Knee Injury

I’m keeping an eye on Twitter for your medical issues. Questions that are common or important are great for me to blog about so everyone in the community can benefit from each other’s problems! I spotted this one:
Twisted knee yesterday. More painful today how do I know if I need to see doc? Or do I just wait for it to get better

What a great topic. Should you go to A+E? Does it need an X-ray? How long is it OK to hurt for before you get advice?

Most of us have had knee pain at some point during our running careers, it’s really common. The knee joint is a hinge joint designed to open and close rather than twist.

Let’s look at the anatomy. The knee joint consists of your femur (thigh bone) at the top and your tibia and fibula (shin bones) at the bottom. So that bone doesn’t grate on bone, there are cartilage shock absorbers called the medial meniscus and lateral meniscus in the middle of the joint. The whole joint is stabilised by ligaments. The ones on each side are called the medial and lateral collateral ligaments. The medial collateral is on the inside of your knee and the lateral on the outside. The anterior and posterior cruciate ligaments are front and back to keep the knee stable in that direction. Over the top we mustn’t forget the patella or knee cap.

There’s plenty in there to stabilise and protect your knee but there’s plenty to injure too. Twisting, stumbling and ‘going over’ on your knee is easy to do. Ligaments can be strained, torn or ruptured. Meniscii can be torn and bones can be fractured.

My general advice would be:

  • If your injury is sudden,very painful and you can’t put any weight on the leg then you should go to A+E. You may need an X-ray to exclude a bony injury.
  • If your knee rapidly swells up immediately or within an hour of your injury and your knee is very painful then go to A+E. This rapid swelling suggests blood within the joint (called haemarthrosis) which can be linked to significant internal damage, including damage to the cartilage.
  • If you can stand on your leg and the swelling comes up gradually over many hours or even overnight then it’s reasonable to give it a bit of time. Follow the usual advice for sports injuries. Rest, Ice, Compression (with a stretchy bandage) and Elevation. Minor strains and sprains will gradually settle over a few days.
  • If your knee is not improving after a 72 hours, feels like it’s locking in position or giving way underneath you then see your GP. You need to be examined and may need some further tests to determine the damage.

It’s not good to keep a joint immobile for too long. So, if your knee is improving but still feels a little stiff then gentle exercises will help. When you can return to sport depends on how severe your injury is; a minor strain will take a couple of weeks. You need to be pain free when you’re walking and have a full range of movement in your knee before you even attempt running again. Start slowly and build up gradually. More severe damage will need input from physios and/or orthopaedic surgeons and your GP can arrange a referral.

You can check out Dr Juliet’s blog here.