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Knee Pain and the “Weekend Warrior”
By Andrew M. Stewart, M.D.
As summer chugs along, the number of patients coming into the office with sports-related knee injuries climbs at a steady rate. Many patients reporting knee pain are so-called “weekend warriors,” former high-level athletes who – for reasons often related more to lifestyle than to desire – are less active than they once were. Despite a decline in fitness, and the wear and tear and loss of flexibility that comes along with normal aging, these folks still go after their athletic goals with the same gusto they once did, and injuries inevitably occur.
While the list of injuries associated with summer athletic activities is long — and often achingly familiar — knee pain is perhaps the most common. Here we cover some of the most common causes of knee pain in “weekend warriors.”
Osteoarthritis
One of the most common causes of knee pain in older athletes is osteoarthritis. While it has no one single cause, it is often related to a history of excessive impact activities such as running. Osteoarthritis is a degenerative process in which the cartilage surfaces — which normally allow the knee to move freely and painlessly — begin to break down. Pain is often associated with swelling and grinding. Treatment most commonly entails rest, non-steroidal anti-inflammatories and physical therapy. Injection of corticosteroids (powerful anti-inflammatories) and viscosupplementation (injectable “joint lubricants”) may also provide relief. Weight loss is encouraged when appropriate, primarily through a combination of diet and low-impact activities such as biking and swimming. Importantly, osteoarthritis is a progressive condition, and severe cases may lead to surgical intervention, including knee replacement.
Meniscus Tear
The meniscus is a structure in the knee that provides cushioning and stability, protecting the cartilage from injury. Meniscus tears can be related to acute injury, such as a twist during a pickup basketball game or an awkward step while descending stairs. They also may be degenerative in nature and associated with osteoarthritis. Pain is usually noted on the inside or outside of the knee, often associated with catching or locking. Initial treatment of acute meniscal injuries involves rest, NSAIDs and physical therapy. For persistent pain, a minimally invasive outpatient surgical procedure, knee arthroscopy, may be offered. This technique allows excision or repair of the meniscus tear through two small incisions, with recovery usually rapid and complete.
Patellofemoral Syndrome
The patella, or kneecap, is a common source of pain in athletes of all ages. Patellofemoral syndrome is distinct from osteoarthritis in that inflammation, rather than cartilage wear, is the source of discomfort. Pain under the kneecap is often associated with catching or grinding, and can be associated with a sensation of instability. This problem commonly results from a combination of muscle imbalance and overuse, and can usually be treated successfully with nonoperative measures. These include rest, NSAIDs, bracing, and specialized physical therapy focused on strengthening, correction of muscle imbalances, and flexibility. In cases of severe patellar instability or patellar dislocation, reconstructive surgery may be recommended.
Tendon Injury
Tendons connect muscle to bone and allow a joint to move. Tendonitis or tendon inflammation commonly affects athletes engaged in repetitive activities such as running and biking. Quadriceps tendonitis affects the tendon just above the kneecap; patellar tendonitis (or “jumper’s knee”) causes pain in the tendon just below the kneecap, and iliotibial band tendonitis affects the tendon at the outside of the knee. Initial treatment focuses on continued activity rather than rest, with the addition of a stretching program, NSAIDs, ice and the use of a brace or strap for exercise. Athletic shoes should be replaced regularly, and proper fit can help to reduce symptoms. In contrast to tendonitis, tendon rupture is a dramatic and unambiguous injury that requires timely surgical repair.
Ligament Injury
Ligaments connect bone to bone and provide stability to the knee. Collateral ligaments provide side-to-side stability, while cruciate ligaments stabilize the knee from front to back. Ligament injury in the knee usually results from injury during activities that involve stopping, cutting or twisting; soccer, basketball and softball are common culprits. The injured athlete may feel a “pop,” and experience pain and swelling. Collateral ligament injuries (MCL and LCL) are usually treated nonoperatively. Posterior cruciate (PCL) tears can heal with bracing and physical therapy, and surgery is reserved for those athletes with persistent, symptomatic instability. In contrast, anterior cruciate (ACL) tears rarely heal, and frequently require surgical treatment to allow return to athletic activities. Surgery involves reconstruction of the ligament using a substitute tissue — either the patient’s own tissue (hamstring or patellar tendon) or donated tissue. The high-profile example of Tiger Woods, who recently underwent ACL reconstruction using his own hamstring tendons, showed the world how difficult it can be to compete without a normal ACL. For the majority of athletes with this injury, regardless of age, four simple yet familiar words apply: “We can rebuild you.”
Preventing Knee Injuries
· Be realistic: if you haven’t run in six months, don’t launch your return to fitness with a 10-mile sprint. Start slow, set goals, and progress comfortably.
· Flexibility is important, particularly for the aging athlete. Stretch before or after exercise, and consider adding yoga or pilates to your regimen to prevent injury.
· New shoes that fit well can go a long way toward keeping your body healthy. There are numerous online sites that can walk you through the type of shoe that’s right for you.
· Use ice and NSAIDs judiciously, but don’t overdo it, as this can mask a more serious injury. 
· Finally, have fun! Exercise is the best form of stress relief in the world, and should never be thought of as a task. Enjoy it, and stay healthy.
Dr. Andrew Stewart is an orthopedic surgeon with Orthopedic Associates of Dutchess County. He specializes in sports medicine and injuries of the knee and shoulder. Bone Matters, written by several doctors addressing orthopedic issues, will run monthly in the Poughkeepsie Journal.
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