs or deformities in the knees not consistent with their age. Such abnormal bone relation puts unequal distribution of forces inside the knee joint and resultant early wear and tear. Such deformities must be brought into notice of an orthopaedic surgeon. It may not require anything but just the observation or sometimes it may require some sort of correction. The relation between knee cap (patella) and the thigh bone (femur) is equally important.


8. Pathological Diseases

There are some diseases on which humans have no control, but these diseases can damage the knee joint e.g. rheumatoid arthritis, gout, pigmented villonodular synovitis etc. One must identify such diseases and start and early treatment to prevent the knee joints. Enough precautions and exercises should also be done to keep knees strong and fit. The problem starts when we decide not to follow the medical advice, since modern medicine doesn’t have guaranteed cure. We start following other methods that too have no guarantee. While modern medicine is aware of its limitations there alternative means is not; and that can cause uncontrolled flare up of the existing disease. 


While reason no. 1 is not under control, reasons no 2-5 are very much under control. However all these reasons from 1-5 require some sort of preventive steps from our side. Reasons no 6- 8 can occur to anyone and are difficult to predict or prevent. However these reasons require definitive treatment under proper guidance.  


A combination of awareness, prevention and extra care in timely treatment can help knee joints getting worn out before time. The knees are for standing up and not for kneeing down. We must do our best to save the knee joints, a greatest gift to mankind by nature.


Dr Deepak Goyal

Arthroscopy, Cartilage & Sports Knee Surgeon

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