Knee Injuries in Sports and Running

Q: I am a 14 year old female. I have had this problem for years, but it is becoming more frequent. When I use a kicking motion while I swim, it begins to pop and causes extreme discomfort, but not pain. I play basketball a lot, which could contribute to some problem. It consistently cracks when I move it in a certain way. Sometimes I can’t even put a lot of pressure on it because it feels awkward standing up. Any advice or thoughts would help a lot. I would like to know if this is serious or not?

Reply:

Looks like you have some mild injury in your knee. Discomfort in the front and center of the knee is common among active, healthy young people, especially girls. It usually stays for 2 to 3 years and then goes as you grow up.

It is usually not caused by any particular abnormality in the knee and does not mean that the knee will be damaged by continuing to do activities. Actually, the complex anatomy of the knee joint that allows it to bend and move is extremely sensitive to problems like alignment, activity, training and overuse.

Factors Contributing to Knee Injury

In teenagers, a number of factors come into play-

  • This is an age for growth spurts. The body is rapidly growing physically. There may be an imbalance in the growth of thigh muscles (quadriceps- in front of the thigh and hamstrings- in the back of the thigh) that support the knee joint.
  • Poor flexibility.
  • Problems with alignment of the legs between the hips and the ankles.
  • Using improper sports training techniques or equipment.
  • Overdoing sports activities.
  • Not wearing proper shoes that provide cushions to the knee joint.

Symptoms

Due to such factors, the following symptoms can be experienced-

1) Popping or crackling sounds in the knee when you climb stairs or stand up and walk after prolonged sitting.
2) Pain at night
3) Pain during activities that repeatedly bend the knee (i.e., jumping, squatting, running, and other exercise, especially involving weight-lifting).
4) Pain that causes your knees to give way (buckle),
5) Pain related to a change in activity level or intensity, playing surface, or equipment.

Management

I would advise you to take some rest right now. Pain/discomfort anywhere in the body is a signal to take rest. Let your body stabilize and recover first, and then you can again play basketball.

You can try the following conservative steps to help ease the discomfort. We call it RICE.

R-Rest
I-  To relieve swelling and inflammation, apply ice wrapped in a towel to your sore knee a few times each day.
C– Cool compress with ice packs.
E– Simple stretching exercises are often helpful. Resume running and other sports activities gradually.

Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, may also help particularly painful episodes.

If you are overweight, losing weight will help to reduce pressure on your knee.

However, if pain behind the kneecap is severe and persists, it is important to see your doctor so that a proper diagnosis can be made.

A standard knee examination will help your doctor determine the cause of pain and rule out other problems.

Standard Knee Examination

He may check:

  • Alignment of the lower legs and the position of the kneecap.
  • Knee stability, hip rotation, and range of motion of knees and hips.
  • Signs of tenderness (pain) underneath your knee cap.
  • Strength, flexibility, firmness, tone of front thigh muscles (quadriceps) and the back thigh muscles (hamstrings).
  • Tightness of the heel cord and flexibility of the feet.

He may order an X-ray. That would provide images of dense structures, like bone with shape and position of the knee cap.

Prevention of Sports Injuries

For further prevention of sports injuries, I recommend:

  • Wear shoes appropriate to your activities.
  • Warm up with stretching exercises before physical activity.
  • Stop or reduce any activity that used to hurt your knees.
  • Limit the total number of miles you run in training and competition.
Take Care
Buddy M.D.

Medical Advice (Q&As) on “Knee Injuries in Sports and Running

  1. Maranda

    PLEASE ANSWER ASAP IF AT ALL POSSIBLE!!!
    I am supposed to have big knee surgery tomorrow, however I got into a bed of fire ants which left of course the bumps, itching, etc. Well my scalp and ears were itching like crazy. I went to the ER because the ash was spreading all over my body. Do you think they will still do the surgery? I hope so because I have been waiting on this surgery for month.

    Reply
    1. Buddy M.D. Post author

      If the rashes and the itching come in control, they may go for the surgery. Are you taking medications for it? The condition is likely to be urticaria.

      Reply
  2. Bru

    MRI RIGHT KNEE
    STUDY PROTOCOL:
    SPIN ECHO T1W, T2W, PD AND STIR SAGITTAL IMAGES OF RIGHT KNEE JOINT WERE
    OBTAINED ON DEDICATED PHASED ARRAY COIL AND CORRELATED WITH T2W AXIAL, AND
    T1W AND T2W CORONAL IMAGES.
    FINDINGS:
    The study shows:
    • • • Mild joint effusion is seen with fluid in the supra patellar recess, para-condylar
    and intercondylar regions and tibio-femoral joint space.
    • • • Gr.I-sprain of lateral collateral ligament noted.
    • • • Gr.II-tear signal intensity communicating with superior articular surface is seen
    in posterior horn of medial meniscus.
    • • • A focal circumscribed cystic area is seen in the lateral cortical margin of
    proximal tibia. Similar symmetrical focus is also seen on the left side on
    correlative NCCT study (images of same provided). No obvious fracture seen.
    Anterior and posterior cruciate ligament appears normal in contours and signal intensity.
    Lateral meniscus appears normal.
    Medial collateral ligament appears normal in course.
    Patellar ligament and Quadriceps tendon is normally visualized.
    Rest of the bones appear normal in cortical outline, alignment and signal intensity.
    Please correlate clinically and with relevant investigations/arthroscopy.

    Sir,
    I have given above the MRI report. Kindly give your advice and opinion on the treatment I have to take. Is the problem serious? Please advice.

    Reply
      1. bru

        Sir, thanks for reply.
        This is post accident injury.
        There is no fever, no swelling. Occasional pain is there. Age 28 years.

        Reply
        1. Buddy M.D. Post author

          The condition is not serious, however, it will take time to heal.

          Your soft tissues, ligament and tendons, that hold together the different components of the knee joint are ruptured during the injury. These would gradually repair and restore the original state.

          This process would take time, 1 to 2 months. You may gradually resume your activities.

          Avoid heavy works, walks or any other exercises involving the knee. Give it as much rest as possible.

          After a month, your doctor would reassess the situation and may advice you certain muscle building exercises for the knee.

          Reply
          1. bru

            Sir,
            Thanks for the reply.
            The above report of Right Knee MRI reads as follows:
            “A focal circumscribed cystic area is seen in the lateral cortical margin of
            proximal tibia. Similar symmetrical focus is also seen on the left side on
            correlative NCCT study (images of same provided). No obvious fracture seen.”

            What does focal circumscribed cystic area means. Does it required further investigation/tests. Further the report reads as “similar symmetrical focus is also seen of the left side on correlative NCCT study” is the report referring to left knee or to the left portion of the right knee of which this MRI report is. Do we require to take MRI of left knee also. There is no problem with left knee. Is it require to take any medicine for treatment or simply take rest for one month. Any further blood test /MRI test is required to be undertaken for further investigation. Is biopsy required to be done. Please advice in length. Thanks.

          2. Buddy M.D. Post author

            No further investigations are required. You just need to give it time and take rest. The injured soft tissue would repair on its own with time.

            If you have any pain or swelling over the affected knee, anti- inflammatory medicines need to be taken.