Knee and Lower Back Discomfort: Causes and Solutions

Knee and lower back discomfort?

Hello, doctor! Earlier this year, I sustained a bruise and swelling on the inner side of my right knee due to an accidental impact with the ground.
After seeing a rehabilitation specialist, the bruising has subsided, and I have undergone rehabilitation for some time (infrared therapy and electrical stimulation three times a week).
However, I still experience discomfort regularly.
The rehabilitation physician used ultrasound to examine the internal condition of my knee and indicated that there were no issues, but there is still some fluid accumulation at the site of impact.
I was prescribed Sishou and Yixin gel for topical application, but currently, if I stand for long periods or walk a bit more, I feel some swelling in my knee.
I also experience a feeling of tightness and even some numbness when bending it.
Due to the nature of my work, which involves lifting clients (disabled adults), I wear a supportive knee brace while working and avoid squatting or kneeling positions, but I still have recurring discomfort and slight fluid accumulation.
What can I do to improve this situation?
Another issue I've noticed recently is that after sitting for a while, my right leg becomes numb, and I feel soreness in my lower back.
Upon examining my lower back, I noticed that the bone on the right side is more prominent.
Could this be the reason for my prolonged knee discomfort? (When I was a child, I fell down the stairs and noticed that my tailbone was tilted to the left.
At that time, sitting down was quite painful, but it was within tolerable limits, and the pain subsided after a while, so I did not seek medical attention.
I also had no issues with walking, but doing sit-ups would cause discomfort due to pressure on the bone.
Is this related to the aforementioned incidents?) I apologize for the trouble, and thank you for your help!

Miss Zhou, 20~29 year old female. Ask Date: 2020/08/25

Dr. Chen Bochen reply Orthopedics

1.
Knee pain can generally be categorized into three sources: inflammatory, structural, and functional.
Rehabilitation treatment primarily targets functional injuries, which can lead to inflammatory pain.
It is recommended that you take medication for two weeks, which should result in significant improvement.
If the pain is structural, X-rays or even MRI scans may be necessary.
Typically, physicians will advise addressing inflammatory and functional pain before considering structural issues.
For mild structural pain, strengthening exercises can help compensate, while more severe cases may require surgery.
2.
Since your job involves lifting clients, it is essential to wear a lumbar support belt and pay attention to your posture.
Try to engage your hips and thighs for strength rather than bending at the waist.
Taking care of your body is crucial for sustaining your work in the long run.
3.
Currently, there is an international consensus against recommending sit-ups.
It is suggested that you engage in more jogging or brisk walking instead.

Reply Date: 2020/08/25

More Info

Understanding knee and lower back discomfort can be complex, especially when multiple factors contribute to the symptoms. Based on your description, it seems that you are experiencing ongoing knee discomfort following an injury, as well as lower back issues that may be related to your knee condition or other underlying factors.

Knee Discomfort
From your account, it appears that you sustained a significant impact to your right knee, leading to bruising and swelling. Despite undergoing rehabilitation, including infrared and electrical therapy, you still experience discomfort, particularly after prolonged standing or walking. The presence of mild swelling and a feeling of tightness or numbness during knee flexion suggests that there may still be some underlying issues that need to be addressed.

1. Persistent Swelling and Discomfort: The accumulation of fluid in the knee joint (effusion) can be due to several reasons, including inflammation of the synovial membrane, irritation of the cartilage, or even minor tears in the ligaments or meniscus. It is crucial to monitor this swelling, as it can indicate that the knee is still not fully healed.
2. Management Strategies:
- RICE Method: Continue to apply the RICE (Rest, Ice, Compression, Elevation) method when you notice swelling.

- Physical Therapy: If you haven’t already, consider a tailored physical therapy program focusing on strengthening the muscles around the knee, improving flexibility, and enhancing stability.

- Activity Modification: Since your job requires physical exertion, it’s essential to modify activities that exacerbate your symptoms. Using supportive knee braces can help, but ensure they are not too tight, as this can lead to discomfort.

- Medication: If topical treatments like the prescribed gels are not effective, consult your physician about alternative pain management strategies, especially if you have sensitivities to certain medications.

Lower Back Discomfort
Your lower back discomfort, particularly the sensation of numbness in your right leg after sitting for extended periods, could be related to several factors:
1. Postural Issues: Prolonged sitting, especially in a position that may not support your lumbar spine adequately, can lead to muscle fatigue and discomfort. The prominence of the right side of your lower back could indicate muscle imbalances or compensatory postures due to your knee injury.

2. Nerve Compression: The numbness in your right leg could suggest potential nerve compression, possibly from the lumbar spine or related to your posture. If you have a history of tailbone injury, it could also contribute to altered biomechanics, leading to discomfort in both the knee and lower back.

3. Management Strategies:
- Ergonomic Adjustments: Ensure your workspace is ergonomically designed to support your back. Use chairs that provide lumbar support and take regular breaks to stand and stretch.

- Strengthening Exercises: Focus on core strengthening exercises that support the lumbar spine. This can help alleviate some of the pressure on your back and improve overall stability.

- Consultation with a Specialist: If your symptoms persist, it may be beneficial to consult with a spine specialist or a physical therapist who can assess your posture and provide targeted interventions.

Conclusion
In summary, your knee discomfort and lower back issues may be interconnected, stemming from your previous injuries and the physical demands of your job. It is essential to continue monitoring your symptoms and engage in appropriate rehabilitation strategies. If your discomfort persists or worsens, seeking further evaluation from a healthcare provider specializing in orthopedic or spinal conditions would be prudent. They can provide a comprehensive assessment and tailor a treatment plan that addresses both your knee and lower back concerns effectively.

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