Knee Pain: Recovery, Rehabilitation, and Treatment Options

Knee pain

Hello, Doctor.
At the end of March, I went hiking on Yangmingshan without wearing knee braces or using trekking poles.
After returning home, my knee felt strange, but I didn't think much of it.
However, after a month, the pain intensified, making it painful to go up and down stairs and to walk for extended periods.
I consulted an orthopedic doctor who recommended home exercises, but there was no improvement.
Later, I tried acupuncture and massage with a traditional Chinese medicine practitioner, which caused my entire knee to swell.
I am now seeing a rehabilitation specialist who advised me to undergo rehabilitation at the hospital for 3 to 6 months to strengthen my quadriceps.
I have been doing this for two weeks, currently undergoing shortwave therapy, heat application, and 30-degree knee resistance training.
Since then, the swelling has significantly decreased, but I still occasionally experience sharp pain or a pulling sensation in my knee.
The sharp pain occurs at the junction of my knee and thigh, while the pulling sensation varies; sometimes, when bending at a large angle, I feel tightness on both sides of my knee.

I have a few questions:
1.
If I continue with rehabilitation, will my knee recover to the point where I can hike or run like before?
2.
What home exercises can I do for rehabilitation?
3.
Should I avoid normal use of my knee for the next three months to six months, only walking slightly and doing rehabilitation, and resting when uncomfortable?
4.
Why does my knee still experience sharp pain and pulling sensations? If there is no improvement, will I need surgery?
Thank you, Doctor.

Ms. Zhang, 30~39 year old female. Ask Date: 2016/05/14

Dr. Shi Guozheng reply Orthopedics

Knee pain after hiking is mostly due to tendon or ligament inflammation, and some cases may be caused by patellar wear.
First, you need to confirm the diagnosis with a physician.
If it is tendon or ligament inflammation, rest and medication will help improve the condition, along with rehabilitation.
If it is a patellar issue, you need to assess whether there is a misalignment of the patellofemoral joint.
In that case, quadriceps strengthening exercises are necessary.
If pain symptoms persist, you should refrain from running or hiking until the symptoms have resolved before resuming activities.
Generally, surgical treatment is not required.

Reply Date: 2016/05/14

More Info

Knee pain can be a significant issue, especially after an injury or overuse, as you've experienced during your hike. It’s great to hear that you are actively seeking treatment and rehabilitation options. Let's address your questions and provide some insights into recovery, rehabilitation, and treatment options for knee pain.

1. Will my knee recover to the point where I can hike or run again?
Recovery from knee pain largely depends on the extent of the injury, the underlying causes, and your commitment to rehabilitation. Given that you have already started a rehabilitation program focusing on strengthening your quadriceps and reducing swelling, you are on the right track. Many individuals can return to their previous levels of activity, including hiking and running, after a comprehensive rehabilitation program. However, this process can take time, and it’s essential to listen to your body. Gradual progression in activity, along with consistent rehabilitation exercises, will be key to regaining strength and mobility.

2. What home rehabilitation exercises can I do?
Home exercises can complement your rehabilitation program. Here are some exercises that may help strengthen your knee and improve flexibility:
- Quadriceps Sets: Sit with your leg straight and tighten your thigh muscle, holding for a few seconds before relaxing. Repeat several times.

- Straight Leg Raises: While lying down, keep one leg bent and the other straight. Lift the straight leg to the height of the bent knee and hold for a few seconds.

- Heel Slides: Sit or lie down and slowly slide your heel towards your buttocks, bending your knee. This helps improve range of motion.

- Calf Raises: Stand and slowly raise your heels off the ground, balancing on your toes. This strengthens the calf muscles, which support the knee.

- Wall Sits: Lean against a wall and slide down until your knees are at a 90-degree angle. Hold this position for as long as comfortable.

3. Should I avoid normal use of my knee for the next three to six months?
While it’s important to avoid activities that exacerbate your pain, complete immobilization is not recommended. Gentle movements and light walking can help maintain circulation and prevent stiffness. However, you should prioritize rehabilitation exercises and avoid high-impact activities until your knee has sufficiently healed. If you experience discomfort, it’s crucial to rest and consult your healthcare provider for guidance.

4. Why do I still experience sharp pain and a pulling sensation?
The sharp pain and pulling sensations you describe could be due to several factors, including inflammation, muscle tightness, or even nerve irritation. It’s not uncommon for individuals recovering from knee injuries to experience intermittent pain as they regain strength and flexibility. If these symptoms persist or worsen, it may indicate that further evaluation is needed. Imaging studies, such as an MRI, can help assess any underlying issues that may require more targeted treatment.

In conclusion, while knee pain can be frustrating, a structured rehabilitation program, combined with patience and gradual return to activity, can lead to significant improvements. If your symptoms do not improve with conservative management, further evaluation by an orthopedic specialist may be warranted to explore other treatment options, including potential surgical interventions. Always consult with your healthcare provider before making any changes to your treatment plan. Good luck with your recovery, and I hope you can return to hiking and running soon!

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