Most minor problems occur as a result of
tight muscles. These problems generally do not involve trauma
twisting or spraining the joint, tripping or falling)
Sharp knee or ankle pain after a fall or
significant swelling after a sprain needs to be evaluated by an MD to rule out
a fracture or ligament tear. Persistent pain due to a minor sprain which lasts more than 2
weeks and does not respond to basic stretches should be evaluated by a MD or
Below you will find advise for treating knee
pain that has occurred without any history of a recent trauma/fall.
It is common to notice knee or heel pain
with out any obvious cause. These types of aches
and pains are often due to tight muscles. They may follow periods of
increased walking, as when sightseeing while on vacation. Often there is
some change such as the addition of hills to your normal walking routine.
In other cases there may be no apparent cause.
exercise muscles get stronger but they also get shorter. Without an equal
amount of stretching we end up with tight muscles. Walking exercises the
major muscles of the leg. Since it is a mild exercise, it may take years
to develop enough stiffness in the muscles to cause knee or heel pain.
Someone with tight muscle is at risk to develop knee and heel pain.
Knee and Heel Pain
(example: Tendonitis / plantar fasciitis)
pain or deep ache of the knee usually in
the front under, just above or below the knee cap (patella)
Stiffness and cracking/clicking of the knee
- Locking or buckling of the knee. (this usually
indicates a more serious problem and requires medical attention.)
- Pain or deep ache of the heel or
back of calf or sole of the foot.
- Pain is worse in AM with first few steps out of
- sudden increase in the amount of walking, such
as sightseeing while on vacation or addition of hills/ stairs to daily
- Slow onset without any clear cause. May be
due to muscles tightening slowly over many years.
Risk Increases With
- deep squats (knee pain)
- change of walking routine
- change of footwear (heel pain click
How to Prevent
- Stretch the basic muscle groups involved in
walking on a regular basis and especially at the first signs of knee
or heel pain.
- Increase frequency of stretches if you increase
your daily walking or when you include more walking on hills or
- Use first aid at the first sign of injury.
here for prevention /first aid for Knee pain.
here for prevention /first aid for Ankle pain.
WHAT TO EXPECT WITH IF YOU SEE AN MD:
Diagnostic Measures for knee or ankle pain
- Observe your symptoms. (What makes the pain worse/better)
- Medical history and exam by a doctor & referral to a
therapist for persistent symptoms.
- Range of motion testing to check how far your
knee or ankle bends.
- Testing to determine if there has been tearing of the
ligaments of knee/ankle or the meniscus in the knee.
- The doctor will bend and
push on the joint looking for abnormal motion.
- If abnormal motion is found or in the case of
severe of persistent swelling of pain the doctor may order an
- MRI (check for ligament tears)
- x-ray (rule out a fracture or heel spurs)
- If the symptoms are not severe the MD may recommend
a trial of conservative treatment including rest, medications and physical
Note: A physical therapy evaluation will be similar.
Since the therapist can not order tests, they will refer you to an MD if
they determine testing is required.
- Physical therapy should be prescribed
if pain persists and the doctor does not feels additional tests are
needed or if testing is negative. If testing shows a torn
ligament or other structural damage your doctor will discuss your options including rest,
physical therapy bracing and surgery.
- In most states you can go directly to a physical therapist.
- If the condition is severe or requires
evaluation by an MD the therapist will refer you to a physician.
- The physician
can prescribe medications, order tests and check to be sure you do not have a more serious
medical condition that may be causing your symptoms.
- Physical therapy treatments should address risk factors, prevention &
set up a home
exercise program. Hands on pain reduction treatments are used as
click here for first aid tips.
A physical therapy evaluation should include:
- History (The therapist will ask: How did you hurt yourself, When did the pain first
appear? What makes the pain worse/better? Have you had this type of pain before?
What were you doing just before you felt pain? What does your daily routine
- Physical exam: ( You will be asked to do certain movements to determine what movements
increase your pain. Your ability to walk with or without a limp will be
evaluated. The mobility and quality of the motion of your joints,
and the flexibility of the muscles will be checked.
- Physical therapy treatments will vary depending on the condition. A through
treatment will include a few basic elements:
- Pain reduction may include use of ice, massage,
mobilization and other modalities including ultrasound & electric stimulation.
- A home program may start out as simple as a list of things to
avoid, ie: long walks and hills. The home program should include exercises, stretches and some type of
simple first aid. The goal is for you to gain control over the symptoms
gradually eliminate the cause of the problem.
- Prevention includes:
- discussing risk factors for your specific condition.
- exercises to increase strength and flexibility.
- training in how to return to sports, etc. without re-injuring
- Suggestions for bracing or orthopedic
devices including orthotics and heel cups if indicated.
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(relieve pain, promote healing, avoid re-injury)
Immediately after an injury and for the next few days,
First Aid #1 - to remember the
basics think R.I.C.E.
R - Rest
the injured joint -
- Stay off the leg as much as possible for the
first few days. You may use a cane or crutches to relieve weight
- Tips: If you are limping then you should use a
cane or one or two crutches. When you use a cane or one crutch
the cane is held in the hand opposite the injury. (ie sprained
right knee - hold cane in left hand) If you have trouble
using a cane a physical therapist can instruct you in proper technique.
I. - Ice -
As soon as possible, apply an
ice pack to the injured area. (10-15 minutes every hour). Cold limits swelling, reduces
pain and speeds healing.
Soft gel packs work well. Apply cold packs or ice for 5-10 minutes three or four
times a day. You can apply ice as much as once an hour.
Continue ice for the first three days. You
can continue beyond three days if the cold continues to provide relief.
C. Compression -
Ace wrapping or use of a soft
If ace wrapping avoid circular turn as
this may block circulation. The wrap should be on a diagonal across
the joint. With both ace wrapping and soft compression wraps, check to
be sure it is not too tight.
You should be able to slip a finger of
two between the wrap and the skin.
When wrapping the ankle if the toes get
cold or change color the wrap is too tight.
E. Elevation - Elevate
the leg on a pillow when in bed or on a foot stool when sitting.
First Aid #2 MEDICATION
Try over the counter
If the non-prescription dose does not relieve your pain
- There are a variety of over the counter medications.
The two classes of medication are pain medications and anti-inflammatory medications. Take as directed on the
bottle Take these medications sensibly. Never exceed the
dosage suggested on the bottle.
the pain completely might allow movement that could lead to re-injury.
First aid # 3 STRETCHES
The goal is gentle stretches to provide PAIN RELIEF.
STOP ANY EXERCISE THAT INCREASES PAIN.
Exercises to Avoid
- Deep knee bends put a lot of compressing on the
underside of your knee cap (patella). This leads to wear and tear type of arthritis (osteoarthritis).
Partial squats (bend knees to 45 degrees or less and hold) are a good
alternative. They provide good quad strength gain without the wear and
tear on the patella.
- Avoid or use caution with exercise machines that
provide resistance while you straighten your knee. (Think sitting and
kicking forward against resistance)
- Stationary bikes / elliptical trainers are a good
- The best exercises for your knee are closed chain
(ie your foot is connected to something - the floor, a bike pedal, a
- There are not any specific ankle exercises to
avoid. Don't over do it with toe raises with resistance remember to
stretch before and after.
Chronic ankle or knee pain.
DON'T LIVE WITH PAIN - SIMPLE TREATMENTS CAN HELP.
A PHYSICAL THERAPIST CAN ASSIST WITH
REDUCING PAIN AND SETTING UP A HOME PROGRAM.
CALL YOUR DOCTOR IF you
have sharp knee or ankle pain after a fall or
significant swelling after a sprain or if you are not able to bear weight on
your leg. This needs to be evaluated by an MD to rule out
a fracture or ligament tear.
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