跟读练习: Why Your Knee Hurts (And What To Do About It!) - 通过视频学习英语口语
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In this video, I'm going to tell you why your knee hurts and what you should do about it.
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There are timestamps for each diagnosis so you can jump exactly to what you're looking for if you'd like.
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There are also timestamps toward the end of the video where
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I explain why knee pain happens in the first place and the general strategies I recommend for rehab.
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And as a heads up, we have videos that are 15 to 30 minutes long about most of the diagnoses I'm going to talk about,
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so please check those videos out if you want more in -depth information.
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Let's start with the front of the knee by discussing patellofemoral pain, also known as runner's knee.
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Patello refers to your patella or kneecap, while femoral refers to your femur or thighbone.
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The patellofemoral joint is where these two bones meet.
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Therefore, patellofemoral pain is just a fancy way of saying that your knee hurts.
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It's usually non -traumatic in nature, with diffuse pain gradually presenting behind or around the patella with squatting,
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jumping, running, or going up and down stairs.
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Symptoms may also be present with kneeling or prolonged periods of sitting, which has been labeled the movie theater sign.
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Imaging is not usually recommended.
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Rehab, consisting of exercise and education, is the focus of treatment.
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While joint noise is associated with patellofemoral pain and may be unpleasant or undesirable, it is not an indication that exercise is dangerous or harmful.
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Knee osteoarthritis is typically described as a degenerative joint disease associated with wear and tear of the cartilage within the knee joint.
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However, it should be thought of as a systemic condition as other factors influence symptoms and the progression of the disease, such as genetics and metabolic health.
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Plus, many of the structural changes seen on imaging
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that are associated with knee osteoarthritis are often found in people with no symptoms.
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Aside from pain that can present almost anywhere in the knee, common signs and symptoms include stiffness, swelling, reduced range of motion, and muscle weakness.
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Imaging is actually not required for the initial diagnosis, and non -operative management is considered the first line of treatment.
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Some options include education about prognosis and self -management strategies, aerobic and strengthening exercise, and weight loss.
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Depending on the severity of symptoms, these interventions may significantly delay or completely eliminate the need for surgery.
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Moving up, the quadriceps tendon attaches the muscles of the thigh, known as the quadriceps, to the top of the patella.
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Pain that is localized to this area is referred to as quadriceps tendinopathy.
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The term tendinopathy just means that there is persistent pain and a loss of function related to loading of the affected tendon,
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such as with jumping, squatting, kicking, et cetera.
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Tendinopathies usually occur as a result of relative overload or overuse.
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Think doing too much too soon.
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Tendinitis, used to indicate an inflammatory process, is not the preferred diagnostic term
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because acute inflammation is not believed to be the primary driver of the condition
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and may reflect the normal response to tendon loading and adaptation.
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Plus, people often associate inflammation with the need for ice, anti -inflammatory medication, and a complete rest,
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which are not the primary treatment strategies recommended.
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Tendinosis, used to indicate a degenerative process, is also not the most appropriate terminology,
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as abnormalities on imaging can be found in people without symptoms and are not always predictive of future issues.
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Patellar tendinopathy, also frequently called jumper's knee, is similar except pain is localized just below the patella
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because the patellar tendon attaches from the bottom of the patella to the tibial tuberosity of the tibia or shin bone.
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Patellar tendinopathy is much more common than quadriceps tendinopathy.
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Imaging is not required for either diagnosis and the primary treatment strategies involve education and exercise.
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Oshkud's Slaughter disease is characterized by localized pain and swelling at the tibial tuberosity where the patellar tendon attaches.
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It is also painful to the touch.
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It is aggravated with exercises and activities that load the knee, which is why it's most prevalent in adolescent athletes,
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particularly those who specialize in a single sport.
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Infrapatellar fat pad syndrome, also known as Hoffa syndrome, refers to irritation or inflammation of the fat pad that sits behind the patellar tendon.
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Pain and swelling can occur along either side of the tendon.
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Causes can include surgery, a direct blow or fall to the area, a hyperextension injury, or activities that repetitively stress the structure.
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Symptoms may be felt with standing, walking, or activities that involve repetitive extension of the knee.
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Non -operatively, the primary treatment strategy is to try to offload the affected area to allow inflammation and symptoms to resolve.
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Let's start moving outward by discussing the medial meniscus toward the inside of the knee
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and the lateral meniscus toward the outside of the knee.
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Pain is typically described as being felt along the joint line.
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If you bend your knee, this is the space between the tibia and femur as you move away from either side of the patellar tendon.
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However, pain can also be present in the back of the knee.
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Traumatic injuries may need to be managed surgically in some cases, but degenerative meniscus tears, which are a natural feature of aging,
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should be treated non -operatively as real surgery has proven to be no more effective than placebo surgery.
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On the outer portion of the knee, the iliotibial band, commonly referred to as the IT band, is named for its attachments to the ilium, or pelvis, and tibia.
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It is the lateral thickening of the fasciolata, which is the deep fascia that envelops the thigh like a sausage casing.
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The expansive nature of the IT band allows it to contribute to stability of the hip and knee,
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as well as store and release energy to make walking and running more economically efficient.
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Despite popular belief, IT band related pain is not a friction syndrome due to tightness of the IT band that requires vigorous rolling or stretching.
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Although the exact mechanism isn't fully understood, it's thought that an error in workload, such as a large spike in running mileage or intensity,
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is a primary contributing factor.
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On the inner portion of the knee is the pesanserine.
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The pesanserine, which means goose's foot in Latin, is where the tendons of the sartorius, gracilis, and semitendinosus muscles come together on the tibia.
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Pesanserine bursitis refers to inflammation of the bursa that sits underneath these tendons.
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A bursa is a small fluid -filled sac that helps reduce friction between structures.
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Tendinopathy of these tendons can also occur.
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Let's move on to the ligaments of the knee.
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Ligaments which attach from bone to bone provide passive stability to the knee joint.
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A sprain is an injury to one of these ligaments such as the medial collateral ligament,
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lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament.
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The medial collateral ligament or MCL is located on the inner part of the knee and consists of superficial and deep layers.
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The superficial portion is a long flat band
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while the deep portion is a continuation of the joint capsule with connections to the medial meniscus.
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Both have attachments on the femur and tibia.
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The MCL primarily acts to stabilize the knee against valgus and rotational forces.
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The most common mechanism of injury is a direct blow to the outside of the thigh
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or leg while the foot is planted producing a valgus movement.
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An example is a player getting tackled in football.
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An injury can also occur when a valgus stress is coupled with tibial external rotation, such as during skiing or sports involving cutting and pivoting.
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In severe cases, other knee structures can be injured as well, including the medial meniscus, lateral meniscus,
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posterior cruciate ligament, and most commonly the anterior cruciate ligament.
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Regardless of the severity of the injury, an isolated MCL injury can often be treated non -operatively due to its high intrinsic healing potential.
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The lateral collateral ligament or LCL is the analogous structure on the outer part of the knee.
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Like the MCL, the LCL helps to stabilize the knee against rotational forces.
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However, its primary function is to resist various forces and it is less commonly injured.
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An injury to the LCL may occur from a direct blow to the inside of the knee
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while the foot is planted or from a non -contact mechanism during sport.
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The severity of the injury, the stability of the knee, and the involvement of other structures will influence whether or not surgery is needed.
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The anterior cruciate ligament, or ACL, and its lesser known counterpart, the posterior cruciate ligament or PCL,
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are located within the knee and therefore cannot be palpated.
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Whether a suspected injury occurs while playing sport or during a motor vehicle accident, imaging is typically necessary.
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Newer research has demonstrated that surgery is not always required, but it's dependent on a variety of factors such as your goals and the stability of your knee.
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Regardless, rehabilitation is always recommended, including before and after surgery.
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Let's move on to the back of the knee.
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A Baker's cyst is an accumulation of fluid that may be associated with swelling, pain, stiffness, and a sensation of tightness or fullness.
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For those experiencing symptoms, it is often secondary to an underlying issue such as knee osteoarthritis.
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Treatment can vary from doing nothing at all, to exercise and pain medication, to draining of the fluid and a steroid injection.
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Next is the popliteus.
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The popliteus is a small deep muscle located on the back of the knee
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that contributes to stability of this region
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and is often described as the key to the knee for its role in unlocking
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or flexing the knee from a fully extended position.
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An isolated injury to the popliteus is rare, but if a strain or tendinopathy is suspected,
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modification of aggravating activities and a structured exercise program are recommended.
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The last diagnosis I'll touch on is distal hamstring tendinopathy.
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The hamstrings are the muscles on the back of the thigh
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that play a significant role in flexion or bending of the knee, and their tendons can be felt along either side of the knee. Although rare,
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localized discomfort of these tendons with flexion -based exercises or movements should be managed similarly to the other tendinopathies previously discussed.
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What about other diagnoses that I didn't mention?
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Well, here are three things to consider.
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One, I can't cover every possible diagnosis.
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For example, I didn't discuss fractures or other injuries that may require immediate medical attention.
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Two, a specific diagnosis or imaging finding doesn't always dictate management or rehabilitation.
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Two people may technically have the same diagnosis or imaging finding, but they might have significantly different symptoms,
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severity of symptoms, aggravating factors, functional capabilities, goals, lifestyles, etc. Oftentimes,
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the person dictates the rehabilitation process more than the diagnosis itself.
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Three, some diagnoses aren't always as useful as previously believed.
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For instance, a common concern for individuals with knee pain is chondromalacia patella.
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Chondro refers to cartilage, while malacia means softening.
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Therefore, chondromalacia patella refers to a softening or breakdown of the cartilage on the backside of the patella.
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However, a paper by van der Heiden et al in 2016 found
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no difference in composition of the patellofemoral cartilage between patients with patellofemoral pain and healthy control subjects.
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Some researchers and clinicians have actually suggested that we stop using the terminology.
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This information is important to know because sometimes a diagnosis or imaging finding can cause people to become fearful of certain movements,
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exercises, or activities.
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An example of this would be someone with knee osteoarthritis who stops exercising completely
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because they've read or heard that exercise wears out the joint faster.
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In reality, tolerable exercise is recommended for the knee and the overall health of the person.
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X -rays and MRIs have their place, but there are times when they can create unnecessary worry and lead to further medical tests or treatments that are unwarranted.
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It's also important for me to briefly point out that not all knee pain is related to the knee.
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Sometimes hip and low back issues can masquerade as knee pain.
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For example, a person with hip osteoarthritis may experience pain down the front of their thigh or in their knee.
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Now that I've reviewed the various diagnoses, you might be wondering why you developed knee pain in the first place.
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In the case of a traumatic injury like a sudden ACL tear during sport, the ligament is unable to withstand the forces experienced in that moment.
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For non -traumatic cases, a simplified framework for why most injuries occur is that the volume,
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frequency, and intensity of loading over the course of days,
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weeks, or months exceeds your current capacity or your ability to recover and adapt appropriately.
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If you're an active individual, such as a regular runner, it might come down to doing too much too soon.
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For instance, if you normally run half marathons, but suddenly increase your total running mileage in preparation for a marathon that you want to do next month,
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that spike in training load may exceed your current capacity.
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As a result, perhaps you developed patellofemoral pain.
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But this process of doing too much too soon can also occur in less active individuals.
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For example, you might have decided to try a couch to 5k running program, or maybe you just went on a vacation that required a lot more walking and stairs than you're used to.
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As I said though, this is a simplified framework
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and it's not always easy or possible to identify the exact cause of your symptoms.
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Plus, pain is complex and multifactorial.
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More than just physical load must be considered.
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Sleep, stress, nutrition, alcohol intake,
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medication usage, and anything else that influences your overall health and well -being can also influence the onset and persistence of symptoms.
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As I alluded to in the knee osteoarthritis section, there's been increasing research into how chronic,
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systemic, low -grade inflammation can impact different musculoskeletal diagnoses and symptoms.
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In some ways, this could be thought of as a good thing
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because it gives you more options for trying to address whatever issue you're dealing with.
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Before I outline my recommendations for rehab, I want you to keep these four things in mind.
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One, unfortunately, there's not always a quick fix.
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Rehab often takes significant time and effort.
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Two, there's usually nothing inherently wrong with you, meaning the shape of your feet or your knees or the way
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that you walk or whatever it may be probably isn't the reason for your symptoms.
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Rehab shouldn't make you feel bad about yourself or overly self -conscious about a part of your body.
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Three, if it sounds overly complicated?
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It probably is.
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Contrary to popular opinion, worrying about how your patella tracks
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or trying to isolate the activation of certain muscles like the VMO is unnecessary.
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Four, you rarely need anything fancy or expensive for recovery.
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The basics that I'm going to list work well.
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To avoid making this video any longer than it needs to be, here's a quick general blueprint for rehab.
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One, modify aggravating factors, whether that's related to the gym, recreational and sporting pursuits, or day -to -day tasks.
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Some discomfort is usually acceptable during rehab, but if you're consistently pushing into unbearable pain and experiencing flare -ups,
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you probably need to temporarily scale back whatever it is that's giving you problems.
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Think of it as taking one step back so you can eventually take two steps forward.
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However, if you're a person who has restricted yourself from all exercise and activities for fear of worsening your condition, you might just need to give yourself permission to move.
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Two, identify if there's anything you can do that would positively influence your overall health.
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My advice would be to reach for the lowest hanging fruit, start small, and write down your intentions so you can reflect on your progress each week.
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Three, implement targeted exercises to address any deficits in power,
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strength, range of motion, etc. Exercise can also be used to improve your tolerance to specific activities such as walking,
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stair climbing, running, or playing sports.
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If you do incorporate an exercise routine, be sure to include exercises for your quads and hamstrings.
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Feel free to train your glutes, calves, and other muscles as well, just don't exclude the muscles that actually cross your knee joint.
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Four, use feel -good treatments as needed such as tape and massage, but you'll probably get the most benefit from the things that challenge you.
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Before wrapping up, I want to remind you that we have full -length videos dedicated to most of these diagnoses, so check those out if you're looking for more in -depth information.
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Thank you so much for watching.
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If you enjoyed the video, please hit that like button, subscribe, turn on notifications, and leave any comments down below.
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If you're looking for a rehab or performance program, or you're interested in working with us one -on -one, visit our website at e3rehab .com.
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Peace.
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