UNBENDING KNEES

"Oh, Doc! My wretched knees refuse to bend. 

I can't sit down, and I can barely stand."  

"Despair not, sir, ‘cause I'll save you from your pain, 

So you would walk and dance with joy again!” 

A person may sometimes be commended for being unbending and unyielding; with knees, this is definitely not the case.  

Various knee disorders  

Nina, 56, started having knee problems in earnest after she turned fifty. She is on the plump side, that is, her weight is twice the norm for her height. “I have two Ninas,” she jokes, “and I wish one of them got off my back!” She gained the extra weight right after giving birth to her second child at 28. Her knees were badly exposed to cold one winter in a Moscow suburb, when “it was too cold for buses to run” and she had to walk to work a mile and a half every day. Since then, her knees have never bent properly, occasionally swelling and aching “like hell”. After Nina turned fifty, they stopped “working” altogether. 

Valera, 28, has only one “unbending” knee that he injured about 10 years ago in a bad tumble during a soccer game. Something cracked in his knee, something got stretched, and there was some swelling. He wore a knee bandage and used a walking stick for a week, and the problem gradually went away.  Nevertheless, now and then, the injured joint freezes and refuses to bend.  

Zinoviy, at 87, is probably the most curious example from my practice.  Indeed, what can you expect from your knees when you are approaching 90! That was the spectacular blunder I made when I saw his name on my appointment list. He walked into my office elegantly, limping ever so slightly. It turned out he had suffered a minor injury playing tennis with his granddaughter. Otherwise, his knees, spine, and everything else showed few of the so-called “age-related” changes.  

Causes  

What can make your knees stiff and painful? What is going on? What should be done? Let us try to answer these questions.  

Contrary to the widespread opinion that knee surgery is risky and troublesome, it happens to be the only option and brings great benefits to many patients.  

Knee disorders, as you can imagine, can start tormenting you for many reasons. One of them is chronic arthritis complicated by the inflammation-induced deformation of the knee joints (the so-called arthritis deformans). This condition requires aggressive pharmaceutical treatment, injections into the joints, and, probably, an eventual joint replacement. Contrary to the widespread opinion that such surgery is risky and troublesome, it happens to be the only option and brings great benefits to many patients like Nina.  

The knee is the largest joint in the human body. Its upper and lower bones are separated by two discs (menisci).  

As for the young soccer player, he suffered an injury to his ligament apparatus, most probably to one of the menisci (thin cartilage layers that absorb shocks during walking, running, or jumping). An MRI test is needed to confirm the diagnosis. It provides a layer-by-layer image of the joint that reveals cracks or ruptures in the menisci. Most often, an injured meniscus is partially or completely removed by an arthroscopic operation (without cutting open the joint). With the technology available nowadays, these operations are both safe and efficient.    

Finally, our elderly tennis lover has a sprained knee ligament and muscle spasms. His case is the most common, and everybody should know how to provide first aid to themselves or someone else in a case like that. An injury or a sprain causes pain. The body responds with a two-barreled reaction: muscle spasms plus swelling to immobilize the traumatized area and protect it from further injury.  

The rule of “three ‘I’s.”  

Help your body by providing artificial immobilization. Put a reasonably tight bandage on your knee to spare it from any strain. Have you ever seen how a dog nimbly trots on three good legs, barely touching the ground with the injured one?  That’s the wisdom of nature, guys; dogs are truly intelligent creatures! We call ourselves Homo sapiens yet often act contrary to nature and common sense – for example, by applying heat to an injured joint.  

If you suffer from inflammation, remember the rule of three “I’s”: Immobilization, Ice, Ibuprofen. 

Dear friends, your joint is already steaming hot! Pain, spasms, and swelling obstructthe blood supply and lead to inflammation (“flames”). External heat just intensifies this process. Break the vicious circle: apply an ice pack, raise your leg, stroke it gently from bottom to top, and you’ll instantly feel better! Remember the rule of three ‘I’s: Immobilization, Ic,e, and that same Ibuprofen (Motrin, Advil) we have discussed in earlier chapters, an excellent means of further soothing inflammation and restoring circulation.  

Everything that hurts the joint is certainly bad, but a lack of movement (caused by pain) is even worse because it may lead to more spasms and a complete degeneration of muscles and joints. What do we do? Well, pursue “the golden rule” – move your joint while lying on your back or sitting. Water exercise. Use smooth and slow circular movements, use gentle turns, and avoid any sudden jostling of the sore joint.  

How the doctor can help 

First of all, the doctor will identify the precise nature of your trouble and determine the extent of your joint degeneration, ligament injury, inflammation, and/or muscle spasms. If needed, he will use X-ray or MRI tests.  At the very first visit, the doctor will try to reduce the swelling and restore the joint’s functionality. He will use special manipulations and deep muscle massage to eliminate spasms and “unblock” the sick joint. Sometimes this may lead to a gentle “crack” and an immediate recovery from both the swelling and the inflexibility, a mind-boggling result indeed! This, however, seldom happens at the very first visit. Inflammation, spasms, and swelling that have accumulated over the years sometimes form such a rigid framework around the knee that it takes several sessions to achieve a breakthrough.  

Targeted injections of a special mix of analgesics and anti-inflammatory drugs into trigger points are also an excellent remedy. 

The process of "liberation" may be accelerated by anti-inflammatory creams, as well as by a customized exercise regimen for stretching and strengthening the specific spasmed muscles. And -- when the more effective and harmless cures for inflammation and pain are prescribed -- I am all for those as well. Targeted injections of a special mix of analgesics and anti-inflammatory drug solutions into the trigger points are also a superb remedy. Acupuncture also impacts these same points to reduce spasms and inflammation, accelerate circulation and healing; injections use a similar mechanism, but they are by far more powerful.  

What about intra-articular steroid injections? Steroid hormones are the strongest enemies of inflammation and swelling there are.  In high concentrations, most unfortunately, they tend to “overdry” joint tissues and cause atrophy, necrosis, functional instability, and, ultimately, fast degeneration.  This is why frequent injections of high-concentration steroids should be generally used only as an exception.  As for those patients who need surgery, they need to consult an experienced orthopedic surgeon.  

So, dear friends, do not despair if your knees become “unbending”.  A manual therapist can always talk them into submission so they become flexible again!