Knee Pain Prevention: Tips and Strategies Recommended by Singaporean Specialists

The pain may occur in people with a recent or past injury. Minor injuries to the ligaments of the knee, which can cause pain and are often overlooked, are a common result from over-twisting or pressure to the knees. Torn ligaments or cartilage can be another cause of pain and are a common injury for those who participate in sports. These injuries can vary in severity and may require surgical repair. Dislocated kneecaps are a common injury in young girls, active people, and older adults. This occurs when the thighbone and the shin bone no longer stay in place. This can cause swelling and pain and may lead to a feeling that the knee gives out. A visit to a knee pain doctor Singapore can help determine the severity of this injury.
Defined as an aching around and in the knee joint, knee pain can be caused by a number of things. The pain can manifest itself in different ways. It can be dull and aching or sharp and intense. It may start gradually and become more frequent, or it can occur suddenly after an injury. For most people, mild knee pain can be relieved by not participating in activities that aggravate the pain and by simple medical home treatment. This can include staying off your feet and applying ice to reduce swelling. More intense pain may require a visit to a doctor and specific treatment.
Knee pain is a common problem that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions including arthritis, gout, and infections also can cause knee pain. Some knee pain is a result of restricted muscles around the knee and hip. In some cases, home remedies can make the pain worse. But whatever the cause, there are often steps that can be taken to help alleviate the pain.
Definition and Causes of Knee Pain
Damage to the frontal cruciate ligament, one among the four ligaments within the knee, often referred to as the ACL, is one among the foremost common injuries. Another common injury is to the tendons. Many tendon injuries in the knee are a results of the tendon being overstretched, the foremost likely way of doing this is often by a fall while skiing or running into an object that planted the foot. Tendons also can be torn or cut. An example of tendon damage is jumper’s knee, or tendonitis. This is an irritation or inflammation of the tendon and is typically due to overuse. A torn meniscus also goes hand in hand with knee pain, and there are many possible causes for this injury. A sudden twist while bearing weight on the knee is perhaps the commonest thanks to tear a meniscus. The chance for a torn meniscus increases with age thanks to the weakening and deteriorating of the meniscus.
Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions including arthritis, gout, and infections also can cause knee pain. Some painful knee conditions result from an inability or difficult task straightening the knee, arising from a whole muscle imbalance between the quadriceps (thigh muscle) and therefore the hamstring (back of the thigh muscle). Knee pain is among the foremost common of orthopedic problems. The knee may be a complex joint with many components, making it vulnerable to a spread of injuries. These injuries are normally thanks to a twist or a blow to the knee, but are often contributed to by overuse or internal problems.
Importance of Preventing Knee Pain
Osteoarthritis can be prevented in similar ways to overuse injuries, and it is possible to reduce its severity or slow its progression. It is a disease of the cartilage in joints, so anything which stresses the joints or has a positive impact on cartilage can be a factor in prevention. This includes maintaining strong muscles around the knee, avoiding excess stress on the joint, and certain dietary and supplementary factors (e.g., consuming antioxidants such as vitamin C and E). Given that it is a disease which develops over time, it is never too early to start preventing osteoarthritis. In fact, the best time for prevention is when people are young and free of joint pain. This is because it is far easier to prevent something happening than to change the pattern and progression of a disease.
Fortunately, in the vast majority of cases, knee pain can be prevented. This is because the most common causes of knee pain are overuse injuries and degeneration due to aging. Both of these causes are preventable. Overuse injuries can be prevented simply by ensuring that the muscles around the knee are strong and well-conditioned. They act as shock absorbers for impact on the knee joint, and if they are weak, a greater amount of stress is placed on the joint, which may result in injury. Simple exercises 2-3 times a week to strengthen the quadriceps (front of thigh) and hamstrings (back of thigh) can prevent many knee injuries. Regular participation in activities such as walking, swimming, or cycling is also good for general fitness and can help to prevent knee pain by maintaining a healthy body weight. Excess weight is a significant factor in knee pain as it puts extra stress on the knee joint.
Furthermore, knee pain in the form of osteoarthritis can have a significant impact on the quality of life of older individuals. It is a degenerative condition, and once the cartilage in the knee joint has worn away, it cannot be reversed. This may lead to chronic pain and a reduction in mobility. It can be a factor in social isolation for the elderly as they are unable to take part in community activities and may have difficulty leaving the house. In severe cases, it may even lead to disability.
As the saying goes, prevention is better than cure. This is especially true when it comes to knee pain. A healthy pair of knees is vital for leading an active lifestyle, and preventing knee pain from developing is a lot easier and far less frustrating than trying to cure it once it has developed. This is because knee pain can be particularly debilitating. It may limit movement and necessitate a long period of rest. This is especially frustrating for athletes or active individuals who are used to exercising or participating in sporting activities.
Lifestyle Modifications
Maintaining a Healthy Weight
Remember, it is still important to have a balanced diet even when trying to lose weight, and although fat should be reduced, it should not be stopped completely.
High calorie foods usually have a high fat content, and one way to identify these foods is to look for the fat content on packaging, which should be labelled per 100g. Each gram of fat contains 9kcal compared with carbohydrate and protein, which only contains 4kcal for each gram. By reducing high fat, high sugar, high alcohol food and drinks, we can reduce our calorie intake, and this should result in weight loss.
The ideal weight loss is losing 1-2 kg per month. Losing weight is not an easy task and many find it difficult to rely on exercise to lose the pounds when their knees are painful. Although you might not be able to do much exercise to help with weight loss, the important thing is to reduce the amount of food eaten, particularly foods with a high calorie content.
Weight loss forms the cornerstone of management for knee pain. The mechanical forces acting across the knee joint are roughly three to four times body weight during walking. If you have knee pain that is affecting your speed to walk, or limiting you to walk only very short distances, then you may find losing even a small amount of weight can make a big difference to your knee pain.
Regular Exercise and Stretching
Stretching can also improve the flexibility of the quadriceps, hamstrings, ITB, and calf muscles. A well-rounded stretching program focused on all the major muscle groups can reduce tension on the tendons and relieve pressure on the knee joint. Static stretching has been shown to be more effective than ballistic, PNF, or dynamic stretching in improving flexibility. Regular bouts of stretching 5-7 days a week appear to be a safe and acceptable frequency to develop and maintain flexibility. Timing stretching with other activities, such as after exercise or hot baths, can increase the overall effectiveness of the stretching program.
Exercise and stretching are a cost-effective way to decrease knee pain and prevent further progression. Exercise, in general, and specific forms (running, jumping, landing) can help increase the strength of the quadriceps and hamstring muscles, which are important in stabilizing the knee joint. Strong muscles help absorb shock and decrease stress on the knee joint. A good way to add strength training to your exercise program is to perform weight training, isometric exercises, and isotonic exercises. It is important to avoid high-impact activities such as running, jumping, and sports like basketball and soccer, as these activities can cause more damage to the knee joint and surrounding structures. Swimming and cycling are good alternatives to maintain fitness without causing increased joint stress.
Proper Footwear Selection
A person with foot problems such as over-pronation or supination may have to use shoes with corrective modifications, either orthotic devices with midfoot support or a shoe with better construction and stability, in order to help reduce knee pain. A good method to determine the level of stability of a shoe is to perform the twist test, where the shoe with good stability will not wring out easily and resists the torsion from applied forces.
In a study designed to determine whether reduction in the magnitude of the knee joint reaction force would be achieved if the subjects walked in shoes promoting greater midsole deformation, it was found that shoes that reduced the knee joint reaction force by 13% showed a reduction in pain during the course of the study. Although this does show that footwear with good shock absorption can help to reduce knee joint stress, it has to be noted that the same shoes also led to increased pain in an earlier part of the study for the subjects. This means that whenever one changes to a new pair of shoes, it is essential to break them in slowly, as the midsole cushioning of the shoe will provide less stress to the knees but other structures of the lower limb e.g. muscles, tendons, and ligaments, may work harder during the adaptation phase to the changes in the shoe.
Poorly-fitted footwear can be a contributing factor to knee pain. It can affect the alignment of the entire body, and this in turn places more stress on the knees which can lead to various problems. Shoes that are either too soft or too rigid may potentially lead to knee pain; therefore, it is important to choose shoes that have good shock absorption and provide cushioning at the heel and midsole.
Injury Prevention Techniques
High relative muscle strength has been shown to be protective of the development of knee pain. Intermediate resistance training exercises can be used to strengthen muscles surrounding the knee without overstressing the joint.
Excess body weight can be reduced by a combination of regular exercise and a balanced diet. The loss of a single pound of body weight results in a four-pound reduction in the load on the knee for each step taken. It has been shown that aerobic exercise not only aids in weight reduction but also increases the amount of nutrition and lubrication that the cartilage in the knee receives from the movement of the joint. This helps to promote self-healing and repair of minor articular cartilage injuries.
The use of proper body mechanics helps to reduce undue stress on the knee joint. A person should sit, stand, and walk with the back straight and the knees bent slightly. When lifting, it is better to have the legs do the lifting than the back. This helps reduce the load felt by the knee and retards the degeneration of the cartilage.
Injury prevention techniques are even more important. Preventing the recurrence of knee pain involves the use of proper body mechanics, control of excess weight, avoiding high-risk activities, use of appropriate protective gear, warm up and cool down exercises, and tips and advice given by Singaporean orthopaedic specialists.
Warm-up and Cool-down Exercises
After an intensive workout or sports game, many people don’t realize just how important cool down exercises are. Suddenly stopping exerting the knees can lead to the blood pooling at the extremities, which causes dizziness and possibly even fainting. On the other hand, if the heart rate comes down too quickly, there is not enough oxygen provided to muscles to remove the lactic acid built up, which causes muscle stiffening and fatigue. A cool down should involve a gradually decreased intensity of the previous activity and should end with gentle stretching. A minimum of 5 minutes is suggested, but this may vary depending on the intensity of the previous exercise. Stretches should be held for 20-30 seconds on each muscle to help muscle relaxation and increase in length. This is again beneficial for the knee as it reduces muscle tightness, which can pull excessively on the kneecap.
Warm-up is defined as a mild exercise programme which usually goes on for about 5-10 minutes. It prepares the body for the more strenuous nature of the activity that is to follow. Muscles work best when they are warm and more elastic, which is good for the knees as it reduces the stress on them. A good warm-up helps to elevate the heart rate and pump more blood to the working muscles. This increases muscle metabolism, helps muscles contract and relax efficiently, and reduces the risk of muscle tightness and tears. Since most knee injuries involve the ligaments, warming up can be especially beneficial. When the quadriceps and hamstrings are more developed and have increased resistance to stretch, the force on the ACL during normal activity can be reduced.
Correct Body Mechanics and Posture
When lying down, individuals should avoid lying on their stomachs because it causes increased back and neck pain. The best position would be to lay on the side with the knees slightly bent or on the back with a small pillow under the knees. The most important factor in maintaining these positions is being conscious because habits play a big role in posture. Following these guidelines will reduce the abnormal forces on the joints and decrease the risk of developing muscular or articular-skeletal pain.
The way individuals sit, stand, and lie down greatly affects the quality of their posture. It is important to distribute weight evenly between both hips when standing and avoid prolonged standing on one foot. When sitting, individuals should practice sitting on a firm, well-elevated chair to avoid sitting low for extended periods of time. This position causes hip and back strain because the hips are lower than the knees. It is also important to avoid crossing legs because it pulls the spine off-center and rotates it, then avoiding slumped sitting by having a small gap between the back of the knees and the chair.
Proper body mechanics and posture involve the way in which people carry out different activities and maintain different postures. It is important for individuals to have good posture and body mechanics in order to avoid muscle imbalances and abnormal forces on the joints. It helps decrease the stress on the ligaments that are responsible for joint stability, prevents fatigue, and prevents back pain caused by altered positions.
Avoiding High-Impact Activities
To avoid knee injuries, it is wise to avoid activities that place the knees in the high-risk position with heavy loads for prolonged periods. Our knees are particularly vulnerable to stress and pressure when the legs are straight or hyperextended. This is the position in which most sports activities that stress the knee are played, including walking, running, skiing, skating, and football. During most sports, there are also movements that involve sharp or sudden changes in direction, such as twisting or pivoting around the fixed leg. All these activities generate a large force between the foot and the surface that is transmitted to the knee, often resulting in a tear or crushing of the soft tissue ligaments within the knee. The force can cause the ligaments to give way or change the direction of the knee during movement, causing further damage to the ligament or to the cushioning meniscal cartilage within the knee. These activities should be replaced with moderate low-impact forms of the same activities. For example, trade regular cycling for road cycling in place of running, or swimming in place of playing team sports. This will decrease the risk of knee injury and slow the onset of degenerative changes within the knee in later life.
Using Protective Gear
Sports medicine specialist Dr. Henry Goh from OrthoSports says that protective gear aims to help prevent injuries sustained with trauma or impact. The proper gear protects your knees from any future injuries. For example, he explains that using a knee brace is effective in absorbing shock as well as shifting load away from the affected area in the case of a meniscus or ligament injury. This prevents any further damage to the knee and allows the injury to heal. Dr. Goh adds that using footwear with proper shock absorption is also important to reduce the load sustained at the knee. This is especially important in those with arthritis where high loads predispose to cartilage wear and exacerbation of symptoms. Heel cushioning can also lessen the impact on your knees. Physiotherapist Ms. Serene Teo from National University Hospital tells us that the decision to use protective gear varies with the knee condition as well as the type and frequency of the activity. For those with existing knee conditions such as arthritis or ligament injuries, using a knee support or taping the knee can provide external stability and internal protection to prevent aggravating the condition or sustaining a secondary injury. Taping can be learned from a physiotherapist or personal trainer to ensure that it is done properly. This is also useful to prevent re-injury to a knee that has undergone surgery. However, Ms. Teo advises that gear is not a definitive solution and that stronger muscles from exercise are still necessary in the long term to provide joint stability. Sadly, prices for protective gear may not be very wallet-friendly. A simple knee brace can cost around $60-100 while the prices of some ankle braces can make one feel a bit shaky. An investment in good footwear will generally cost above $100 although it is well worth it. However, one must remember that the costs incurred for the gear will be much lower than the costs of any future treatment for knee injuries and much less a knee surgery. So think of the gear as a small but valuable sacrifice for the long-term health of your knees.
Medical Interventions
Mr. Panos Thomas, an extended scope physiotherapist, also notes the importance of an elimination or confirmation process in order to identify the exact pathological condition, structural or mechanical defect responsible for the symptoms. This, he believes, is vital to achieve successful rehabilitation and to prevent chronicity of symptoms. As is the case in any successful treatment of a specific condition, he adds that this can only be achieved by someone with specific expertise in the area of clinical diagnosis.
The most obvious consultation that people consider for knee pain is to visit a specialist such as an orthopedic surgeon or a rheumatologist. Dr. Gowreeson Thevendran, an orthopedic surgeon, advises, “For symptoms which have been present for less than 3 months, analgesia, physiotherapy, and joint protection advice is probably the most appropriate course of action. Chronic symptoms of greater than 3 months may require further investigations.” This implies that some knee pain may actually only need a short-term solution, while other pain has a longer-term course of action. For best results, it may be necessary to try several different approaches of pain relief and to monitor improvements, or lack of, fairly closely. This is especially so if the pain is to avoid surgery as a last resort.
Medical interventions are appropriate for those whose knee pain is particularly severe. There are several different medical options, and a knee pain sufferer may need several to combine for effective pain relief.
Consultation with a Knee Pain Specialist
The knee pain specialist can be referred to as an orthopedic surgeon, a medical doctor who specializes in the diagnosis and treatment of disorders related to the entire musculoskeletal system. While it may seem logical to see a knee specialist if you are having chronic knee pain, the visit can still be of great benefit. Specialists are the most familiar with the treatments that will serve you best. Usually, it is also a specialist who will decide if you are or are not a candidate for surgery. This can be very important information because some surgeries, such as a knee replacement, may be better to have done sooner than later, while other surgeries have a higher success rate if put off until absolutely necessary. Finally, if you decide that you do not want surgery, a knee specialist will have the broadest knowledge of what the best non-operative treatment options will be. When you visit a knee specialist, he/she will require a lot from you, especially in the form of images of your knee, whether it is x-rays, MRIs, or other tests. Specialists often require repeat images of your knee, so the appointment doesn’t always give immediate answers or treatments. It is because knee specialists are usually the most thorough in their diagnoses and, unlike primary care physicians, often the success of their treatment is more heavily based on their accurate diagnosis. Be prepared to tell your specialist a specific history of your knee pain, detailing when and how the pain began, as well as what makes it better or worse. With this information and a physical examination, your knee specialist will usually be able to give you the best understanding of your knee pain and the various treatments available.
Physical Therapy and Rehabilitation
Physical therapy and rehabilitation are usually recommended for patients who have sustained injuries to the knee region and those suffering from degenerative joint disease. The main aim of a physical therapy program is to increase the strength and flexibility of the muscles and tendons that surround the joint. This, in turn, stabilizes the joint and reduces the chances of degeneration occurring. Strong muscles act as shock absorbers for the joint and prevent disease progression. A second goal of therapy is to re-establish a functional level of activity. This is done through specific exercises designed to simulate certain activities. For example, a person who has trouble climbing stairs due to muscle weakness would practice a simulated pattern of stair climbing. Studies have shown that therapy can increase function and decrease pain in osteoarthritis patients. On the contrary, bed rest and immobilization have been shown to weaken the quadriceps and can decrease muscle tone by 20% in as little as 2 weeks. An important part of therapy is a home exercise program which can form the basis for a maintenance program designed to slow the progression of the disease. Rehabilitation strategies for patients post knee surgery not only involve physical therapy but also incorporate pre-operative therapy and education. Pre-operative conditioning for patients who are undergoing orthopedic surgery has been seen to improve post-operative recovery. This is because a body that is in better shape physically will respond and heal better after surgery. Pre-operative therapy would involve strengthening the muscles around the joint and increasing the range of joint movement. Education programs are aimed at informing patients about the surgery and what to expect after surgery. This preparation will reduce patient anxiety and create a more effective post-operative rehabilitation.
Medications and Pain Management
Opioids and narcotics are reserved for cases of severe pain but can cause constipation and bladder dysfunction. Ultimately, medications are merely a tool to reduce pain and improve function while other treatments such as exercise therapy and weight loss take time to have their effect. It is unwise to rely solely on medications for the management of chronic knee pain.
Furthermore, my healthcare provider friends have told me interesting tales about the retired folks in the community who regularly take warfarin, a blood-thinning medication, and NSAIDs concurrently. Blood-thinning agents will potentiate the effects of NSAIDs and cause spontaneous hemorrhaging into joints and muscles, resulting in severe pain and bruising. Patients who have tried this will tell you that they will never forget the pain.
Despite medications providing some short-term relief, they are not without their downsides. Paracetamol has a mild but significant potential for liver damage if taken in high doses and can irritate the stomach lining. NSAIDs inhibit an enzyme that helps protect the stomach lining from damage, and as a result, can cause gastritis or even gastric ulcers. Patients with a history of peptic ulcers or gastrointestinal bleeding must not take NSAIDs.
Medications play an essential role in managing knee pain. They include simple analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), to more potent medications such as narcotics and even injections into the knee joint. Each medication has its side effects and potential interactions with your general health, so it is best to tailor a medication regimen to an individual patient in conjunction with a physician.
Surgical Options for Severe Cases
Options for surgical treatment are many. Orthopedic surgeons have at their disposal a vast array of techniques. Clean-up procedures such as arthroscopy and partial meniscectomy can be very successful at dealing with mechanical symptoms such as catching and locking. These procedures are often done as day surgery with patients going home the same day. Estimated recovery time is usually 4-6 weeks.
Surgery is considered when your knee symptoms are not relieved by the other treatment methods. The surgeon will usually conduct the surgery with the intention of correcting a specific problem that is causing your knee pain symptoms. This is a shift from the early days of knee surgery where arthritic knees were just “cleaned out”. The procedures of today are directed at specific problems that can be quite effectively resolved.
Severe cases of knee pain symptoms need surgical treatment. With modern surgical advances, the process has become very refined with results that are very predictable. Despite the claims of quick fixes by the new wave of arthroscopic surgeons, the decision to proceed with knee surgery should be a well-planned out step with an understanding of the entire process and its outcomes.

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