As the weather improves and we start to get outside more to exercise, clean up the yard, cut the grass, etc. there are many activities that will result in knee pain. There are a host of things that can go wrong with our knees depending on the activity. As the weather improves, remember that you don't have to reverse an entire winter’s worth of damage in one weekend. Take your time, clean up the residual mess of winter gradually, and save yourself the inconvenience of knee pain this spring.
So what can go wrong? Let's start with the front of the knee and work our way around. The kneecap, or patella, will be a great source of knee pain for the weekend warrior trying to clean up the yard in one weekend. The most common overuse complaint will be related to patellar tendinopathy. This is a term used to describe a painful patellar tendon — the tendon that attaches from the lower portion of the kneecap to the tibia, or shinbone. The next issue is known as chondromalacia. This is a softening of the cartilage on the under-surface of the kneecap. When the cartilage begins to soften, your knee will squeak, snap, pop and crunch. It may not hurt right away, but eventually it will. Most of the pain will be felt while squatting, walking up and down stairs, and/or standing from a seated position. If you have been out in the yard kneeling and squatting repeatedly for hours, you can irritate the cartilage and start the process of chondromalacia.
If you are over the age of 40, you may be more susceptible to a meniscus or cartilage tear in the knee with something as simple as squatting down in your garden. As we age, the meniscal cartilage will dry out and start to become brittle. This is why tears can occur after trivial activities such as kneeling, squatting, twisting or even rolling over in bed.
On the inside or medial aspect of the knee is a collection of three tendons referred to as the pes anserine, or “goose’s foot.” With repeated bending, walking, climbing and squatting, the hamstrings are subjected to sustained tension and loads. Since the hamstrings get progressively weaker with age, it is not uncommon to experience pes anserine bursitis or tendonitis on the medial aspect of the knee after an early season day or days in the yard.
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The most common ailment on the outside or lateral aspect of the knee is called iliotibial band (ITB) syndrome. The ITB is a fibrous band of tissue that connects the hip with the knee along the outside (lateral) edge of the thigh. As the knee bends repeatedly, the ITB can rub over a bony prominence on the thigh bone (femur). This will cause an irritation that can be so painful that you may think you have torn cartilage. If you have had a less-than-active winter, it is likely that your hip and thigh muscles have become weakened, leaving the ITB to absorb the brunt of the force. This excessive strain on the ITB, combined with some weakness, will cause the portion of the ITB at the knee to compress against the bone. As the knee bends and straightens, the band rubs and becomes inflamed, causing pain when you stand up.
With the exception of the meniscal tear, all of the conditions previously mentioned can be treated and managed without surgery. If you have a sore knee after early season yard work, the first thing to do is apply ice over the painful area for 15 to 20 minutes, two to three times per day. If you have ever used over-the-counter medication in the past with success, such as Tylenol or ibuprofen, that would be a reasonable addition to the ice. If the knee pain does not resolve with these conservative measures within 10 to 14 days, you should see a health care provider with whom you have confidence and have your knee assessed thoroughly.
Once you have your knee assessed, you may be referred for physical therapy. Overuse conditions typically respond favorably to physical therapy. Initially, your physical therapist will apply a variety of modalities and/or techniques to reduce swelling and pain. As the pain reduces and the range of motion improves, you will be taught a series of progressive resistance exercises to strengthen the hips and knee. This will be part of a therapeutic and home exercise program that you will need to perform on a regular basis to ultimately prevent recurrence of your knee pain. If the ITB is involved, you may be prescribed a foam roller to help mobilize the band at home before or after activities. Remember: You can avoid this simply by easing your way into the spring cleanup season!