Knee Pain and Physical Activity: Guidelines for Safe Exercise in Singapore

People with knee pain or knee problems should seek medical advice on exercise and the best exercises to start with if they are not given any from a physiotherapist or other medical practitioners. It is advisable to start with exercises that are of low resistance and do not place the knee in extreme flexion or stress. This can include riding on a stationary bike, swimming or aquatic exercises. These are good to begin with as water provides resistance but also support, so the muscles can be exercised with minimum stress on the knee joint. Other exercises can also be done in a pool such as knee extension and flexion, but these have to be approached with caution. Those with knee problems where the cause of the pain is due to mal-tracking or other joint problems should avoid deep knee flexion. This is because the patella is likely to be under more stress at these angles and these exercises could make it worse. Step aerobics and deep knee bends should also be avoided for this reason. The type of exercise done should also be tailored to

Knee problems are very common, and they occur in people of all ages. Knee problems can interfere with many things, from participation in sports to simply getting up from a chair and walking. This can have a big impact on day to day life, and can even lead to further problems such as obesity or other diseases. This resource is designed to give patients with knee pain the information needed to begin and maintain a safe exercise programme. Strong muscles are important in maintaining healthy and pain-free knees. The information included in this document will help those with knee pain in the first instance where it is aimed to simply reduce the pain, as well as those with more severe pain or knee problems who are unable to partake in their desired sporting activities.

Overview of Knee Pain

Another common problematic knee condition is arthritis. Arthritis can affect the knee joint in many ways, leading to pain, discomfort, and stiffness. This often leads to muscle atrophy (wasting) and weakness as the quadriceps (front thigh muscles) are inhibited due to pain. The strength of the quadriceps is an essential factor in maintaining knee joint integrity and reducing the load or stress on the joint. This can be done with strength training exercises. The benefits of strength training for arthritis sufferers are substantial. Studies have shown that, in particular, both aerobic and aquatic-based strength training exercises have led to decreased disability and improvements in physical performance. This style of exercise can improve quadriceps strength without aggravating the symptoms of arthritis, which is a common problem with aerobic-based exercises like walking and jogging.

The knee joint is commonly affected by pain and/or discomfort. In Singapore, the prevalence of knee pain in individuals over the age of 55 is estimated to be between 25% and 43%. This increases to an appalling 63% in individuals over 60 years old. Knee pain or discomfort can greatly influence an individual’s ability to function optimally on a day-to-day basis. One main consequence of knee pain is the reluctance to participate in physical activity due to fear of making the pain worse. This can actually lead to increased knee problems and a gradual decline in general health and well-being. The most severe consequence is the loss of independence.

Do you suffer from knee pain? Have you ever thought about how this could be affecting your health and general fitness levels? The good news is that most people with knee pain can perform some type of exercise. The key is knowing what type of exercise is most suitable, what will help and not hinder your knee condition, and how to exercise safely. Unlike the past belief that exercise can be detrimental to the knee joints, recent evidence has shown that exercise is beneficial for people with knee pain.

Importance of Safe Exercise

Recent exercise studies in knee osteoarthritis have provided exercise protocols that included both strengthening and aerobic components, with promising results on symptoms and disease progression. This essay discusses the benefits of various exercise modalities in conditions that result in knee pain, and potential barriers to exercise in these patients. Specific emphasis is focused on patients with knee osteoarthritis due to the high prevalence of this condition and exercise therapy being a core treatment modality.

Safe exercises are important for patients with knee pain. They help in relieving pain and stiffness, and ensure functional independence. The benefits of exercise are supported by strong evidence from randomized controlled trials and expert opinion in many conditions, particularly for osteoarthritis, rheumatoid arthritis, and osteoporosis. The most effective modality of exercise is not known, although land-based therapeutic exercise has been a common feature in studies exploring the benefits of exercise therapy. Exercise compliance can be difficult to achieve depending on the form of exercise prescribed, and motivated patients often continue unsupervised exercise.

Guidelines for Safe Exercise with Knee Pain

Precautions are preventative measures taken to avoid the occurrence of an adverse event or to avoid exacerbating an existing condition. A modification is a variation or change to a specific activity that is considered to be safer or more suitable for an individual with a particular condition, injury, or disability. Precautions and modifications can relate to timing, type, intensity, or duration of an activity and are based on an analysis of the demands and effects of said activity, compared to the functional abilities and tolerance levels of the individual in question. The use of precautions and modifications is very relevant to individuals with knee pain, as it provides a means to safely continue physical activities that would otherwise aggravate their pain or cause further injury to their knees. The cause of these precautions and modifications should be explained to the patient, as this enhances the understanding and compliance of the patient to this altered method of exercise, increasing both the safety and efficacy of the program.

In general, therapeutic exercise has been advocated to improve strength, endurance, or flexibility of specific muscle groups, the selection of which should be based on a reasoned analysis of the functional deficits or muscle performance impairments. The primary impairments and functional limitations of various knee conditions are well documented in the context of the disablement model. This information can be used to prioritize certain exercises or physical activities said to have a strong association with beneficial outcomes. For example, regular general exercise has been advocated to delay the onset of disability in elderly individuals with poor lower extremity function. Thus, a specific neuromuscular exercise program should not be initiated at this time in an attempt to correct muscle performance impairments. A successful outcome in conservative or postoperative rehabilitation of knee injuries is achievable; the methodology is simply critical in achieving an optimal result. The term exercise implies a specific activity or task that is designed to improve a fitness component or rehabilitate a functional or structural deficit. This differs from physical activity, which is any bodily movement produced by skeletal muscles that results in energy expenditure. Exercise is thus a more specific subset of physical activity, the prescription of which should be thought out and based on a solid understanding of the relative benefits and contraindications.

Changes in physical activity are the main contributor to the increase in knee pain. Rest or reduction in general activity had the largest detrimental effect. Those who moved from a higher to a lower level of recreational or occupational activity, regardless of whether this involved exercise of a higher or lower intensity, were at increased risk of frequent knee pain. This suggests that favoring an exercise to a movement pattern that uses the quadriceps muscle more and the hamstrings less plays a role in knee pain. Such movements often lead to changes in tracking of the patella in its groove and overloading of the PF joint. This occurs in ascending or descending stairs or slopes, squatting, kneeling, and running. These are risk factors for the development or worsening of PFPS. The mechanism of acute injury can be an intrinsic overload on the PF joint and surrounding tissues beyond their tolerance, or direct trauma to the anterior knee or said joint. This type of injury can occur during a slip or fall, or as a result of uncontrolled movement of the quadriceps (such as that which occurs in skiing or competitive cycling). Anatomic abnormalities or trauma to the knee can lead to excessive cumulative abnormal stress that eventuates tissue breakdown and pain. The most common example of a chronic condition characterized by recurrent exacerbations of pain is osteoarthritis. By understanding these causes of knee pain, the type and mechanism of the pain can be inferred, and a more optimal treatment or prevention strategy can be adopted.

Understanding the Cause of Knee Pain

Understanding what makes the pain worse is important. Certain positions or activities can cause the painful or injured part of the knee to be loaded more than other parts, and this can hinder recovery. For instance, sitting in a low chair can cause more pain for someone with kneecap pain compared to sitting in a high chair, because the kneecap is loaded more in the former case. Often, people will need to modify aggravating activities. Failure to understand this concept can lead to prolonged pain or frequent recurrences.

Knee pain can result from a number of different causes. Some knee injuries produce pain with no discernible cause, for instance a muscle strain or a cartilage injury. Pain from degenerative conditions, such as arthritis or meniscus tears, is often more complex. These conditions can be thought of as a tire that has gone bald: the tire may function reasonably well most of the time, but it will have less traction and will slide around more easily, especially on slippery surfaces. When the tires skid, there may be no obvious damage, but the effects are not helpful. Similarly, the arthritic knee may hurt or swell with no obvious cause. Finally, some systemic conditions (those that affect the whole body), such as muscle imbalances or different leg lengths, can lead to knee pain.

Recommended Types of Exercise

This involves exercises to be used as a means for the patient to return to their sport or activity. Three key factors need to be considered for a successful return to the previous level of activity. These include exercise type, intensity, and duration. Specificity is the most important principle relative to the type of exercise. Basically, this means that an exercise must adequately stress the certain muscle or energy system the patient is aiming to improve. For example, an individual who is aiming to climb stairs with less knee pain must practice an exercise which replicates the action of stair climbing. Outcomes that have been measured for stair climbing in patients with knee OA have shown that muscle strengthening, in particular the quadriceps, is beneficial. This occurs using various forms of knee extension exercise. Isometric exercises have shown to decrease pain yet have little effect on strength or function. Dynamic resistance exercise has had positive effects on pain and improved strength. It appears that high-intensity strengthening exercise is beneficial for the knee OA patient, though an optimal duration and frequency is unclear. A study which tested high-intensity strength training with resistance machines 3x per week over 6 months had improved strength and function as well as decreased knee pain. This was compared to low-intensity machine exercise or a placebo group. And yet another group which participated in a home program of high-intensity knee extensor exercises using a simple elastic resistance (duration of program unclear). This group had similar improvements in strength and function, yet decreased knee pain was only significant in the machine resistance group.

Precautions and Modifications

Pain and swelling following unaccustomed physical activity or a flare-up of a previous knee injury can be a sign that certain activities or exercises need to be modified or reduced. This is particularly important with overuse activities such as walking, cycling, or swimming where it may be necessary to use a walking aid such as a stick in order to reduce the load on the joint and limit the onset of pain. In some cases, taking a short-term rest for a few days from aggravating activities is necessary to settle pain and inflammation.

Avoid activities that place excessive weight on the knee joint. This can exacerbate any underlying arthritic changes, result in further injury to the cartilage, or cause increased inflammation in the joint. Examples of activities to avoid include deep knee bends, jumping and landing activities, and high-impact aerobics. Instead, exercises that focus on strengthening the quadriceps and hamstring muscles to improve the shock-absorbing function of the muscles around the knee are less tiring on the knee joint and beneficial for knee pain. These include straight leg raises, leg presses and extensions, and hamstring curls using resistance.

Finding a Knee Pain Doctor in Singapore

If you have decided that seeking help from a health professional is vital to your condition, you may be wondering what kind of professional would be best to see. Often the choice will be between a doctor, physiotherapist, or sports physician. Physiotherapists are equipped to deal with many muscle and joint injuries and are a good starting point. A sports physician, particularly one with experience in knee injuries, can provide a clear diagnosis. However, many knee injuries (for example, meniscus or ligament tears) may require the expertise of an orthopedic surgeon to provide the best long-term outcome. If unsure, it may be best to first consult with a knee pain doctor Singapore who can then determine the best course of action and possible referral to another health professional.

Doctors who specialize in knee pain provide a valuable service to those who are suffering from an injury or experiencing chronic problems in this area. Due to the complex nature of the knee, finding the right treatment is often difficult for those who are not sure where to look. Seeking out the opinion of a professional is the best place to start and can have a big impact on the outcome of your condition. Professional help is especially important if you are unsure about the nature of your injury or find that your knee gives way or locks. In such cases, a health professional can provide a clear diagnosis and outline a relevant treatment plan.

Importance of Seeking Professional Help

A doctor specializing in knee pain helps to review and diagnose your condition to decide on the best course of treatment for you. He may recommend further tests such as blood tests, or it may be that you need an operation to improve your condition. A doctor can also advise you on the best self-help treatments and medications for pain relief. He can refer you to a physiotherapist to provide advice and work on a rehabilitation program specifically for your knee. The physiotherapist will assess your knee and work with you to improve your strength and flexibility. This will help to reduce the chances of the pain returning or further episodes of knee pain/instability. A physiotherapist can also use a variety of treatments and techniques such as mobilization, manual therapy, electrotherapy, and exercises. Other health professionals such as occupational therapists or dieticians may also be involved in your care. A doctor specializing in knee pain is able to monitor the progression of your knee, and he will continue to review your condition at future appointments. This allows him to make changes to the treatment he has planned for you if it is not having the desired effect.

Qualities to Look for in a Knee Pain Doctor

Look for a knee doctor who is a Fellow of the Royal Australasian College of Surgeons (FRACS), possesses a Master of Medicine or equivalent, and attends regular courses and conferences to keep up to date on the latest techniques and technology. The standard of medical care in Singapore is very high, but some doctors still practice techniques that have been outdated for many years, leading to suboptimal results. These doctors are often content in their practice and have stopped learning and thus should be avoided. A knee doctor who takes the effort to learn the latest evidence-based medicine is more likely to provide the best for his patients. An easy method to find out if the doctor is up to date is to ask him if he attends any courses or conferences regularly. A positive answer is a good sign, a negative one is definitely a bad sign.

Tips for Finding a Reliable Doctor

It is best to look for a doctor once knee pain starts affecting activities of daily living, or if the pain follows an injury. If a person is not certain that their knee pain warrants a doctor’s visit, they should speak with a medical professional. General practitioners (GP) can provide a diagnosis and treatment plan for many injuries and conditions causing knee pain. They may refer the person to a specialist if the problem is clear-cut, or if the condition fails to improve. Although it is clear when an injury such as a fracture is serious enough to require a visit to the GP, people often put off seeing a doctor for minor sprains or chronic knee pain. Many of these chronic conditions can be managed more effectively if they are addressed promptly after the onset of symptoms. A visit to the doctor can also prevent an acute on chronic injury, in which a longstanding condition such as tendinitis becomes suddenly complicated by a superimposed injury. An example would be an athlete with chronic tendinitis who sustains a ligament tear around the knee. The tendinitis can weaken the ligament, making it more susceptible to injury. Treatment of the acute injury might be more involved than the treatment of the original condition, and could require a lengthy rehabilitation phase.

Knee pain is an extremely common complaint and one which may affect all age groups. It is most commonly caused by a multitude of things from acute injuries to medical conditions. The pain experienced can be sudden or gradual, constant or intermittent, remain mild or become severe. There are many ways to manage knee pain, one of which is exercise therapy. The benefits of exercise are well known and there is a general consensus that activity and exercise are beneficial for overall health and wellbeing. However, the role of exercise as a treatment for those with knee pain is not so clear. This is largely due to the fact that exercise can both be beneficial and harmful for knee pain. If the type, intensity and frequency of exercise are not suited to the specific knee condition, symptoms may be exacerbated. On the other hand, undertaking the right form of exercise can result in reduced knee pain, improved physical function and enhanced quality of life.

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