RICE therapy

RICE therapy includes rest, ice, compression and elevation. This therapy is good initial therapy for many knee conditions.

Rest means resting and protection of sore or injured area of the knee. Rest is connected with stopping, changing or taking a break from any activities that may cause knee pain or soreness, or make it worse.

Ice is known as remedy which can reduce knee pain and swelling. In cases of knee pain or swelling you can apply an ice or just cold pack right on the knee to minimize or even prevent swelling. It is recommended to apply the coldness for 10 to 20 minutes three or more times a day. After 48 to 72 hours (2 to 3 days), if swelling is gone, it is recommended to apply the heat on the sore area of the knee. It should be mentioned, that the ice or the heat cannot be applied directly on the skin, because it can cause damages of skin or even tissues, therefore it is advisable to place a towel over the cold or heat pack before applying it on the skin.

Compression or wrapping of the sore or injured area of the knee, using elastic bandage or sleeve, can help to decrease pain and swelling. It is important to put tight bandage or sleeve, but it cannot be too tight, because it can restrict the blood flow, making the problem even worse, therefore, if the bandage or sleeve gets too tight, it has to be loosen. Signs that there is too much compression are numbness, tingling, increased pain, coolness or swelling below the bandage. It should be mentioned, that if you think that you need compression for longer than 48 to 72 hours, you have to talk to your doctor at first.

Elevation means that the sore or injured area of the knee has to be elevated, for example, on pillows anytime patient is lying down or sitting. Swelling and pain can be relieved by keeping the knee at or above the level of the heart.

Pain medicines

Pain relievers, which are available over-the-counter or by the prescription, such as acetaminophen, ibuprofen and naproxen can treat most knee pain.

Acetaminophen, also known as paracetamol, is a widely used over-the-counter medication which is used for pain relief and fever reduction. This remedy treats inflammatory pain and reduces all types of pain, starting with headaches and finishing with such severe pain as post-surgical and cancer pain.

Ibuprofen is a nonsteroidal anti-inflammatory drug which is used for pain relief, fever and inflammation reduction.

Naproxen is a non-selective cyclooxygenase (COX) inhibitor which is usually sold as the sodium salt. Naproxen is a nonsteroidal anti-inflammory drug of the propionic acid class which is commonly used for various pain relief and fever, swelling and stiffness reduction.

Physical therapy

Physical therapy includes an exercise program which strengthens the muscles which surround the knee, increasing knee’s stability, flexibility and mobility. Almost every physical therapy includes exercises which build the strength and stretch muscles. Strengthening exercises such as straight leg rises, hip abduction and quarter squats help to rebuild and tone the muscle. Stretching exercises such as hamstrings, quads and runner’s stretch help to improve the range of motion and flexibility. Strength and flexibility can be enhanced by single leg balance exercises too.

Physical therapy also includes passive modalities such as ice, heat and elevation which help to reduce discomfort and swelling. Sometimes the electrical stimulation is used as well.

Physical therapy always includes examination of feet to determine the necessity of orthotics or other corrective exercises.

Cortisone injections

Medical experience has shown that cortisone injections, aka steroid injections, into the knee can help reduce swelling, inflammation and pain. Cortisone is a hormone which is naturally produced by human body – normally produced by the adrenal gland in stress situations, but the effect of natural cortisone is short lived. Natural and synthetic cortisone are very similar, but the synthetic cortisone is enhanced to produce a longer term effect – its benefits may last from few days to six months. Cortisone injections are often combined with local anesthetic which provides instant pain relief, but the cortisone part provides longer term relief of swelling, inflammation and thus pain. Steroid injections such as cortisone injections are usually given when other treatments are not working. It should be mentioned that repeated knee injections may contribute to cartilage breakdown, therefore, doctors usually put a limit on the number of knee injections.

Hyaluronan injections

Hyaluronic acid is an important protein which is found in large amounts in the synovial fluid of joints. As medical researches has proved, injections of hyaluronan into the knee may reduce the pain from arthritis and delay the necessity of knee surgery. They also lessen the inflammation and pain. Hyaluronan injections are known as joint lubricants as well, because they improve the cushioning and lubrication of the knee joint. Hyaluronic substances are injected into knee joints to supplement naturally occurring hyaluronic acid which acts as a lubricant and shock absorber, allowing joints to move smoothly over each other. Hyaluronan injections are given weekly for three or five weeks, depending on the product.

Knee surgery

Knee surgery may be done to correct a lot of different knee conditions, for example, surgery can remove an injured meniscus, replace of repair torn ligament, or fully replace a severely damaged knee joint. Knee surgery can be done with large incision (open) or small incision (arthroscopic). One of the most popular knee surgeries is knee replacement surgery. Knee surgery is usually done when patient has stiff and painful knee which makes it difficult to perform even simply activities and other treatments are no longer working. Patients of this knee surgery are usually people over the age 50 and who have severe osteoarthritis. Knee replacement surgery starts with general or spinal/epidural anesthesia and 8 to 12 inches long cut in the front of the knee. Then damaged parts of the knee joint are removed and the knee surface is shaped for holding a plastic or metal artificial knee joint. The artificial knee joint is attached with cement or other special material. When it is done the incision is stitched.

Arthroscopic surgery

Arthroscopic surgery or, in other words, arthroscopy is used for diagnosing and treating several knee joint problems, for example, torn meniscus, misaligned kneecap or damaged ligaments. Arthroscopic surgery starts with very small incision on the knee joint and it is performed by arthroscope (small tube which consists of a system of lenses, a small video camera and a light for viewing) which is inserted into the knee joint. This procedure allows to view the inside of the knee joint on a screen – it helps investigate a problem and, if necessary, correct it, using small instruments within the arthroscope. It should be mentioned, that arthroscopy has a shorter rehabilitation and recovery period than open knee surgery.

Arthrocentesis

Arthrocentesis, also known as joint fluid aspiration, is removal of joint fluid through a hollow needle which is inserted into the joint space. The purpose of this procedure is getting of joint fluid, so it can be tested in the laboratory, and removing of excess joint fluid, easing knee swelling, pressure and pain. Joint fluid aspiration is usually done before cortisone or hyaluronan injections as well. The aspirated joint fluid is called synovial fluid which is slippery and viscous, and is usually found not only in joints, but also in bursae. Synovial fluid in joints and bursae provides smooth movement and cushioning between bones.

ACL repair

ACL reconstruction is a surgery which is performed to replace damaged ACL (anterior cruciate ligament) which is one of the major ligaments in the knee. Unfortunately, a torn ACL cannot be sewn back together, therefore it is replaced with a piece of tendon from another part of patient’s leg or from a donor. ACL repair is performed through small incision around the knee joint, and the arthroscope is used to guide the placement of the ACL graft.