Knee pain or injuries are very common and have numerous causes. Knee pain can emerge from delicate tissue wounds like ligament sprains and muscle strains. Bone conditions like knee joint pain, Osgood Schlatters, and biomechanical dysfunction can also cause knee pain. Treatment can include basic knee mobilization techniques, taping, massages or knee strengthening exercises completely through a careful recovery method after knee replacement or reconstruction.

Physiotherapy can help you overcome the pain and increase your strength and flexibility. A physiotherapist can suggest you a number of treatments and also help you understand your issue and get you back to your everyday routine. Physiotherapists are said to be successful in getting rid of the source of the knee pain by diagnosing a cause. This includes tightness around the knee and treating it with stretching and exercises.

Following are some of the exercises a physiotherapist might generally recommend for knee pain:

Hamstring stretch: Stretching keeps you flexible and increases your scope of movement, or how far you can move your joints in different directions. It additionally helps you reduce your chances of injuries and pain. Continuously warm up with a five minute walk first. Lie down when you are prepared to stretch your hamstring. Circle a bed sheet around your right foot, use the sheet to pull the leg up and hold for twenty seconds and then lower the leg. Repeat twice and switch legs.
Calf stretch: Use a chair for balance. Bend your left leg. Step back with your right leg and gradually straighten it behind you. Press your left heel toward the floor. You should feel the stretch in the calf of your back leg. Hold for 20 seconds. Repeat twice and then switch legs.
Straight leg raise: It helps build muscle strength to give support to the weak joints. Lie on the floor. Twist your left knee, foot on the floor. Keep the right leg straight, toes pointed up. Tighten your thigh muscles and raise your right leg.
Quad set: With these, you don't raise your leg. Just tighten the thigh muscles, also called the quadriceps, of one leg at once. Begin by lying on the floor. Keep both legs on the ground, loose. Flex and hold the left leg tense for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Cushion squeeze: This move strengthens your legs from the inside so that they can support the knees. Lie on your back, both knees facing inwards. Place a cushion or a pillow between the knees. Press your knees together, squishing the cushion between them. Hold for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Heel raise: Stand tall and hold the back of a seat for support. Lift your heels off the ground and rise on the toes of both feet. Hold for three seconds. Gradually lower both heels to the ground. Do three sets of ten repetitions. 

Knee Pain - How Physiotherapy Can Heal Knee Pain?

When is your pain chronic?

Your pain is chronic if it last for more than a period of six months. Chronic pain is a long-term pain whose nature can vary from mild to excruciating, and it may trouble you either continuously or at short and regular intervals. Chronic pain is so dangerous that it does not only cause discomfort and inconvenience but also robs you entirely of your capacity to work for a long time.

Chronic pain can occur in a number of organs of the human body like head, joints, back, shoulders, neck etc. In fact, pain in any part of your body can turn into chronic pain. Here are a few symptoms that can help you identify if what you are going through is, in fact, chronic pain:

- persistent and severe body pain

- burning sensation accompanied by the body pain

- fatigue and sleeplessness

- weak immune system

- stiff and sore joints

The 4 types of chronic pain disorders that you should be aware of are:

1. Nociceptive pain

The pain that affects the soft tissues of the body such as the skin and the muscles or the organs that have sensory nerves present in them is called nociceptive pain. The sensory nerves, known as nociceptors can detect the stimuli of pain and send information to the brain and the spinal cord for interpretation. The pain could be either somatic (originating in the outer body) or visceral (originating in the internal organs).

2. Neuropathic pain

This pain is caused when the nerves stop functioning normally. It is caused due to nerve disturbances that result in pain stimuli being spontaneously transmitted to the brain and spinal cord. If you are suffering from this type of chronic pain disorder, you will feel a sharp, shooting and stabbing pain. Neuropathic pain can also be caused due to the formation of neuroma (abnormal growth of the nerve tissue).

3. Psychogenic pain

The pain that is caused by psychological disorders like depression and anxiety is known as psychogenic pain. Sometimes this pain can be accompanied by physical complications like fatigue, body pain and muscle weakness.

4. Idiopathic pain

The pain that exists even though there is no physical or psychological cause for it is known as idiopathic pain. This pain is more common in people who have suffered from a pre-existing painful disorder. Some common examples of idiopathic pain are fibromyalgia (intense pain all over the body) and tmj disorders (pain in the jaw area).

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Related Tip: Why does PAIN occur? Understand the Mechanism of Pain

Your Pain is Chronic if it Falls Under These 4 Types of Chronic Pain Disorders!

A stinging pain in the neck that makes you feel broken from the neck joint could be a reason to worry. It is often accompanied by an aching head or a throbbing shoulder joint. Neck pain, such as this occurs due to an injury in the area resulting from sudden back and forth movement of the neck. It is referred to as whiplash as the nature of the pain and subsequent discomfort resembles the snapping of a whip. The pain is more like a sprain, but not exactly so. This can affect athletes or even any person in general who has faced an accident in recent past. Whiplash is characterized by a tearing of ligaments and tendons that connect one bone to another.

Causes of whiplash:

1. Sports that involve contact- any extracurricular activity involving collisions or other forms of physical contact can cause neck injuries. Football and rugby players frequently suffer from whiplash.

2. Road accidents- public transport has a host of disadvantages. Reckless driving can make the tendons of your neck tear. Auto accidents cause immense strain on your neck; it can also lead to whiplash.

3. Any kind of physical abuse- if you have gotten into a violent fight with someone your neck could suffer from a whiplash. Instances of physical abuse where the neck is jerked or punched at can also result in neck strains. Domestic violence often leads to instances of neck strains.

Symptoms related to this condition:

1. You may or may not suffer from tinnitus. Tinnitus is a physical disorder where you hear ringing sounds. It is quite distracting.
2. Your vision might get blurry.
3. You can experience irregular sleep patterns.
4. You can find it hard to concentrate on any one thing for more than a while.
5. You can grow irritable at the drop of a hat.
6. Your memory may fail you. You might find it next to impossible to trace back a day's activity.

Some of the other direct symptoms are:

1. Your neck might turn stiff preventing you from moving it left, right, up or down.
2. Pangs of pain can be felt in and around your shoulders.
3. Your upper arms can grow numb and tender.
4. Your head can spin repeatedly or you could feel dizzy.
5. Whiplash can also result in serious fatigue.

All About Whiplash

It is normal and alright to feel pain in the knees occasionally after a physical activity or prolonged walking. However, it is a serious cause of concern if the pain is experienced every now and then. Not responding to your knee pain for long can lead to the extreme disability. Knee pain does not crop up in a day and it may surprise you when it first appears. 

Initially, you may notice slight pain and discomfort. If you have identified knee pain at this level, managing it is easy. You can perform different exercises to prevent pain from occurring. If the pain severe, you need to go consult a doctor, who will then help identify the real cause of pain. The following exercises, along with medications, can help you overcome knee pain and restore the mobility of the joint.

Stair Step ups: Choose a comfortable stairway. Place your hand on the wall or banister. This is to ensure that you are balanced. Your left foot should be on the taller step. Your right foot should be on the ground. Stay in this posture for a second. Now, step back, and bring left foot to the right foot. Repeat this 6 times. Reverse the legs and continue doing for 6 times. If you want to take rest between the steps, feel free to do so.
Ups and Downs: You need an armless chair that is strong. Sit on the edge but comfortably. Your arms should be at your side, relaxed and loose. Sit erect and your feet should be flat. If you feel you need balance, and then cross your arms. Start standing up. This should not be instant but deliberate, controlled, and gradual movement. Stand slowly up to the full height, and hold on for 2 seconds. Again sit down. Repeat this 5 times.
Straight Leg Raise: This can be a part of your everyday exercise regime. This is a strengthening workout that does not put too much effort on the knees. Lie down on your back. One leg should be straight on the ground and the other one should be bent. Now, slowly lift the leg that is straight, and the toes should point upward. Raise your leg up to 30 degrees, but you can start with 15 to 20 degrees in the initial stage. Repeat 15 times and perform at least 3 sets of this exercise. Keep alternating legs. This workout strengthens the knees, thigh muscles, and the ankle joints, thus offering multifold benefits.
Wall Hamstring Stretch: Hamstring muscles too can be the cause of knee pain and discomfort. To strengthen the hamstring muscles and alleviate knee pain, this exercise helps a lot. Lie down on the floor flat. Your feet should be flexed. Choose a space that is close to a wall, or a sturdy table. Your right leg should be propped on the wall or table. If you don t prefer any, a resistance band is a good alternative. When stretching, you can find your flexibility level and when you feel that you have reached the deepest point, start relaxing. Keep alternating contracting and relaxing every 5 seconds. After 10 to 15 sets, you can try the same with the left leg.
Knee Rolls: Use an exercise mat or a carpet that is cozy. Lie on your back. Bend the knees, and ensure your feet are flat. Your arms should be stretched on the sides. Look at the ceiling, and hold the knees together. In the same posture, slowly roll the knees towards the right. When you feel a gentle twitch or after 5 seconds, move to original position. Then lower the knees to the left. Hold and release. For each side, repeat 10 times.
These exercises strengthen the knees and improve the quality of life by bidding bye to the pain. Understanding that these are magic remedies that work overnight is the key to stay focused and keep going without quitting.

Exercises That Can Help Relieve Knee Pain!

Cervical spondylosis is a disorder that affects the joints and disc around the cervical region or neck. Earlier, it was believed that spondylosis can occur in old people only and is an age-related disorder. However, it is not true nowadays. Today, even youngsters complain of pain in the neck region due to cervical spondylosis. It occurs mostly to people who spend longer hours sitting and working on the computer. It is caused due to damage of cartilage and bones in this region. Symptoms of cervical spondylosis include chronic pain and stiffness around the neck.

Causes for cervical spondylosis-

A number of factors can be responsible for cervical spondylosis. Following are the common causes for the disorder:

1. Overgrowth of bones in the neck region: this can hamper the sensitive areas around the spine.

2. Drying of fluid: the spinal bone is made up of disc-like structures. There is fluid present in between the disks. Spondylosis is often caused due to the drying up of this fluid.

3. Herinated disks: in some cases, cracks get developed on the disks. This causes leakage of fluid in between them. Consequently, the nerves in this region get damaged.

4. Injury: if you have had an injury to your neck, such as during a fall or car accident, this can accelerate the aging process.

Homeopathic medicines to cure cervical spondylosis-

There are homeopathic medicines, which can cure cervical spondylosis over a period of time. However, the dosage of these medicines must be administered properly to get rid of the disorder. Some of these useful medicines have been listed below:

1. Conium: this medicine is prescribed for patients suffering from vertigo. If a patient feels pain or vertigo while turning the head sideways or lying down on bed, this medicine can prove helpful. Other symptoms that should be taken into account while prescribing this drug include feeling of tightness in the temporal region and pain in occipital area.

2. Gelsemium: if the pain in the neck region extends to the back of the head, one may be given doses of gelsemium. The patient complains of having the pain at the centre of the occipital region. Besides, the patient will feel inactive, dull and dizzy most of the times.

3. Kalmia latifolia: this is given when the pain spreads upto the arm region and fingers. The pain can also be felt around the shoulder blades. The patient suffers from frequent nausea. The pain increases when the patient tries to look down.

4. Silicea: when the pain is felt on eyes or forehead, this medicine is prescribed. It is also useful in treating spine curvature. These patients cannot adjust with cold weather. They feel chilly most of the times. The get quick relief by warm fomentation.

5. Calcarea phos: this is useful for treating patients who have developed spondylosis due to the overgrowth of bones in the cervical region or bone spurs.

Homoeopathic Remedies for Cervical Spondylosis

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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