Knee pain in children
Acute Knee Injuries
Knee Strapping & Taping
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Common knee injuries
Knee injuries are very common in sport and the most frequent injuries are medial ligament sprains (MCL), anterior cruciate ligament (ACL) tears, cartilage injuries and patella tendonitis. Knee ligament injuries can take between 2 weeks (grade 1 MCL sprain) to 12 months (ACL tear) to rehabilitate to full fitness and if incorrectly treated in the early stages they can also lead to osteoarthritis in the knee in later life.
Acute Knee Injuries
An acute knee injury usually occurs suddenly through either trauma or a twisting action. They can vary in severity from very mild to very severe and this depends on the injury mechanism (how the injured occurred) and the forces involved during the impact.
Knee injuries frequently occur in contact sports such as rugby and American football and also those sports that involve significant amounts of twisting, turning and changes of direction, such as soccer. Symptoms often include sudden pain and rapid swelling but may also include locking of the knee or “a giving way sensation” of the knee during walking/running.
It is strongly advised not to carry on with acute knee injuries as they can easily progress to chronic injuries or progress to more complex knee injuries.
Read more on acute or sudden onset knee injuries
Chronic Knee Injuries
Chronic knee injuries usually develop gradually demonstrated in a slow increase in pain and/or swelling. They often start out as seemingly minor injuries with mild pain and little or no swelling and therefore athletes often “play on” through them.
An example of this is patella tendonitis which, if treated correctly by following the P.R.I.C.E principles in the acute stages, can prevent the injury progressing to the very debilitating chronic condition (as is often seen in many professional athletes).
Immediate First Aid for Knee Injuries
All acute and chronic knee injuries should be treated using the P.R.I.C.E. therapy principle. This should be applied at home for at least the first 2 - 3 days. P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation.
- Protection - Protect the knee injury from further damage. Where applicable, use of a knee support is recommended.
- Rest - Refrain from exercise and try to reduce the demands of your daily activity to encourage recovery.
- Ice - The topical application of ice or cold therapy to the area of the knee injury/swelling can assist in reducing the symptoms of pain and inflammation.
- Compression - The use of a compression support or compression bandages to the knee can can help reduce swelling.
- Elevation - Keeping the knee elevated above heart level whenever possible to help reduce swelling due to the effects of gravity.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is using a support or splint.
In the early stages, resting your knee injury is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If a knee injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute knee pain. It is cheap, easy to use and requires very little time to or expertise to prepare. The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:
- Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
- Reduces pain (pain gate theory)
- Reduces muscle spasm
- Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
When Should I see a Doctor?
The majority of knee injuries, especially the minor ones can be treated at home. However, if you have any of the following symptoms you should seek further medical assistance.
- Severe pain in or around the knee, especially during walking.
- Severe swelling (oedema) in the knee.
- An audible “pop” or “crack” in the knee joint that is painful.
- A “giving way” feeling in the knee during walking or going up/down stairs.
- A feeling when the knee “locks” whilst bending or straightening it.
- Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the lower leg.
- Unable to complete your normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.
In the first instance, if you have followed the P.R.I.C.E. principles (see above) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Also, if your knee gives way whilst walking, feels loose (“unstable”) or locks (unable to move the knee due to pain) then you should consult your doctor or visit A&E.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness or knww pain that lasts a long time (more than 2 weeks) or have ongoing discomfort in your knee, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program