Good standing and sitting postures both place the least amount of stress on the knees. Proper posture aligns the body, minimizing stress to the legs and knees. Correct posture places the body in an “aligned position”. Proper standing posture involves distributing body weight equally to both legs with the knees straight and without locking. The pelvis would be in a neutral position, which maintains the natural curve of the lower back. The head would be straight, balancing the weight of the body, and the shoulders would be back. People often overlook the importance of sitting posture. A typical person sits on a chair by sitting forward and having an excessive lumbar curve, by crossing the legs, or by having the knees and ankles together on one side. All these sitting positions transfer weight unequally to the knees. With both sitting and standing, it is important to note the amount of time one can maintain good posture. Usually, if a person has not been accustomed to maintaining good posture, the back and thigh muscles will fatigue fairly quickly. Often, they will slouch or sit in a different position, which will place stress on the knees and cause further muscular imbalances in the legs. Again, this will not be too much of a concern if there is no pain anywhere around the knees. However, a person with knee pain must make the extra effort to maintain good posture as much as possible so that they do not aggravate the knees.
The knees are the largest and most complex joints in the body, carrying a significant proportion of a person’s body weight. The knee joint is subjected to a great deal of stress, which is exacerbated by the demands of impact sports and other vigorous activities. In the general population, knee pain is a common complaint. Often, a patient will go to the knee pain specialist complaining of pain in the knee, and they will not know the cause of it. Knee pain can come from a local injury to any of the structures in and around the knee, or referred pain from other active trigger points. It is important to look at posture when dealing with knee pain. Correcting flawed posture minimizes the load on the knee joint. It is also important for the doctor to identify whether the knee pain is from a local injury, overuse, obesity-related, or systemic cause.
Understanding Knee Pain and Posture
The importance of proper posture Having bad posture can cause uneven distribution of weight throughout the joint surface, which can lead to misalignment of the knee joint. Misalignment is one of the most common mechanical causes of knee pain. The knee joint is the largest joint in the body, and it is a vulnerable area where the thigh bone meets the shinbone. This joint has poor stability and is highly dependent on surrounding ligaments and muscles for support. If the joint is not aligned, the weight can cause damage to the meniscus, which is a cartilage that acts as a cushion in the joint. When the meniscus is damaged, the inside of the knee can feel like it’s giving way, and it can often lead to arthritis in the affected area. Weight and age are contributing factors to arthritis of the knee, and the best way to avoid early development of this condition is to have good posture and a healthy lifestyle. The condition of arthritis cannot be reversed and only worsens with time.
Common causes of knee pain Knee pain can be caused by a sudden injury, an overuse injury, or by an underlying condition, such as arthritis. Sudden knee injuries often occur during sports or accidents. A common example is a torn anterior cruciate ligament (ACL). Overuse injuries occur with repetitive activities or prolonged kneeling, such as in gardening or construction. These activities cause inflammation in the patellar tendon known as patellar tendinitis. A less obvious, but often more serious cause of knee pain is an abnormal alignment of the leg. If the legs are not straight and in alignment, the mechanical imbalance can cause uneven wear on the surfaces of the knee joint. This can lead to rapid deterioration of the joint surface and development of arthritis. A severe deformity, such as bowlegs or knock knees, can lead to arthritis of the knee joint. An example of an underlying condition that can lead to knee pain is osteoarthritis. Osteoarthritis is the most common form of arthritis, and it occurs when the protective cartilage on the ends of the bones wears down over time.
Common Causes of Knee Pain
Because the knee is the largest joint in the body and quite complex, it is also one of the most easily injured and painful areas. Muscle weakness or imbalance, poor alignment, or overuse can lead to injury and result in the wear and tear of the joint causing irritation, effusion (build-up of excessive joint fluid), and tightness or stiffness around the knee. The most common causes of knee pain are patellofemoral pain syndrome and osteoarthritis. Patellofemoral pain syndrome is a broad term used to describe pain at the front of the knee and around the patella, or kneecap. It is the most common of all knee complaints and is caused by the patella not tracking properly on the front of the femur, causing pain both from the inflammation and damage to the back of the patella. This pain is often sharp and sudden, although sometimes it may be dull and aching and can be accompanied by a grinding or clicking noise. Osteoarthritis (OA) is one of the leading causes of knee pain. It is a chronic condition in which the material that cushions the joints, called cartilage, breaks down. This causes the two rough surfaces to rub together with little or no protection, which results in pain, swelling, and stiffness in the joint. OA is more common in middle-aged to elderly people, and people who are overweight are also at a greater risk of developing the condition. OA can also follow a serious knee injury. It is thought that the injury may cause joint damage that leads to the development of OA.
The Importance of Proper Posture
Considering that knee pain has multiple root sources (biomechanical, biochemical, and psychological), often there is no single answer. However, one of the most common factors is faulty alignment. When a joint is not positioned optimally, whether by muscular imbalance or poor movement patterning, there is increased wear and tear on the joint surfaces. The muscles and tendons around the joint are also overstressed, leading to pain and weakness. Over time, this can cause degeneration in the joint and osteoarthritis. Joints higher up in the body can also be a source of pain at the knee. For example, a flat or overly arched foot can lead to excessive internal rotation of the tibia, causing the knee to twist under load. This further illustrates the complexity of knee pain. However, because posture governs the position of all body segments, it is involved in some way in all faulty movement patterns.
In the US, knee pain is responsible for about 4 million primary care visits a year, with another 5 million visits to orthopedic specialists. It is the third leading cause of chronic pain. Unfortunately, for many, the problem of chronic pain remains despite medical treatment. This is because the conventional medical model has no cure for chronic degenerative conditions. Too often, the symptomatic approach is taken. Typically, this involves removing fluid from the knee, corticosteroid injections, painkillers, and if unresolved, surgery to scrape or replace the joint. However, none of these provide a lasting solution because they do not deal with the underlying postural cause of the pain.
Tips for Alignment and Relief
The next part is a little more challenging. While keeping the knee pushed into the ball and the thigh muscles contracted, lift the whole lower leg off the floor. Remember, this must be done without changing the position of the trunk and without the pelvis tucking under. This is important because the vastus medialis only works effectively when the knee is straight, so as soon as you allow the knee to bend, the exercise becomes ineffective. Do 2 sets of 10 repetitions. If you struggle with maintaining a straight leg on both the static hold and the heel slide, then some more ball work at the same lighter level is necessary before progressing to this stage.
Next up is the easy part. With the ball still in place, just practice contracting the thigh muscles and pushing the knee back tight into the ball. You should feel some work going on at the inner quadriceps above the knee. Hold this for 5-10 seconds and do 10 repetitions.
Now take a little red ball and place it on the knee of the leg you will be working first (if your kneecaps are sensitive from patella-femoral syndrome, use a support under your knee for comfort).
Take an upright post with the assistance of a wall or the back of a strong seat. Gradually slide down until in a sitting position, trying to keep aligned so that your head and shoulders are stacked over your trunk. This may be challenging because your head, shoulders, and hips might want to jut forward.
Strengthening Exercises for Knee Health
Exercises which involve bending and straightening the knee are excellent for building strength in the quadriceps muscle and will reduce the stress on the knee joint. To increase the strength of quadriceps, doing step-ups and lunges or partial squats are all very effective. Strong hamstring muscles are equally important to support the knee and prevent injury. Hamstring strengthening exercises such as leg curls are essential in the treatment of knee pain, but you should contact your physical therapist as to which type you are capable of doing. It is important to build up strength in the muscles around the knee slowly and carefully. High impact type exercises, such as those that involve a lot of jumping, can further increase the chance of knee injury, so should be avoided. Exercises in a standing position are usually more functional, since activities of daily living are done from the standing or single-leg stance position. This is especially true for those whose work involves prolonged standing and/or walking. However, muscle-strengthening exercises, while an important beginning, are not enough by themselves to ensure the long-term stability of the knee, let alone improved posture. Increased muscle strength must be coordinated with the use of this strength in more demanding functional activities and specific training of muscle power.
Stretching Techniques for Improved Posture
One of the best ways to stretch your hamstrings can be seen demonstrated in the image to the left. Use a towel or resistance band and take your leg to its maximum range of movement and hold in this position. Hamstring flexibility is very important to posture and knee health, so it may be necessary to continue stretching this muscle for a few months if it is particularly tight. During this time of active stretching and to prevent future muscle imbalances, it is wise to avoid exercises such as leg curls and focus on the use of low resistance exercises such as swimming and cycling.
To stretch your hamstrings, you can take a seat on the floor and bend one leg, leaving the other straight out. Bend forwards from your hips and slide your hands down your straight leg. You will feel the stretch at the back of your thigh; it should be held for 20-30 seconds. Ensure your knee is kept straight as this isolates the hamstring muscle.
Another way to stretch your quadriceps in a standing position is to hold onto something for stability and take your ankle/foot towards your buttocks. Ensure that you are standing up straight and your knees are kept together. Hold onto your ankle/foot to increase the stretch and hold for 20-30 seconds. Only perform these exercises if you have no pain during or after, if pain is experienced cease performing this stretch immediately.
One simple stretching technique to achieve this is the quadriceps stretch. Stand on one leg and pull your other foot up behind you towards your buttocks. Hold onto your foot to increase the stretch and ensure your knee is pointing directly downwards. You should feel tension at the front of your thigh and hold this for 20-30 seconds.
Muscle imbalances contribute greatly to poor posture and thus a great amount of stress on the knee joint. Usually, the muscles on the front of the thigh (quadriceps) are overworked, while the muscles at the back of the thigh (hamstrings) are weak. This pulls the tibia (shin bone) and creates a lot of pressure on the knee joint. The aim is to get muscle balance between the quadriceps and hamstrings.
Ergonomic Adjustments for Everyday Activities
Another tip is to avoid sitting at 90 degrees for long periods, whether it’s at a desk, a table, driving, or anything else. The best position for your knees is straight, and by sitting at 90 degrees, your thighs are angled down and your knees are closed packed. A better knee angle would be greater than 90 degrees, and this will take a lot of pressure off your kneecap. Use any means to change the angle of your legs while keeping good posture. If your feet can still be on the ground, then the most convenient option is to lift the level where your feet are and use cushions on the seat. If your knees are no longer at 90 degrees, you’ll slowly slide down in the seat until you’re again sitting at 90 degrees, so perhaps a better alternative is to use a sloping seat, or you can even take regular breaks where you can elevate your legs.
First tip for the knees: Avoid squatting. The worst position for your knees is squatting because of the compressed knee angle (60-90 degrees). When kneeling, the knee angle is greater than when standing. When you kneel, all of your body weight is directly supported by the knee on the ground, putting a lot of pressure on your kneecaps. Use a stool or something else to avoid squatting when you’re working close to the ground. An ergonomic alternative is to use knee protection for work that requires kneeling. Also, if he has to kneel, he’ll use a knee that isn’t painful yet because it’s a false economy to protect one knee at the expense of the other.
Seeking Help from a Knee Pain Specialist
Typically, a general physician can manage your knee pain effectively. But if they are unable to provide a definite diagnosis or relief from the pain, they may refer you to a specialist. There are many orthopedic surgeons in knee pain Singapore who can help manage your knee pain. Diagnostic arthroscopy is a useful tool to help identify problems in the knee. It is a surgical procedure often carried out by an orthopedic surgeon. He will insert a narrow tube containing a fiber optic camera through a small incision about the knee to examine the joint. This can help confirm a diagnosis, or in some cases, the surgeon may be able to correct the problem at the same time without the need for further surgery. If the cause of knee pain has been confirmed as osteoarthritis, there are many effective treatment options available. Total knee replacement surgery is often necessary for end-stage osteoarthritis, but there are many other conservative management options to consider. A rheumatologist is an internist or pediatrician who has further training in the management of chronic (long-term) diseases, in particular those that involve inflammation. Rheumatologists also give non-surgical treatment for joint and musculoskeletal pain. This may be an alternative for people who are unfit for surgery. Physiotherapists are trained professionals who help rehabilitate patients who are recovering from surgery or have functional problems. A good physiotherapist is very knowledgeable in helping to relieve symptoms related to knee pain. For example, if you have a muscle imbalance around the knee, the physiotherapist can provide you with exercises to correct this. This would be highly beneficial in preventing the progression of knee osteoarthritis. No matter which type of specialist you choose, you should always consult with your general physician first. They will help to identify the cause and provide you with information on the various treatment options available.
Benefits of Consulting a Specialist
For some patients, consulting a healthcare professional such as an orthopedic surgeon, rheumatologist, or physiatrist may be a good idea. Physiatrists are medical doctors who specialize in rehabilitation. Some orthopedic surgeons may recommend referral to a rheumatologist or physiatrist to obtain a full assessment. This is necessary for determining an appropriate course of non-operative treatment. Physiatrists are doctors who are experts in improving movement and function and may use an array of proven treatments. This includes specific exercises, stretching, manual techniques, and the use of modalities such as ultrasound and TENS. Moreover, rheumatologists are internal medicine doctors who possess additional training in the diagnosis and treatment of arthritis and other diseases of the joints, muscles, and bones. They are highly adept at determining the cause of swelling and pain in joints, as well as gaining control of systemic disease, which may be an underlying factor in certain types of knee pain. Choosing the right medical professional and the right course of treatment is a key factor in optimizing your long-term outcome and effective management of your knee pain.
Treatment Options for Knee Pain in Singapore
Prolotherapy involves the injection of an irritant solution with the intent of causing temporary inflammation in the injected area. The inflammation triggers a wound healing cascade, resulting in an increase in blood supply and nutrients to the area, which in turn helps to stimulate the repair of damaged tissues. Over a series of injections, the intensified healing process can improve the stability of the knee and decrease pain. This therapy has been proven effective for certain soft tissue injuries to the knee, such as ligament laxity or tendinopathies.
Knee pain treatment in Singapore has seen a trend in recent years in moving away from surgery and towards interventions that try to stimulate the body’s own natural healing processes. Knee pain treatments such as Prolotherapy and Platelet Rich Plasma Therapy have cropped up in a number of pain clinics, and there seems to be interest in the possibilities that they present. Both of these therapies involve an injection into the knee with the intent of addressing damaged tissues and stimulating the body to repair these tissues through inflammation and heal