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Pain Treatment Tips

Knee Joint Pain - How To Subdue It?

Knee Joint Pain - How To Subdue It?

The Elementary knowledge of biology tells you how important joints are for the overall functionality of a human body. If not for biology experience teaches us the inevitable importance of joints. The link between a tooth and the jawbone is also a joint. Without joints, the human body would have been in bits and pieces.

Having known that, you should also try to remember or understand how disabling joint pains can be. They hardly let you move a limb and can also cripple you for life. Knee joint pain can hinder a person's free movement. Knees bear an entire load of your body; they support your frame. Knee joint pain should therefore be a cause for alarm.

Going by the following ways can relieve you of knee joint pain:

1. Maintain a healthy weight: Carrying extra pounds can exert additional pressure on your joints and contribute to knee pain. If you're overweight, losing as little as 5 percent of your body weight can help relieve the stress on your knees. Talk to your doctor about developing a healthy eating plan and exercise program to help you lose weight sensibly.

2. Find a low-impact exercise you enjoy: Talk to your doctor before beginning an exercise program. Good choices for people with knee pain include walking and swimming. Be sure to warm up before and cool down after exercising. Avoid hilly terrain and high-impact activities like running and jumping, as these can worsen knee pain.

3. Give physical therapy a try: Physical and occupational therapy often are helpful for people with knee pain. A physical therapist can help design an exercise program that fits your individual ability level and teach you proper techniques to spare your joints. Occupational therapy can teach you how to reduce strain on your knees in your daily activities.

4. Get enough rest and relaxation: Sure, physical activity is important, but rest and relaxation can go a long way to promote good health - and reduce pain. Achieve a healthy balance in your life by learning stress-relief techniques like deep breathing and meditation.

5. Make sure you're getting enough sleep: No question-arthritis pain can interfere with a good night's sleep. However, proper sleep is necessary for overall health, so if you are having trouble sleeping, talk to your doctor. Proper pain management can help break the cycle to help you slumber soundly.

6. Use Ice and/or Heat: For many people with arthritis pain, ice can help relieve pain and swelling and heat can help ease stiffness. Ask your doctor about how to safely use an ice pack and/or a warm towel or heating pad. A hot shower in the morning or warm bath before bed at night also may be helpful.

7. Apply a topical pain reliever: A number of over-the-counter and prescription creams, gels, sprays and patches are available to help relieve arthritis pain. These pain relievers contain ingredients like capsaicin, salicylates, menthol, or a combination of medicines. Ask your doctor if one of these products might be right for you.

8. Consider Injections: Persistent arthritis pain may respond to treatment with injections. Available options include corticosteroids, which can be used up to 2 or 3 times a year to relieve severe pain, and hyaluronic acid, which can help replenish lubricating substances in the knee. Talk to your doctor about the benefits and risks of injectable treatments for knee pain.

09. Talk to Your Doctor about Surgery: If you have severe osteoarthritis symptoms that interfere with daily life and do not respond to conservative treatment, surgery may be necessary. Ask your doctor about arthroscopic procedures or total knee replacement, may be necessary.

Back & Neck Pain - How To Administer It?

Back & Neck Pain - How To Administer It?

The neck and back are closely related, and pain in one area can easily affect the other. Both neck and back pain have become lifestyle problems, due to prolonged sitting and incorrect working postures. Treating one area can help in subtly treating the other and also reduce the onset of pain.

Pain in neck and back can be due to strained muscles, wrong posture, injury or stress due to knots in muscles and can be easily treated with a number of ways such as physical therapy, muscle relaxants and trigger point injection. Also, facet joint arthritis occurs due to degeneration of joints in elderly, excessive strain in some type of jobs or injury. Physical therapy along with injection in the nerves that carry a message from these joints to the brain along with medications that can numb sensation and Radiofrequency Rhizotomy for long-term relief is performed by pain specialists. Disc prolapse of neck/ lumbar vertebrae can also cause back pain.

Read on to know the best ways to manage back and neck pain, as the following techniques work for both.

  • Ice and heat therapy: Alternating heat and ice therapy can help reduce pain. It helps by reducing the sensation of pain and improving blood flow, thereby providing relief.
  • Physical therapy: Exercising and stretching, whether as a preventive measure or as a part of therapy, can work wonders. It improves the agility of the bones and tendons, improves movement, reduces stiffness, and relieves pain. A program should be drawn up based on the patient’s overall health condition and symptoms. Patients should be monitored for any improvements or changes in symptoms.
  • Pain medication: When nothing else works, then pain medications become the next course of action. These can be taken for immediate relief, but cannot treat the pain permanently.
  • Steroids: Injecting corticosteroids into the bone and joint spaces can help with acute pain management.
  • Collar or brace: A neck collar or brace is used to keep the neck in place to reduce movement and provide support, thereby, it helps in reducing pain.
  • Acupuncture: Each area has associated pressure points in the body. These pressure points are identified and needles are applied to provide relief from pain.
  • Massage: The Massage can help by stimulating tissues, improve blood flow and also to relax muscles. The herbal oils that are used provide added benefit too, and so periodic massages are being widely used for pain management of neck and back.
  • Chiropractic therapy: This involves manipulation of the spinal cord with the belief that the spinal cord could be incorrectly settled. The cord is manipulated to get it to the correct location, thereby relieving pain and stiffness and improving movement
  • TENS (transcutaneous electrical nerve stimulation): The nerve in the affected area is stimulated by electrical impulses, thereby providing pain relief. This needs to be repeated at frequent intervals and is often reserved for acute cases.
  • Surgery: Often, used as a last resort, where all other measures have failed. Whether it is a herniated disk or a pinched nerve, the cause is identified and then surgery planned.
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Importance Of Treating Rheumatoid Arthritis!

Importance Of Treating Rheumatoid Arthritis!

Rheumatoid arthritis is chronic inflammatory arthritis with a prevalence of 0.5-1% in India. It is characterized by joint pain and swelling associated with morning stiffness lasting for more than 30 minutes. It generally has a slow onset - over weeks to months, though the onset can be acute also. Most common joints involved are small joints of hands and feet. Larger joints like knee and shoulder can also be involved. The incidence of RA increases with age. It is twice more common in females than in males. Early treatment is necessary to bring down the inflammation, avoid joint deformities and prevent other complications ( lung, heart, vasculitis). 

CAUSE: 

Predisposition to RA is multifactorial. It has a genetic component (family history of RA increases the risk). Environmental factors like smoking also play a role. 

SYMPTOMS: 

Initial symptoms start with fatigue, malaise, generalised body aches, low-grade fever. The onset is generally slow and eventually the patient develops joint pain and swelling. Though the joint involvement is symmetrical in most cases, asymmetric onset is common (involving joints predominantly on one side). 

DIAGNOSIS: 

Diagnosis is made by a physician after detailed history, clinical examination and supportive lab tests. Rheumatoid factor and anti-CCP antibody are positive in 75-80% of patients with RA. They have raised inflammatory markers (ESR, CRP) during active inflammation. 

TREATMENT:

RA treatment options are wide and quite effective. It starts with patient education regarding the nature of the disease and the risk of complications. The need for early aggressive therapy should be emphasized. The patient should put in efforts for physiotherapy which play a very important role in muscle strength and joint mobility. Pharmacotherapy options are wide and include disease-modifying antirheumatic drugs ( DMARDs). These can be conventional DMARDs like methotrexate ( usually the first line drug), sulfasalazine, hydroxychloroquine, leflunomide. Failure to adequately respond to these drugs should lead your Rheumatologist to consider Biologic DMARDs ( TNF antagonists, Rituximab, Abatacept, Tocilizumab). Your Rheumatologist is the best person to guide you about dose, indications, monitoring and side effects of the drugs used in RA. Treatment duration depends on the patient's response but is generally long ( 5-10 years or lifelong). 

COMPLICATIONS BEYOND JOINTS: 

RA patients can have rheumatoid nodules in skin, lungs, heart and other sites. These patients are at risk of accelerated bone loss, so calcium and vitamin D intake should be optimized. Eye complications include dryness, redness ( scleritis and episcleritis) and certain eye threatening complications. Lung involvement can be seen in various forms ( fluid in lungs, nodules, interstitial lung disease). 

These patients are at high risk of atherosclerosis ( heart and blood vessel disease). They also have a tendency to have frequent infections. 

NEED OF THE HOUR: 

All patients with joint pains should be seen early by Rheumatologist for diagnosis and treatment. With so many treatment options, no patient should suffer from joint deformities and other complications associated with long-standing, untreated RA. LEAD A HEALTHY LIFE! 

Heel Pain - What Are Its Causes & Treatment?

Heel Pain - What Are Its Causes & Treatment?

Oh my aching Heel!! The combination of foot and ankle consists of 26 bones, 33 joints and an excess of 100 tendons. The longest bone present in the foot is the heel. Over usage or injury to the heel would lead you to experience pain in the heels. The severity of the heal pain can range from mild to excruciating. 

The cause behind heel pain is typically associated with excess usage of the heel bone (learn more about to maintain bone and joint health). Straining of your heel occurs if you excessively pound your feet on surfaces that are hard, or you are overweight or even if you wear shoes that do not fit your feet properly. These strains cause irritation in the muscles, bones or tendons that are present in the heels. Some of the other common causes include: 

  1. Heel Spurs: Development of heel spurs occurs due to the continuous stretching of the lining, which covers the heel. Upon continuous stretching, pieces of the lining tend to break off. Development of heel spurs is common in athletes who frequently jog or run. People who are obese also tend to experience pain due to heel spurs.
  2. Plantar Fasciitis: Development of Plantar Fasciitis occurs due to the inflammation of the tendinous tissue that connects the heel to the ball of the foot. Development of Plantar Fasciitis is common in athletes who frequently jog or run as well as people who wear shoes that don't fit the feet properly. It may occasionally be associated with Vitamin B12 deficiency and raised uric acid in blood 
  3. Achilles Tendinitis: This is the inflammation of the Achilles tendon. Achilles Tendinitis occurs commonly in people who have active lifestyles, such as people who are joggers, runners or even dancers. 

Treatment-

Physical therapy, medication or alternative treatments can be used to treat this form of pain. Medications for heel pain can only be in the form of anti-inflammatory drugs. Although these oral medications cannot significantly relieve heel pain, some injections containing substances such as corticosteroids, as well as Arthrocentesis (removal of fluid present in joints using hollow needles) might be able to provide relief. Recently PRP (Platelet Rich Plasma) injection have been found very useful in treating recalcitrant Plantar fasciitis and heel pains. 

Common practices that can be used to relieve discomfort include: 

  1. Application of ice to the heel for a duration of 15 minutes daily. 
  2. Utilize over-the-counter pain medications .
  3. Have adequate amounts of rest .
  4. Wear shoes that fit properly .
  5. Walking on tip toes to stretch the plantar fascia helps to relieve heel pain.

Osteoarthritis - 5 Effective Ways To Keep It At Bay!

Osteoarthritis - 5 Effective Ways To Keep It At Bay!

Osteoarthritis is among the most common ailments that people on the other side of 50 are affected with. Few of the primary reasons behind osteoarthritis are age, obesity and weakened bones. Sometimes, osteoarthritis stems from joint injury or some sort of stress on the bones. It leads to acute pain and stiffness and can only be cured through medication and exercise. The symptoms may vary from mild creakiness in the joints and swelling to the loss of cartilages between bones.

Long periods of inactivity can also trigger extreme stiffness as well. While it is an extremely painful disease, it does not spread to the other parts of the body. Inflammation of various degrees in the ligaments and joints is the primary cause of osteoarthritis and sustained treatment can only result in abating of pain. Osteoarthritis is usually treated through detecting the symptoms and through other imaging tests, while joint replacement may be a viable solution, there are other non-surgical processes that reap fruitful results while battling osteoarthritis.

It usually involves an optimum mixture of exercises and drug therapy. While there are several cures available, prevention should always be a priority:

  1. Physical activity: Obesity is one of the primary causes of osteoarthritis. Certain prescribed exercises can go a long way in improving muscle strength and reducing joint pains. However, excessive exercises must be avoided. Other preventive methods include medicinal spa, massage and chiropractics. These are extremely beneficial in cases osteoarthritis.
  2. Medicines and drugs: Osteoarthritis can be kept under control and averted through specific medications. Drugs can be consumed orally or can be injected directly as per the prescription of the doctor if he or she forebodes an onset of osteoarthritis. Knee lubricants have also been helpful in curing osteoarthritis. For more severe conditions, specified medical attention may be required.
  3. Nutritional Supplements: For obtaining relief from joint pains, a proper and healthy diet is necessary. An enhanced supply of calciumvitamin D and Omega-3 fatty acids is thus mandatory for remedying and preventing osteoarthritis. A healthy diet builds your immunity and prevents such diseases.
  4. SurgeryAlthough not the favorite, knee replacement surgery is often undertaken even if initial signs of osteoarthritis or rheumatoid arthritis are detected. These are relatively hassle-free surgeries which go a long way in providing relief. However, you must follow the advice of the doctors thoroughly before opting for this.
  5. Acupuncture: Acupuncture has gained a lot of popularity in the recent times. Based on ancient techniques, this involves gently needling the various pressure points to purify the system from within and reduce the joint pains. They have extremely health boosting properties and contribute to one’s overall well-being.
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Knee Pain - How Ayurveda Can Tackle It?

Knee Pain - How Ayurveda Can Tackle It?

Ayurveda is a very old system of medicine, which originated in India. Using herbs found in nature to cure various illnesses, knee pain can also be permanently cured with this method indigenous to India. It reduces knee pain caused by various illnesses including arthritis, inflammation of the cartilage and wearing of the patella among others. Here are some common Ayurvedic remedies, which help reduce knee pain:

1. Alfalfa: Alfalfa is medically known as Medicago Sativa. Alfalfa is excellent for making sure that your joint pain reduces, when taken in liquid form four times a day.

2. Ashwagandha: Ashwagandha is medically known as Withania Somnifera. In the West, Ashwagandha is popularly known as Winter Cherry. Also, it has a lot of therapeutic properties, which include reducing joint pains. 

3. Banyan: The Banyan tree's medical name is Ficus Benghalensis. It has a sap very similar to the form of rubber known as latex is derived from the Banyan tree. The Banyan tree's sap is externally applied over the joints and the pain usually disappears after a few regular applications. 

4. Bishop's weed: The medical name for Bishop's weed is Trachyspermum Ammi. The oil extracted from this herb is usually applied to the knees to reduce the intensity of such knee pains.

5. Celery: The medical name for celery is Apium Graveolens. Celery is not only effective treatment for rheumatoid arthritis and associated pains in the knees, but it is also helpful in treating gout. It is usually agreed upon that this particular treatment is usually long lasting because of its alkaline nature.

6. Dandelion: Dandelion's biological name is Taraxacum Officinale. It is rich in magnesium and is crucial for the correct mineralization of the bones. This mineralization allows the bones to become stronger and also prevents knee pain.

7.  Garlic: The medical name for garlic is allium sativum. Five to six cloves eaten every day has proved to reduce knee pains.

8. Ginger: Ginger is biologically called Zingiber Officinale. These can be easily included in your diet and go a long way in curbing knee pain.

There are some panchakarma procedures which are very beneficial to overcome the swelling as well as pain. 'Janu vasti' is specific procedure for it which is perform by various types of oil depending upon severity of the patient.

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Low Back Pain - Know The Ayurvedic Treatment For It!

Low Back Pain - Know The Ayurvedic Treatment For It!

Ayurveda is an ancient healing technique that is very effective for today's lifestyle ailments. For many people, low back ache can be troublesome. While strong pills and capsules may give you temporary relief, they do not address the core issue and have a number of side effects. Ayurveda on the other hand, addresses the trigger and has no side effects.

Intrigued! Take a look at these Ayurvedic techniques to cure low back pain:

  • Cut out on spices: We may think it unrelated, but low back pain is often accompanied by indigestion. Spinal cord nerves connect to back muscles and digestive organs. Hence, a small change in your diet can have a great impact on your health. Spicy food aggravates the digestive system and has a drying effect on the body. By cutting back on spices and oil, the digestive system can work better and there will be less stress on the nerves connecting the spinal cord and back muscles and thus result in lesser back aches.
  • Warm your body: According to Ayurveda, back pains are caused by an increase in vata dosha or the amount of air and ether elements in the body. Warming the body can help lower these levels. Apply a heat pack to the back as a way of keeping the external body surface warm. Additionally, add warm food to your diet. This opens out any blockages in your digestive system and in turn reduces low back pain.
  • Padahastasana: Ayurveda is very closely linked to yoga. Padahastasana is a yoga asana which addresses lower back pain by opening up the digestive channels and allowing the vata dosha to flow easily through the body. To practice this asana, stand with your legs together and lift your arms straight above your head while inhaling. As you exhale, bend forward from the hips while keeping your back and legs straight. Try and touch your toes. Hold the position for as long as possible and come back to the starting position while inhaling.
  • Anuloma Viloma: Anuloma Viloma is a breathing exercise that balances the vata dosha. This is a technique that involves breathing from alternate nostrils. To begin, close the right nostril with your thumb and inhale through the left nostril. Close both nostrils and hold your breath for a few seconds. Then, release through the left nostril. Repeat this process, starting from the left nostril.
  • Bishop's weed seed tea: Tea made from the seeds of Bishop's weed is can provide instant pain relief from low back pains. This is suitable for men and women of all ages except those with heart problems.
  • Ayurveda Panchkarma: A) Katibasti - Pouring special oils on back in a specific ayurvedic way. B) Basti - Enema therapy with oil C) Agnikarma - are helpful in low backache.

The core principle of Ayurveda is to listen to your body's messages. These techniques will help you become more tuned to your body's needs and keep you free from back aches.

Pain In Joint - How Homeopathy Can Eradicate It?

Pain In Joint - How Homeopathy Can Eradicate It?

If you have recently experienced pain and inflammation in the joints, then it could be a symptom of rheumatoid arthritis, which doesn’t subside on its own. This can lead to swelling and excessive pain along with stiffness and deformities in the affected area and can sometimes interrupt your regular routine as it limits your movement. This mainly affects people aged over 40 years, but this doesn’t imply that it cannot occur among young people. And if you are suffering from such a condition, then you can seek refuge in homeopathic treatments.

Why you should opt for homeopathic treatment?
Though most people are running after allopathic treatment these days, homeopathic treatment is far more effective since it uproots the cause of the joint ache and stiffness and helps you lead a happy and healthy life. Furthermore, it is 100% natural, meaning that the medications would not lead to any kind of ill effects in the future. Some of the most useful homeopathic treatments for joint pain include the following:

  1. Causticum for joint pain leading to deformities: If you are feeling weak to an extent that you are barely able to walk, then causticum can be of help. Sometimes it can lead to restlessness at night, with the restlessness particularly centred on the leg as the tendons tend to contract, causing acute pain as well as deformities. There can be a loss of sensation owing to excessive pain, and it becomes nearly impossible to hold anything firmly.
  2. Caulophyllum: This is especially a remedy for woman, implying that the medicine is effective in treating the joint stiffness, pain and other allied symptoms found among women. If your toes and hands are affected with erratic and severe pain which shifts from one place to another in a short span of time, then you may have to take this medication.
  3. Colchicum: If you have been suffering from joint aches for a long time, then this homeopathic remedy would work well for you. The drawing nature of the pain is known to affect important tissues like synovial membranes and periosteum along with muscular tissues, and all the parts appear swelled up and inflamed. The pain becomes excruciating and the patient cannot allow the affected place to be touched. There is also a feeling as if the fingers are being pinned, making the rest of the hand numb.

These are some of the best-known medications for the treatment of joint pain, though it is always recommended to ask an expert to know what would work best in alleviating your symptoms.
 

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Knowing More About Shoulder Pain!

Knowing More About Shoulder Pain!

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch/wash your back, comb your hair or reach your back pocket. Shoulder pain can happen due to various reasons, vary from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc.. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In the case of middle to old age, injuries that can cause shoulder pain are-

  • Biceps Tendonitis
  • Acromioclavicular Joint arthritis
  • Scapular Dyskinesia
  • Trapezitis
  • Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
  • Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of the shoulder can cause shoulder pain due to...

  • Bankart lesion
  • Hill-Sachs lesion

Diagnose Shoulder Pain-

Shoulder pain can be diagnosed only after a thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

  1. X-rays: Through an x-ray one can view the shoulder in many different views
  2. Ultrasound: With ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
  3. MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
  4. Diagnostic Arthroscopy: A surgical procedure often used by orthopedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain-

  1. For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
  2. Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions --

  1. Pain relief and physiotherapy as first step If this fails then following surgical options are available
  2. Arthroscopic debridement or repair of labrum
  3. Biceps tenotomy or tenodesis

Arthritis --

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle-aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle are not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

Remember "a stitch in time saves nine"

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Knee Sprain - What Causes It?

Knee Sprain - What Causes It?

 A knee sprain is a disorder that is characterized by tearing of the ligaments of the knee. The ligaments are tissues in the knee, whose function is to keep the bones together. They also help in keeping the bones and the knee joint in their proper position. In terms of function, they help you walk, turn and twist. Usually, ligaments get sprained due to sports or exercise-related injuries.

Causes

  1. If the knee is directly hit: Sprains occur when the knee is hit directly by a strong force on the sides, front or back of the knee. It may also occur, if you trip or fall on your knees. Car accidents and football tackles are other instances where the knee may be impacted in this manner.
  2. A sudden twist to the knee joint: If the knee joint is suddenly twisted, then it may result in knee sprain. This usually occurs in situations wherein you plant your foot and then suddenly turn from the knee. This can occur in various sports such as football or hockey where you run and change direction suddenly.

Symptoms
The symptoms of knee sprain are pain in the knee joint, impaired movement and swelling. You will have difficulty while walking as the knee may give out or buckle. In some cases, you may also hear a painful pop from the knee joint.

Treatment
The treatment of a knee sprain begins with a proper diagnosis wherein you may have to undergo various tests such as X-rays or MRI. Once the diagnosis confirms that it is a knee sprain, treatment will begin. The various modes of treatment include:

  1. Acetaminophen: This medication is used to reduce fever and pain resulting from the knee sprain.
  2. NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen also reduce swelling and pain.
  3. Physical support devices: You may also use splint or an elastic bandage to provide support to the knee joint so as to allow the area to heal faster.
  4. SurgerySevere ligament tears in young patients will require surgery to regain full and normal function to carry on playing regular sports in future.

In addition to the treatment, plenty of rest is required. Do not carry out tasks that require you to move your knee excessively as it may damage it further. Perform stretches and strengthening exercises to keep the joints strong and mobile. Sometimes ligament injuries are serious and do not settle down with the above measures. If the problem persists, you must visit your nearest sports injury specialist.

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