Stiff Knees

author : AMSSM
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I now find that after sitting for long periods of time during the day for two hours or so my knees are very stiff and weak when I then try to move them. Do I need to take better care of my knees?

Member Question

I am 25 years old and very active. I am involved in many different activities. 

In 2012 I was in a motorcycle accident. I tore my PCL tendon in my right knee and it was very stiff and swollen for a few weeks. I couldn't extend my knee without a TON of pain. It was hard to put weight on it. After 3-4 months of physical therapy I feel like I'm back to being okay. 

A few months ago I was playing a game of football and I went to my knee to catch a ball and my knee really swelled up and it was very stiff for a week. It was really hard to extend it just like it was for my motorcycle accident but it was the other knee this time. 

I now find that after sitting for long periods of time during the day for two hours or so my knees are very stiff and weak when I then try to move them. I travel a lot for my job and when I fly (especially my last flight to Hong Kong) I could barely walk in the airport after my flight. I couldn't extend my legs all the way without pain. Is this a red flag? Or is this something that I just need to be better at - stretching, moving often, etc? 

Do I need to take better care of my knees or must I see a doctor?

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Answer by Philip Salko, MD
Member AMSSM

Flying from the US to Hong Kong sounds frustrating enough! My legs get stiff during a short flight from Rhode Island to Florida. Seriously though, I am sorry to hear about your knees and hope I can provide you with some good information to move forward and continue with what you enjoy in life. It is incredibly frustrating for athletes and active people, such as you, when an injury occurs. It leads to such significant changes…physical, emotional and social. From what you have described, both knees have seen very active exercise and their own particular injuries.

It sounds like you have done all the right things shortly after your motorcycle accident and tearing your PCL.

When a direct blow to a knee occurs, while playing football or riding a motorcycle, there are many important parts of the knee that can be injured. As you found out for you right knee, one of those structures is the posterior cruciate ligament (PCL). Two other important parts are the meniscus and the articular cartilage of the bones of your knee.

The PCL is an important structure in the knee. Its job is to stabilize the knee, specifically to restrain the knee from translating backward. Thankfully, there are many other parts of the knee that assist in stabilization, and therefore keep it from feeling unstable. With an isolated PCL tear, many people continue to function in their normal daily activities as well as participating in sports. There was a study done on incoming college seniors at the NFL draft. The authors found that 3% of these highly physical football players had a knee without a working PCL. The most interesting part was that most of them were completely unaware of the fact that they had any sort of knee issue. This is partly why the treatment of PCL injuries is somewhat controversial. Often, when a person is diagnosed with a PCL tear, they do not require surgery to have it reconstructed or repaired. Many people, like you, rehab over a period of time and go back to pre-injury knee function. Sometimes a brace or protective pad for the front of the knee may prevent developing further pain and stiffness after this injury. But despite all the other anatomy in your knee that help to stabilize it, there still may be some part of your active lifestyle or knee anatomy that may lead to discomfort, weakness, and stiffness when you sit for long periods of time.

The meniscus serves as the shock absorber of the knee. When you run, the knee sees somewhere between 4-6x your own body weight. The meniscus sits between the bones in your knee like padding. It is durable yet softer than bone therefore helps disperse impact force and friction when running and jumping. When injured or torn it can cause swelling, pain and stiffness. Sometimes a tear can be large enough to also cause the knee to have mechanical problems such as locking or catching. When a tear is smaller and does not cause mechanical symptoms, conservative treatment is sufficient. This typically entails a short period of rest followed by gradual return to activities as pain allows and perhaps a short course of physical therapy. When this is not enough, or the tear is large enough to cause mechanical symptoms surgery may be necessary.

Articular cartilage is a dynamic yet hard tissue that covers the part of the bones that form joints, such as your knee. Its job, like your meniscus, is to absorb impact in the knee. With direct impact, it can be damaged causing similar symptoms to what you may be experiencing (pain, stiffness and swelling). Often-times this cartilage is damaged at the same time as other parts, like the meniscus or PCL. Articular cartilage does not have a very good blood supply therefore can be difficult to heal. Treatment options range from a period of significant rest (sometimes with the use of crutches) to different surgeries. The goal of most surgeries is to help the cartilage repair itself or replace the defective part of cartilage. 

Finally, you most definitely can gain significant incite for your knees if you choose to see a doctor. At the very least, with a simple conversation and a comprehensive physical exam, your doctor can help you along the right path to recovery and to make the appropriate changes in order to avoid further discomfort when you fly. One of my favorite subjects to talk about with my patients is prevention. By talking to your doctor you can, in the least, learn ways to prevent future potential issues that can develop, such as arthritis. Often-times, there are imbalances in you leg or even core muscles, when modified they can alleviate pain and improve performance. Simple adjustments ranging from posture when sitting to the way a person runs can also help. Visiting your doctor or physical therapist to discuss your symptoms can help you realize a personalized strategy to an active and pain free lifestyle.

Philip Salko, MD
Sports Medicine Physician

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date: February 18, 2014

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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