Knee pain from walking - and how to treat it
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Here we speak to leading sports physio Amanda Robertson who identifies three of the most common knee injuries suffered by walkers and gives advice on symptoms, causes, preventions and treatments for each type of pain.
Amanda says: "Knee pain can be 'acute' where direct trauma has happened, such as a fall which sprains a ligament or bashes the knee, or the pain can be caused by chronic problems from unknown causes where the pain often comes and goes (usually with activity) and the cause can't be related to one incident.
"As there are so many different types of knee pain and injuries this article will only cover basic injuries. It is prudent to seek medical advice through a GP, chartered physiotherapist or a sports medicine specialist, especially if you're suffering from knee pain over a prolonged period."
Injury 1: Meniscal / cartilage problems
Symptoms: These vary a great deal, however, there is usually swelling that can come and go. Pain is often sharp, inside the knee joint and a residual ache can be present. Some clicking or locking may occur. Doing a deep squat will be painful and most people will avoid it!
Causes: Often the pain will have started after a particular incident where trauma may have happened, usually where the knee twisted or sheared. This can also happen over time too, where it is more degenerative.
Prevention: Unfortunately there is little to be done to prevent this from happening. Just use common sense on the hill and general injury prevention tactics.
Treatment: Though worth a try, conservative treatments are often not effective. If there is cartilage damage then an orthopaedic consultation is necessary and treatment may end up in surgery. A knee arthroscopy will be performed to remove the offending piece of cartilage and clean up the inside joint. This is a day surgery and return to activity is quick, though post-surgery physiotherapy will be required.
Injury 2: Medial ligament damage
Symptoms: Pain at the medial aspect (inside) of the knee together with a sense of instability and swelling in the knee joint.
Causes: This is a traumatic injury, usually cause by a fall or stumble that twists the knee. You may feel a 'crack' or 'something go'. Pain will be local to the area and the knee will swell quickly.
Prevention: Common sense on the hill is imperative to avoid a traumatic injury like this. Fatigue is often a key factor in stumbles and falls, so understand your limitations and those of your companions in order to avoid this situation.
Treatment: Getting off the hill is a priority. If the sprain isn't too severe weight bearing will be possible with support - either from another walker or trekking poles. Support over the knee is a good idea, but watch it isn't too tight, as the knee will swell. Descending the hill will be difficult so a rescue might be necessary. Once off the hill RICE (Rest, Ice, Compression bandage and Elevation) of the limb is key. It's worth visiting A&E for assessment to make sure no other damage has been done. Seek advice from a chartered physiotherapist for proper rehabilitation to the knee afterwards. This will speed recovery and reduce the pain. Rehab on this type of injury can take anything between six weeks six months, depending on the severity of damage.
Injury 3: Anterior knee pain
Symptoms: A nagging ache at the anterior medial (front) aspect of the kneecap. The pain tends to be present during activity and worsens going up and down hills or steps. There is a lack of tendency to squat or deep knee bend. No swelling or bruising is present and there is no known incident where this happened. Often the pain has appeared over time.
Causes: Can be related to a muscle imbalance in the quadricep muscles, where the kneecap isn't functioning properly and grinding on the bone, or due to issues associated with biomechanics.
Prevention - Keep your knees strong and flexible. Good footwear is imperative. Changes in arch support can be a problem if you aren't used to them. Watch your workload and make sure you don't increase your activity levels too dramatically.
Treatment: Advice from a chartered physiotherapist is very useful. Often they'll be able to calm the area down and teach some exercises to help the kneecap move more effectively. They'll also be able to assess if there are any biomechanical issues and refer you onto the appropriate people. Shoe insoles may be required to correct any foot problems that are causing the knee issues.
More common walking injuries
Amanda is a former international Alpine skier who has worked as a physio with various national teams. She started her career as the physio at Glenmore Lodge (Aviemore) following which got her place as Team GB physio for the Great Britain Olympic Biathlon Team.
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