Search for tag: "knee pain"

Interviewer: Experiencing pain or swelling on the outside of your knee might not be a problem with the knee itself, but rather the IT band. And to better help us understand more about this tendon, how it can be injured, and how to ultimately treat it, we're joined by sports medicine specialist, Dr. Chris Gee.

Let's start with the basics. What is the IT band?

Dr. Gee: Yeah. So the iliotibial band is basically a big thick band of tissue that . . . Well, I shouldn't say thick. It's a wide band. It attaches on your ileum, which is your pelvis, so kind of the side of the upper part of your hip, goes down across the bony hip bone on the side, and travels all the way down and attaches on the side of your leg or your tibia. And it's got a little bit of muscle called the tensor fasciae latae that sits within it, and it basically kind of holds things into the side of your leg, is what it does.

Interviewer: And what causes IT band syndrome? When somebody says, "Oh, I've got IT band problems," what were they likely doing that led to that?

Dr. Gee: So IT band syndrome is generally an overuse kind of problem. What it does is, since it is over the side of the hip and over the side of the knee and it's kind of holding things in, every time you bend the knee or bend the hip, it has a potential to kind of catch on some bony prominences that are there.

So it's most common in the knee, and what'll happen is every time you flex your knee, the IT band kind of swings back and snaps over the side of the femur.

Now, you can imagine if you are running or doing some other activity that there's a lot of kind of knee bending over and over and over, that's going to start to potentially get that area inflamed and it'll cause some pain in that area.

There can be a little bursa that sits underneath it. The bursa is a little sack that has very little fluid in it, and it's there to decrease friction, but that'll sometimes get inflamed and it makes it painful to run and walk, and it starts to get very tight feeling on the side of the knee or the hip.

Interviewer: So it would be similar to if you had something rubbing on your skin constantly over and over and over again. Eventually, that would start to irritate your skin. Is that kind of what's going on, except for it's on the inside?

Dr. Gee: Exactly. It's kind of like if you're wearing a backpack and that backpack has a strap that's rubbing on your shoulder. And over time, you're going to try to adjust that backpack. But with the IT band, you can't. It's still there and every time you're moving, it just keeps on snapping and catching and causing that pain.

Interviewer: That sounds like a design flaw that it would rub like that when you're doing something like running or moving.

Dr. Gee: Yeah, it's sort of a structural stabilizer and we need it, obviously, to kind of maintain things. But, well, it can be very painful at times and be quite limiting, particularly to runners or people that are in running sports like soccer.

Interviewer: So is there a reason why some people might have IT band syndrome? Two people doing the exact same thing and some people might experience IT band syndrome and some people don't?

Dr. Gee: A lot of it depends on kind of structural differences. Some people tend to be a lot tighter in their joints and they'll have tighter muscles in general. And that little tensor fasciae latae that sits within that can be a little tighter in some people, and so it'll pull on that a little bit more and it'll cause it to potentially snap in that area.

So that's number one, is that you're just sort of set up for it by your musculature and your tension. But number two, sometimes the way people run or their activity, if they're maybe rotating their leg in a certain way and just causing that to be a little more tight. So if their leg almost bows out a little bit, it will kind of put more tension onto that IT band, and just cause it to kind of catch and snap a little bit.

Interviewer: So if somebody's experiencing knee pain and it's caused by the IT band issue, it sounds like perhaps some of the treatments might include some exercises to strengthen the glutes and other muscles or some . . . I don't even know. What would you call that, where you're teaching your body how to fire muscles in a different way? What's that called?

Dr. Gee: Yeah, we mostly just say strength or dynamic control, is kind of what the term I'll use with people. It's not about just firing that muscle. It's more about getting it to fire with others in concert so that as you're moving that joint, they're all firing together and supporting that joint a little better.

Interviewer: And there are exercises that can help teach the body that?

Dr. Gee: Yeah. So a lot of times we'll work on something called clamshells, if you've heard of that. Those can be really helpful. They basically strengthen the lateral glutes and hips.

Interviewer: What about stretches? Actually, before I say stretches, I want to talk about foam rolling.

Dr. Gee: Yes.

Interviewer: Because I've heard people that have IT band syndrome, they swear by foam rolling. Is that helpful or is that not helpful?

Dr. Gee: So I find it very helpful, both personally and with patients. So you want to try to stretch this area out. Like we talked about, the IT band is a little tight and it's snapping over the side of the knee on the hip and it's going to cause pain, but it's actually a very difficult thing to stretch.

Even if you look up different kinds of stretches and do them, it's hard to really get a good stretch in that area. It's not like when you stretch out your quad muscle, you do the little hurdle or stretch or whatever, and you can really feel it pull that muscle. Sometimes it's harder to feel much of a pull on the side of that IT band.

And so what foam rolling does is you basically use the weight of your body against a roll and you're kind of rolling it back and forth and it's helping to loosen that tissue and to break up some of the tension that's in the muscle there and allows that to calm down. And that can be significantly helpful for people.

Interviewer: So the band itself is stretching when you foam roll, and then you're also stretching that attachment muscle that you mentioned earlier. What was that called? The . . .

Dr. Gee: The TFL.

Interviewer: The TFL, yeah.

Dr. Gee: Tensor fasciae latae. Yeah.

Interviewer: Yeah. And you're kind of stretching that as well. Is that what that foam rolling is doing?

Dr. Gee: Yeah, you're kind of putting some tension on it so that it releases and relaxes. Foam rolling can be a little painful for sure as you start off doing it. And depending on how painful it is, you may have to adjust how much weight you're actually putting on it.

I see high-level athletes that put their whole body on it and they're putting a lot of force in it, and sometimes you have to adjust and, "Okay, I can't quite put all of my force onto the side of my leg because it's so painful." But as you build that up, it feels better and you're able to work through more and more of the foam rolling.

Interviewer: What about percussive therapy, like Theraguns or something like that? Is that a good thing to use on your IT band?

Dr. Gee: Those can be helpful as well. What you're basically trying to do is just to get the muscle, the tensor fasciae latae in there, to release a little bit. If it has too much tension, it's going to pull too hard on that tissue and make it tight. And so, effectively, you're trying to hit that or cause it to break so that the tension in that releases a little bit. That can be helpful in that area.

As you get further down towards sometimes where the IT band attaches on the knee or the side of the leg, there's not as much tissue there, and so those Theraguns are going to cause more pain in that area. So you probably can't use them that well there. But up higher on the side of the hip, you can definitely do it and that can be helpful there.

Interviewer: And then knee braces, are those something that you find success with as well?

Dr. Gee: For IT band, not quite as much. Sometimes if they're having more anterior knee pain, so the kneecap tracking is an issue, you can put a brace on. It almost looks like one of those that has a hole in the front, like a neoprene sleeve with a hole in the front. Those basically are designed to kind of hold the kneecap in place so that it doesn't slide around and cause pain. The IT band doesn't quite have a good brace for it.

But most of the time what I will tell people is working on those muscles, like we talked about, and sometimes even doing something like a running gait analysis can be helpful. What that is, is you basically put a patient on a treadmill and then you film them and then you slow down the video and you kind of watch, as they're running, what they're doing.

So I tell people nobody teaches us how to run, we just start doing it, and sometimes we do things that aren't really helpful for our bodies. It can cause some pain. So sometimes speeding up the way we run, meaning we take shorter steps, so we're taking fewer steps, can help. Sometimes the way our foot hits the ground is a problem, and so adjusting maybe the type of shoe you wear or the way you bring your foot down can help.

And so there are a lot of different things that we can find on that that sometimes we can help patients to work through. They're a runner or running sport and they're having a lot of IT band issues, we can kind of work through some therapy, work through a running gait analysis, and get them back to their activity, where they want to be.

Interviewer: And then are kind of the treatments that you would use for IT band therapy very similar to what somebody might want to do to prevent it from happening in the first place or to keep it from coming back?

Dr. Gee: Yeah. This can be very much a chronic issue, and so patients that have this, I kind of tell them, "Hey, this is something you're going to have to be really good about, even after you get it feeling better, maintaining that length on there. And so working on stretching, working on doing some IT band things."

And this was something I had mentioned before. I've personally struggled with this. I have to foam roll after I run. It's just to make it so that it doesn't hurt the next day and things like that. And when you do that, you can maintain that really well.

And so I tell people, "Yeah, having some good stretches that you do when you run can be helpful to prevent this from becoming a problem or help maintain it once you've kind of got it under control."

Interviewer: And I know when somebody comes in, everybody is different and everybody has a different level of injury. Generally, though, when somebody starts doing some stretches, some exercises, what kind of recovery time are you looking at where the pain starts to go away?

Dr. Gee: It's probably going to take a few weeks for a muscle injury to recover. If it's a bad muscle injury, it can be up to six weeks or so. And so I advise people when they come in and they have sort of a lower grade muscle injury, maybe they've kind of strained a muscle, I tell them, "Give it a couple of weeks of avoiding that activity."

So maybe if running was your thing, you're trying to avoid lower extremity stuff. Maybe you're getting in a pool or swimming or something like that so that you're not impacting that for a couple of weeks. Allowing that to calm down and then gradually working your way back into your activity is probably the best way to prevent that from lagging on and to allow it to recover.

Interviewer: And do you recommend any sort of ibuprofen or anything like that for the inflammation?

Dr. Gee: One thing I should probably point out, and maybe I should have pointed this out before, but whenever we are exercising, what effectively we're doing is we're putting a strain on the muscle or the tendon. And to clarify, the tendon is a piece of tissue that attaches the muscle to the bone. So it's kind of like a rope holding the muscle to the bone.

But we're stretching those tissues to the point that if you could see it, you're going to see these tiny little tears in the muscle or the tendon. And the point is that when you tear it like that, your body goes back and strengthens it, makes it stronger.

But if you're doing that repeatedly, sometimes that will cause it to . . . you'll get too many tears, too many of those little tiny tears in there, and that's where pain comes in.

And so, at that point, decreasing some of the inflammation with ibuprofen, with ice, some rest, just to allow the muscle to kind of calm down and let your body's healing processes catch up, will allow you to then feel better.

Now, when it's healed, generally it's stronger. And so now you're going to be able to go out and lift more, you're going to be able to work more, you're going to be able to do more, than you were before, and that's the point of getting stronger with exercise.

Interviewer: And when is it time to see a sports medicine doc or a physical therapist if you're experiencing knee pain that you suspect might be IT band?

Dr. Gee: First of all, if you ever get an effusion in your knee, meaning the knee is really swollen, that's usually a concern that something more is going on.

The other thing is if you have tried some of the things I've talked about, so you looked up some stretches, you did some icing and anti-inflammatory and it's still really bothering you, then definitely getting in and seeing us could be helpful.

Sometimes we have to try some different studies and other imaging, X-rays, or things like that to see if something else is going on, or even other treatments like injections sometimes to kind of calm down the inflammation because ice and anti-inflammatories just haven't been enough to get on top of it.

So IT band is something that can definitely affect a lot of different kinds of athletes, and it can be very limiting to the point that you can't run and you can't be active in the way you want to be.

But the good news about it is that it's something that can be treated with good stretching, anti-inflammatories, icing, and even sometimes some physical therapy to get on top of it.

Ideally, we want you to be able to work through it and we want you to be able to stay active. And so if you're having issues managing it, definitely getting in and seeing a provider and getting on top of this is the way to go. And we can get you to a point that you can work through this and enjoy your sport or your activity without pain.

Interviewer: When should you have your knee pain checked out? Dr. Matheau Eysser is an orthopedic surgeon. What advice do you have for patients?

Dr. Eysser: Well, I tell my patients to look for two things: number one, pain. Acute pain or pain that interrupts your sleep could indicate a torn tendon, meniscal tear, or arthritis. Second, symptoms. If your knee locks up on you or you are unable to fully straighten your knee, it could indicate a torn meniscus. Feelings of instability, a painful clicking or popping, or sharp stabbing pain are also some of the complaints or symptoms of a meniscal tear.

However, if your symptoms are a dull ache, pain when standing from a sitting position, or pain that improves after walking a couple of steps, this could indicate arthritis. If you are experiencing these types of symptoms, it is a good idea to have your knee checked out by your doctor.

updated: July 6, 2021
originally published: May 29, 2019

Announcer: Seven question, seven answers. It's Seven Questions for a Specialist on the Scope.

Interviewer: It's time for another edition of Seven Questions for a Specialist. Today we have Dr. Chris Peters. He's an orthopedic surgeon who specializes in knee and hip replacement. Are you ready for Seven Questions?

Dr. Peters: I'm ready. Go.

Interviewer: All right. What's the best thing I can do for my knee or hip health?

Dr. Peters: Staying active, maintaining ideal body weight, and avoiding cliff jumping. I don't know, joining a . . .

Interviewer: What's the best thing I can do after a joint replacement surgery?

Dr. Peters: Go out and live a full, active life.

Interviewer: What's the most common knee and hip problem that you encounter?

Dr. Peters: Arthritis.

Interviewer: What's one thing you wish people knew when it comes to joint replacement?

Dr. Peters: It's not as painful a thing to go through as most people think.

Interviewer: Knowing what you know about hips and knees, you cringe a little when you see someone doing what?

Dr. Peters: Marathon running.

Interviewer: Really? Expand on that a little bit.

Dr. Peters: Well, that's not really fair, because, you know, if you look at it, marathon runners are usually super-fit. They're slight people, and they're highly conditioned, and there's actually not a lot of evidence that says running well into your 50s and 60s leads to arthritis, but it gets to the point of overuse in very vigorous athletic activity, so for instance, NFL players tremendously high rate of hip and knee arthritis. So extremely high-impact, competitive athletics, I think, is very hard on your hip and knees

Interviewer: How can I prevent common knee and hip injuries?

Dr. Peters: It's common sense, you know? And I think, to a certain extent, you can't eliminate that if you want to live a full life, you know? So I hear parents a lot of times asking me, "Well, should my kid play football?" "Should my kid not play basketball?" Well, no. We have to accept that there are some risks in the things that bring enjoyment in life, and recreation's one of those things.

Interviewer: What do I need to know about nutritional supplements that say that they will help my joint health?

Dr. Peters: Save your money. In most cases, a once-a-day multivitamin is probably all that you need.

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Dr. Miller: When's the best time to get that hip replacement? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller, and I'm here with Dr. Chris Peters. Chris Peters is a professor of orthopedic surgery here at the University of Utah.

Chris, the old saw was, well, at least when I trained in medical school, if you had to have your hip replaced, or your knee replaced, you ought to wait as long as possible, maybe even until the time that you're crawling, because there was some concern that the surgery was a little risky. That's not the case now is it?

Dr. Peters: No, you're right, Tom. There has been a very profound change over the last, I would probably say the last twenty years. When hip and knee replacement was first begun in the late 1960s and 1970s, those initial cases were done on people who had kind of disastrous arthritis, and they were folks who were predominately wheelchair bound.

Dr. Miller: They were the worst of the worst.

Dr. Peters: Yeah, the worst of the worst. Over time, what we have seen is that there's been a slow, steady change, and a realization that actually waiting is perhaps detrimental to overall patient health in many cases, and so I think now we realize that, for instance, if a patient's in their early 60s and has some health problems, which is common these days, diabetes, high blood pressure, and their functional status is profoundly impaired, that is they can't go out and recreate, they can't go for a walk around the block, they can't go play with the grandkids comfortably, those patients are probably better off treated with surgery earlier, rather than the old conventional wisdom of waiting as long as you possibly can.

Dr. Miller: Well, technology and techniques have improved, I would think, remarkably since the first joint implants had been done, right? So a lot has changed in terms of the functionality of the implants, and the time to recovery, and the physical therapy that's done afterwards so that people can get back to do many of the things that they were doing previously sooner.

Dr. Peters: Absolutely, and again, back in the '70s and even into the early '80s and '90s, we had concerns about implant longevity. We used to tell patients, we hoped this would last, that a hip or a knee replacement would last ten years. And what we found is that the longevity of the current generation of prostheses that we use is probably more likely 15 to 20 years. And so again, that patient who's in their early 60s is likely to see a hip or a knee replacement last the rest of their life, and they're likely to see their functional status be quite good throughout the last several decades of their life.

Dr. Miller: Now is it true the longer one waits, the kind of weaker the ligaments and muscles around that particular joint become? I would think, if that was the case, that rehabbing that area after surgery would be even harder.

Dr. Peters: Right, and what we find is that patients who wait too long come to us in what we call a deconditioned state. So we start to see deterioration in other organs, and often what goes along with that is obesity, weight gain. And many of these things can be reversed. When you restore ambulation, you restore the ability to get out and exercise. So I think patients often today are much better to have an arthritic hip or knee replaced sooner rather than later.

Dr. Miller: So Chris, when will the right time be? I mean, it's individual. Obviously it's an individual decision, but how do you advise patients?

Dr. Peters: The optimum time obviously is individualized for every patient that we see, but if a patient comes to us and they have X-ray or radiographic evidence of arthritis and can describe to us a significant impairment in their life, whether that impairment is the inability to go out and play nine holes of golf after work, or whether that impairment is an inability to go to the zoo with their grandkids on the weekend, and they're experiencing significant pain, and they've gone through a period of time using the standard medications that people use for pain, such as anti-inflammatories, if they've gone through that process and they're in that position, they're probably ready for a joint replacement.

Dr. Miller: Do you ever recommend that they do some of these other treatments such as injections into the joints of lubricants or prednisolone, something to calm the joint down before you make that decision?

Dr. Peters: Sure, there is absolutely a role for what we would call conservative or non-operative therapy. And there's evidence that, for instance in the knee, that corticosteroid injections can provide short term symptomatic relief, and we'll use those fairly commonly in patients in the earlier stages of arthritis. But once you get to significant bone on bone contact, and the whether it's in the hip or the knee, those modalities tend to be just very short term pain relief, really aren't the long term strategy for treating the patient.

Dr. Miller: They just don't last, do they?

Dr. Peters: Right.

Dr. Miller: The primary reason to do a hip replacement, as I understand it, is to reduce pain and to increase function, but it's so much more than that, isn't it Chris?

Dr. Peters: Right, and it's really a fascinating thing. As orthopedic surgeons, we start a little bit with this tunnel vision. You've got a patient comes in with an arthritic hip or knee joint and we get excited about replacing that, because we know that there's a pretty predictable improvement in pain and function when we do a hip or a knee replacement, but what we found over time is that there's incredible added benefits to the patient as well. So their overall health tends to improve.

We see patients who come in to us as a diabetic, and who are significantly overweight, and now they can get back out and exercise, they can get on their bike, they get into a Zumba class, they lose weight. Often they'll go from an insulin dependent diabetic to on to an oral agent controlled diabetic. We see we see significant improvements in overall health just resulting from the ability to be more active after a hip or a knee replacement.

Dr. Miller: So it's so much more than just improving function and decreasing pain.

Dr. Peters: Absolutely, yeah. I mean, I think it's one of those things that joint replacement surgeons didn't appreciate very much until, I would say, the last decade or so, but now we can, I think very reliably, with good literature support, tell patients that not only is their arthritic hip or knee going to feel better, but likely their overall well-being will be better.

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