Joint swelling or what is referred to as an effusion, or water on the knee, implies that an inflammatory process has occurred in the knee. This can be caused by injury such as a fall or twist. Injury to the internal structures of the knee including the meniscus, articular cartilage, and ligaments can cause bleeding into the knee. We call this a hemarthrosis. Chronic injury and arthritis , which is the degeneration of the articular cartilage or joint surfaces, can cause the normal knee fluid to be overproduced causing swelling. Inflammatory conditions including infections like Lyme’s disease, rheumatologic disorders and metabolic diseases like gout can also produce painful swelling of the joint.

Anterior knee pain describes a condition in which there can be discomfort around the kneecap or patella. Often occurring in runners thus called “runner’s knee”. Symptoms include diffuse discomfort around the front of knee associated with activity including stair walking. Sitting for long periods of time with knees bent like sitting in the car or at the theater can cause discomfort when getting up. This condition can affect all age groups. Overuse and alteration of lower extremity biomechanics due to muscle tightness and or weakness can cause these symptoms. Treatment includes conservative management including reduction of inflammation with application of ice, improving flexibility with appropriate stretching, and addressing muscle imbalances with a series of strengthening exercises for the core and knee.

Instability of the knee or feelings of it giving way can be caused by two separate mechanisms. Very commonly when the front of the knee or kneecap has been injured and or is painful, the knee may feel weak and buckle when performing activities like going up or down stairs. The other significant injury to the knee is a tear of a ligament. The anterior cruciate ligament is a commonly torn structure of the knee. One of four major ligaments that help maintains stability and smooth motion about the knee. When such a structure is torn, the knee can feel unstable when placed under jumping and pivoting forces. These instability episodes can cause progressive damage to other structures inside the knee like the meniscus and joint cartilage surfaces. Treatment can include conservative management including physical therapy but surgery can be indicated if persistent instability occurs.

The sensation of the knee locking can be caused by a variety of conditions. A tear of the meniscus or cartilage of the knee can cause the knee to feel locked or to get stuck in one place. The menisci, of which we have two in each knee (medial and lateral), are semicircular pieces of fibrous cartilage tissue that act as shock absorbers in our knee. They help maintain stability and assist with function of knee movement. A tear in the meniscus can cause a piece to get caught between the knee and cause pain and loss of motion. Sometimes it can move around and cause feelings of mechanical clicking in the knee. Other causes can originate around the kneecap as well as from loose fragments of cartilage in the knee. When mechanical symptoms as described above are encountered, professional intervention should be sought out.

In order to go up and down stairs the kneecap, or patella, assists the quadriceps in producing strong muscular forces around the joint. The cartilage on the undersurface of the patella and the groove in the end of the femur, trochlea that it tracks in allow for smooth gliding motion. From injury to the tissues around the patella and sometimes to the cartilage surfaces of the so-called patellofemoral joint can cause pain about the front of the knee with these activities. Sometimes pain is also experienced when sitting for long periods of time like going to the movies or sitting in a car.

The sensation of crunching under the kneecap is what is referred to as crepitance. This can be a sensation or an audible sound that occurs with activities that involve bending of the knee. As we bend our knee, the kneecap slides down a groove called the trochlea of the distal femur or thighbone. This joint or articulation is responsible for generating he force that enables the body to go up and down stairs, get up from a chair, and even walk on an incline. Anything that compromises these smooth cartilage surfaces could potentially lead to a grinding, crunchy feeling. Things like arthritis, where the cartilage surface is irregular from deterioration could cause crepitance, but there are many scenarios in which there is no abnormal cartilage surface. Abnormal tracking of the patella or abnormal biomechanics of the lower extremity can cause this sensation. Scar tissue around the knee or a condition called a plica should be considered as a source of crepitance. As a general rule of thumb, if it is not painful and not associated with swelling, it should be evaluated by a professional but is probably not a serious condition

The knee has two meniscal cartilages, medial and lateral. They are two semicircular structures that serve as shock absorbers in our knees. Injury from forces occurring in sports like rotation and compression can cause a tear in the ring of cartilage. As an individual progresses through the decades of life, the menisci become less resilient to such forces and small injuries from squatting to stepping off a curb can cause a tear in the meniscus. As a child these structures have a very good blood supply but again through maturity the blood supply recedes to the periphery of the meniscus. Blood is the essential element for healing. So when someone tears a meniscus we want to know location, size, and complexity. These factors will often determine treatment. Most all of meniscus tears should be treated conservatively at first, which would include activity modification, application of ice to the knee, a course of anti-inflammatory medication, and physical therapy or home exercises like those in BodyworksMD DVDs. Surgery is reserved for tears that fail conservative management or those that are displaced and block or lock range of motion to the knee. Both meniscal repair, actual suturing of the meniscus, and or partial excision are options available to a patient and are based on many of the factors described above.

The hip joint lies just below the groin crease so groin pain may be an indicator of a hip problem. These problems can include hip sprains, muscle pulls, hip arthritis, labral injuries, hip fracture or osteonecrosis of the hip bone. Groin pain can also be a sign of non-orthopedic problems such as hernias, abdominal or vascular problems.

Pain on the outside or lateral side of the hip is often indicative of a hip bursitis. A bursa is a small soft tissue sac often found over a bony prominence, such as the greater trochanter on the lateral side of the hip. Pain is typically increased at night with lying directly on the involved side. See you doctor for a definitive diagnosis and treatment.

Buttocks pain is usually referred from the low back. Occasionally hip problems may present as buttocks pain but the problem is usually in the low back or lumbar spine area.

Pain behind the thigh, posterior thigh pain is usually coming from the hamstrings. The hamstring muscles actually cross both the hip joint and the knee joint. The muscles start just under the buttocks crease and insert behind the knee at the top of the calf muscle. Hamstring pain can occur anywhere along the muscle’s path but is usually localized just below the buttocks or along the back of the thigh.

Hip stiffness can occur from a variety of ailments ranging from muscle strains, groin pulls, arthritis, or fractures. They may also be a sign of congenital or childhood hip problems such as hip dysplasia, a slipped epiphysis, or Perthes disease. If the stiffness is persisting see you physician for a complete hip evaluation.

Arthritis is a loss of cartilage over the ends of the bones that form the hip joint (femoral head and pelvis socket or acetabulum). Hip arthritis pain is usually localized to the groin area but may occur in the low back, outside of the hip, or in the thigh. Common findings in hip arthritis are difficulty walking long distances and difficulty putting on shoes and socks.

The labrum is a soft tissue lining or extension of the socket portion of the hip ball and socket joint. It can be torn with vigorous twisting or turning activities while weight bearing on the injured side. Sports that require rapid turning or direction changes such as tennis, racquet sports, soccer, and basketball are more conducive to labral injuries.

Any bone that undergoes repetitive small loads can be susceptible to developing a stress fracture. We often see stress fractures in patients who increase their previous activities without giving the bone a chance to accommodate to the new activity level. Any athlete who increases his or her distances, training times, weight loads or speeds can develop a stress fracture. These can be very painful injuries and may not be initially seen on x-rays. Stress fractures of the hip may require surgery.

Pain in the shoulder is a very common complaint in individuals that perform repetitive overhead activities. Often there is no single event that causes the discomfort but a series of microscopic injuries that eventually lead to the development of pain. Symptoms can include night pain, loss of motion, and discomfort with activities of daily living including combing hair, buttoning a bra strap, and reaching behind to putting on a coat. The most common cause can be from an injury to the rotator cuff including inflammation of the tissue around it, bursitis and capsulitis ”frozen shoulder”, and a tear of the rotator cuff both partial and complete. It is also extremely important to rule out cervical spine disorders including a herniated disc as a potential cause of pain.

Weakness about the shoulder can be caused by pain as well as due to a rotator cuff injury. Pain inhibits muscle activity and may cause a feeling as if the shoulder were to feel weak. Rotator cuff injuries can cause both pain and weakness as described above. Complete tears of one or more of the tendons can cause the feeling of weakness because the other muscles have to compensate for the loss of the others and become weak and over worked

Stiffness about the shoulder can be caused by pain but also from a condition called adhesive capsulitis or frozen shoulder.

The most common cause of ankle swelling following a twisting injury is a sprain of the ankle ligaments, most specifically the ligaments on the outside (lateral side) of the ankle. There are three ligaments that hold the ankle together on the lateral side and one large ligament on the inner or medial side. These ligaments can be stretched or even torn during a twisting or rolling injury causing an ankle sprain. These injuries are usually treated with ice and immobilization in an ankle support splint.

Swelling behind the ankle is known as a Haglund’s deformity but is often referred to as a “pump bump”. It is a bony enlargement in the area where the Achilles tendon attaches to the back of the heel bone (calcaneous). Local irritation from shoe ware can cause the bursa or sac over the bump to become enlarged. Treatment usually consists of minimizing the local pressure to the area, anti-inflammatory medication, protective padding, stretching exercises or surgical intervention if the condition becomes chronic.

Heel pain can be due to a variety of causes including heel spurs, plantar fasciitis, Achilles tendinitis or even stress fractures from overuse. Since the treatment for each of these conditions is vastly different, a physician should evaluate persistent heel pain.

Calf pain can be due to a variety of conditions. Calf pain that occurs suddenly following a burst of speed or toe push-off is usually due to tearing of the gastrocnemius muscles or plantaris tendon. Calf pain can also occur from muscle strains, ruptured Baker’s cysts or overuse injuries. However, calf pain can also be a sign of a blood clot in the veins of the calf known as a DVT or deep vein thrombosis. DVT’s can occur after an injury or surgical procedure. They can also occur after any prolonged immobility of the leg such as extended plane flights or car rides, or after casting or splinting of the lower extremity. DVT’s are more common in smokers and women on oral contraceptives.

Ankle instability may be a sign of weak ankle ligaments. This can occur following an injury to the deltoid ligament or to the lateral ligament complex. Instability may also be due to a genetic condition called generalized ligamentous laxity (double jointed) where many of the ligaments throughout the body are lax or highly mobile. Giving way can also be a sign of a loose body caught in the ankle joint.

Pain localized to the low back area is usually coming from the lumbar spine. Back pain can represent a variety of ailments including lumbar strains, disc herniations, degenerative arthritis, lumbar fractures, infections, or even tumors. Back pain may also occur from non-orthopedic problems such as kidney stones, kidney infections, abdominal aneurysms, gynecological issues or other abdominal problems.

Pain that radiates from the back into the legs may be a sign of a disc herniation in the spine. When a disc herniates or protrudes out from its normal position it can come in contact with the nerves exiting the spine and travelling down the leg. These pains may be accompanied by numbness or tingling into the leg and should be evaluated by your physician. If one experiences a loss of bowel or bladder function you should seek immediate medical attention

Back stiffness usually represents a muscle strain in the back. If the muscle is irritated, over-worked or fatigued it will develop a spasm and become stiff and tight. These injuries usually respond to rest, moist heat and anti-inflammatory medications.

Hamstring injuries can occurs with explosive contractions of the muscle especially when sprinting. As always on ounce of prevention is worth a pound of cure. Adequate warm up of the lower extremities before engaging in such type of activities is recommended.This may include 10-15 minutes of easy aerobic exercise followed by gentle stretching and short burst fo 5-10 seconds of higher level activity intended to prepare the area for more work.

90% of the population suffers from some ailment to the back at some point during their life. Back soreness can be due to muscular injury of the lower back. The tendons, ligaments, and joints between the bones of the back,vertebral bodies, can also contribute to the symptoms. Treatment of this condition, lower back strain, is addressed with pain control using heat and or ice, medications prescribed by a physician and a series of exercises intended on increasing flexibility of the surrounding tissues and strengthening the muscles of lower back and abdomen. Core muscles or trunk stabilizer strengthening is instrumental in making your back feel better and help prevent further injury.

Injury to a ligament in the thumb from falling on an outstretched hand is referred to as skier’s thumb. The ulnar collateral ligament that provides stability to our thumb allowing us to grasp and hold can be partially or completely torn from a fall. Partial injuries are often treated in a splint or cast. Complete tears on the other hand should be treated surgically to obtain the best result and restore thumb stability

Thirst is a poor indicator of dehydration. Often you have lost a significant amount of water before this response kicks in. If you are exercising a good rule of thumb is to have approximately 8-10oz every 15 minutes of exercise. Losing 2% of your body weight in fluid significantly affects exercise performance. How do you know how much you lose? If you weigh yourself before and after exercise and calculate the loss in terms of water, that is how much you should replace after exercise. If you notice that the color of your urine is particularly dark and is associated around exercise there is a good chance that your body is holding onto fluids and concentrating your urine to conserve water. Good time to drink.

Joint swelling or what is referred to as an effusion, or water on the knee, implies that an inflammatory process has occurred in the knee. This can be caused by injury such as a fall or twist. Injury to the internal structures of the knee including the meniscus, articular cartilage, and ligaments can cause bleeding into the knee. We call this a hemarthrosis. Chronic injury and arthritis , which is the degeneration of the articular cartilage or joint surfaces, can cause the normal knee fluid to be overproduced causing swelling. Inflammatory conditions including infections like Lyme’s disease, rheumatologic disorders and metabolic diseases like gout can also produce painful swelling of the joint.

The hip joint lies just below the groin crease so groin pain may be an indicator of a hip problem. These problems can include hip sprains, muscle pulls, hip arthritis, labral injuries, hip fracture or osteonecrosis of the hip bone. Groin pain can also be a sign of non-orthopedic problems such as hernias, abdominal or vascular problems.

Pain on the outside or lateral side of the hip is often indicative of a hip bursitis. A bursa is a small soft tissue sac often found over a bony prominence, such as the greater trochanter on the lateral side of the hip. Pain is typically increased at night with lying directly on the involved side. See you doctor for a definitive diagnosis and treatment

Buttocks pain is usually referred from the low back. Occasionally hip problems may present as buttocks pain but the problem is usually in the low back or lumbar spine area.

Pain behind the thigh, posterior thigh pain is usually coming from the hamstrings. The hamstring muscles actually cross both the hip joint and the knee joint. The muscles start just under the buttocks crease and insert behind the knee at the top of the calf muscle. Hamstring pain can occur anywhere along the muscle’s path but is usually localized just below the buttocks or along the back of the thigh.

Hip stiffness can occur from a variety of ailments ranging from muscle strains, groin pulls, arthritis, or fractures. They may also be a sign of congenital or childhood hip problems such as hip dysplasia, a slipped epiphysis, or Perthes disease. If the stiffness is persisting see you physician for a complete hip evaluation.

Arthritis is a loss of cartilage over the ends of the bones that form the hip joint (femoral head and pelvis socket or acetabulum). Hip arthritis pain is usually localized to the groin area but may occur in the low back, outside of the hip, or in the thigh. Common findings in hip arthritis are difficulty walking long distances and difficulty putting on shoes and socks.

The labrum is a soft tissue lining or extension of the socket portion of the hip ball and socket joint. It can be torn with vigorous twisting or turning activities while weight bearing on the injured side. Sports that require rapid turning or direction changes such as tennis, racquet sports, soccer, and basketball are more conducive to labral injuries.

Any bone that undergoes repetitive small loads can be susceptible to developing a stress fracture. We often see stress fractures in patients who increase their previous activities without giving the bone a chance to accommodate to the new activity level. Any athlete who increases his or her distances, training times, weight loads or speeds can develop a stress fracture. These can be very painful injuries and may not be initially seen on x-rays. Stress fractures of the hip may require surgery.