Ask Us Anything About… Knee Problems

Barbara Schindo – Good afternoon and thank you for joining us. You’re watching Ask Us Anything about the Problems. My name is Barbara Schindo. Today we are going to talk about knee pain, knee problems, treatments, and everything you need to know. If you have, you know, sore knees or hurt knees from either aging, stress, or, perhaps, athletic injuries. So, statistics show that about one in four adults report that they suffer from knee pain, and we are going to talk today about knee pain, and I’m fortunate today to be joined by two experts. We have two orthopedic surgeons from Penn State Health, Milton S. Hershey Medical Center is joining us this afternoon. Dr. Charles Davis and Dr. Aman Dhawan are both with us today to talk about knee pain and to answer your questions. So, we’ll get started here, but if you are watching this with us live on Facebook or if you’re watching on playback, and you have a question about knee pain for Dr. Dhawan, please put your questions in the comment section below this video, and we will get an answer for you. So, Dr. Dhawan, Dr. Davis, thank you so much for joining us this afternoon. Let’s start with the basics, and the two of you have a little bit different areas of expertise. So, what we’re going to do today is Dr. Dhawan will be our kind of expert in sports-related medicine, sports injuries, and Dr. Davis can talk more about, you know, arthritis, aging, day-to-day stress, but they’re both here to help us out. So again, thank you for joining us, and let’s start with one for you, Dr. Dhawan. Let’s talk generally about knee pain. What can cause knee pain and younger folks or young patients and athletes? What might be some causes of knee pain for them.

Dr. Aman Dhawan – Yeah, so knee pain is, as you’ve mentioned earlier, very, very common in all age groups and, you know, I think probably the most common cause, especially in younger athletes, grade school, middle school, high school adolescent athletes, is usually overuse. Typically, a tendinitis phenomenon, either the patellar tendon or quadriceps tendon. Most causes of knee pain in that age group, I would say, are overuse, and typically, a tendinitis.

Barbara Schindo – Okay, thank you, and Dr. Davis, let’s talk a little bit about knee pain. What are some causes of knee pain in the older aging population?

Dr. Charles Davis – Yeah, so it’s a little different in the older population. Again, it tends to be a lifetime of heavy use. Arthritis, which is the wearing away of the joint surface tends to be the most common thing that we see. Sometimes you can get some bursitises or some tears and the cartilage, but for the most part, arthritis, osteoarthritis, is what we’re talking about for older folks.

Barbara Schindo – Okay, and for that population, Dr. Davis, what are some things they can know about preventing knee pain?

Dr. Charles Davis – I think, similar to what Dr. Dhawan talks about is avoiding overuse things. It takes longer to recover from those things when you’re older than when you’re younger. So, if you’re going to start a new exercise program, start slowly. Gradually build it up, and you know, use some moderation when you’re doing that, but we still want people to be able to be active and exercise and enjoy their lives and their families. They can sometimes take Tylenol or ibuprofen if things get a little sore, and then, just take it a little easy if it starts to get, starts to hurt you, and that can take even a few weeks for it to calm down.

Barbara Schindo – Okay, so, going from there, you know, I made a note when Dr. Dhawan said overuse, as well. So, that seems like that’s a pretty common cause in any age group, but how will somebody know if it’s just, you know, overuse. That maybe they need to take a break from working out or take it easier, or when they should call a doctor and see somebody about the pain?

Dr. Aman Dhawan – Yeah, no, I mean, that’s an issue that I think I see every day while I’m in clinic, and, you know, certainly, to start with is this traumatic and acute in onset? Did it occur with some sort of twisting injury or a fall or some sort of collision versus more insidious in onset, more gradual. That can be a cue, obviously. Things that are more acute and traumatic can be more concerning for a more structural injury than just overuse. Certainly, things like the pain is getting worse with rest, ice, elevation, anti-inflammatories, activity modification. That’s usually concerning. If you have difficulty with weightbearing. If you start getting swelling. So, swelling inside the knee, if the knee starts looking like, you know, a soccer ball or a basketball and there seems to be a lot of fluid on there, that’s a very quick indicator or a very prime indicator that something is amiss, and usually it’s something structural within the knee. It doesn’t necessarily mean that you need surgery, but does mean that you should get this looked at by a physician.

Barbara Schindo – Okay, thank you, Dr. Dwahan, and that, actually, is a very nice segue into my next question. You said, you know, that you don’t always need surgery. So, let’s talk a little bit about the treatments for knee problems or knee pain. Let’s start first with what are ways to treat knee pain without surgery, and then kind of move on to win do you start to consider surgery? When is that necessary?

Dr. Charles Davis – Again, I think for most patients, for older patients, it’s a little bit different. Usually, you can keep an eye on things. Short of a really major injury, a fall, getting, you know, hit by a bike or car or the dog knocking you down, most of the time, older folks, you keep an eye on it for a few days, or even a week or two, and it should gradually begin to calm down. As Aman said, if it’s getting worse on it, then you should let us know. If you really can’t walk on it, then you probably need to come in and be seen. But if you’re kind of getting around and you could give it a few days or a week. There aren’t very many things that are really emergencies. Of course, we’re happy to see you urgently if you need us to, but most of the things are not true emergencies that you have to come immediately. It’s not going to get worse by waiting a little bit. Things that help are icing it, ibuprofen, Motrin if you can take those kinds of medications. Tylenol, and again, just moderating your activities to see how things go.

Barbara Schindo – So, if those treatments aren’t proving to be helpful, then that is that when you start to consider surgery, or what makes you, as a provider, start to think maybe they need surgery?

Dr. Charles Davis – Again, I would think that that’s when you certainly should be evaluated. If those things aren’t working, you certainly should get checked out. For, you know, the older — sometimes we can do steroid injections into the knee. Steroids act as an anti-inflammatory to take down some of the pain. So, we can do that sometimes. So, there’s still some nonsurgical things that we can do, but again, if you’re still having trouble, then it’s worth getting checked out.

Barbara Schindo – Okay, great, and you are watching Ask Us Anything about Knee Problems. I’m here with two orthopedic experts, Dr. Aman Dhawan and Dr. Charles Davis. Both are orthopedic surgeons at Penn State health Milton S. Hershey Medical Center, and they are here to answer your questions about knee pain. So, if you have a question for Dr. Dhawan or Dr. Davis, please put that in the comment field below this video, and we will get an answer for you. So let me ask a question of both of you that you probably do get a lot from your patients, folks who want to stay active while they are, you know, either have a knee injury or are recovering from a knee injury. What kind of things, you know, Dr. Dhawan, you had mentioned that you work with a lot of younger folks and athletes. So, they probably want to keep working out, even though they maybe should be taking it easy. So, what kind of things do you recommend to those patients?

Dr. Aman Dhawan – Yeah, absolutely. So, I mean, in general, you know, if you have pain with working out. If you have swelling with working out, that’s usually a signal that your knee is probably not happy with something that you’re doing. It doesn’t necessarily me something structurally wrong, but it definitely means you’ve got to change, maybe, the way you do things, and some tips. For instance, I’ve had surgery on both my knees many years ago from sports injuries. And so, there are certain workouts, like for instance, high-impact exercises that bother my knees if I do this consistently. So, I, myself, have had to find ways to work out differently, and you know, you’ll hear this term low-impact quite a bit, and what does that mean? It just means that the contact stresses on the cartilage in the lower extremities, or ankles or knees and your hips, are seeing less impact, less force, which tends to create less irritation and less wear and less discomfort. So, what are exercises that are low impact? Well, those include things like elliptical trainer or cross-country machines. Swimming is an outstanding exercise and one that I like to participate in. It’s a great upper and lower body workout. The water tends to really decrease, obviously, gravitational forces, and swimming, the buoyancy, tends to decrease the stress on your joints, especially your lower extremities, and it’s a great way to work out for people that have knee pain or knee issues, whether they be younger and/or older. I get that question a lot about walking. Well, what about walking? Well, interestingly enough, while walking is kind of better than running, the contact stresses are less than in running, they still are fairly quite high, and people with knee problems can have significant pain and discomfort with long periods of walking. So, while not actually forbidden, you know, there are other ways to kind of be more gentle with your knees and your lower extremities in general and not have to see a lot of those forces. So, walking better than doing nothing. There are other ways to still exercise, still work out, and still maintain fitness, despite knee issues.

Barbara Schindo – That is really interesting [inaudible]. Walking is not going to cause any kind of issue, but I see what you mean there, but I have heard, you know, a lot of folks say that running can be very tough on the knees over long, you know, long, extended — if you’ve been a runner for years, that to be very, very hard knees.

Dr. Aman Dhawan – I think that’s one of the big changes, really, in the last 15 years or so, Barb, is much more emphasis on getting people back to high-level activity and more quickly. Certainly, you know, the older folks in the joint placement world, that’s true, and I think, for the younger patients, as well, people have different expectations now, and people want to be skiing and playing tennis and doing other somewhat demanding activities after their knee injury has been treated. And so, I think that’s, we’ve to stretch the indications of what we’ll let people do after some of the treatments that we do. That’s been a real focus over the last several years, I think that’s been quite effective for folks and really help them out with their lives.

Barbara Schindo – Yeah, I bet patients are very happy to be getting back faster to the things they like to do, even after, you know, a big injury or possibly even having to have a surgery. You know, even after a big injury or possibly even having to have a surgery. You know, Dr. Dhawan you said you had multiple knee surgeries, and Dr. Davis, I know that you do specialize in knee and hip replacements, right? So, can you talk a little bit about, you know, if that’s what you need to have, if your knee problem is — the solution – if the solution to your knee problem is having a knee replacement. What is that process like? What do patients need to know?

Dr. Charles Davis – Yeah, so, usually, first of all, you want to be sure that you’ve tried the nonsurgical things, as we’ve talked about. So, only do the knee replacement, really, as a last resort, if all those nonsurgical things haven’t worked, but knee replacements are a very good and reliable operation. Not everyone’s perfect. It can last a long time, and our goal, again, is to get people back walking pretty quickly, get them back to doing things with their family, whatever is important to them. Some folks, playing golf is really important. Some folks want to go to Hershey Park with their family, and that’s what we’re really trying to achieve. The recoveries are a lot better than they used to be, and so, that’s really been the big improvement in the last 10 years. So, most people are in the hospital no more than overnight and maybe even 30 to 50% of patients can now go home the same day. So, that’s a big change from years ago, and that’s just because we’ve made the recovery a lot better. And so, folks don’t have to pay as afraid of the recovery as they used to be. Certainly, knee replacements hurt, and it’s a process to get over it, but it is better than it was a few years ago. Overall, it takes 6 to 12 weeks to really totally get over it and get back to your lifestyle, but then they can last 15, 20 years, and work really well for folks. So, it’s a great operation. Again, not everyone’s perfect, but most folks do really well, and folks can play tennis. They can ski. They can walk. So, they can do lots of things with their families and for recreation.

Barbara Schindo – Okay, great. You are watching ask us anything about knee problems. I’m Barbara Schindo, here with Dr. Aman Dhawan and Dr. Charles Davis both orthopedic surgeons at Penn State Health Milton S. Hershey Medical Center. If you have any questions for either of them, please feel free to put your question in the chat. Whether you’re watching it with us now live or if you’re watching this on playback. If there’s something we haven’t discussed that you still have a question for, for either of these doctors, we will get an answer for you, and also, please feel free to share this video as we have talked about knee pain and knee problems are fairly common. So, there’s probably somebody in your life who may need this information. So, please feel free to share. So let me get into little bit of myth busting. So, this is a — what about, you know, if your knee is cracking and popping anytime you — you know, I work out pretty frequently. I do a lot of strength training, and if I’m doing, you know, squats, sometimes my knees will pop every time. Is that a sign of something bad?

Dr. Aman Dhawan – Yeah, not necessarily. I mean, usually, most sounds associated with joint movement are just structures kind of passing over one another, tendons passing over bony prominences or bursa. Sometimes there can be air pockets. There can be a number of causes “sounds” in a joint, and I would tell you the two things that should reassure you that it’s not anything concerning is tied to, one, if it’s nonpainful, you can feel pretty rest assured that that’s just a physiologic sound, something that is common, and you don’t need to be very concerned about and/or swelling. So, if you notice either of those, I think, you know, sounds can be indicators of project, for instance, tears of cartilage or meniscus or otherwise, but sounds are very, very common project, often benign,. and usually associated with just normal structures passing over other structures, and it creates some sound.

Barbara Schindo – Well, that is [inaudible] — I think I’m echoing. So, that’s a bit of a relief, especially for me, because this is not related to knee pain, but you guys are probably the ones to answer this. I have what is probably the most annoying habit in the world, which is like crack my knuckles. Like I’m a big knuckle cracker, and so, people always say that you’re going to get arthritis. That’s going to cause you problems. So, is that true if you crack your knuckles that you will make yourself have arthritis eventually?

Dr. Aman Dhawan – I don’t think so

Barbara Schindo – That is good to know.

Dr. Aman Dhawan – I don’t think that’s anything to be concerned about.

Barbara Schindo – Okay, so we are talking about knee pain and knee problems, and before we wrap up, I want to be sure that we didn’t miss. Is there anything that we missed that either Dr. Dhawan or Dr. Davis, you think, is important for folks to know about before we wrap up this afternoon?

Dr. Aman Dhawan – Yeah, I mean, I think, and you know, this extends from youth to, you know, regardless of age, you know, practicing good joint health is really a good idea, and things, you know, fitness and continuing to be active are important. And that doesn’t necessarily mean that you have to be able to run marathons or play, you know, six hours of basketball, the staying active is very important, you know, psychologically, physiologically, cardiac, for so many things, but practicing good joint health is a good idea, and ways you can do that are, one, you know, trying to vary your workouts, especially if you do a lot of high-impact. It’s a good idea to try to do some cross training and try to mix in some lower-impact activities. It’s also good to listen to your body. So, you know, a lot of people that are very active that, you know, maybe at a younger age who were used to pushing through pain, you know, those injuries can add up and can, you know, become sequential and something that would have been benign and would have been very easy to file may turn into something that’s a little bit more significant. And then, lastly, you know, just practicing good health. You know, not smoking, keeping your weight down, and eating well, those are all things that just like they would be for any other organ in your body, you know, your joints also will benefit from those.

Dr. Charles Davis – [inaudible] strong and fit, which is what Aman’s talking about is really important at every stage in your life, and that will help you, and that will help prevent you from getting knee injuries, and that will help prevent you from being sore. And so, I think having a regular exercise program and trying to diligent with that at all stages of your life is really important.

Barbara Schindo – I’m glad that you guys have brought that up, because I’ve been hearing this a lot lately that the importance of exercise as preventative medicine. You know, I hear a lot of sports medicine experts say things like, you know, if we could bottle up the benefits of exercise and, you know, put it in a pill, everybody would want to take it, because it would be doing a lot of great things for you all. So, I’m glad to bring that up, and we actually did have a question just come in on the chat from a viewer here. So, we’ll get to this question. This is from Hanza [assumed spelling], and Hanza says, “I dislocated my knee. It’s been over a month, and I still have swelling. What is the best treatment for swelling in the knee?

Dr. Aman Dhawan – Yes, I’ll take this one. This is something that we see commonly in our athletes, I assume he means he dislocated his kneecap, which is somewhat a little different than a true need this location where the tibia and the femur, the thigh bone in the shin bone, separate, but assuming the kneecap dislocation, that’s fairly common, and again, most of those do not require surgery. They can require several months of activity modification. Swelling is something that I think there’s a number of things that can be done for that. One modality that I think is really underutilized is ice, and icing in, you know, 2022 is as simple as going to Walmart or Walgreens or what have you in getting some of those refreezable ice bags. It usually comes in a pouch, and they usually come in a series of two or three. So, you can change these out, but icing every single day for 20 minutes at a time at least twice a day I think is probably the most effective treatment. Compression can also help. If you want to use an ACE wrap on top of the ice. Just make sure that you have some sort of cloth or something that’s between the ice and your skin, they don’t get frostbite, and ice for no more than 20 minutes at a time, but icing, I think, is really underutilized. Compression is also a great modality, and then, anti-inflammatories like over-the-counter Aleve or ibuprofen can also be very helpful. And obviously, activity avoidance or pain avoidance is a good idea. Every time you’re doing activities when you’re trying to recover from an injury, and you experience pain or discomfort, that’s usually a sign that you’re irritating the structures in and around your knee and creating inflammation, and thus, more swelling.

Barbara Schindo – Okay, thank you [inaudible]. Thank you, Dr. Dhawan for that. So, kind of spinning off of that, do you ever recommend using heat on an athletic injury, and if so, you know, when do you recommend icing and when do you recommend using heat?

Dr. Aman Dhawan – It depends, really, on the nature of the injury. So, you know, in general, when we talk about acute injuries, we want to be anti-inflammatory. And so, as a general rule, for 48 to 72 hours, you want to try to use ice, and if you have any sort of inflammation and swelling, ice is really a better modality than heat, because heat will promote more inflammation and more swelling. Heat can be outstanding for certain things, for instance, chronic Achilles injuries or chronic patellar tendon injuries or certain chronic conditions of tendons or muscle where you’re trying to promote blood flow and you’re trying to promote healing and in order to do that, heat can be a great modality to try to create some of that new blood flow, neovascularization, and often will feel better at the same time. And those are more for chronic-type injuries or ones that are well out of that acute phase. But I think it depends on the injury and depends on the timing, but in general, when you’re talking about acute injuries or things that have occurred relatively recently, you want to go with ice. In more chronic type injuries, heat can be helpful.

Barbara Schindo – Okay. That is good to know. So, thank you very much for that explanation, because I think a lot of folks think you’re supposed to — you vary between, you know, ice it for 20 minutes. Then put a hot compress on it for 20 minutes. So, thank you for clearing that up, and thank you Dr. Dhawan. Thank you, Dr. Davis, for joining us this afternoon to talk with us about knee problems and knee pain. Thank you for joining us and watching. If you are watching this on playback, and there’s something that you want to know about knee problems or knee pain, and we did not answer it here, please still feel free to put that question in the chat under this video, and we will get an answer for you. So, thank you for joining, and again, Dr. Dhawan, Dr. Davis, thank you for your time. You guys have a good day. Thank you.

Dr. Charles Davis – Thanks, Barb. Can we put the phone number in the chat?

Barbara Schindo – Yes. We’ll put the phone number to the Penn State Health Bone and Joint Institute in the chat. So that way, anybody who thinks they may need to see somebody about, you know, an injury or recurring pain or an issue, please reach out that way, and we’ll get you where you need to go.

Dr. Charles Davis – Yeah, and we’re, I mean, we’re committed to seeing people as soon as we can. So, there’s almost always a way to get folks in quickly. So, when you call, if you feel like you need to be seen quickly, be a little insistent about it, and there’s usually a way to figure that out. So, we want to make sure that folks can get to us as easily as they can.

Barbara Schindo – All right. We will make sure that they have the information that they need. Thank you very much. All right, have a good afternoon and a good weekend.

Dr. Aman Dhawan – Great, have a nice weekend.

Dr. Charles Davis – Bye. Take care.